1. The Body as One Upper Extremity Movement Mechanics
Scapulothroacic Region = Stable
Thoracic Spine = Mobile
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

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.
Requires appropriate levels of simultaneous stability and mobility.
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
Movement Efficiency
Arthrokinetics
Muscle Properties
(hardware)
Neural Control (software)
What happens when the Software or Hardware becomes faulty?
Analogy of computer software and hardware

4. Movement Examining the Body as One Glenohumeral = Mobile
Foot = Stable
Knee = Stable
Lumbar Spine = Stable
Scapulo-thoracic Region = Stable
Ankle = Mobile
Hips = Mobile
Thoracic Spine = Mobile
Glenohumeral = Mobile
Define Stability: Ability to control joint position or movement
Define Mobility: Functional ROM needed at a joint
Demonstrate LE relationship with gait
Demonstrate UE relationship with overhead reach

5. What Happens if the Body Loses / Lacks this Relationship?
Movement
What Happens if the Body Loses / Lacks this Relationship?
Step One: Law of Facilitation = ‘Dyskinesis’
Compensation: Compromised stability to facilitate mobility.
Compensation: Movement into other planes.
Example: Bird-dog
Why?
Step One: Law of Facilitation = “Dyskinesis”
Compensation: Stable joints give up some stability to help provide mobility.
Example: Increased lumbar lordosis when trying to extend the thoracic spine.
Compensation: Moving joint will incorporate movement into another plane
Example: Hip extension (sagittal) involving transverse plane rotation.
Step Two: Loss of stability = injury potential.
Chronic overuse injuries versus acute injuries.
Coincidence?
Low back – stable !
80 – 90 % of all adults,60% of work-related injuries involve LB = 9 missed work days / event
Knees – stable !
200,000 ACL injuries/year. 70 – 75 % non-contact.
Osteoarthritis = 10x increase with ACL injuries
Shoulder girdle – stable !
21 % of population with 40% persisting < 1 year

6. Movement and Injuries
What Happens if the Body Loses / Lacks this Relationship?
Step Two: Loss of stability = injury potential.
Chronic overuse injuries versus acute injuries.
Low back – stable !
Knees – stable !
Shoulder girdle – stable !
80 – 90 % of all adults
200,000 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
1997
13.4% of all injuries
11.6% of all injuries
26.4% of all injuries
2007
17.9% of all injuries
15.0% of all injuries
30.7% of all injuries
Step One: Law of Facilitation = “Dyskinesis”
Compensation: Stable joints give up some stability to help provide mobility.
Example: Increased lumbar lordosis when trying to extend the thoracic spine.
Compensation: Moving joint will incorporate movement into another plane
Example: Hip extension (sagittal) involving transverse plane rotation.
Step Two: Loss of stability = injury potential.
Chronic overuse injuries versus acute injuries.
Coincidence?
Low back – stable !
80 – 90 % of all adults,60% of work-related injuries involve LB = 9 missed work days / event
Knees – stable !
200,000 ACL injuries/year. 70 – 75 % non-contact.
Osteoarthritis = 10x increase with ACL injuries
Shoulder girdle – stable !
21 % of population with 40% persisting < 1 year
Look at popular programs since 2004 – What will happen to injuries between 2007 and 2017?

7. Specifics: Shoulder Abduction
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. Specifics: Shoulder Abduction
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. Specifics: Overhead Press
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. Scapulohumeral Rhythm
Force-Coupling Vectors
Direction, Magnitude and Timing
Movement application?
180° abduction - scapular and glenohumeral (GH) joint movement ratio = ~ 2-to-1.
2° of GH motion for every 1° of scapular motion (120°-to-60° ratio).
True scapulae movement = 45 – 60° upward rotation coupled with:
20 – 40° posterior tilt.
15 – 35° external rotation.
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:
Compress, depress, stabilize and steer the humeral head within socket - constrained within 1-2 mm of center of glenoid fossa (creates ICR).
Also function to clear humerus from acromion process.
RC muscles play important role in initiating movement and facilitating humeral inferior glide.
Muscle
Function
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. Scapulohumeral Rhythm
Movement: 0 – 15°
Supraspinatus = inward / upward pull
Infraspinatus + Teres Minor + Subscapularis = inward / downward pull
Glide
Movement: ~ 15° +
Deltoids = primary agonist
RC Group = stabilizers
Abduction

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

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

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

16. Corrective Exercise-Movement Quality
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
Inhibit
Lengthen
Strengthen
(type I fibers)
Integrate
Myofascial release
Static Stretching
PNF
Positional Isometrics
Isolated dynamic strengthening
Integration
(Mobility)
(Stability)
(Integration)

17. Corrective Exercise-Movement Quality
Scapula dyskinesis: Represents imbalance in stability-mobility relationship.
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
Pre-requisite: Lumbar Stability
Phase One:
Promote Thoracic Mobility
Phase Two:
Promote Scapulo-thoracic Stability
Phase Three
Promote Integrated Function

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

19. Corrective Exercise-Movement Quality
Phase Two: Promote ST Stability
Focus: ST position & control (stability), not GH movement
Parascapular muscles best stabilized with CKC exercises (joint compression – muscles function as stabilizers).
Too challenging initially?
Start with OKC exercises
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:
Packed Quadruped Loading – progressions
Loading and 3-D weight shifts
Off-set hand position
Elbow extension
Lengthen moment arm
Unstable Surfaces
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
Follow M.O.V.E.
MOVEMENT
OBSERVE
VALIDATE
EDUCATE

22. References …
American Council on Exercise (2010). ACE Personal Trainer Manual (4th edition). San Diego, CA, ACE.
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.
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.
Clark, MA, Lucett, SC, and Sutton, BG, (editors) (2012). NASM Essentials of Personal Fitness Training (4th edition). Baltimore, MD: Lippincott, Williams and Wilkins.
Cook, G (2003). Athletic Body in Balance. Champaign, IL., Human Kinetics
Gray, G and Tiberio, D (2007). Chain Reaction Function. Gray Institute, Adrian, MI.
Gray, G (2008). The Thoracic Spine. Gray Institute Newsletter, Gray Institute, Adrian, MI.
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
Sahrmann S, (2002). Diagnosis and Treatment of Movement Impairment Syndromes, St Louis, MO: Mosby.

23. Questions? ?

24. Contact Information
Fabio Comana

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Thank You!
For Your Commitment to Excellence

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