JOURNÉE KINÉ 2016 - SLKS | Sport-Kine.lu

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Mercredi 01.06.2016

Amphithéâtre CHL-CENTRE13h00 à 17h00

JOURNÉE KINÉ 2016

„De l‘évidence au traitement“

Académie Luxembourgeoisede Médecine, de Kinésithérapie et des Sciences du Sport

Scapular Dyskinesis :

current concepts in rehabilitation

Danièle Schaack

Physiotherapist CHL-CE

Journée Kiné Ι 01.06.2016Centre Hospitalier de Luxembourg

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Role of the scapula

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Journée Kiné Ι 01.06.2016

Centre Hospitalier de Luxembourg

Role of the scapula in normal shoulder function

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Cools WCPT 2015,Kibler 2013

UT/MT/LT UT LT

SA SA SA

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Normal scapular movement and muscle recruitment patterns

Int / Ext Rotation Upward Rotation Posterior tilt

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= alteration of static scapular position or dynamic scapular

motion

= general term reflecting the loss of normal control of scapular

motion

„DYS“: alteration of „KINESIS“: motion

Kibler 2013, Kibler,Sciascia 2016, Cools 2013

Definition of Scapular Dyskinesis

Individual’s functional requirements and problematic activities

Cools 2013

Screening Kinetic Chain examination

Cools 2013,Kibler 2013,2016

Clinical evaluation of scapula: position,motion,strength,…..

Kibler 2013,2016 Cools 2013

Identify predominant type of dyskinesis based on observation

Kibler 2002,Cools 2015

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Evaluation for Scapular Dyskinesis

Guideline for a science based scapular rehab program

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Cools 2013, Kibler 2013

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Pectoralis Minor

Angular Stretching

self-stretching program in healthy athletes

Cools et al Shoulder & Elbow 2011

Direct manual stretching

in patients

Van de Velde 2011,Ann Cools.ESSKA 2016

Soft tisse technique?

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Other muscles

Levator scapulae

Rhomboidei

Latissimus dorsi

External rotators (ISP,Teres major,…)

Soft tissue techniques including dry needling

Ischemic compression (by manual TRP)

might be an added value,clinical practice

B.Cagnie 2013

Teres major

Levator scapulae

Teres minor

Heidi Tanno-Rast Praxisbuch Myofsziale Triggerpunkte Elsevier 2014



POSTERIOR GLENOHUMERAL MUSCLES/CAPSULAR STIFFNESS

Posterior capsule

Infraspinatus

Latissimus dorsi

Sleeper‘s Stretch

Cross Body StretchCools 2015

Manual Mobilisation

Manske 2010,Cools 2011,Cools 2015

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Conscious muscle control

Goals: improve local muscle control and proprioception

correct scapular position

selective activation of LT

Challenge: maintenance of new scapular position under load

functional requirement of the patient

Cools WCPT 2015,Kibler 2016

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Conscious muscle control

Spinal Posture correctionBarbara Cagnie 2014

Taping GIRD,Posterior tilt,

Cools,Cagnie 2013,Van Herzeele 2013

NMES with feedbackHorsley ESSKA 2016

Don‘t forget the brain:make rehab sensory richGibson ESSKA 2016

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„Low load functional movements“

Activation of key stabilisers in retraction

LT and SA

Scapular co-contraction maybe trained

in basic positionsmovementsexercises

in response to open or closed-chain acivities

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Low row

Lawnmower

Robbery

Inferior glide

+ER

……

Kibler 2016,Cools 2013

Examples of exercices for muscle control and co-contraction

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Wall push-up

Wall wash

Wall slide (with resistance)

Rhytmic stabilisations

Bench slide exercise

Closed-chain or semi-closed chain exercises



Cools 2013, Kibler 2013

Improve muscle strength and

inter/intra muscular balance

„High load strengthening exercises“

LT/MT/SA = weak

UT = hyperactive

SA

Exercises to restore the balanceProgression to functional exercises

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Intramuscular trapezius training

Side lying external rotation

Side lying forward flexion

Prone horizontal abd with ER

Prone extension

Isometric low row exercise (+ball sitting)

Examples of exercices for balance-ratio

Cools 2013,Kibler 2013,Castelein 2013

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Activity of SA

Push-up Plus exercise

Serratus punch in CKC (bench slide)

Dynamic Hug

Bouncing exercise

Wall slide exercises Elbow Push-up

Serratus punch supine

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Throwing athletes

load external rotators eccentrically

Swimers

no focus on plyometrics

train in sport-specific positions such as lying prone or supine

in situations demanding a lot of core stability

Gymnasts and climbing sports

high-level closed chain exercises

sling exercises might be added to their programCools 2013

Advanced control during sport movements

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Catching exercise with plyo-ball

X-Tube

W-V exercise

Bouncing serratus punch

Side bridging and prone bridging

Sling exercises

…

Cools 2013,Kibler 2013,Maenhout 2016

Examples of exercises

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Any stage of rehabilitation implementation of KC

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Diagonals

Open-chain exercises

standing the controlateral leg

Close-chain exercises

extend the controlateral leg

Cools 2013,Kibler 2016

Kinetic chain

CLINICAL CASE

Female patient: O.C.

