Keeping Your Shoulders Healthy

8/2/2019 Keeping Your Shoulders Healthy

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Keeping Your Shoulders Healthy

Witaya Mathiyakom1, PT, PhDJill McNitt-Gray2, PhD

1Andrus Gerontology Center2Biomechanics Research Laboratory

Department of Kinesiology

USC


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Musculoskeletal pain in dental hygienists

Neck/

Shoulders

Neck Shoulders Elbows/

Wrists/Hands

Elbows Wrists/

Hands

Prevalence of

Musculoskeletal

Symptoms

(%)

0

20

40

60

80

100

*

** *

Dental Hygienists

Reference

Akesson et al., Int Arch Occup Environ Health, 1999


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Common diagnoses observed among

dental hygienists with shoulder pain

Upper Trapezius Myalgia

Levator Scapulae Myalgia

Akesson et al., Int Arch Occup Environ Health, 1999

Thoracic Outlet Syndrome

Supraspinatus Tendinitis Frozen Shoulder


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Tasks

Force Repetition

Static posture

Common contributing factors

associated with the common diagnoses

Result

Adaptation andImbalance of the

muscles involved


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Static contraction:

Uppertrapezius

Levator scapulae Reducing circulation to these muscles

Repeated microtrauma

Upper Trapezius and Levator ScapulaeMyalgia

Prolonged stretch:

Lower trapezius

Middle trapezius Poor scapular stabilization

Prolonged elevation of the scapula


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Tightness: Pectoralis Minor

Brachial plexus

Axillary artery

underneath the pectoralis minor

Thoracic Outlet Syndrome

Prolonged stretch:

Lower trapezius

Middle trapezius

Poor scapular stabilization

Prolonged Anterior tilt of the scapula


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Strong contraction

Pectoralis major

Latissimus dorsi

Teres major

Counterbalanced by

Subscapularis

Imbalance between these muscles

will result in anterior translation

of humeral head - tendinitis

Static shoulder flexion

and internal rotation


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Static abduction of the shoulder

Strong contraction

Deltoid

Adequate activation of the

rotator cuffs to position the

humeral head

Imbalance between these muscles will result in upward

translation of humeral head impingement, tendinitis


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What do you need

to keep your shoulders healthy? Keeping good posture throughout the day

Changing position often

Preserving adequate muscle length and joint mobility

Tight and stiff muscles limit range of motion

and create compensatory movements Lengthened muscles are likely to be weak

Strengthening muscle at the range required

Weakness of the lengthened muscles observed in end range

Coordinating the involved muscles

Proper muscle length and strength provide a window for good

coordination


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What can you do?

If you have symptoms, pain, discomfort,

Seek professional help from MD and PT

You can benefit from a preventive exerciseprogram

Gentle range of motion and stretching

Simple strengthening exercise

Simple self-assessment will help you identifythe exercises that fit you!!!


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What to look for?

DepressedDownward Rotated

Scapula

Anterior tilt

of scapulaShoulder

Internal

Rotation

ForwardHead

Posture as a clue of alignment and muscle length

Long and Weak

Upper Trapezius?

Tight Shoulder

internal

rotators?

Long and Weak

Upper Trapezius

& Levator

Scapulae?

Tight

pectoralis

minor?

Weak Lower

Trapezius?


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Posture

Anterior tilt of

the scapula

Forward

Translation of

the humeral

head


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Pectoralis Minor Tightness

Anterior

tilt ofscapula

Between-sides differences in tightness of

the pectoralis minor


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Tight Pectoralis Minor

affects trunk control


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Tight shoulder internal rotators

limit external rotationStarting Position Finishing PositionResting Posture


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Weakness of the external rotators

Starting Position Finishing Position


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Latissimus Dorsi Tightness


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Limited Shoulder Internal Rotation


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Weakness of Internal Rotators

SubscapularisStarting Position Finishing Position


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What can you do?

