Category Archives: Shoulder

labral tear physical therapy

ATC Tip: The Labrum

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Anatomy of the Shoulder
The shoulder can move in almost every plane of motion, it’s the most mobile joint in the human body; but more mobility = more instability. The shoulder joint is often described as a “ball in socket,” but it’s wide range of motion makes it a highly vulnerable joint. We have a network of soft tissue structures, such as the rotator cuff and ligaments, whose main job is to keep the humeral head in its assigned seat. However, often these muscles alone are not sufficient as they can become weak or tight and thus less efficient. The labrum is a small ring of cartilage that provides additional stability to the shoulder joint.

How Does a Labrum Become Damaged?
Direct trauma, shearing forces, or repetitive stress can cause damage to the labrum. Often, this damage will present as a tear in the labrum, which can restrict motion, decrease strength, and cause pain in the shoulder. Picturing that ring of cartilage, imagine a roughening of the edges of the bowl-like golf tee, or even a rip that flaps when the ball is spun around. It is not uncommon for a shoulder dislocation or subluxation to be accompanied by a labral tear; chronic shoulder instability can also lead to labrum injury.

What Does a Labrum Do?
Because the “ball and socket” is so shallow, the shoulder joint is often described, quite accurately, like a “golf ball sitting on a tee.” To picture the shoulder labrum, imagine a ring around the outer edge of a golf tee, effectively deepening the overall bowl shape, almost suctioning the humerus into the space. The labrum helps stabilize the shoulder by making the “ball” more difficult to remove from the “tee.”

How Can I Prevent a Labrum Injury?
The best way to prevent a labral tear is to strengthen the musculature surrounding the shoulder joint. The best case scenario is all of the muscles are working together to keep the shoulder joint moving fluidly through its full range of motion. Important within this group of muscles are the muscle that control the shoulder blades. By strengthening the stabilizing muscles individually and functionally, it helps them stay balanced and strong with the other, stronger muscles (like the RTC). The other way to prevent a labrum tear is to avoid excessive contact, repetitive overhead motions, and falls.

This article about athletic injuries was provided by PT & Me physical therapy partner: The Center for Physical Rehabilitation. More information about the center and their locations throughout Grand Rapids, MI can be found on their website at www.pt-cpr.com

To see a shoulder strengthening program visit our Sports Medicine Tip Page by clicking here.

throwing injuries PTandMe

Guidelines to Prevent Throwing Injuries

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In this monthly series, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


WRIST EXTENSION
Start with the arm supported on a table and your wrist facing toward the ground. Hold the weight off the edge of the table and bring the back of your hand toward the ceiling.


WRIST FLEXION
Start with the arm supported on a table and your wrist facing toward the ceiling. Hold the weight off the edge of the table and bring your palm toward the ceiling.

ASMI GUIDELINES TO HELP PROTECT PITCHERS FROM SHOULDER & ELBOW THROWING INJURIES:

Don’t throw too much:
Daily, weekly and annual overuse is the greatest risk to a pitcher’s arm health. Numerous studies have shown that pitchers who throw more pitches per game and those who do not adequately rest between appearances are at an elevated risk of injury. While medical research does not identify optimal pitch counts, pitch count programs have been shown to reduce the risk of shoulder and elbow injury in Little League Baseball by as much as 50% (Little League, 2011). The most important thing is to set limits for a pitcher and stick with them throughout the season.

Don’t pitch through arm fatigue:
Individuals are 36 times more likely to develop shoulder and elbow injuries when routinely pitching with arm fatigue.

Don’t pitch more than 100 innings per year:
If an athlete throws over 100 innings they are 3.5 times more likely to be injured than those who did not exceed 100 innings pitched.

Don’t throw more than 8 months per year:
Athletes who throw > 8 months per year are 5 times as likely to suffer an injury requiring surgery of the elbow or shoulder. Pitchers should refrain from throwing for at least 2-3 months per year and avoid competitive pitching for at least 4 months per year.

Don’t pitch on consecutive days:
Pitchers who pitch on consecutive days have more than 2.5 times greater risk of experiencing arm pain.

Don’t play catcher following pitching:
If the player catches following pitching they are 2.7 times more likely to suffer a major arm injury.

Don’t play on multiple teams at the same time:
There is increased risk of injury due to the difficulty in monitoring pitch limits and rest time. If the player is on multiple teams, make meticulous efforts to keep track of the amount of pitches thrown to allow adequate rest.

