Scapulohumeral Rhythm

By: Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS

The shoulder is one of the most vulnerable joints in the body due to its vast range of motion and complexity. It is a complex ball and socket joint, uniquely comprised of various connective tissue, supporting structures, including muscles. It is an important joint because functionally, it is involved in most daily and sport activities, such as reaching, lifting, carrying and throwing a ball. Knowledge of the biomechanics of the shoulder can help you with training and aiding in rehabilitation of the shoulder and related injuries.

The shoulder complex involves coordinated movements between the humerus bone and the scapula. The scapula, clavicle, and humerus serve as attachments for most of the muscles in the shoulder. The shoulder is comprised of four primary joints:

  • Glenohumeral joint (GH)
  • Acromioclavicular joint (AC)
  • Sternoclavicular joint (SC)
  • Scapulothoracic joint

 

 

 

Scapulohumeral Rhythm (SHR) is defined as the movement relationship between the humerus and the scapula during both shoulder flexion and shoulder abduction. Arthrokinematics is the movement that takes place between articular surfaces in a joint.

For example, during abduction of the arm at the shoulder (side arm raise) the following happens (See Figure):

  • The glenohumeral joint (concave) is stable (depicted by the vertical arrow), while the humerus (convex) abducts (depicted by the horizontal arrow).
  • There is a sliding down or glide of the convex humerus on the concave glenohumeral joint.
  • The scapula rotates upward (bottom of the scapula moves laterally and upward).

 

During shoulder abduction, there is 120 degrees of movement that occurs at the glenohumeral joint, while 60 degrees occurs at the scapulothoracic joint, creating a 2 to 1 ratio (2:1). This movement is known as the scapulohumeral rhythm (SHR) of shoulder abduction. The same SHR occurs both during shoulder flexion and shoulder abduction. (See Figure)

The muscle actions that occur when you abduct the arm at the shoulder include: (See Figure)

  • Biomechanically, the supraspinatus muscle raises the arm during the first
    15 degrees of shoulder abduction.
  • Then, from 15-90 degrees of shoulder abduction, the medial deltoid assists to raise the arm biomechanically.
  • There are several muscles within the shoulder that play important roles, specifically at the rotator cuff. The rotator cuff is comprised of four primary muscles known as the S.I.T.S muscles. These muscles include the supraspinatus, infraspinatus, teres minor and subscapularis which pull the bone in different directions due to different attachment points and angle of pull.
  • A force couple can be defined as a pair of muscle forces that act together on a joint to produce rotation. These forces may exert pulls in opposite directions. Force couples may be synergistic pairs or agonist/antagonist pairs of muscles.  In the Figure shown, a force couple occurs between the low trapezius and serratus anterior. During shoulder abduction, the lower trapezius and serratus anterior work together to anterior upwardly rotate the scapula on the thorax.

 

Abnormal scapulohumeral rhythm is a dysfunction that occurs within the scapulothoracic junction.  There are many causes for this including:

  • A rotator cuff tear where the individual does not have the musculotendinous connection and strength to abduct the arm.
  • Limitations due to joint and capsule hypomobility (restriction) known as adhesive capsulitis (frozen shoulder).
  • Pain and/or muscular weakness that prevent the ability to raise the arm to the side.
  • Occurrence of excessive upper trapezius and scapular elevation which becomes a means of compensation, and provides the individual with an alternative ability to abduct the arm.

Why is this important?

  • Connective tissue (muscles, tendons, ligaments, and fascia) are supposed to move. Joints, as well, have a certain amount of movement and should glide and translate with everyday movement.
  • Muscle imbalances and tightness create dysfunction. If a muscle does not have adequate muscle length to concentrically and eccentrically contract, compensation will occur typically above and below a joint.
  • If this tightness continues, it will result in trigger points. Trigger points are where a muscle shortens and, in essence, has increased sensitivity affecting the muscle’s ability to completely move as it was designed. If trigger points become bigger and more prominent, they can compress the nerve that innervates the respective muscle creating radicular (fuzzy feeling, numbness, or tingling) symptoms.

