What team open baseball the
first 60 years?
How many president threw out the
first pitch? Who was the first?
Eleven - Taft
What did Truman do differently?
First Southpaw
Opening day Snow Fight
•
Unfortunately, Opening Day has also been marred by riots and civil disobedience.
•
At the start of the 1907 season, the New York Giants opened against the Phillies
following a heavy snowstorm.
•
In preparation for the game, groundskeepers were forced to shovel large drifts of
snow onto the outer edges of the field in foul territory.
•
•
After falling behind 3-0, the disappointed fans at the Polo Grounds began hurling
snowballs onto the playing field, disrupting play.
•
As the melee progressed, chaos ensued and fans began rushing onto the field to
continue the snowball fight.
•
After being pelted, Home plate umpire Bill Klem had enough and called a forfeit
in favor of the Phillies.
Rehabilitation of Shoulder
Instability
• Ligamentous/capsular laxity (non-contractile)
Treatment strategies
•
•
•
•
•
Bracing
Taping
Muscle strengthening
Proprioceptive/kinesthetic training
Neuromuscular dynamic stability
• Posterior instability response better than
anterior instability
Scapulothoracic Exercises
4 Core Exercises (Mosley)
• 1. Scaption with the thumb up for the upper
trapezius
Scaption
• (abduction in the scapular plane of 30-45
degrees forward in the horizontal plane) or
flexion;
2. Press up for the lower trapes,
latissimus doris and teres minor
3. Push up with a plus for the serratus
anterior
4. Scapular Retraction for the Middle
Trapezius and Rhomboids
Glenohumeral Exercises
Townsend 4 Core Exercises
• 1. Scaption with the thumb down (up) empty
can or full can for the supraspinatus
2. Press ups for the lower trapezius,
latissimus dorsi and teres major
3. GH flexion for the anterior deltoid
and the coracobrachialis
4. External Rotation with horizontal extension
for the infraspinatus, teres minor, and posterior
deltoid
Rotator Cuff Exercises (30/30/30 Position)
• 30 degrees of abduction
• 30 degrees of scaption
• 30 degrees of diagonal tilt
30 degrees of abduction
• Used to protect the rotator cuff and prevent
wringing out effect on the supraspinatus
tendon
Second 30 degree position places the
arm into scaption
• Protects the anterior inferior capsule
• Prestretches the posterior rotatator cuff
muscles
• External rotation muscles are the weakest of
the 6 directions of the GH joint
30 degree diagonal tilt
• Prevents a posterior internal impingement
and is more comfortable than the transverse
plane position when performing GH rotation
exercises
• Studies show that adducting muscle activity
will increase the space of the subacromial
space
Summary reason to use the 30/30/30
• Prevents the wringing out effect
• Scaption position protects the anterior
inferior capsule
• The scaption position is a functional arc of
motion for the shoulder
• Comfortable positions to do ER/IR exercises
• GH adduction increases the width of the
subacromium space
• Advance the patient to the 90/90 position to
advance the rotator cuff strengthening
program if the patient need to use the arm in
overhead activities
Total Arm Strengthening Exercises
(TAS)
• Biceps and triceps cross the GH joint can
contribute to dynamic stability of the GH
joint
Exercise Progression Continuum
•
•
•
•
•
•
Multiple-angle isometrics submaximal effort
Multiple-angle isometrics maximal effort
Short arc exercises submaximum effort
Short arc exercises maximum effort
Full ROM exercises submaximum effort
Full ROM exercises maximum effort
Cross Education Training?
10-15% increase in strength on
the contralateral side
Bilateral deficits?
Total strength is less than sum of
each individually
Systematic Variable Range
Repetition
E2C
E2C
Eccentric to concentric
Deceleration and acceleration
impulses create more muscle
tension
Increasing progressive ranging
exercises the intensity of exercises is
increased at the additional angle
Progressive Range of Motion
Protects the soft tissue healing
structures
As heal add more ROM
Time rate of force development
Ability to develop force rapidly (FT
fibers)
Contra-Coup Concept of
shoulder stability
(C3-S2)
Common Thought
• ER most important and the subscapularis for
anterior instability
Contra-Coup Concept
• Subscapularis contraction cause anterior
translocation of the humeral head
• Infraspinatus contracture causes posterior
translation of the humeral head
• Use GH: IR:ER is 3:2 or ratio 100%:66%
Neuromuscular Proprioceptive/Kinesthetic
Deficits (Functional Neuromuscular Dynamic
Stability
Functional Stability is dependent on
neuromuscular dynamic control
Stage 1: Proprioception and Kinesthetic Exercises
(baseline for Dynamic stability)
•
•
•
•
Diminish Pain and Inflammation
Normalize motion
Restore proprioception and kinesthesia
Establish muscular balance
Stage 2: Dynamic (Proactive)
Stabilization Exercises
• Restore muscular balance
• Enhance dynamic functional stability
• Rhythmic stabilization
Stage 3: Reactive Neuromuscular
Control
• Improve muscular power and endurance
• Enhance dynamic stability thru
proprioceptive and kinesthesia
• Improve reactive NM abilities
• Rhythmic stabilizations
Stage 4: Functional Skill Movements
and Activities
• Maintain shoulder joint complex muscular
balance
• Maintain reactive NM dynamic stability
• Gradual return back to activities
Summary
• Heavy Focus on dynamic stabilizers and
neuro muscular control