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.

5 Things to Know About Breast Cancer and Exercise

This information is adapted from the Fitness Learning Systems continuing education course Return to Life: Breast Cancer Recovery using Pilates, by Naomi Aaronson MA OTR/L CHT Certified Cancer Exercise Trainer, Ann Marie Turo OTR/L Yoga/Pilates Instructor, Reiki Master

In 2016, there are expected to be 246,660 new cases of invasive breast cancer and 61,000 new cases of ductal breast carcinoma in situ (DCIS). More than 2.8 million individuals have survived breast cancer. Breast Cancer is the most common cancer in women other than skin cancer.

Due to the ramifications of treatment, exercise is a modality that can be used to facilitate recovery, return to function, and ongoing prevention. Numerous studies have demonstrated that exercise can improve quality of life, reduce side effects of treatment, and improve strength and endurance. However, it is essential that health-fitness professionals understand the various treatments that survivors undergo to provide safe and effective exercise programs. It is important to understand where in the recovery continuum the fitness professional can start with exercise programming minimizing risk of potential exercise side effects and complications.

Following are 5 things to know about exercise for clients with breast cancer.  It is important to understand how to safely and effectively work with the client through recovery, through treatment (chemotherapy and radiation), and then into the prevention and survival phase.  Specialized continuing education will qualify you to work with this growing group of clients who can greatly benefit from the care and expertise of a trained exercise professional.

1. There are two types of local treatments for breast cancer: surgery and radiation. Surgery can be radical (involving breast tissue, and surrounding nerves and muscles) or relatively non-invasive (such as lumpectomy), but typically involves the lymphatic system with removal of lymph nodes.  Knowledge of treatment is important for exercise for recovery.

2. Systemic treatments include chemotherapy and hormonal treatments (typically via medication) which affect all systems in the body, not just the surrounding tissue. Exercise can help with the side effects of systemic treatment, but must be adjusted or suspended for certain signs and symptoms which may require referral back to the health care provider.

3. One of the primary goals for breast cancer recovery should be to restore range of motion to the chest and shoulder including flexion, abduction, and internal/external rotation. The muscles most affected are the pectoralis major, serratus anterior, and the rotator cuff. Typically a client will work with a therapist initially to re-establish range of motion, and then can be referred to a fitness professional who will work with the client to retain range of motion and improve strength.

4. If your client has lymphedema or is at risk for lymphedema, research indicates that order of exercises is important. Use a proximal to distal exercise sequence designed to encourage lymphatic flow in alternative pathways. Muscles are contracted in the abdomen, chest, and shoulders and then to the arm to reduce fluid in the arm.

5. It is important to have physician’s clearance before starting an exercise program with someone who is recovering from or has a history of breast cancer. In recovery, it is good to make contact with the therapist that is on the health care team to work together for the client in the continuum of care.

Fitness Learning Systems (an IACET accredited continuing education provider) offers a Breast Cancer Recovery and Prevention Specialist Certificate Program for 12 hours of specialized continuing education. Expand your knowledge and specialize in order to expand your expertise and income.
Special Offer: The Holland Foundation, Inc (a family related breast cancer foundation) is sponsoring 5 people who want to receive this credential with a $50.00 discount. To use this sponsorship, be one to the first 5 people to use the coupon code “HOLLAND” at check out. The Breast Cancer Recovery and Prevention Specialist Certificate Program is recommended by the American Breast Cancer Foundation.

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.

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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
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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”