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.
Related Courses
1https://www.physicaltherapy.com/pt-ceus/course/complex-and-chronic-impairment-in-4353Complex and Chronic Impairment in ConcussionThis webinar will include an exploration of the various etiologies of dysfunction following mTBI, including, headache, visual/oculomotor impairment, chronic dizziness, and pain. The challenging issue of prioritizing intervention and appropriate referral to other medical practitioners will be discussed. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT. Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for .5 hour of general and 1.5 hour of Direct Access CE credit.auditory, textual, visual
This webinar will include an exploration of the various etiologies of dysfunction following mTBI, including, headache, visual/oculomotor impairment, chronic dizziness, and pain. The challenging issue of prioritizing intervention and appropriate referral to other medical practitioners will be discussed. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.
Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for .5 hour of general and 1.5 hour of Direct Access CE credit.
2https://www.physicaltherapy.com/pt-ceus/course/clinical-use-reformer-for-upper-3330Clinical Use of the Reformer for the Upper BodyA reformer is an effective tool for rehabilitating the upper body. This course will provide exercises appropriate for progressing upper extremity rehab from scapular control to glenohumeral stability, to fully-integrated shoulder girdle training. Exercises focus on the concepts of motor control, stability/mobility system balance, movement competency and training functional movement patterning. This is part four of our four-part series on Pilates. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.auditory, textual, visual
A reformer is an effective tool for rehabilitating the upper body. This course will provide exercises appropriate for progressing upper extremity rehab from scapular control to glenohumeral stability, to fully-integrated shoulder girdle training. Exercises focus on the concepts of motor control, stability/mobility system balance, movement competency and training functional movement patterning. This is part four of our four-part series on Pilates. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.
3https://www.physicaltherapy.com/pt-ceus/course/cycling-related-injury-common-injuries-4868Cycling Related Injury: Common Injuries of the Recreational Indoor and Outdoor CyclistsWith the pandemic and post-pandemic popularity of spin cycling exercise classes, as well as outdoor road biking, an increase in spinning-related injury and pain is ever present in the active population. This course is designed to highlight the mechanics and muscular activation required during the cycle revolution and the implications of speed, stand cycling, and power output on the risk of development of overuse injury.auditory, textual, visual
With the pandemic and post-pandemic popularity of spin cycling exercise classes, as well as outdoor road biking, an increase in spinning-related injury and pain is ever present in the active population. This course is designed to highlight the mechanics and muscular activation required during the cycle revolution and the implications of speed, stand cycling, and power output on the risk of development of overuse injury.
4https://www.physicaltherapy.com/pt-ceus/course/groin-pain-etiology-differential-diagnosis-4869Groin Pain: Etiology, Differential Diagnosis, and Treatment StrategiesDelve into the intricacies of groin pain as we unravel its causes, discuss effective differential diagnoses, and explore cutting-edge treatment approaches. Don't miss this opportunity to enhance your understanding and refine your clinical strategies in addressing this common yet complex medical concern.auditory, textual, visual
Delve into the intricacies of groin pain as we unravel its causes, discuss effective differential diagnoses, and explore cutting-edge treatment approaches. Don't miss this opportunity to enhance your understanding and refine your clinical strategies in addressing this common yet complex medical concern.
5https://www.physicaltherapy.com/pt-ceus/course/lower-extremity-myofascial-chains-identifying-4361Lower Extremity Myofascial Chains: Identifying the Source of Dysfunction and Treatment StrategiesThis course is a concise resource for the practicing clinician to solve those ”mystery” diagnoses the next day due to vague lower extremity symptoms and makes it hard to point to the exact source as it may be an etiology anywhere along the chain mimicking the symptoms. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.auditory, textual, visual
This course is a concise resource for the practicing clinician to solve those ”mystery” diagnoses the next day due to vague lower extremity symptoms and makes it hard to point to the exact source as it may be an etiology anywhere along the chain mimicking the symptoms. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.