If the scapula is not able to properly upwardly rotate on the thorax, an individual will compensate using other muscles to perform the work. This compensation will lead to muscle imbalance, pain, and dysfunction affecting activities of daily living and sports movements.

For more information about working with clients with shoulder issues, see the Fitness Learning Systems Human Movement Matrix: Shoulder continuing education course by Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS of Pinnacle Training & Consulting Systems.  www.pinnacle-tcs.com “Teaching The Science Behind The Movement.” Fitness Learning Systems is an IACET accredited continuing education provider.

Alzheimer’s Disease Part 3

Exercise and Alzheimer’s Disease
Adapted from the Medical Fitness Specialist Certificate Program by Alzheimer’s Research and Prevention Foundation: Alzheimer’s Disease Prevention and Intervention.
(Article 3 in a 3-part series about Alzheimer’s disease.)

In the first article in this series, it was noted that:

  • although there are natural physiological changes that occur with age, memory loss is neither normal nor a natural process of aging.
  • there is no medication at this time that cures fatal Alzheimer’s disease, so prevention is the best line of defense against the disease.
  • exercise plays a very important role in prevention of cognitive decline and brain health.

In the second article, prevention for cognitive decline and Alzheimer’s was discussed with The 4 Pillars of Prevention, a program researched and developed by the Alzheimer’s Research and Prevention Foundation.

This article will look at evidence-based information about the role of exercise in prevention and intervention of Alzheimer’s disease and cognitive impairment.

There are now dozens of research studies that look at the effect of exercise for prevention and intervention for cognitive decline and the risk for developing Alzheimer’s. The evidence supporting exercise continues to grow, as more studies are conducted. Exercise continues to prove to be an important therapeutic strategy for prevention of cognitive decline and Alzheimer’s.

“Although at this time, medications have no proven neuroprotective effect on dementia, an evolving literature documents significant benefit of long-term regular exercise on cognition, dementia risk, and perhaps dementia progression.” (Ahlskog 2011 metanalysis) Many studies suggest that exercise reduces the effects of dementing neurodegenerative mechanisms.

Currently, research significantly indicates that exercise is associated with a reduced risk of cognitive impairment and dementia. This appears to happen in two ways: (Ahlskog 2011)

  1. A convergence of evidence from both animal and human studies indicate that aerobic exercise seems to reduce the risk of degeneration of brain processes and seems to protect the brain from biological and neurological decline.
  2. The cardiovascular benefits of aerobic exercise reduce vascular risk improving cerebrovascular (carotid and brain artery) health, reducing plaque build-up, and maintaining better circulation to the brain.

There are several types and doses of exercise being researched in association with brain function in order to determine the type and dose of exercise that produces beneficial results. Moderate physical activity was reported in many studies to improve brain function. Moderate exercise was quantified in different ways including:

  • the number of blocks walked over 1 week. Walking 72 blocks/ week was necessary to detect beneficial increased gray matter.(Erickson 2010)
  • working at a duration of 40 minutes in a target heart rate zone of 50-60% for the first 7 weeks and then 60-75% for the remainder of the program determined by Karvonen method provided beneficial brain and memory changes. (Erickson 2015)
  • moderate exercise 30 minutes per day for at least 5 days per week showed less accumulation of “beta amyloid plaque” (proteins that build up on brain with Alzheimer’s Disease), less shrinkage of the hippocampus, and less reduction in use of glucose in the brain. They also had fewer neurofibrillary tangles (twisted fibers inside brain cells) and did better on memory tests. (Bernstein 2014 review)
  • current levels of Recommended Physical Activity (RPA). Subjects wore an accelerometer and were categorized as having met physical activity recommendations or not based on the US Department of Health and Human Services recommendations of 150 minutes of moderate-to-vigorous physical activity per week. (Dougherty 2016)
  • sedentary lifestyle (<5 hours activity per week) was significantly associated with more than double the risk for dementia. A physically active status was determined as 5 hr/wk or more of light activity and at least occasional moderate to vigorous activity. (Norton 2012)

Other types of physical activity such as resistance training, moderate intensity cycling, and strenuous activity are being studied to determine their value in maintaining cognitive function in aging. In particular, the dose-response relationship is being explored. If minimum physical activity requirements are found to be neuroprotective, investigation continues to see if higher doses of exercise training are more beneficial. At this time, mixed results have been found.

