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The Body as One Upper Extremity Movement Mechanics By: Fabio Comana, MA., MS. NASM CPT, CES, PES; NSCA CSCS; ACS< HFS: ACE CPT, HC; CISSN NASM Faculty.

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Presentation on theme: "The Body as One Upper Extremity Movement Mechanics By: Fabio Comana, MA., MS. NASM CPT, CES, PES; NSCA CSCS; ACS< HFS: ACE CPT, HC; CISSN NASM Faculty."— Presentation transcript:

1 The Body as One Upper Extremity Movement Mechanics By: Fabio Comana, MA., MS. NASM CPT, CES, PES; NSCA CSCS; ACS< HFS: ACE CPT, HC; CISSN NASM Faculty Instructor April 24, 2014 Scapulothroacic Region = Stable Thoracic Spine = Mobile

2 What Do You Want to Learn? Learning Outcomes: Describe the overall function of the human body in movement. Explain primary components of human movement science. Administer and interpret an upper extremity movement screen. Implement a simple UE corrective exercise program. Instruct proper mechanics for UE movements.

3 Movement Fundamental trait we all share – improve movement efficiency. o Requires appropriate levels of simultaneous stability and mobility. What happens when the Software or Hardware becomes faulty? Stability Ability to maintain or control joint movement or position Mobility Possessing uninhibited 3-D ROM around a joint or body segment Must Never Compromise Each Other

4 Foot = Stable Knee = Stable Lumbar Spine = Stable Scapulo-thoracic Region = Stable Ankle = Mobile Hips = Mobile Thoracic Spine = Mobile Glenohumeral = Mobile Examining the Body as One Movement

5 What Happens if the Body Loses / Lacks this Relationship? Step One: Law of Facilitation = ‘Dyskinesis’ oCompensation: Compromised stability to facilitate mobility. o Compensation: Movement into other planes.  Example: Bird-dog Why?

6 Movement and Injuries What Happens if the Body Loses / Lacks this Relationship? Step Two: Loss of stability = injury potential. o Chronic overuse injuries versus acute injuries. Low back – stable !Knees – stable !Shoulder girdle – stable ! 80 – 90 % of all adults200,000 ACL injuries/year. 70 – 75 % non-contact. 21 % of population with 40% persisting < 1 year $100 billion annually$650 million (surgery + rehabilitation) $39 billion annually Sport & Exercise- related Injuries Injuries in Recreational & Sports Facilities Sprain/Strain-type Injuries % of all injuries11.6% of all injuries26.4% of all injuries % of all injuries15.0% of all injuries30.7% of all injuries Look at popular programs since 2004 – What will happen to injuries between 2007 and 2017?

7 Movement Mechanics Specifics: Shoulder Abduction Frontal Plane Action Application: Internally rotate the arms and abduct as high as possible – notice end ROM. Externally rotate the arms and abduct as high as possible – notice end ROM. Difference? Impingement of greater tuberosity (humerus) against coracoid process (scapula) - space is generally small (~ 5-10 mm). Implications for Movement: Caution against excess shoulder abduction with internal rotation = bursitis and tendonitis (supraspinatus and biceps long head). Example: Upright rows, front and lateral raises.

8 Movement Mechanics Specifics: Shoulder Abduction Scaption Plane Action Application: Perform a lateral raise movement with the arms in the frontal plane – notice any resistance to movement? Perform a lateral raise movement with the arms 30° forward in the frontal plane – notice any resistance to movement? Difference? With arms 30° forward to frontal plane, greater tuberosity falls in line with highest point of coraco-acromial arch - experiencing least amount of resistance. Implications for Movement: Perform lateral raises with slight external rotation or forward 30° in frontal plane. Example: Moving from 3 / 9 o’clock position to 4 / 8 o’clock position for shoulder flexion exercises (press, lat pull-down, lateral raises).

9 Movement Mechanics Specifics: Overhead Press Frontal Plane Action Application: Three heads offer anterior, middle and posterior containment of shoulder (lowered position). Place index finger and thumb over origin and insertion points of anterior deltoid - perform overhead raise movement. Difference? Observe external rotation of humerus - changes muscle’s orientation. Arm lowering - no anterior stabilizer to prevent anterior humeral displacement (exacerbated with behind the head presses). Implications for Movement: Overhead positions – External humeral rotation creates no anterior containment beyond passive structures – need to engage lats as stabilizers.

10 Force-Coupling Vectors Direction, Magnitude and Timing Movement application? Scapulohumeral Rhythm 180° abduction - scapular and glenohumeral (GH) joint movement ratio = ~ 2-to-1. o 2° of GH motion for every 1° of scapular motion (120°-to-60° ratio). True scapulae movement = 45 – 60° upward rotation coupled with: o 20 – 40° posterior tilt. o 15 – 35° external rotation. o All designed to reduce encroachment into sub-acromial space.