These exercises are suggested to improve your shouldermechanics.

You need to perform them correctly Check your posture throughout the day

Good quality practice at all time

To strengthen the muscles, use high enough weightbut without compensation

10 reps, 3 sets

Always check your form!!!

To stretch, hold the position at least 30 seconds


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Levator Scapulae Stretch


Lateral Flexion to opposite side

Flexion

Rotation to the opposite side


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Upper Trapezius Stretch


Lateral Flexion to opposite side

Flexion

Rotation to the same side


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Pectoralis Minor StretchStarting Position Finishing Position

Applied downward force on

the coracoid process

Added a roll of towel under

the spine


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Pectoralis Minor StretchStarting Position Finishing Position

Applied downward force on the coracoid

processAdded rotation to the opposite side


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Latissimus Dorsi Stretch


Maintained shoulder external rotation

Stabilized the inferior angle of the

scapula with the other hand if it

protudes out to the side


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Shoulder Internal Rotation Stretch

Limited shoulder internal rotation is

indicated by an inability to internally

rotated the humeral head to 70

Compensatory movement of the scapula

is observed when the person is trying to

internally rotate the shoulder beyond the

available range

To do this stretch, start with arm at 90

with your elbow flexed

Internally rotate your shoulder as far asyou can without moving your shoulder

blade, use the other arm to stabilize the

shoulder


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External Rotators Strengthening

Starting position:

Prone, Arm at 90, elbow flexed

Movement:External rotate your shoulder

as shown without movements

of the shoulder blade

Also, DO NOT move your elbowoff the table

Range of motion:

Normal range of motion is ~ 90

from the starting position

if you have limited shoulder

internal rotation range, you may

need to work your way toward that


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Starting position:

Side lying, with a towel under

your arm, elbow flexed 90

Movement:External rotate your shoulder



Range of motion:Normal range of motion is ~ 90



internal rotation range, you mayneed to work your way toward that


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Internal Rotators Strengthening

Starting position:

Prone with arm at 90, elbow

flexed

Movement:

Internally rotate your shoulder



Also, DO NOT move your elbow

off the table or toward your body

Range of motion:

Normal range of motion is ~ 70



internal rotation range, you may

need to work your way toward that


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Lower Trapezius Strengthening

Starting position: Prone on your stomach with arms at 135, elbows extended

thumbs up

Movement: initiate with movement by squeezing the shoulder bladestogether then lifting the arms off the table

Tips: Add 1-2 lbs weight, progress slowly


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Middle Trapezius Strengthening

Starting position: Prone on your stomach with arms at 90, elbows extended

thumbs up

Movement: initiate with movement by squeezing the shoulder bladestogether then lifting the arms off the table

Tips: Add 1-2 lbs weight, progress slowly


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References Akesson, I., B. Johnsson, et al. (1999). "Musculoskeletal disorders among female dentalpersonnel--clinical examination and a 5-year follow-up study of symptoms." Int Arch

Occup Environ Health 72(6): 395-403.

Decker, M. J., J. M. Tokish, et al. (2003). "Subscapularis muscle activity during selectedrehabilitation exercises." Am J Sports Med 31(1): 126-34.

Hintermeister, R. A., G. W. Lange, et al. (1998). "Electromyographic activity andapplied load during shoulder rehabilitation exercises using elastic resistance." Am JSports Med 26(2): 210-20.

Hoppenfeld, S. (1976). Physical Examination of the Spine and Extremities. Norwalk,Appleton-Century-Crofs.

Reinold, M. M., K. E. Wilk, et al. (2004). "Electromyographic analysis of the rotatorcuff and deltoid musculature during common shoulder external rotation exercises." JOrthop Sports Phys Ther34(7): 385-94.

Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes.St. Louis, Mosby.

Yee, T., L. Crawford, et al. (2005). "Work environment of dental hygienists." J Occup

Environ Med 47(6): 633-9.

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Keeping Your Shoulders Healthy

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