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:
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
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.
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
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
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?
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?
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.
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).
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.
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.
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
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.
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
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
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
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
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
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
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)
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Contact Information Fabio Comana
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