Posts in shoulder pain
Muscle Activation During an Inverted Row

The standing row is an excellent exercise to develop strength and stability in the upper back, shoulder, and arms.  In addition to the standard standing position, individuals may choose other positions including using TRX straps or a bar to increase the demands on the upper body and core musculature.  A recent article examined the recruitment of these muscles during various positions of the row exercise (Youdas et al. J Strength Cond Res. 2016).

Authors placed 26 patients through 4 different versions of the inverted row to determine their relative muscle recruitment patterns.  The authors noted all positions of the inverted row were excellent for targeting the biceps, deltoids, latissimus dorsi, and trapezius muscles.  Surprisingly no significant differences were noted performing the exercise in either a single or double leg supported position.   This article adds to the existing strengthening literature indicating the inverted row with straps or a bar is an excellent option to strengthen the upper back musculature. 

Altered Muscle Recruitment in Patients with Shoulder Pain

Shoulder pain is a common musculoskeletal problem and one of the top reasons patients seek care from their primary care physician.   There are many sources of shoulder pain including impingement and rotator cuff tendonitis or tears, but they all have one impairment in common altered muscle recruitment.  When pain is introduced into the body the nervous system's ability to contract and coordinate the activity of the surrounding muscles is altered.  These changes lead to compensatory movements, more pain, and loss of function.   In addition to treating a patient's pain Physical Therapists utilize exercises to restore normal muscle function to the affected areas.

A recent article in the Journal of Shoulder and Elbow Surgery compared the muscle activation levels between patients with impingement and their pain free peers (Michener et al. 2016).  All participants were asked to perform a weighted arm lifting task as the researchers collected muscle activation data.  The patients with impingement demonstrated an altered movement pattern while performing the task overworking their neck muscles in the process.  In comparison, the healthy controls were able to perform the task using the correct shoulder blade muscles without overcompensation from their necks.

This study highlights the importance of correcting these muscle imbalances and coordination deficits to reduce the risk of a patient's pain returning.  To learn more about how to reduce your pain and improve your shoulder function contact your local Physical Therapist.  

The Impact of Core and Leg Muscle Fatigue on Baseball Throwing Mechanics

As we move into Spring we begin to see our youth athletes return to the baseball diamond often with a sudden increase in practice volume.  The sudden increase in throwing volume, either in the field or on the mound, places the athlete's shoulder and elbow at greater risk of baseball injuries. The greatest risk factors for injury include throwing more than 80 pitches/game, playing baseball greater than 8 months/year, and pitching with arm fatigue. As discussed in our prior posts, an athlete's throwing velocity is driven by their legs strength and power. Athletes with leg weakness are more likely to suffer from progressive changes in performance and increased injury risks.

A recent study in the Orthopedic Journal of Sports Medicine authors analyzed the impact of fatigue on throwing velocity, accuracy, and throwing mechanics (Chalmers et al. 2016). Authors studied 28 elite adolescent (13-16 year old) pitchers as they pitched a simulated game (90 pitches). Each pitch was analyzed for velocity and accuracy while every 15th pitch was analyzed for pitching mechanics. As expected the velocity, accuracy, and mechanics suffered with increased pitch counts. Importantly, the authors showed the loss of velocity, accuracy, and biomechanics were preceded first by core and leg muscle fatigue.

This study adds to the importance of controlling pitch counts and treating the lower extremities in order to improve throwing performance and reduce injury risk.  

Mental Health and Its' Impact on Shoulder Function

 "We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world."  - Buddha.

Mental health has a significant impact on recovery from many musculoskeletal diagnoses including low back pain, neck pain, and shoulder pain.  Our thoughts and perceptions about our bodies and their ability to recover from injury and illness strongly influence our course for recovery and healing.  In prior posts we have described the limitations of imaging such as MRI and CT for musculoskeletal diagnoses.  In particular, we can find the same pathology (disc herniation or rotator cuff tears) in people with and without symptoms.  Thus, imaging does not correlate strongly with how patients function and what symptoms they experience due to these imaging findings.  

A recent study in the Journal of Bone and Joint Surgery highlights both the limitations of imaging findings and the importance of mental health on patient function (Wylie et al. 2016).  The authors recruited close to 200 patients with complete rotator cuff tears to determine which clinical and diagnostic factors correlated best with the patients' symptoms of shoulder pain and function.  Interestingly, a patient's mental health had the strongest association with the patient's reporting of pain and shoulder function.  This association was stronger than the correlation between the severity of the shoulder injury on MRI and their reporting of pain and function.  

This study adds evidence to support the assessment of mental health variables in individuals suffering from musculoskeletal pain and may help us understand which patients can or cannot function well given a positive imaging finding.  In our experience, patients with a positive outlook on their recovery have the most optimal outcomes with Physical Therapy.

Sports Specialization and Injury Risk

With a changing in the seasons we also see a changing of the sports in our Boulder County student athletes.  Athletes previously focused on winter sports including swimming and basketball are now able to focus on spring sports including baseball and track.  Prior research shows athletes who change sports during the sports year have half the risk of injury compared to their peers who focus on one sport all year round.  Early sports specialization  in school sports places athletes at greater risk of overuse injuries during their seasons due to lack of recovery/rest periods, muscle imbalances, and repetitive sports movements such as pitching.  

A recent article in the American Journal of Sports Medicine adds further support to the risk of student athletes playing one sport year round.  Bell and colleagues studied over 300 athletes aged 13-18 from 2 high schools to determine the prevalence and impact of year round athletics (2016).  Athletes were classified in 3 groups including low, moderate, and high specialization based on their single sport participation.  Not surprisingly, athletes from larger high schools were more likely to specialize in one sport and these athletes reported greater rates of overuse injuries than their peers who played at smaller schools or multiple sports per year. Specifically, athletes playing one sport greater than 8 months per year were at greater risk of injury than athletes who participated in one sport less than 8 months of the year.  

Parents, coaches, and student athletes are advised to consider the risk of spending >75% of the year training for an individual sport.  Coaches and athletes are advised to schedule their training year based on periods of dedicated to both training and recovery.  

Thoracic Manipulation and Shoulder Pain
boulder physical therapy thoracic manipulation shoulder pain

Treatment of the thoracic spine utilizing joint mobilization or manipulation is a excellent treatment approach to accelerate the recovery of patients dealing with neck, elbow, and shoulder pain.  Utilizing a regional interdependence approach where areas adjacent or distant to the site of pain are treated by the physical therapist, in addition to the painful area, lead to greater outcomes in fewer visits.  The benefits of manual therapy alone often last 1-2 days but when combined with physical therapy exercises can deliver both short and long term improvements in pain and function.  In our practice, manual therapy treatments produce a valuable reduction in a patient's pain allowing them to move with less discomfort as we transition into a strengthening program.  Previous research showed patient's receiving this combined approach demonstrates better outcomes and strength development than those receiving only exercise treatments (Bang et al. 2000). 

boulder physical therapy shoulder pain treatment

Recently, a review of the available literature on manual therapy in the management of shoulder pain was published in the Journal of Manual and Manipulative Therapy (Peek et al. 2015).  The pooled results of the 7 studies found between 76-100% of patients reported significant reductions in shoulder pain immediately after the thoracic manipulation.  Some of the studies demonstrated improved shoulder outcomes up to 1 year after the treatment period.  This review article adds to our available evidence supporting the utilization of thoracic manipulation during physical therapy treatments for shoulder pain.  To learn more about how thoracic manipulation can help you reduce pain and get back to your activities contact your local physical therapist.