A clear dose-response relationship exists between exercise and cardiorespiratory fitness. Cardiorespiratory fitness is an indicator for brain health. Adherence to more strenuous exercise programs may be problematic for many older adults. (Vidoni 2015) Health-fitness professionals need to work with clients of all ages, carefully balancing fitness gains and intensity/volume with program adherence.

The ultimate goal for quality of life and good health is not realized if your client does not build healthy exercise behaviors to adhere to exercise long term, at least at minimal physical activity requirements. It is important for the general public, and especially the older adult population, to be properly informed of the benefit to risk relationship for the exercises they choose, and most importantly, for those which they can tolerate and adhere long term.

When looking at the research, it is very difficult to say that exercise is not beneficial to brain health. In fact, it appears to be critical to brain health. Research substantially supports that the currently accepted minimum physical activity requirements are neuroprotective. This gives health-fitness professionals a good starting point from which to build programs with clear minimum requirements.

At this time, other intensities and types of exercise are being researched in relation to brain health. As fitness as medicine continues to evolve and develop, it is imperative for health-fitness professionals to consider all aspects of exercise behavior including exercise tolerance and adherence. The art of exercise prescription is creating and fostering long term adherence for good health through the life span.

For more information about Prevention of cognitive decline and dementia, visit the ARPF website at www.alzheimersprevention.org.

The information in this article is taken from the arpf_seal_of_approval_color“Exercise Prescription for Alzheimer’s Prevention and Intervention” course, the second course in a two-course 11 hour Medical Fitness Specialist Certificate Program: Alzheimer’s Disease Prevention and Intervention.

Alzheimer’s Disease Prevention and Intervention Medical Fitness Specialist Certificateunprecedented-logos

Alzheimer’s Disease: Part 2

Prevention of Cognitive Decline and Alzheimer’s Disease
Adapted from the Medical Fitness Specialist Certificate Program by Alzheimer’s Research and Prevention Foundation: Alzheimer’s Disease Prevention and Intervention.
(Article 2 in a 3-part series about Alzheimer’s disease.)

Through many years of research, the Alzheimer’s Research and Prevention Foundation has determined a four-part program to use in the prevention, delay, and treatment of cognitive decline and Alzheimer’s disease.  This program is called “The 4 Pillars of Alzheimer’s Prevention.”

Recent research, some of which was sponsored by ARPF, supports the notion that lifestyle interventions can help decrease chances of developing memory loss and possibly help prevent Alzheimer’s disease. Medical findings support the correlation between positive lifestyle changes and prevention of certain diseases, such as cancer and heart disease. The same relationship is being examined and assumed positive with respect to Alzheimer’s disease. The basic concept behind the ARPF is that it is important to take a proactive, integrative approach to assist in preventing cognitive decline and Alzheimer’s disease.

Pillar 1: Diet
Diet is critical to the brain’s health. Prevention starts with smart diet and positive lifestyle changes that can influence the health of your cells and your genes.  One of the best ways to feed the brain for better memory is to avoid a diet high in trans-fat and saturated fat. These fats can be found in animal products, such as red meat, and can cause inflammation. This type of diet can also produce free radicals, which are a normal by-product of body metabolism. However, in high quantities, they can damage and even kill valuable, functioning brain cells.

Eating foods that are high in antioxidants, such as those rich in Vitamin C and E, is an effective way to eliminate free radicals from the body. Scientists believe that consuming a vast intake of fruits and vegetables, fish, which is rich in omega-3 oils, and a vegetarian protein substitute, such as soy, can be protective against memory loss.  Supplements prescribed by a healthcare professional can also be beneficial.

Pillar 2: Stress Management
Stress management has many positive benefits, including improved physical and cognitive performance, lower blood pressure, improved heart function, reduced anxiety, less chronic pain, and even increased longevity.

Learning to balance daily stress is a vital part of any Alzheimer’s prevention strategy. Studies have shown a strong correlation between having elevated cholesterol, blood pressure, and/or high cortisol levels and the onset of Alzheimer’s disease. Stress has been found to be a common key factor in all of these conditions.

