3 Tips for Assessing the Patellofemoral Joint

The latest Inner Circle recording on 3 Tips for Assessing the Patellofemoral Joint is now available.

3 Tips for Assessing the Patellofemoral Joint

3 Tips for Assessing the Patellofemoral Joint

This month’s Inner Circle presentation is on 3 Tips for Assessing the Patellofemoral Joint.  In this live inservice recording, I discuss a few tips that that I follow when evaluating someone with anterior knee pain, or patellofemoral pain syndrome.  Often times the patellofemoral joint gets little attention during the examination.  But, in order to treat patellofemoral pain successfully, you need to have an accurate diagnosis that is very specific.  Not all anterior knee pain is the same!

This presentation will cover:

  • How your anatomy of your trochlea can alter your ability to statically stabilize
  • How to assess the static stabilizers of the patella
  • A detailed overview of how I palpate different soft tissue structures around the knee
  • How and why you need to look both proximally and distally as well as at the knee
  • The one simple test I do with everyone to assess how proximal and distal factors xalter the forces at the knee

To access this webinar:

Assessing the Shoulder Shrug Sign

The latest Inner Circle webinar recording on Assessing the Shoulder Shrug Sign is now available.

Assessing the Shoulder Shrug Sign

Assessing_the_Shoulder_Shrug_SignIn this inservice recording, I overview the two main types of shoulder shrug signs that I see.  The classic shrug sign typically involves either a rotator cuff injury or significant capsular hypomobility.  However, we also see shrugs in people that have poor overhead mobility.

This webinar will cover:

  • What are the different types of shoulder shrug signs?
  • How to tell if you have a mobility or motor control issue
  • The sequence I follow to determine what to choose for my treatments

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How to Assess Overhead Shoulder Mobility

The latest Inner Circle webinar recording on How to Assess Overhead Shoulder Mobility is now available.

How to Assess Overhead Shoulder Mobility

How to assess overhead shoulder mobilityThis month’s Inner Circle webinar is a live demonstration of How to Assess Overhead Shoulder Mobility .  In this recording of a live student inservice from Champion, I overview my process for assessing loss of overhead mobility.  This is a very common occurrence at Champion and something we do all day.  Many people don’t even realize they have a mild loss of mobility.

In this webinar, I’ll cover:

  • Why you must look at the shoulder, scapula, thoracic spine, and lumbar spine
  • What to look for during active elevation
  • How to assess for passive loss of motion
  • A couple of easy tweaks to assess if loss of mobility is coming from the joint or soft tissue
  • How to teach someone self assessments so they can monitor themselves

To access this webinar:

 

 

 

How to Assess the Scapula

The latest Inner Circle webinar recording on How to Assess the Scapula is now available.

How to Assess the Scapula

How to assess scapular dyskinesisThis month’s Inner Circle webinar is a live demonstration of How to Assess the Scapula.  In this recording of a live student inservice from Champion, I overview everything you should (and shouldn’t) be looking for when assessing the scapula.  When someone has a big nerve injury with significant winging or scapular dyskinesis, the assessment of the scapula is pretty easy.  But how do you detect the subtle alterations in posture, position, and dynamic movement?  By being able to identify a few subtle findings, you can really enhance how you write a rehab or training program.

In this webinar, I’ll cover:

  • What to look for in regard to static posture and scapular position
  • How to check to see if static postural asymmetries really have an impact on dynamic scapular movement
  • What really is normal scapulothoracic rhythm (if there really is a such thing as normal!)?
  • How to reliably assess for scapular dyskinesis
  • How winging during the concentric and eccentric phases of movement changes my thought process
  • How to see if scapular position or movement is increasing shoulder pain
  • How to see if scapular position or movement is decreasing shoulder strength

To access this webinar:

 

 

 

A Simple Test for Scapular Dyskinesis You Must Use

A common part of my examinations includes assessing for abnormal scapular position and movement, which can simply be defined as scapular dyskinesis.  Scapular dyskinesis has long been theorized to predispose people to shoulder injuries, although the evidence has been conflicting.

Whenever data is conflicting in research articles, you need to closely scrutinize the methodology.  One particular flaw that I have noticed in some studies looking at the role of scapular dyskinesis in shoulder dysfunction has involved how the assess and define scapular dyskinesis.

Like anything else, when someone has a significant issue with scapular dyskinesis it is very apparent and obvious on examination.  But being able to detect subtle alterations in the movement of the scapula may be more clinically relevant.  There’s a big difference between someone that has a large amount of winging while concentrically elevating their arm versus someone that has a mild issues with control of the scapula while eccentrically lowering their arm.

Most people will not have a large winging of their scapula while elevating their arm.  This represents a more significant issue, such as a nerve injury.  However, a mild amount of scapular muscle weakness can change the way the scapula moves and make it difficult to control while lowering.