Don’t forget the shoulder in strength and conditioning programs:
Numerous studies have shown that deficits in upper extremity strength and mobility are strongly correlated to serious arm injuries. Shoulder and forearm strengthening exercises can build strength, endurance and motor control which can prevent injury.

Be cautious with throwing curve balls and sliders:
While existing research has not consistently shown a strong connection between the curveball and injuries, Yang et al., found that amateur pitchers who threw curveballs were 1.6 times more likely to experience arm pain while pitching and Lyman et al, found that youth pitchers who throw sliders are 86% more likely to experience elbow pain.

Be cautious with the radar gun:
Radar guns do not directly cause harm to a pitcher, however, the gun may cause the pitcher to over throw beyond their normal comfort level. This could possibly create arm strain.

Following these guidelines may keep the throwing athlete safe from the debilitating shoulder and elbow throwing injuries seen on a regular basis in physical therapy clinics.

Pitching Guidelines Chart

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. They specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Their staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

prevent throwing injuries

Guidelines to Prevent Throwing Injuries

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In this monthly series about how to prevent throwing injuries, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


PRONE ROW
Lay on your stomach with your arm hanging off the edge toward the ground. Squeeze your shoulder blade and bring your elbow toward the ceiling while keeping your forearm perpendicular to the ground.


PRONE ROW WITH EXTERNAL ROTATION
Lay on your stomach with your arm hanging off the edge toward the ground. Turn your wrist so your palm is toward your feet. Squeeze your shoulder blade and bring your elbow toward the ceiling while keeping your forearm perpendicular to the ground. Once your arm is parallel with the ground rotate the back of your hand toward the ceiling while keeping the elbow bent.


PRONE T (HORIZONTAL ABDUCTION)
Lay on your stomach with your arm hanging off the edge toward the ground. Lift your arm straight out to your side and squeeze your shoulder blade with the palm continuing to face toward the ground.


PRONE Y (SCAPTION)
Lay on your stomach with your arm hanging off the edge toward the ground. Lift your arm at a 45 degree angle over your head with your thumb facing toward the ceiling. Squeeze your shoulder blade down and toward your spine.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. They specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Their staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

Guidelines to Prevent Throwing Injuries

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In this third intallment of our series to prevent throwing injuries, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


INTERNAL ROTATION WITH SHOULDER AT 90 DEGREES OF ABDUCTION
Attach band high up on a doorway and face away from door. Hold band and move your arm out sideways away from your body until your arm is parallel with the ground. Bend your elbow to 90 degrees and point your fist toward the ceiling. Rotate from your shoulder bringing your hand forward while keeping your arm parallel to the floor and your elbow bent to 90 degrees.


EXTERNAL ROTATION WITH SHOULDER AT 90 DEGREES OF ABDUCTION
Attach band high on a doorway and face toward the door. Hold band and move your arm out sideways away from your body until your arm is parallel with the ground. Bend your elbow to 90 degrees and point your fist toward the door. Rotate from your shoulder bringing your hand away from the door while keeping your arm parallel to the floor and your elbow bent to 90 degrees.


SHOULDER INTERNAL ROTATION AT SIDE
Attach band to the doorway at chest height. Stand perpendicular to the doorway with the arm you are exercising closest to the door. Keep your arm at your side with a towel roll under the arm and bend the elbow to 90 degrees. Bring your hand toward your stomach while keeping the elbow bent to 90 degrees.


SHOULDER EXTERNAL ROTATION AT SIDE
Attach band to the doorway at chest height. Stand perpendicular to the doorway with the arm you are exercising furthest from the door. Keep your arm at your side with a towel roll under the arm and bend the elbow to 90 degrees. Bring your hand away from your stomach while keeping the elbow bent to 90 degrees.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. We specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Our staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

Prevent Throwing Injuries

Guidelines to Prevent Throwing Injuries

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In our second installment of “Guidelines to Prevent Throwing Injuries” we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


SHOULDER ABDUCTION
Begin with your arms at your side with your palms facing forward. Raise your arm straight out to the side until they are straight overhead.


SHOULDER SCAPTION
Begin with your arms at your side. Raise your arms at a 45 degree angle creating a V shape with your arms until they are overhead.


D2 EXTENSION
Secure band to wall or top of the doorway. Pull diagonally down across your body toward your opposite hip. Make sure to keep the elbow straight. Return to the starting position with a straight elbow and repeat.