Cortisol, the stress hormone, plays a role in memory. Normal cortisol has no effect on the hippocampus (part of the brain where memories are processed and stored); however, excess cortisol overwhelms the hippocampus and actually causes atrophy in this area of the brain. Elevated stress levels play a role in cognitive impairment and even the development of dementia and Alzheimer’s disease. Stress is therefore not only a direct risk factor for Alzheimer’s, but indirectly affects other Alzheimer’s risk factors, such as diabetes, thyroid dysfunction, and cardiovascular disease.  Stress-management techniques such as meditation, deep breathing, yoga, and many other relaxation techniques have been found very valuable in alleviating stress. A specific type of meditation developed by the ARPF called Kirtan Kriya is a brain aerobic exercise that works to reduce stress responses.  You can learn more about the technique at www.alzheimersprevention.org.

Pillar 3: Physical and Mental Exercise
Both physical and mental exercise have been found in research to be important in prevention and treatment of AD. Physical exercise is discussed in article 3 of this 3-part series and is covered extensively in the ARPF Specialist Certificate Course: Exercise Prescription for Alzheimer’s Prevention and Intervention. This article will look at mental exercise and prevention.

Neurologists report that mental exercise can help reduce the chance of developing Alzheimer’s disease by up to 70%. Brain Aerobics are activities that challenge the brain with tasks that are new and different. These novel tasks challenge the brain and function can be improved. It is recommended to spend at least 20 minutes, three times a week doing mental exercises. Examples of brain aerobics include reading, writing, playing board games, and doing crossword puzzles. Brain aerobics exercises do not have to be complex. They can be done at any time and any place.

Pillar 4: Spiritual Fitness
Increased consciousness and cognition is the final purpose and frontier of Alzheimer’s prevention. Spiritual Fitness may also contribute to brain health and is a proven defense against Mild Cognitive Impairment (MCI) and even Alzheimer’s. Spiritual fitness contributes directly to your ability to maintain a high level of mental function as you age.

Spiritual fitness is the combination of attributes of:

  • psychological well-being (such as contentment, socialization, and having a purpose or mission in life)
  • combined with spiritual well-being (includes service to others and the ongoing search for peace of mind).

Aspects of Spiritual Fitness include:

  • Socialization or being with like-minded people
  • Acceptance and forgiveness of yourself and others
  • Patience and allowing yourself to be in the moment
  • Compassion and empathy towards yourself and others
  • Purpose or meaning in life via self-discovery and building your legacy
  • Sense of spirituality, regardless of origin or religion, which makes you happier
  • Volunteering or service without thought of self-reward is a very beneficial, life-affirming act

Current research suggests that some of the most striking brain benefits of Spiritual Fitness are:

  • Reversal of amyloid plaque in the brain, which may increase risk of Alzheimer’s
  • Improvement in your genes via healthier telomeres
  • Slowing of Alzheimer’s progression

For more information about Prevention of cognitive decline and dementia, visit the ARPF website at www.alzheimersprevention.org.

The information in this article is taken from the arpf_seal_of_approval_color“Introduction to Alzheimer’s Disease” course, the first course in a two-course 11 hour Medical Fitness Specialist Certificate Program: Alzheimer’s Disease Prevention and Intervention. Stay tuned for additional information about exercise and prevention of Alzheimer’s.

Alzheimer’s Disease Prevention and Intervention
Medical Fitness Specialist Certificateunprecedented-logos

Alzheimer’s Disease: Part 1

About Alzheimer’s Disease
Adapted from the Medical Fitness Specialist Certificate Program by Alzheimer’s Research and Prevention Foundation: Alzheimer’s Disease Prevention and Intervention.
(Article 1 in a 3-part series about Alzheimer’s disease.)

dreamstimemedium_32992482Although there are natural physiological changes that occur with age, memory loss is neither normal nor a natural process of aging. It is important to take a proactive role in retaining the strength, resiliency, and vitality of the brain. Research has shown that just as the body needs strength-building exercises to maintain muscle strength, so does the brain.