11 Scapulohumeral Rhythm Scaption Plane Action Glenoid fossa (GF) is ⅓ size of the gleno-humeral head (GH) Golf ball & tee analogy - labrum increases socket depth by 50 %. Due to GF-GH shape, rotator cuffs (RC) collectively coordinate GF-GH movement : o Compress, depress, stabilize and steer the humeral head within socket - constrained within 1-2 mm of center of glenoid fossa (creates ICR). o Also function to clear humerus from acromion process. RC muscles play important role in initiating movement and facilitating humeral inferior glide. MuscleFunction Supraspinatus Abduction + compression/depression during arm elevation + slight external rotation (ER). Infraspinatus + Teres Minor ER + compression/depression during arm elevation. Subscapularis Internal rotation (IR) + compression/depression during arm elevation

12 Movement: 0 – 15° Supraspinatus = inward / upward pull Infraspinatus + Teres Minor + Subscapularis = inward / downward pull Glide Movement: ~ 15° + Deltoids = primary agonist RC Group = stabilizers Abduction Scapulohumeral Rhythm

13 Programming Pre-Requisites/Screens Wall Screen: Overhead Reach Contact Points: Heels, butt, shoulder blades. Shoulder Flexion to OH position. o Approx ° movement o Increased lumbar lordosis Overhead Squat Arms elevated overhead: o Stresses shoulder complex. o Increases core stabilizing muscle-demand.

14 Ideal Compensation LPHC Low Back Arch Overactive Muscles Hip Flexor Complex Erector Spinae Latissimus Dorsi LPHC Low Back Arch Underactive Muscles Abdominal Complex Gluteus MaximusHamstrings Programming Pre-Requisites/Screens

15 Arms Fall Forward Overactive Muscles Arms Fall Forward Underactive Muscles Pectoralis Major Pectoralis MinorLatissimus Dorsi Middle/Lower Trapezius Rhomboids Ideal Compensation Programming Pre-Requisites/Screens

16 Identify desired planes of movement Identify regions of stability and mobility throughout kinetic chain Explain – demonstrate – practice trials Observe movement efficiency and limitations Where to start? Segmental Corrective Exercise Desired Movement? Observe Educate Validate Identify locations and movement breakdown Identify possible reasons InhibitLengthenStrengthen (type I fibers) Integrate Myofascial releaseStatic Stretching PNF Positional Isometrics Isolated dynamic strengthening Integration (Mobility) (Stability)(Integration) Corrective Exercise-Movement Quality

17 Scapula dyskinesis: Represents imbalance in stability-mobility relationship. o Ineffective joint positioning; general lack of neuromuscular control of scapulae (altered muscle activation patterns). Causes - Examples Inappropriate or deficient training Repetitive trauma (overuse) Improper posture / poor positioning Structural / congenital issues Degenerative changes Shoulder Program Overall Goal Improve parascapular stability – promote T-spine mobility & movement efficiency Corrective Exercise-Movement Quality

18 Phase One: Promote Thoracic Mobility Address planes sequentially: o Sagittal Plane 1st o Frontal Plane 2nd o Transverse Plane 3rd – most problematic. Never compromise lumbar stability !! – demonstration Thoracic Spine: o Supine foam-roller. o Supine arm movement – short-to-long lever (progress to prone – short lever).  Examples: Alphabets – “I”, “Y” o Spinal twists with rib-grab. o Thoracic matrix (Gary Gray). Corrective Exercise-Movement Quality

19 Phase Two: Promote ST Stability Focus: ST position & control (stability), not GH movement o Parascapular muscles best stabilized with CKC exercises (joint compression – muscles function as stabilizers). o Too challenging initially? o Start with OKC exercises o Use supported surfaces (e.g., floor, wall) + kinesthetic feedback ‘feel’  Shoulder Packing (reduce scapular elevation)  Reverse Codman’s – short lever (alphabets)  Supine Letters – short lever (“I-Y-T-W”, “Wipers”) Depress Retract

20 Corrective Exercise-Movement Quality Phase Two: Promote ST Stability Progress to CKC: Example: o Packed Quadruped Loading – progressions  Loading and 3-D weight shifts  Off-set hand position  Elbow extension  Lengthen moment arm  Unstable Surfaces o Scapular Clocks - hand fixed, change scapular loading positions.  12 o’clock (depression).  6 o’clock (elevation)  3 o’clock (retraction)  9 o’clock (protraction)

21 Corrective Exercise-Movement Quality Integrated 3-D Shoulder Press Pattern o Follow M.O.V.E.

22 1.American Council on Exercise (2010). ACE Personal Trainer Manual (4 th edition). San Diego, CA, ACE. 2.Bell, DR, and Padua, DA, (2007). Influence of ankle dorsiflexion range of motion and lower leg muscle activation on knee valgus during a double-legged squat. Journal of Athletic Training, 42:S84. 3.Centers for Disease Control and Prevention (2009). Injury episodes and circumstances: National Health Interview Survey, , Vital and Health Statistics, 10 (241). Retrieved 06/15/13. 4.Clark, MA, Lucett, SC, and Sutton, BG, (editors) (2012). NASM Essentials of Personal Fitness Training (4th edition). Baltimore, MD: Lippincott, Williams and Wilkins. 5.Cook, G (2003). Athletic Body in Balance. Champaign, IL., Human Kinetics 6.Gray, G and Tiberio, D (2007). Chain Reaction Function. Gray Institute, Adrian, MI. 7.Gray, G (2008). The Thoracic Spine. Gray Institute Newsletter, Gray Institute, Adrian, MI. 8.Kendall, FP, McCreary EK, Provance, PG, Rodgers, MM, Romani, WA (2005). Muscles Testing and Function with Posture and Pain (5th edition). Baltimore, MD., Lippincott, Williams and Wilkins 9.Sahrmann S, (2002). Diagnosis and Treatment of Movement Impairment Syndromes, St Louis, MO: Mosby. References …

23 Questions?

24 Contact Information Fabio Comana

25 Thank You! For Your Commitment to Excellence

26 Additional Professional Opportunities Visit us online at for more product informationwww.nasm.org/credentials We are offering 20% off CPT promo code: FITCPT and 15% off specializations with promo code: FITFEST


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