Wednesday, March 2, 2011

Using the PCA to save time

This athlete is a pitcher who came to me complaining of posterior shoulder pain during the early acceleration phase of his delivery.  Evaluation revealed a forwardly rotated scapula, a tender coracoid process, and GIRD.  I used the gauge to This scapular malposition is usually associated with weak same side lower trapezius muscles and a tight pec. minor; the GIRD a tight posterior shoulder capsule.

The tests I used were:

1.  Shoulder Liftoff
2.  Shoulder IR (note:  NOT an official PCA test)
3.  Standing shoulder ER
4.  Thomas Test 1.

The whole process only took me less than 5 minutes and gave me good information.  The shoulder liftoff was expected- the athlete scored a "1", which would be consistent with weak lower traps.  This is problematic, indicating this athlete cannot really get "hip to shoulder".  What I didn't expect was the good performance on the standing shoulder ER, meaning the pec. minor was probably not a culprit.  The Thomas Test 1 revealed a slightly tight same side iliopsoas (this would grade a "3", which normally isn't bad, but in throwers your really want a "5", meaning the thigh should drop below the table) which could theoretically prevent a good low trap load via poor torso extension.  The internal rotation shoulder test will provide the athlete with a visible indication of their progress.  This would grade a "1", which is undesirable for a thrower.  This score indicates the possibility of shoulder & elbow injuries as per Donnelly.

My next step was to confirm my suspicions further by inspecting some of the myofascial centers of coordination about the scapula.  Interesting the pec minor myofascial cc was indeed negative.

I'll only get to see this athlete a half of his lunch period 5 days a week.  But with the help of a streamlined remedial program he should have a great season.


Kev said...

Would you mind talking a bit more about the myofascial centers of coordination please? Is it a specific anatomic or biomechanical area? Thanks!

Joe Przytula said...

They are areas of the fascia that the the Steccos have documented on anatomical studies as being rich in mechanoreceptors. Interesting they correspond almost perfectly with accupuncture points. 30% of muscle force never reaches the tendon. Many biomechanists see this as a "defect in the design" sort of speak. The Steccos see this as a way muscles mechanically influence each other, by way of tension in the fascia. Injury, such as contusions, sprains etc cause inflammatory reactions which causes the deep layers of fascia to bind. This causes two issues: abnormal tension on joints, and alpha-gamma, or "circuitry" problems sort of speak.

So Thomas (Anatomy Trains) Myers looks at fascia from more of a structural point of view, while the Steccos take a more neural approach. Myers is a Rolfist, the Steccos orthopedists. What place does it have in the A.T. room?? Haven't used it enough to say yet. Stay tuned.

Kev said...

When you say "inspecting" what do you mean? Palpation of tenderness, tone, trigger point, etc?

Joe Przytula said...

Upon compression, a "positive" CC would produces a burning senstation that often radiates pain to the injured joint. To the practitioner, it would feel like a densified or roughened area about 1.5cm in circumference.

Jack Martin said...

Joe, timing is a beautiful thing. I just got our PCA and gauge in the mail this week. I can see that we can make some good use of it with the fellas and hopefully reduce the frequency and severity of injuries.
Speaking of which, my hip pain has returned. I read an interesting study today and I am figuring (in my own self-diagnosis) that it is not bursitis but rather a gluteus minimus problem. I had my wife help me with a Thomas test and to no surprise I am well below average.
I realize I need to fix the mechanics so the body can take care of itself. What do you think about this minimus as a contributor to hip pain and what can we do about it? Martin
PS Day 1 of spring track and the Devils began with a bit of Frans Bosch running drills. The fellas did some good work and didn't realize it.

Joe Przytula said...

Modified Thomas 1,2, or 3 Jack?

Runners are locked into that sagittal plane for long periods of time, so its not unusual to score low. A stiff FA capsule usually goes hand in hand. I will have to do a post on remedial work for that. Not sure what "gluteus minimus" problem means. It is the diagnosis de jour. Are you doing the miniband routine?

Jack Martin said...

Joe, I did Thomas 1. I do some miniband, but probably not enough.
The study I read linked minimus weakness, strain, etc to the hip pain I am experiencing. I am going back to the ortho on Thursday, any advice as to what I should say. Personally I think my problem(s) are linked to bad mechanics at this point. Things just keep breaking down. Martin

Joe Przytula said...

I think runners spending remedial time out of the anterior sagittal plane does them good. 3D lunge & reach, retro running really stimulates those deep hip rotators. Have you ever been videtaped running? Slo-mo-ing it and breaking it down per Frans' DVD is helpful.

BTW- ran into Bonsall's partner at the fascial manipulation course. Different than ART/Graston, as areas away from the site of pain are treated.