The brain goes through natural changes with age. However, mental decline may be preventable and even reversible with appropriate and adequate stimulation. Studies have shown that by keeping mentally active, cognitive deterioration may be reduced and even avoided. (The Power of Brain Aerobics: Maximize Your Memory 2016) Rigorous mental activity may also improve the mind and memory in those who are starting to show signs of mental deterioration.

Signs of Normal Change vs. Early Alzheimer’s Symptoms
Alzheimer’s Disease: Symptoms, Stages, Diagnosis and Coping 2016
Reprinted with permission from helpguide.org
Normal Early Alzheimher’s Disease
Can’t find your keys Routinely place important items in odd places, such as keys in the fridge, wallet in the dishwasher
Search for casual names and words Forget names of family members and common objects, or substitute words with inappropriate ones
Briefly forget conversation details Frequently forget entire conversations
Feel the cold more Dress regardless of the weather, wear several shirts on a warm day, or shorts in a snow storm
Can’t find a recipe Can’t follow recipe directions
Forget to record a check Can no longer manage checkbook, balance figures, solve problems, or think abstractly
Cancel a date with friends Withdraw from usual interests and activities, sit in front of the TV for hours, sleep far more than usual
Make an occasional wrong turn Get lost in familiar places, don’t remember how you got there or how to get home
Feel occasionally sad Experience rapid mood swings, from tears to rage, for no discernible reason

There are 47.5 million people suffering from dementia worldwide, with 7.7 million new cases each year. The most common cause of dementia, Alzheimer’s disease, makes up 60-70% of cases. (Dementia 2016) Millions of Americans are challenged by Alzheimer’s disease and other forms of dementia. In 2016, an estimated 5.4 million Americans of various ages are diagnosed with Alzheimer’s disease, and approximately 5.2 million of those are ages 65 and older. (Alzheimer’s Disease Facts and Figures 2016)

Although Alzheimer’s is not a new illness, it seems like it has become a household name. The reason for this accelerated trend is that people are living longer now than ever before in history, which is causing the exponential growth of the number of cases of Alzheimer’s disease. Seniors age 85 and older unfortunately have a 50% chance of developing this disease. In addition, women are more prone to have Alzheimer’s, partially because they live longer than men. In addition, Alzheimer’s disease and other dementias are one of the most expensive chronic diseases. Approximately $46 billion (19%) of the cost of the disease is out-of-pocket spending, which creates a considerable personal financial burden for the families of those with the disease. (Alzheimer’s Disease Facts and Figures 2016)

There are a number of risk factors that may lead to cognitive decline. (Adapted from Alzheimer’s Risk Factors 2016 and 2016 Alzheimer’s Disease Facts and Figures 2016)

  • Age. There is a greater incidence of cognitive decline with age. Most experience the disease at 65 years old or older, however, some can also develop the disease at a younger age. Older age is not sufficient enough alone to cause the disease.
  • Family History. A first-degree relative (mother, father, or sibling) with Alzheimer’s increases your risk up to seven times greater that you may develop the disease.
  • Genetic Predisposition. Everyone inherits one of three forms of the APOE gene from each parent. There is an increased risk of developing the disease later in life if a person has two APOe-4 genes. However, this does not guarantee the disease will develop.
  • Stroke. Brain health is closely linked to the overall health of your heart and blood vessels. A healthy heart ensures enough oxygen and nutrient-rich blood is supplied to the brain so that it functions properly. Stroke is typically caused by vascular disease, including blockage in the carotid arteries that supply the brain.
  • Depression. Depression and lack of social involvement, interaction, or connection, as well as loneliness, have been linked to increased risk for Alzheimer’s.
  • Head/Brain Injury. A head/brain injury is defined as a disruption in normal brain function caused by a blow/jolt to the head or penetration by a foreign object to the skull. Moderate and severe traumatic brain injuries (TBI) increase the risk of developing dementias, including Alzheimer’s disease. Those who have had repeated TBIs are at a higher risk of dementia, neurodegenerative disease, and cognitive impairment.
  • Lack of Adequate Sleep. Sleep deprivation leads to increased risk of many chronic diseases including cardiovascular disease. There is an increasing body of research about the implications of inadequate sleep on the brain. It’s believed that while you sleep, the brain clears out harmful toxins, a process that may reduce the risk of Alzheimer’s. A breakthrough study on mice showed that, during sleep, the flow of cerebrospinal fluid in the brain increases dramatically, washing away harmful waste proteins that build up between brain cells during waking hours.
  • Cardiovascular Disease and CVD Risk Factors.
    • Smoking
    • Diabetes
    • Hypertension (high blood pressure)
    • High cholesterol
    • Physical inactivity
    • Obesity

