Phase One

Report
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
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.
Stability
Must Never Compromise Each Other
Ability to maintain or control joint
movement or position
Mobility
Possessing uninhibited 3-D ROM
around a joint or body segment
What happens when the Software
or Hardware becomes faulty?
Movement
Examining the Body as One
Glenohumeral = Mobile
Scapulo-thoracic Region = Stable
Thoracic Spine = Mobile
Lumbar Spine = Stable
Hips = Mobile
Knee = Stable
Ankle = Mobile
Foot = Stable
Movement
What Happens if the Body Loses / Lacks this Relationship?
• Step One: Law of Facilitation = ‘Dyskinesis’
o Compensation: 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 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 & Exerciserelated 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
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.
Scapulohumeral Rhythm
Force-Coupling Vectors
Direction, Magnitude and Timing
•
Movement application?
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.
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
Scapulohumeral Rhythm
Supraspinatus = inward / upward pull
Movement: 0 – 15°
Infraspinatus + Teres Minor +
Subscapularis = inward / downward
Glide
pull
Deltoids = primary agonist
Movement: ~ 15° +
Abduction
RC Group = stabilizers
Programming Pre-Requisites/Screens
Wall Screen: Overhead Reach
• Contact Points: Heels, butt, shoulder blades.
• Shoulder Flexion to OH position.
o Approx. 170 - 180° movement
o Increased lumbar lordosis
Overhead Squat
• Arms elevated overhead:
o Stresses musculature @ shoulder complex.
o Increases core stabilizing muscle-demand.
Programming Pre-Requisites/Screens
LPHC Low Back Arch
Overactive Muscles
Ideal
Hip Flexor Complex
Erector Spinae
Latissimus Dorsi
LPHC Low Back Arch
Underactive Muscles
Compensation
Abdominal Complex
Gluteus Maximus
Hamstrings
Programming Pre-Requisites/Screens
Arms Fall Forward
Overactive Muscles
Ideal
Latissimus Dorsi
Pectoralis Major
Pectoralis Minor
Arms Fall Forward
Underactive Muscles
Compensation
Rhomboids
Middle/Lower Trapezius
Corrective Exercise-Movement Quality
Desired
Movement?
Observe
Validate
• Identify desired planes
of movement
• Explain – demonstrate –
practice trials
• Identify locations and
movement breakdown
• Identify regions of
stability and mobility
throughout kinetic
chain
• Observe movement
efficiency and limitations
• Identify possible reasons
Inhibit
Lengthen
Strengthen
(type I fibers)
Integrate
Myofascial release
Static Stretching
PNF
Positional Isometrics
Isolated dynamic
strengthening
Integration
(Mobility)
(Mobility)
(Stability)
(Integration)
Educate
• Where to start?
Segmental Corrective
Exercise
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”)
Retract
Depress
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)
Corrective Exercise-Movement Quality
• Integrated 3-D Shoulder Press Pattern
o Follow M.O.V.E.
References …
1. American Council on Exercise (2010). ACE Personal Trainer Manual (4th 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, 1997-2007, 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.
Questions?
Contact Information
• Fabio Comana
– [email protected]
Thank You!
For Your
Commitment to Excellence
Additional Professional Opportunities
• We are offering 20% off CPT promo code: FITCPT and
15% off specializations with promo code: FITFEST
• Visit us online at www.nasm.org/credentials for more product information

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