 

A Simple Test for Scapular Dyskinesis

One of the simplest assessments you can perform for scapular dyskinesis is watching the scapula move during shoulder flexion.  Performing visual assessment of the scapula during shoulder flexion has been shown to be a reliable and valid way to assess for abnormal scapular movement.

That’s it.  Crazy, right?  That simple!  Yet, I’m still amazed at how many times people tell me no one has ever looked at how well their scapula moves with their shirt off.

However, there is one little tweak you MUST do when performing this assessment…

You have to use a weight in their hand!

Here is a great example of someone’s scapular dyskinesis when performing shoulder flexion with and without an external load.  The photo on the left uses no weight, while the photo on the right uses a 4 pound dumbbell:

scapular dyskinesis

As you can see, the image on the right shows a striking increase in scapular dyskinesis.  I was skeptical after watching him lift his arm without weight in the photo on the left, however, everything became very clear when adding a light weight to the shoulder flexion movement.  With just a light load, the ability to prevent the scapula from winging while eccentrically lowering the arm becomes much more challenging.

I should also note that there was really no significant difference in scapular control or movement during the concentric portion of the motion raising his arms overhead:

scapular winging concentric

This person doesn’t have a significant issue or nerve damage, he simply just needs some strengthening of his scapular muscles.  But if you didn’t observe his scapula with his shirt off or with a dumbbell in his hand, you may have missed it!

 

How to Assess for Scapular Dyskinesis

In this month’s Inner Circle webinar, I am going to show you a live demonstration of how I assess scapular position and movement.  I’ve had past talks on how to assess scapular position and how to treat scapular dyskinesis, however I want to put it all together with a demonstration of exactly how I perform a full scapular movement assessment and go over things I am looking for during the examination.

I’ll be filming the video and posting later this month.  Inner Circle members will get an email when it is posted.

 

 

 

How to Assess Shoulder Capsular Mobility

The latest Inner Circle webinar recording on Assessing Shoulder Capsular Mobility is now available.

 

Assessing Shoulder Capsular Mobility

Assessing Shoulder Capsular Mobility - Social MediaThis month’s Inner Circle webinar is on Assessing Shoulder Capsular Mobility.  This is a recording of an actual inservice we performed with the students and interns at Champion this week.  I’m super excited to be able to record and share things like this with my Inner Circle.  It’s like having a front row seat at our inservices!  I think this offers many benefits over the traditional webinar/lecture format, as you can watch the interaction and also see some of the clinical techniques better.

In this webinar, we discuss:

  • The anatomy of the shoulder capsule and glenohumeral ligaments
  • How different arm positions stress different aspects of the capsule
  • How to determine which ligament and aspect of the capsule is tight
  • How to assess range of motion at different positions to assess different portions of the capsule
  • How to perform range of motion and capsular mobility assessment of the shoulder
  • Clinical tips on the assessment technique

To access this webinar:

 

 

How to Improve Overhead Shoulder Mobility

The latest Inner Circle webinar recording on my How to Improve Overhead Shoulder Mobility is now available.

 

How to Improve Overhead Shoulder Mobility

Improving Overhead Shoulder MobilityThis month’s Inner Circle webinar is on how to improve overhead shoulder mobility.  In this webinar I’ll discuss:

  • We we are losing overhead shoulder mobility
  • Why it matters
  • The 4 main reasons why we lose overhead mobility
  • How the body compensates when we lose overhead mobility
  • How to assess for a loss of overhead shoulder mobility
  • What you MUST stop doing immediately with people that have lost overhead mobility – you are making them worse!
  • Corrective exercises to enhance overhead position
  • Manual therapy techniques to improve mobility

 

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Scalene Hypertrophy

I recently evaluated yet another Major League baseball player with the “yips,” or what I like to call thoracic outlet syndrome.  I really don’t believe in the yips at all and feel that thoracic outlet syndrome is almost always to blame.  Telling a professional athlete it’s all in their head or some mysterious mechanical flaw is just insulting.

One of the major reasons that thoracic outlet syndrome occurs in baseball pitchers is from hypertrophy of the scalene muscles (and sternocleidomastoid).  Throwing a baseball causes many adaptations to the body, including this increase in scalene size.

Here is a video of the athlete inhaling with his head turned to each side.  Notice the significantly larger scalene and sternocleidomastoid on his right side.

scalene hypertrophy

I wish I had a magic trick to help in this situation.  I will perform manual therapy on the scalene muscles, surround musculature, 1st rib, and thoracic cage, however, it’s hard to combat the hypertrophy associated with throwing.

Understanding what to look for is the first step, though.  Scalene hypertrophy is a subtle finding to detect on examination.

 

 

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