How important is it to strengthen the lower trap when treating rotator cuff dysfunction?
Answer
I think that it is really important. It is not one of the things that I look at right away, but I do look at it when I am reestablishing scapulohumeral rhythm (that is to say that the capsule of the joint is loose). At this point, the healing time constraints are gone, and we are talking post-op. Now we are starting to work on a little function and how their scapulohumeral rhythm progresses. We are watching the scapula to see if they have a tip early on, that is as soon as they get past about 30 degrees of abduction. Early on in rehab, that scapula inferior angle is just going to blast out to the side. Then as it gets stronger, they are able to maintain it a little bit better. At that point, the client can concentrically come up, but then they will fail eccentrically. So this is where I watch that eccentric failure and keep the deltoid working against gravity within that substitution-free range of motion. Early on is typically where you start to get a little bit of a hitch coming up concentrically. Watch for that little hitch to see if you've got any scapular tipping. You can keep your eye on that inferior angle; it is not going to wing out like a serratus anterior and hit you right in the face. It is going to be a little bit of tip where that inferior angle just kind of bumps away from the thorax a little bit. If you can palpate that movement, it is a pretty good bet that if you put the client in prone into a position to strength test their lower trap that it will not be there. In those cases, I think it is absolutely essential to address it.
Steven Tippett, PT, PhD, SCS
Steve Tippett is presently the Chair of the Department of Physical Therapy and Health Science at Bradley University. His primary teaching responsibilities include undergraduate courses in kinesiology and in sport applications in the health sciences, as well as graduate instruction in extremity orthopedics. Steve treats Bradley students in conjunction with Bradley Health Services, is the physical therapist consultant to Bradley’s athletic department, and also sees out patients one-half day per week at OSF Saint Francis Medical Center.
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