Scapular taping rationale

The purpose of my taping is to influence scapular position on the thorax, period. Restoring normal length/tension myofascial relationships in the process. In "the lucky 7", I'm correcting anterior rotation with the vertical strip, abduction, int. rotation, & downward rotation with the horizontal. I "tape it as I see it". I'm not attempting to facilitate/inhibit any muscle groups- I don't believe a piece of tape can do that. I know I'm going to hear it from the kinesiotape enthusiasts, & I don't want to seem hard headed, but I'm sorry, there's not enough evidence based practice to support it. From my previous posts you know how I am, if I can't pull out my goniometer or ruler & see something happening with my own eyes, it isn't happening.

More HS injuries

A good article in this month's "Sports Health" mag- "An evidence-based approach to hamstring strain injury: A systematic review of the literature".

1. Hip flexor flexibility appears to be more important than hs flexibility.

2. hamstring strength,quad/hs imbalances assessed isokinetically is conflicting.

3. Yet another article that points to the efficacy of the Sherry/Best functional protocol outlined in JOSPT '04.

Lucky 7

Oh, did I tell you this kid continues to play? The problem here in NJ is the baseball season is only 8 weeks long. So, if I kept him out of the sport long enough to correct his shoulder dysfunction, the season would be over. With the cooperation of the coach, he's being platooned to reduce his "reps". And, I'm correcting the malposition by taping it (doesn't it look better?!). He plays pain free; no more subluxating shoulder as long as he wears the tape. The strange thing I notice is the tape seems to have a temporary proprioceptive effect lasting hours after it is removed.

By the way Heidi- as long as you clean the skin good with alcohol, then spray it good with tough skin, it will even stay on pretty good in the water!

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.

The SICK Scapula

Take a look at the right scapula:

Scapular Malposition

Tender Coracoid Process

Prominent Inferior Angle

Scapular Dyskinesis

Downwardly rotated to boot.

Kibler took a lot of poetic license on the SICK scapula term.

This is our JV catcher, met him for the first time today with complaints of a "popping" R shoulder during throwing/batting. He is anteriorly unstable. He has barely done any throwing, it is the pre-season. A lot of the stuff we see on the high school level are remnants of poorly designed programs of the past. 12 year olds playing on 3 different little league teams. Physical education is 3 hours a week with the personal trainer. Now it is our problem.

High school ATC's, let's make sure the buck stops with us. Let's not send them up to the college or minor leagues with this stuff. The baseball player's back should be ripped by the time you get through with them. The thrower's 10 is fine to milk out post game soreness, but you'll need to be a lot more creative to fix these. To be continued...

Can I have an ice pack?

Here I am working with an outfielder with pain in the distal bicep & forearm. By way of neurodynamic tension testing I determined that this athlete had a median nerve entrapment in both the lig. of struthers & the pronator teres. I explained to him ice was for sprained ankles & things like that. A few simple neural glide techniques & his symptoms disappeared. Whole process took a few minutes.

Neurodynamic entrapments were documented in cadavers about 15 years ago. In this month's JOSPT nerve gliding was documented for the first time in vivo by some Australian researchers. Frijoles Frios!

May I recommend Butler's "Mobilisation of the nervous system" & "The sensititive nervous system" for your reading pleasure.

Reactive Abs 2: Throwing & Swimming

Last summer I gave an emample of how we might integrate the abs in with the UE in a functionally consitant manner. I gave an example in which the hips were going out-of-sync with the shoulder, running.

Now we're going hips in sync with the shoulder, a la a right handed thrower. My drivers are the R hand & foot. I'm using a L SLB, RUE posterior @ overhead L120 reach c/ 3lb. powerball; RLE @ knee height L 120 reach c/ 6lb. ankle weight.

I'm using different weights because I want the hips to lag behind the torso just a bit to create a proximal acceleration, even though they are moving in the same direction.