I’ve been reading and listening to probably what is more than a healthy amount of scapular research and rehabilitation lately.  It’s great for me because I’m currently working with a few athletes with scapular dyskinesia and shoulder pain.  I wrote a bit about scapular dyskinesia some time back and it’s easily one of my most popular articles to date.

Now, it’s important to understand that winging and dyskinesia can happen for variety of reasons.  Pain is a huge player in the mix as well as specific weakness or muscle imbalance.  As a therapist it’s our job to determine why this winging is occurring and troubleshoot how to correct it.  This article is going to talk more about specific weaknesses.

There are also several different types of winging and dyskinesia.  Sometimes the inferior border of the scapula pops up with movement (Type 1).  Sometimes the shoulder is protracted (scap anterior tilt/internal rotation) at rest (Type 1).  Sometimes we get a shrug with excessive downward rotation when we raise our arms overhead (Type 3).  What I’d like to talk about today is medial border prominence (Type 2) as shown in the picture above.  I see this quite a bit in athletes especially when they’re attempting pushups.

This article’s inspiration comes from Ann Cools.  She is a researcher, physiotherapist and professor.  She is an absolute boss when it comes to the shoulder and specifically the scapula.  The clinical reasoning process used in this article comes from her.

First off, when you see this occur in your patients you have to ask the question of why is this occurring?  Dyskinesia could theoretically cause shoulder pain but can also occur because someone is in pain (Maybe an individual is moving differently to decrease stress on a sensitive area in the shoulder).  Ultimately we want to promote symmetry …read more

To recap from last week, as therapists sometimes I feel as if we lack in our exercise selection for certain athletes trying to return to sport.  We do a good job of finding evidence based EMG exercises for specific conditions but sometimes drop the ball when it comes to finding great exercises that are specific to getting back to sport.  Those basic exercises are of extreme importance but what do we do once our athletes have reached their maximum benefit from these exercises and aren’t yet back to their activities.  I work with a decent number of weightlifters and crossfit athletes.  Besides a lack of knowledge of their sport, the second biggest reason for failed previous treatment is a lack of specific exercise progression to get them back to their activities.  Getting someone back to their ADLs pain free and getting them back to high level performance are two different things.

I wanted to put together a series of exercises I use with my athletes to get them back to their sport.  In part 1, the exercises are specific to strengthening and conditioning an athlete along their rehab/physical therapy process to get back to open chain activities like handstands, pushups and handstand pushups. The second example will be a series of open chain exercises.  Populations that would benefit from these exercises would be an olympic lifter, power lifter or crossfit athlete that wants to return to bench press, overhead press, push press, jerks and any other open chain pressing activity.  The exercises are split into phases, so you know how to progress an athlete throughout the course of their rehabilitation.

This exercise progression is by no means a replacement to a thorough evaluation with specific emphasis on correcting deficits and potential causes of injury.  However, I think it provides several ideas on how …read more

I’ve been working with a lot of students lately in my clinical practice as a physical therapist lately.  In my experience most students tend to have pretty good clinical decision making skills, a fairly sound evidence based approach as well as some solid evaluation and treatment ideas.

When it comes time for program directors to visit their students at our clinic they usually ask about ways to improve their physical therapy curriculum.  Far and away the biggest comment I give is the lack of experience with exercise selection.

I also feel that as a profession overall we lack a bit in this area.  We do a good job of finding evidence based EMG exercises for specific conditions but sometimes drop the ball when it comes to finding great exercises that are specific to getting back to sport.  Those basic exercises are of extreme importance but what do we do once our athletes reach their maximum benefit from these exercises and aren’t yet back to their activities.  I work with a decent number of weightlifters and crossfit athletes.  Besides a lack of knowledge of their sport, the second biggest reason for failed previous treatment is a lack of specific exercise progression to get them back to their activities.  Getting someone back to their ADLs pain free and getting them back to high level performance are two different things.

I wanted to put together a series of exercises I use with my athletes to get them back to their sport.  These exercises are specific to strengthening and conditioning an athlete along their rehab/physical therapy process. The first example will be a series of closed chain exercises.  Populations that would benefit from these exercises would be a gymnast or crossfit athlete that wants to return to handstands, handstand walking or any other closed chain pressing …read more

1) Running Drills Every Triathlete Should Master

I use these drills at least several times per week.  They’re excellent drills from a rehab perspective as well as from a performance perspective.  Chris Johnson is also an athlete and excellent therapist.

2) TED talk with Lorimer Moseley on Pain

This is another video I point patients to frequently.  Pain is a very complex topic and understanding it is enormous from a rehab and injury prevention perspective.  Lorimer Moseley helps out on this front with an entertaining and informative video.

Now You’re Smarter,

Dan Pope DPT, CSCS

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