D2 FLEXION
Secure band to bottom of the doorway. Pull diagonally up across your body away from your body. Make sure to keep the elbow straight. Return to the starting position with a straight elbow and repeat.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. We specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Our staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

 

Throwing Injuries

Guidelines to Prevent Throwing Injuries

like what you see? share...Share on FacebookTweet about this on TwitterShare on LinkedInShare on Google+Share on TumblrShare on Reddit

In this monthly series, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


PUSH UPS
Start on your stomach with your hands below your shoulders. Maintain a straight line from your ankles, through your hips, to the shoulders. Extend your elbows pushing your stomach away from the floor.


BICEP CURL
Begin seated with your elbow extended and palm facing forward. Bend the elbow as far up as you can without flexing your shoulder or rotating your wrist.


TRICEP DIP
Find two even surfaces to support your upper body with your elbows bent (a chair with arm rests works well). Extend your elbows pushing your body up toward the ceiling. Lower slowly.


OVERHEAD TRICEP EXTENSION
With your shoulder in full flexion overhead, hold a weight in your hand with your elbow bent behind your head. Straighten your elbow toward the ceiling without changing the angle of your shoulder.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. We specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Our staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

shoulder surgery

Self Care: Safe Dressing Following Shoulder Surgery / Injury

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When recovering from shoulder surgery, it can be difficult to dress and undress without assistance. With the help of one of our trusted Certified Hand Therapists (CHT) they have compiled a list of tips to get dressed safely and independently while recovering.  It is highly recommended that you follow the instructions prescribed by your surgeon or attending physician.

DRESSING

Upper Body
• Bend forward at your hips and let your affected arm dangle loosely forward
• Always dress the affected arm through the sleeve of your shirt first
• Proceed to dress the unaffected arm

Lower Body
• One handed techniques to don socks: touch all fingers to your thumb, then slide the sock over your hand. Spread your fingers apart to open the sock and slide it onto the foot

Bra
• Clip the bra from the front and as low as possible to your waist. Guide the bra enclosure towards your back. Slide the strap over the affected arm and then slide

shoulder_3D

GROOMING

• Bend forward at the hips and dangle arm in order to clean and apply deodorant

These post shoulder surgery dressing tips were provided by The Hale Hand Center, with locations in Melbourne and Rockledge, FL. The Hale Hand Center offers both physical therapy and certified hand therapy services, as well as provides custom splinting. More information about The Hale Hand Center can be found on their website here.

dry needling physical therapist

Trigger Point Dry Needling

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Dry needling uses small, thin needles to stimulate underlying myofascial trigger points, muscular and connective tissues for the management of many orthopedic conditions, both acute and chronic. By inserting a needle into the dysfunctional tissue, it often leads to a contraction of the muscle which then stimulates a relaxation. This leads to a reduction of pain, improvements in flexibility and a restoration of normalized movement when combined with corrective exercises.

WHAT IS A MYOFASCIAL TRIGGER POINT?
A myofascial trigger point is a hyperirritable spot within a taut band of skeletal muscle that produces local or referred pain. The trigger point can lead to increased pain, decreased flexibility and decreased muscle function if not treated. Trigger point dry needling is a safe, effective and efficient treatment technique to release these painful spots.

dry needling

WHAT TYPE OF PROBLEMS CAN BE TREATED?
Muscle dysfunction can be the primary or secondary contributing factor to many neuromusculoskeletal conditions.

WHAT YOU NEED TO KNOW:
• Dry needling must be specifically prescribed by a physician.
• Dry needling is not covered by insurance, it is a cash based modality.

This information was written by The Jackson Clinics, a locally owned physical therapy practice in multiple locations throughout Northern Virginia. They specialize in outpatient orthopedics and sports rehabilitation. Their therapists and assistants possess advanced clinical skills in spinal disorders, sacroiliac joint dysfunction and peripheral joint problems, including rotator cuff injuries, knee injuries and foot and ankle pain. They also also have specialty programs in breast cancer rehab, vestibular rehab, pediatrics, post-cancer rehab, aquatic therapy and women’s health. For more information click here.

avoid pitching injuries

Physical Therapist Tips on Avoiding Injury to Your Throwing Arm & What to Do in Case You Do

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Throwing a baseball or softball is one of the most demanding motions on the human body in sports. For each throw, the athlete generates high levels of energy in the arm and body to accelerate the baseball and softball to a high velocity. Just as it is important to understand proper biomechanics to improve performance, it is important to understand the stresses placed on the throwing shoulder and elbow by the throwing process.

