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Scapular Based Rehabilitationfor the
Shoulder
Dale J. Bchberger, DCPast-President, American Chiropractic Board of Sports Physicians
Team Chiropractor, Auburn Doubledays and Syracuse Skychiefs Baseball Clubs
SWIS Health and Fitness Symposium
October 23-24, 2004
The secret to education is in respecting the students.Ralph Waldo Emerson
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Why is the scapula the center of the universe?
No true
articulation with
the torsoSuspended on the
thorax by muscle
attachments onlyPosture in the
Shoulder is
Paramount!
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Scapular Stabilizers Serratus anterior
Rhomboids
Lower trapezius
Secondary
Levatore scapulae
Middle and uppertrapezius
Inferior Attachment
Long Head of the
Triceps (X-factor)
Anterior
attachments
Coracobrachialis
Pec Minor
Short head Biceps
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Anterior Instability -Eccentric failure of the anterior
wall (subscapularis)
-Ante-version of the glenoid face
-Excessive ER/Reduced IR Morphological V. capsular
-Scapular Dyskinesia(asymmetrical scapular spinaldistance) Schizophrenic Serratus Ant. Dominant
Scapula
-Primary movers are unopposed
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Scapular BasicsFind the scapula and build a solid
foundation
Scapular retraction supine (towel)
Cervical retraction supine
Protraction from the quadruped-Lock the
spine
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RTC Program Day 1Side Lying Abduction (weight)
Plus (dyna-disc)Field Goal (weight)
Concentric/Eccentric ER (weight)
Modified Empty Can (weight)T-curl-alt. Pro./Sup. W/hand (weight and/or
tube)
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Side Lying Abduction 1 Keep the
humerus
(upper arm) in
the scapularplane
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Side Lying Abduction 2 Lift the
humerus in the
scapular plane
This is a linear
movement
Only raise to
the height of
the knee
Approx. 30
degree arc
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Plus 1 Elbows stay
fully
extended Retract
scapulas
Torso, spine
and LEs arerigid
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Plus 2 Protract scapulae
(DO NOT FLEX theThoracic-Spine!)
Keep elbowsextended
From the Dyna-Disc progress toperforming theplus with feet on a
physio-ball andvary the leverlength (place ballunder knees tostart and progressto ball under feet.
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Field Goal 1 Place dyna-disc under chest
Arms hang relaxed
First move (pictured) is toactively retract the scapulae
(pinch the shoulder blades
together).
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Field Goal 2
While maintaining
scapular retraction,
extend the shouldersto 90 degrees.
The elbows should be
flexed to 90 degrees
(as Pictured).
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Field Goal 3
Maintain 90
degrees of shoulder
extension and
scapular retraction. Now ER the
shoulder with the
thumbs pointed up
as pictured.
Be sure to reverseeach motion
SLOWLY!
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Concentric/Eccentric 1 Side lying ER,
thumb
backwards
Elbow tuckedinto ASIS (front
of your hip)
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Concentric/Eccentric 2 From the ER position press up to
the ceiling extending the elbow.
In the next photoyou will keepthe elbow fully extended while youperform horizontal adduction withIR (turning the thumb to the floorwhile crossing the chest).
For baseball pitchers, find yourfollow through position and usethat for this exercise. If there isanterior shoulder pain, lower thearm to a comfortable level of
adduction.
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Concentric/Eccentric 3
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Modified Empty Can 1 Start in the thumbs down or empty
can position. Retract bothscapulae (scapular set).
In the next photo you will begin toelevate the humerus (upper arm)with the thumbs pointed downwardin the scapular plane. When youreach approximately 45 degrees ofscapular plane elevation begin to
ER while continuing to elevate thehumerus.
**Maintain the scapular planethroughout the motion!
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Modified Empty Can 2
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Modified Empty Can 3 Be sure to
continue toelevate the
humerus whileyou perform ER.**Notice theposition of theelbow (100degrees ofabduction)
The scapula shouldbe reset beforeeach rep!
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Elbow Flexion Pronation/Supination Photo 1:Elbow
flexion withsupination(biceps)
Photo 2:Elbowflexion withpronation(brachialis)
In both DO NOTdrop the elbow!!!Maintain elbowposition duringelbow flexion. Thiswill work theserratus anteriormuscle
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Subscapularis Pull
Start with the elbow fully extended and the thumb up. Pull the tube behindthe back (causing IR) and touch thumb to the inferior angle of oppositescapula.
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ER with Scapular Retraction Keep the elbow tucked into the side as you ER the humerus.
As ER is completed retract the scapulae together.
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Bilateral Blackburn 3 - position 1 Dyna-disc under chest
Arms in ER
Retract scapulae with elbows fully
extended
In next photo lift thumbs to the
ceiling with the elbows fully
extended
Do not hyperextend the shoulders
Hyperextension of the shoulders
will cause excess stress on the
anterior capsule resulting in
shoulder instability.
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Bilateral Blackburn 3position 2
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Standing Three-way 2 As in
position
one begin
with the
scapular
set
Raise the
arms with
the thumbs
up in thescapular
plane
Elbows fully
extended
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Standing Three-way 3 As in position
one begin with
the scapular
set
Thumbs up in
abduction
Elbows fully
extended
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Dynamic Blackburn 1 Step 1 is to place the
hands on the
buttocks and retract
the scapulae
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Dynamic Blackburn 2 Depress the
scapulae by
reaching for
your feet
Keep the
hands
together
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Dynamic Blackburn 3 While
keeping the
hands
together lift
them off of
your
buttocks
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Dynamic Blackburn 4 Slowly release
hands
Begin to ERthe humerus
while
continuously
abducting the
humerus
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Dynamic Blackburn 5 Continue ER and abduction: thumbs are up now and you areat 90 degrees of abduction
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Dynamic Blackburn 6 Continue ER and abduction: thumbs are up now and you are at 100
degrees of abduction
This is the end range of motion for this exercise. Do Not go higher!
Reverse the motion slowly. The next rep is started from position 1.
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Scapular Retraction - End range 1 Face down; dyna-disc
under chest
Shoulders and elbowsat 90 degrees
First movement is to
retract the scapulae
The forearms shouldnot come off the floor
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Scapular Retraction - End range 2 While
maintaining
scapular
retraction
lift the
elbows and
thumbs to
the ceiling Maintain
90/90
position
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Thank You!