Wednesday, March 25, 2009

Integrating the Core- SICK R Scapula

Thanks to Jennifer Walle P.T. from CJW Sports Medicine in Virginia for the great question. She asked for an example of my take on the "core". Here is how I integrate into SICK scapula rehab:

We know that two weak muscles responsible for the SICK scapula are the rhomobids & serratus anterior, right? We also know that these muscles are part of the sling that creates the "serape effect". As you recall in a previous post I said placing a weight in the hand of this type of athlete is not a good place to start. Picture the arm as a back hoe, with the scapula as the cab controlling it. If the cab is not stable, the load will cause the cab to tip over, no? So, I have a better idea- my wall slides.

The athlete begins this exercise facing a wall with both hands side by side in front of the Right shoulder. The hands are covered by socks so they slide easier on the wall. Now the athlete takes a right cross step with his left foot. The hands slide across the wall at shoulder height, in the opposite direction of the left foot. The eyes move opposite the hands. The athlete then returns to the start. He controls the amount of weight bearing on the hands by how far away he stands from the wall. This is continued for 30 seconds, 10 sets.

Now the rhomboids & serratus ant. are loaded from the top down by the hands leaning & sliding on the wall. The hands are "buddied up" to minimize the stress on the R glenohumeral joint. It also encourages more motion in the thoracic spine, which is desirable in this condition. The pelvic R rotation loads the int/ext obliques from the bottom up which myofascially is linked to the SA & rhomboids. The head rotation? I'm not sure about that one, it just seems to load the shoulder better.

The prone planks are a little easier to figure out. The athlete is shifting his weight R/L, diagonal R/L, followed by the sponge bob "bring it around town" R/L circumductions. The lever arm is shortened, & all of the abs & hip flexors are integrated.

Of course there's still lots more to address, other muscle groups to integrate, the possibility of some long thoracic nerve neuropraxia et al. Any comments pro or con are always welcomed.


JH said...

Vern shows some medball exercises suchb as hip to hip and but to butt rotations. Do you think these would be effective in this situation as the ball is close to the body and still getting the transverse plane motion of the thoracic spine as well as the scap hugging of teh spine??

PS I like the exercises you shared with us. Very cool.

Joe Przytula said...

Sure. Arms are short-levered; should be well within the athlete's threshold of function during early rehab, same "hip to shoulder" concept.

JH said...

I wanted to tell you I've used the wall scap exercises you posted on 2 different patients. One is a shoudler rehab case and they are working great. The other is a back patient so I've been using the exercise as a transverse plane thoracic mob. Also worked great for that as well. So thanks for being so willing to share your knowledge.