Most experts believe that Alzheimer’s disease, similarly to other common chronic diseases, develops as a result of multiple factors versus a single cause. They also support the idea that some risk factors can be controlled by making smart lifestyle choices.

One thing that permeates the research about cognitive decline is the role that exercise plays in prevention.  Existing drugs at this time treat only symptoms and do not stop the progression of Alzheimer’s disease which is fatal.  Since there are no drugs that cure the disease, prevention becomes critical, and exercise is a very important element in prevention of Alzheimer’s disease.

arpf_seal_of_approval_colorThe information in this article is taken from the “Introduction to Alzheimer’s Disease” course, the first course in a two-course 11 hour Medical Fitness Specialist Certificate Program: Alzheimer’s Disease Prevention and Intervention. Stay tuned for Article 2: Prevention of Cognitive Decline and Alzheimer’s.

Alzheimer’s Disease Prevention and Intervention
Medical Fitness Specialist Certificateunprecedented-logos

 

American Breast Cancer Foundation (ABCF) Colaboration

The American Breast Cancer Foundation (ABCF) is collaborating with the Medical Fitness Network (MFN) and Fitness Learning Systems (FLS) to sponsor and promote the Breast Cancer Recovery and Prevention Specialist Certificate Program for fitness industry professionals.

Click here to see Press Release

6 General Recommendations for Working with Clients with Respiratory Conditions

respiratory_rescue_150x150       Knowledge of the respiratory system

and pulmonary function is fundamental for training the client with chronic conditions known as pulmonary disorders. These disorders are characterized by airflow obstruction, cardiovascular and muscular impairments, abnormalities of gas exchange, and psychological issues including fear and embarrassment that often accompanies shortness of breath. Properly done exercise can improve musculoskeletal and psychosocial factors that limit clients with pulmonary disease.

 

  1. It is important to do a longer warm up and cool down for clients with asthma, COPD, and other respiratory issues.

 

  1. Choose an appropriate, lower demand cardiorespiratory activity for beginner or compromised clients such as cycling or walking. Switch to a lower demand exercise during periods of respiratory condition flare ups.

 

  1. Teach the client proper breathing techniques. There are breathing exercises such as “Pursed Lip Breathing” or “Diaphragmatic Breathing” that help with shortness of breath and the anxiety, fear, and embarrassment that may be present.

 

  1. Do not use continuous overhead arm work. This can cause the client fatigue by making the heart work harder.

 

  1. Incorporate resistance training, especially in the upper body to help improve stamina and function in the chest, upper back, shoulders, and arms.

 

  1. Do exercises in a well-ventilated area. Make sure room temperatures are not too low or too high for comfort. Be aware of humidity and the presence of allergens or respiratory irritants that may be present in the exercise area.  Just opening windows during allergy season can cause an allergy or asthma attack.

CLICK HERE For more information about CE course… Respiratory Rescue: Understanding the Pulmonary Dysfunctional Client

The Wasserman Learning Method……by June M Chewning BS, MA

The Wassermann Learning Method was developed by Dr. Jack Wasserman PhD. He started looking at learning styles and learning methods after he discovered later in life that he had Attention Deficit Disorder (ADD). This discovery shed light on many questions about how he personally approached learning and the difficulties he encountered trying to learn in a traditional education setting. He learned how to “side-step” traditional learning formats. Through understanding his own deficits, he managed to earn several degrees including a Doctorate of Science in Biomedical and Mechanical Engineering.

Continue reading “The Wasserman Learning Method……by June M Chewning BS, MA”