upload 1214927606 dale buchberger presentation

8/13/2019 Upload 1214927606 Dale Buchberger Presentation

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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!

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