1. Neuromuscular Therapy Approach to Shoulder Injuries Review of Anatomy

2. Muscles related to front of the shoulder pain

3. Infraspinatus
Pain in this muscle creates an inability to reach behind to a back pocket or to bra hooks , and in front to comb the hair or brush the teeth
Corrective actions : pillows , avoid abitual sustained repetitive motion (putting on curlers)

5. Deltoid Pain in this muscle creates a dull ache
Trigger points in this muscle may result from impact, trauma ,and sports,or from over exultion
Posterior Deltoid Tps painfully weaken abduction of the internally rotated arm
Corrective actions : Include elimination of perpetuating mechanical stresses,and a program of daily stretching exercise to prevent reactivations of TPs

7. Supraspinatus �Subdeltoid Bursitis Mimicker�
Activation of TPs is likely to result when heavy objects are carried with the arm hanging down , or when lifted above shoulder height
Corrective Action : include the avoidance of continued overload of the muscle ,and the use of a stretch exercise at home while seated under a hot shower

9. Scalene Muscles 典he Entrappers�
Activation of trigger points: occurs by pulling , lifting , and tugging ; by over use of these accessory inspiratory muscles as in coughing and by chronic muscle strain due to a tilted shoulder-girdle axis caused by body asymmetry with a short leg or small half-pelvis
Corrective actions: essential for continued relief and require daily passive side bending by doing the neck-stretch exercise,correction of body asymmetry, relief of respiratory overload

11. Pec Mayor 撤oor posture and heart attack�
Patient examination reveals shortening of the Pectoralis mayor muscle by active or latent TPs which pulls the shoulder forward to produce a stooped,round-shouldered posture
Corrective Actions: convincing the patients(when true) that the myofascial chest pain is a treatable pain of skeletal muscle rather then of cardiac origin. Correction of poor standing and sitting posture, avoidance of mechanical overload of this muscle, and in the door way stretch exercise help to insure continued freedom from this myofascial

13. Subscapularis � Frozen shoulder�
Patient examination identifies involvement of this muscle by the marked reciprocal limitation of abduction and external rotation of the arm at the shoulder.
The humeral attachment of the muscle is tender to palpation.
Corrective action include: avoidance or prolonged shortening of the muscle both at night and during the day time , and regular use of in the door stretch exercise at home.

49. Initial Assessment Twelve Steps 1. Client History
2. Assess Active Range of Motion
3.Assess Passive Range of Motion
4.Assess Resisted Range of Motion
5. Area Preparation
6. Myofascial Release

50. Initial Assessment cont.
7. Trigger Point Therapy
8. Cross Fiber or Multidirectional Friction
9. Pain Free Movement
10. Eccentric Scar Tissue Alignment
11. Stretching
12. Strengthening

51. The Physiological Factors:
1.) Ischemia
2.) Trigger Points
3.) Nerve Entrapment
4.) Posture & Biomechanical Dysfunctions
5.) Nutrition
6.) Emotional Well Being

52. Acute Injury
Rest
Ice
Compress
Elevate

53. Chronic Pain
Is considered to be that which remains at least three weeks after injury

54. Four Steps of Soft Tissue Therapy- (In order listed)
1.)    Decrease the spasm and hyper contraction of the soft tissue with neuromuscular therapy
2.)    Restore flexibility by appropriate
stretching

55. Four Steps of Soft Tissue Therapy cont.

56. NMT- Powerful tool � but commitment to
change in lifestyle and self-care
will be necessary for long lasting
results

57. Common features of Trigger Points
Primary activating factors

58. Secondary Activating Factors

59. Active and latent features
Trigger points may be either active or latent

60. Activation of Trigger Points

61. Evaluating for the presence of trigger points

62. Other Common Observations

63. Treatment Options

64. Which Method was more effective

65. Applications of NMT

66. The order of the routines
-         Superficial to deep
-         Gliding strokes
Static pressure and T.P. don�t last

67. Moderate Gliding Speed:
- Assures proper palpation of tissues

68. How long to apply pressure:
- Will vary, should soften 8-12 sec.

69. Amount of pressure - Can vary greatly - Physical make up
Scale 1-10 (5 � 6 � 7 ) ideal

70. Communication during the therapy
-         Pt. Active involvement in treatment.
-         Q: Is it tender?
-         Q: Does it refer
Q: Is it responding

71. The Laws

72. Specific Shoulder Dysfunction
Capulitis
Supraspinatus Tendinitis
Bicipital Tendinitis

73. Capsulitis
Generalized pain rather than localized
Frozen shoulder

74. Supraspinatus Tendinitis
- Associated with subdeltoid or acromeal bursites or rotation cuff dysfunction

75. Bicipital Tendinitis
Symptoms similar to superaspinatus tendonitis location differs
(Lipmans test)