Physical Therapist Tips on how to avoid pitching injuries

• Teach young athletes to be mindful of how their bodies feel. Pain is the first sign of a problem, and athletes of all ages need to pay close attention to any type of muscle twinge, tightening, or burning sensation.

• Coaches should carefully observe their pitchers’ techniques. Success on the field may be fleeting if the pitches ultimately are damaging a young player’s shoulder.

• Conditioning and strengthening exercises are most effective after mechanics are learned and put into action. If possible, begin a conditioning program at least a month before the season begins. A basic stretching regimen should be used before a player ever picks up a baseball.

• Players should start with short tosses and gradually work up to throwing the ball a greater distance. Increasing the velocity should be the final step.

• If the arm region is sore or tight, apply ice to the area for 10-15 minutes to help diminish the amount of blood that might otherwise leak into the muscle. When there is microscopic tearing of the muscle tissue, blood is leaking into the surrounding muscular tissue, causing pain and muscle spasms. Using ice will help reduce the pain, spasms, and inflammation associated with this condition.

• Before age 10, only fast ball and change-up should be permitted.

This information about how to avoid pitching injuries was written by University Physical Therapy, an outpatient physical therapy group with eight locations in New River Valley, Virginia. University PT is THE choice for outstanding sports rehabilitation, physical therapy and occupational therapy services. For more information click here.

Frozen Shoulder

Physical Therapy can Help Patients Experiencing Frozen Shoulder Regain Movement Faster

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Physical therapy can help patients experiencing frozen shoulder regain movement faster. If your initial pain doesn’t go away with usual pain relievers, it’s probably time to check with a physical therapist. That’s because it can take up to TWO YEARS to go away on it’s own! This is definitely not something to be ignored.

Adhesive capsulitis is more commonly known as frozen shoulder, and with good reason: It can render your shoulder so stiff, it’s almost impossible to button your shirt — that is, if you aren’t in too much pain to get dressed in the first place.

Where does Frozen Shoulder Come From?
In general it comes on after an injury to your shoulder or a bout with another musculo-skeletal condition such as tendinitis or bursitis. Quite often its cause can’t be pinpointed. Nonetheless, any condition that causes you to refrain from moving your arm and using your shoulder joint can put you at risk for developing frozen shoulder.
Frozen shoulder affects 10-20 percent of people with diabetes according to the American Academy of Orthopedic Surgeons. Women are more likely to develop frozen shoulder than men and it occurs most frequently in people between the ages of 40 and 60.

Where does the diabetes come in?
Well, doctors still aren’t exactly sure. But they believe that excess glucose impacts the collagen in the shoulder. Collagen is a major building block in the ligaments that hold the bones together in a joint. When sugar molecules attach to the collagen, it can make the collagen sticky. The buildup then causes the affected shoulder to stiffen, and the pain prevents you from moving your arm. Ouch!

Frozen Shoulder has Three Stages:
FREEZING
Pain slowly becomes worse until range of motion is lost.
(Lasts 6 weeks to 9 months)

FROZEN
Pain improves, but the shoulder is still stiff.
(Lasts 4 to 6 months)

THAWING
Ability to move the shoulder improves until normal or close to normal.
(Lasts 6 months to 2 years)

Physical therapy is often very effective in treating frozen shoulder. If your initial pain doesn’t go away with the usual pain relievers, it’s probably time to check with a doctor. That’s because frozen shoulder can take up to two years to go away on its own! This is definitely not something to be ignored.

shoulder

TREATMENT
Treatment of frozen shoulder focuses on controlling pain and getting movement back to normal through physical therapy. Sometimes surgery is also considered. Talk to your doctor about treatment options that are right for you.

PREVENTION
Because doctors don’t really understand the causes of frozen shoulder, it can be difficult to prevent it in most cases. Keeping your blood sugars under control is always key to avoiding all complications. Doctors have also found that people who’ve suffered an injury to their shoulder or stroke are also at an increased risk of frozen shoulder, because of the immobility the other condition has caused. If you have diabetes and have had a shoulder injury, talk to your doctor or a physical therapist about what kind of exercises you can do to make sure frozen shoulder doesn’t happen to you.

Written by the Therapy Team at Advanced Physical Therapy