1. REHABILITATION AND TREATMENT FOR ATRAUMATIC SHOULDER PAIN
Jessica Nonkes, PT
Physical Therapist
Rochester Regional Health Physical Therapy

2. Biomechanics of Elevation
Upright Posture
Scapula
upward rotation, external rotation & posterior tilt
Scapulohumeral Rhythm 2:1
Scapular Force Couples

3. Scapular Force Couples
Scapular Upward Rotation Shoulder Abduction Upper & Lower Trap Deltoid & RTC

4. Types of Impingement Subacrominal Internal
Primary – abnormal structural characteristics
Secondary
Instability of GH joint & dyskinesia leading to compression on the bursal side of the RTC
Internal
Compression of the undersurface of the infraspinatus & supraspinatus when the arm is elevated & externally rotated.

5. Clinical Findings of Impingement
Altered biomechanics with elevation
Increased scapular elevation and anterior tilt
Delayed activation of MT & LT
Weakness of RTC and SA
Passive Restraints
Pec Minor tightness
Posterior shoulder tightness

6. Progression of Interventions
Decrease pain, inflammation, normalize tone
Improve GH & scapular stability in midrange
Strengthening – RTC, MT, LT, SA
Stretch Pec Minor & posterior musculature
Regain proprioception & neuromuscular control
Progress exercises to full range while maintaining scapular control
Use plyometrics, sport specific and overhead drills to improve overhead scapular control

7. Serratus Anterior Strengthening

8. Middle & Lower Trapezius Strengthening

9. Rotator Cuff Strengthening

10. Pec Stretch
Post Shoulder Stretches

11. Exercises to regain proprioception & neuromuscular control

12. GH Instability & Scapular Dyskinesia

13. Dynamic GH Stability Joint Compression Convex on Concave
Negative Pressure
Glenoid Labrum
Tensioning of GH ligaments
Coordinated contraction of RTC & LH Biceps

14. Clinical Findings of Instability
Multidirectional hypermobility of GH capsule
Scapulothoracic and glenohumeral dyskinesia
Primary – RTC, Deltoid, LH biceps, SA, Trapezius
Secondary – Teres Major, Lat Dorsi, Pec Major
Postural malalignment
Excessive scapular protraction
Scapular winging
Loss of Proprioception & Neuromuscular Control

15. Rehab Progression Retrain muscular activation and scapular stability
Strengthening through pain-free ROM
Regain proprioception & neuromuscular control
Progress strengthening & endurance training, plyometric and sport specific drills

16. Shoulder Rehabilitation Overview
Correct posture, alignment and joint biomechanics
Facilitate correct timing and activation of mm recruitment
Strengthen RTC and scapulothoracic muscles
Regain overhead control through sport specific training

17. Thank you!