Here is some of the information I recently shared in my May newsletter. Each newsletter has a specific focus. This month is focused on the shoulders and rotator cuffs. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
NOTE: This will be the final newsletter about Shoulders and Rotator cuffs. I want to thank each of you for your interest in receiving the newsletters. I know many of you are also receiving some of my other newsletters and those newsletter will continue. If you are not receiving the other newsletters and would be interested, please let me know to add you to the list: chronic pain & Fibromyalgia, upper cross and neck, foot & ankle problems, PTSD & trauma, fascia & trigger points, lymph & lymph drainage, cupping, aromatherapy.
STUDIES and ARTICLES
I receive a weekly update on anything published anywhere on the internet that includes information about shoulder and rotator cuff injuries and treatments. I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: email@example.com
1. Whitney Lowe, on his website for Academy of Clinical Massage, posted a great article titled Hooked on Shoulder Pain which provides an excellent discussion of the subacromial space and impingement.
2. A study, titled Distorted distance perception to reachable points in people with chronic shoulder pain, published in Musculoskeletal Science and Practice in July 2019, suggested: this study aimed to investigate whether people with chronic shoulder pain show perceptual distortions of space and body that may promote protective behavior and concluded: results suggest that distorted perception is not a typical consequence of chronic shoulder pain, however, that it may occur in cases where pain is strongly linked to movement.
3. A study, titled Vibration as an adjunct to exercise: its impact on shoulder muscle activation, published in European Journal of Applied Physiology in May 2019, concluded: the use of vibration as an adjunct to exercise provokes a near-global increase in shoulder muscle activation level. Furthermore, exposure to vibration alters muscular recruitment improving readiness for movement.
4. A study, titled Degenerative rotator cuff tears are associated with a low Omega-3 Index, published in Prostaglandins, Leukotrienes and Essential Fatty Acids in Sept 2019, concluded: Patients with full-thickness degenerative rotator cuff tears had a significantly lower Omega-3 Index than controls without rotator cuff tendinopathy. Whether a lower Omega-3 Index represents an independent risk factor for degenerative rotator cuff tears should be further investigated, e.g. in a longitudinal study.
5. A study, titled Association between physiological and subjective aspects of pain and disability in post-stroke patients with shoulder pain: a cross-sectional study, published in Journal of Clinical Medicine, in July 2019, concluded: Post-stroke patients showed a relationship between widespread pressure pain hypersensitivity with lower pressure pain threshold levels and pain disability perception, suggesting a central sensitization mediated by bilateral and symmetric pain patterns.
6. A study, titled A randomized controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain published in the BMJ Open Sport & Exercise Medicine concludes: Omega-3 polyunsaturated fatty acids supplementation may have a modest effect on disability and pain outcomes in rotator cuff related shoulder pain.
7. A study titled Effects of Wiper Exercise and External Rotation Exercise in Side-Lying on the muscle activity and thickness of the infraspinatus, published in the International Journal of Pharmaceutical Research in March 2019, concludes: This study recommends the wiper exercise is a good indication for the selective and functional strengthening of the infraspinatus muscle while minimizing the posterior deltoid for shoulder dysfunction.
8. A study, titled Effects of Sling exercise with vibration on range of motion, muscle strength, pain, disability in patients with shoulder injuries, published in Physical Therapy Korea in Sept 2019, concludes: The sling exercise with local vibration of 50Hz affected the external rotation of the shoulder range of motion and improved shoulder flexor strength in the patients with shoulder injuries. Therefore, we propose the use of the sling exercise intervention with vibration in the exercise rehabilitation of patients with shoulder joint injuries.
9. A study titled Effect of fatigue and the absence of visual feedback on shoulder motor control in a healthy population during a reaching task, published in Gait & Posture in October 2019, concludes: Muscle fatigue and lack of visual feedback can compromise shoulder kinematics; lack of visual feedback decreased reaching accuracy; lack of visual feedback increased time taken to complete the task; the addition of fatigue did not increase the effect of the lack of visual feedback.
1. TIDBITS and UPDATES Muscle Energy Technique for Subscapularis Shared by Healthy Street on January 10
ASSESSMENT OF SUBSCAPULARIS
The therapist takes the patient's arm to 90 degrees of abduction and 90 degrees of elbow flexion – an assessment in this position is known as the 90/90 test. From this position, the therapist supports the patient's elbow with their right hand and the patient's forearm with their left hand. The therapist then takes the patient's arm into external rotation until a bind is felt. For normal range of motion of the subscapularis, the external rotation should achieve 90 degrees, i.e. the patient's forearm should be parallel to the couch. If there is shortness of the subscapularis, the range of motion will be less than 90 degrees.
MET TREATMENT OF SUBSCAPULARIS
The therapist takes the patient's shoulder into external rotation until a bind is felt. From the position of bind, the patient is asked to contract the subscapularis by internally rotating their shoulder. After 10 seconds and on the relaxation phase, the therapist applies traction to the shoulder joint (to prevent an impingement) and slowly encourages the shoulder into further external rotation.
If the patient has discomfort activating the subscapularis, the antagonistic muscle of the infraspinatus can be activated instead. From the position of bind, the patient is asked to resist external rotation: this will contract the infraspinatus and allow the subscapularis to relax through RI. On the relaxation phase, a lengthening procedure of the subscapularis can then be performed.
🔑 The subscapularis is one of the rotator cuff muscles and is the main medial rotator of the glenohumeral joint. A subscapularis strain can result in referred pain to the area of the deltoid tuberosity.
Reference: MET John Gibbons