Age: 30 years

Profession: secretary-receptionnist

Sports: dance 2/week

Actual complaints: shoulder + neck pain

Physiotherapy: massages

mésothérapie Neck

Actually: back rehabilitation

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Treatment goals

flexibility (LS-PM-UT,ER,Lat.dorsi,scaleni,SCM…)

GIRD increase shoulder mobility

posture correction (f.ex. while woking with computermouse,…)

improve neuro-muscular control

imrove scapular muscle strength

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Rehabilitation of scapular dyskinesis:from the office worker to the elite overhead athlete

Cools,Struyf,De Mey,Maenhout,Castelein,Cagnie Br J Sports Med (2013)

Effect of ischemic compression on Trigger Points in the neck and shoulder muscles in

office worker:a cohort study

Cagnie,Dewitte,Coppieters,Van Oosterwijck,Cools,Daneels Journal of Manipulative and Physiological

Therapeutics (2013)

Prevention of shoulder injuries in overhead athletes:a science based approach

Cools,Johansson,Borms,Maenhout Brazilian Journal of Physical Therapy (2015)

Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus

statement from the ‚scapular summit

Kibler,Ludewi,McClure,Michener,Bak,Sciascia Br J Sports Med (2013)

The role of the scapula in preventing and treating shoulder instability

Kibler,Sciascia Knee Surg Sports Traumatol Arthrosc (2016)

The relevance of scapular dysfunction in neck pain:a brief commentary

Cagnie,Struyf,Cools,Castelein,Danneels,O Leary Journal of Orthopedic and Sports Physical Therapy

(2014)

Current Concepts:scapular dyskinesis

Kibler,Sciascia Br J Sports Med (2010)

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Effect of 2 stretching techniques on the length of the pectoralis minor in adolescent

swimers.Paper in progress

Annemie Van de Velde,Ann Cools.ESSKA 2016

Serratus anterior or pectoralis minor: Which muscle has the upper hand during

protraction exercises?

Castelein,Cagnie,Parlevliet,Cools

Internal impingement in the tennis player:rehabilitation guidelines

Cools,Declercq,Cagnie,Cambier,Witvrouw Br J Sports Med (2008)

Rehabilitation of scapular muscle balance:Which exercises to prescribe?

Cools,Dewitte,Lanszweert,Notebaert,Roets,Soetens,Cagnie,Witvrouw The American Journal of Sports

Medicine (2007)

Clinical assessment of the scapula:a review of the literature

Struyf,Nijs,Mottram,Roussel,Cools,Meeusen Br J Sports Med (2014)

Conscious correction of scapular orientation in overhead athletes performing selected

shoulder rehabilitation exercises:the effect on trapezius muscle activation measured by

surface Electromyography

De Mey,Danneels,Cagnie,Huyghe,Seyns,Cools Journal of Orthopedic and Sports Physical Therapy

(2013)

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Reduced glenohumeral rotation,external rotation weakness and scpular dyskinesis are

risk factors for shoulder injuries among elite male handball players:a prospective cohort

study

Clarsen,Bahr,Andersson,Munk,Myklebust Br J Sports Med (2014)

Scapular-muscle performance:two training programs in adolescent swimers

Van de Velde,De Mey,Maenhout,Calders,Cools Journal of athletic training (2011)

Shoulder muscle activation levels during four closed kinetic chain exercises with ans

without record slings

De Mey,Danneels,Cagnie,Borms,Jonck,Van Damme,Cools Journal of Strength and Conditioning

research (2014)

Kinetic chain influences on upper and lower trapezius muscle activatiob dúring eigth

variations of a scapular retraction exercise in overhead athletes

De Mey,Danneels,Cagnie,Van den Bosch,Flier,Cools Journal of science and Medecine in Sport (2013)

Is neuroplasticity in the central nervous system the missing link to our understanding of

chronic musculoskeletal disorders?

Pelletier,Higgins,Bourbonnais BMC Musuloskeletal Disorders (2015)

Impact of movement training on upper limb motor strategies in persons with shoulder

impingement syndrome

Roy,Moffet,McFadyen,Lirette Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology

(2009)

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Shoulder Rehabilitation course Level II

Cools (2015)

Rehablitation of scapular dyskinesis in patients with impingement related shoulder pain

(SIS)

Cools WCPT Congress 2015 Singapore

Role of specific muscle training in shoulder rehabilitation

Cools ESSKA 2016 Barcelona

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JOURNÉE KINÉ 2016 - SLKS | Sport-Kine.lu