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The Body as OneUpper Extremity Movement Mechanics
By: Fabio Comana, MA., MS. NASM CPT, CES, PES; NSCA CSCS; ACS< HFS: ACE CPT, HC; CISSNNASM Faculty Instructor
April 24, 2014
Scapulothroacic Region = StableScapulothroacic Region = Stable
Thoracic Spine = MobileThoracic 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.
Movement Efficiency
Arthrokinetics
Muscle Properties
(hardware)
Neural Control
(software)
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 = StableFoot = Stable
Knee = StableKnee = Stable
Lumbar Spine = StableLumbar Spine = Stable
Scapulo-thoracic Region = StableScapulo-thoracic Region = Stable
Ankle = MobileAnkle = Mobile
Hips = MobileHips = Mobile
Thoracic Spine = MobileThoracic Spine = Mobile
Glenohumeral = MobileGlenohumeral = Mobile
Examining the Body as One
Movement
MovementWhat 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-dogWhy?
Movement and InjuriesWhat 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 & 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
Look at popular programs since 2004 – What will happen to injuries between 2007 and 2017?
Movement MechanicsSpecifics: 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 MechanicsSpecifics: 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 MechanicsSpecifics: 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 VectorsDirection, 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 RhythmScaption 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
Movement: 0 – 15° Movement: 0 – 15°
Supraspinatus = inward / upward pull Supraspinatus = inward / upward pull
Infraspinatus + Teres Minor + Subscapularis = inward / downward
pull
Infraspinatus + Teres Minor + Subscapularis = inward / downward
pull
Glide Glide
Movement: ~ 15° +Movement: ~ 15° +
Deltoids = primary agonist Deltoids = primary agonist
RC Group = stabilizers RC Group = stabilizers
Abduction Abduction
Scapulohumeral Rhythm
Programming Pre-Requisites/ScreensWall Screen: Overhead Reach
• Contact Points: Heels, butt, shoulder blades.• Shoulder Flexion to OH position.
o Approx. 170 - 180° movemento Increased lumbar lordosis
Overhead Squat• Arms elevated overhead:
o Stresses musculature @ shoulder complex. o Increases core stabilizing muscle-demand.
Ideal
Compensation
LPHC Low Back ArchOveractive Muscles
Hip Flexor Complex Erector Spinae Latissimus Dorsi
LPHC Low Back ArchUnderactive Muscles
Abdominal Complex Gluteus Maximus Hamstrings
Programming Pre-Requisites/Screens
Arms Fall ForwardOveractive Muscles
Arms Fall ForwardUnderactive Muscles
Pectoralis Major Pectoralis MinorLatissimus Dorsi
Middle/Lower TrapeziusRhomboids
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 EducateValidate
• Identify locations and movement breakdown
• Identify possible reasons
Inhibit Lengthen Strengthen (type I fibers)
Integrate
Myofascial release Static StretchingPNF
Positional IsometricsIsolated dynamic
strengthening
Integration
(Mobility) (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
Pre-requisite: Lumbar Stability
Phase One:
Promote Thoracic Mobility
Phase Two:
Promote Scapulo-thoracic Stability
Phase Three
Promote Integrated Function
Corrective Exercise-Movement Quality
Phase One: Promote Thoracic Mobility• Address planes sequentially:
o Sagittal Plane 1sto Frontal Plane 2ndo 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
Corrective Exercise-Movement Quality
Phase Two: Promote ST Stability
• Focus: ST position & control (stability), not GH movemento 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)
Corrective Exercise-Movement Quality
• Integrated 3-D Shoulder Press Patterno Follow M.O.V.E.
MOVEMENT
OBSERVE
VALIDATE
EDUCATE
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.
References …
Questions?
?
Thank You!For Your
Commitment to Excellence
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