Links About IASTM Around the Web

This week’s Stuff You Should Read is all about Instrument Assisted Soft Tissue Mobilization (IASTM)!

 

Inner Circle and RehabWebinars.com Updates

My last webinar on “Integrating Corrective Exercises Into Rehab and Performance” was awesome.  This is a follow up to last month’s webinar on Why Corrective Exercises Don’t Always Work.  I’ll get a recording up ASAP some time next week.  Next month will be an evening live Q&A which is always fun, ask me anything!

RehabWebinars.com has a bunch of awesome new webinars coming up over the next few months.  Michael Mullin had part 1 of a webinar on Integrating Postural Restoration Institute Concepts into Training.  This was a great webinar and a great intro into the PRI concepts!

 

IASTMtechnique.com Now CEU Approved and on Sale!

We are pleased to announce that our online program teaching you how Erson Religioso and I perform Instrument Assisted Soft Tissue Mobilization (IASTM) is now officially approved for 6 CEU hours by the NATA and APTA of MA (and we give you everything you need to submit to other states).  To celebrate, we are offering the fully online program for a special sale price of only $99.99 this week only!  Sale ends Sunday at midnight EST.

 

What IASTM Is and Is Not

Leonard Van Gelder wrote an article on IASTM going over some of the current research.  We go over a lot more than this in the IASTMtechnique.com program but this was a nice summary.

 

Visualizing IASTM with Ultrasound

Erson Religioso has an awesome video of an ultrasound evaluation before and after IASTM, pretty cool!

 

 

 

 

6 Keys Factors in the Rehabilitation of Shoulder Instability – Part 2

Shoulder Instability Rehabilitation

Last week we began exploring some of the factors that I think are most important in designing rehabilitation programs for nonoperative shoulder instability.  As we discussed, shoulder instability covers a very large group of people, and different types of instability will require modifications to our rehabilitation and training programs.

 

Key Factors in Shoulder Instability

Check out part 1 of this series on my key factors in the nonoperative shoulder instability rehabilitation to see my first 3 factors.  Below I will summarize my final 3 key points.

 

Factor # 4 – Direction of Shoulder Instability

Multidirectional InstabilityThe next factor to consider is the direction of shoulder instability present. The three most common forms include anterior, posterior and multidirectional. Anterior shoulder instability is the most common traumatic type of instability seen in the general orthopedic population. It has been reported that this type of instability represents approximately 95% of all traumatic shoulder instabilities. However, the incidence of posterior instabilities appears to be dependent on the patient population. For example, in professional or collegiate football, the incidence of posterior shoulder instability appears higher than the general population. This is especially true in linemen. Often, these posterior instability patients require surgery as Mair et al reported 75% required surgical stabilization.

Following a traumatic event in which the humeral head is forced into extremes of abduction and external rotation, or horizontal abduction, the glenolabral complex and capsule may become detached from the glenoid rim resulting in anterior instability, or a Bankart lesion as discussed in part 1. Conversely, rarely will a patient with atraumatic instability due to capsular redundancy dislocate their shoulder. These individuals are more likely to repeatedly sublux the joint without complete separation of the humerus from the glenoid rim.

Posterior shoulder instability occurs less frequently, only accounting for less than 5% of traumatic shoulder dislocations. This type of instability is often seen following a traumatic event such as falling onto an outstretched hand or from a pushing mechanism. However, patients with significant atraumatic laxity may complain of posterior instability especially with shoulder elevation, horizontal adduction and excessive internal rotation due to the strain placed on the posterior capsule in these positions.

Multidirectional instability (MDI) can be identified as shoulder instability in more than one plane of motion. Patients with MDI have a congenital predisposition and exhibit ligamentous laxity due to excessive collagen elasticity of the capsule.

imageOne of the most simple tests you can perform to assess MDI is the sulcus sign.  I would consider an inferior displacement of greater than 8-10mm during the sulcus maneuver with the arm adducted to the side as significant hypermobility, thus suggesting significant congenital laxity.  You can see this pretty good in this photo to the right, the sulcus is clearly larger than my finger width.

Due to the atraumatic mechanism and lack of acute tissue damage with MDI, ROM is often normal to excessive. Patients with recurrent shoulder instability due to MDI generally have weakness in the rotator cuff, deltoid and scapular stabilizers with poor dynamic stabilization and inadequate static stabilizers. Initially, the focus is on maximizing dynamic stability, scapula positioning, proprioception and improving neuromuscular control in mid ROM. Also, rehabilitation should focus on improving the efficiency and effectiveness of glenohumeral joint force couples through co-contraction exercises, rhythmic stabilization and neuromuscular control drills. Isotonic strengthening exercises for the rotator cuff, deltoid and scapular muscles are also emphasized to enhance dynamic stability.

 

Factor #5 – Neuromuscular Control

neuromuscular controlThe fifth factor to consider is the patient’s level of neuromuscular control, particularly at end range.  Injury with resultant insufficient neuromuscular control could result in deleterious effects to the patient. As a result, the humeral head may not center itself within the glenoid thereby compromising the surrounding static stabilizers. The patient with poor neuromuscular control may exhibit excessive humeral head migration with the potential for injury, an inflammatory response, and reflexive inhibition of the dynamic stabilizers.

Several authors have reported that neuromuscular control of the glenohumeral joint may be negatively affected by joint instability.  Several research articles have been published looking at this. Lephart et al compared the ability to detect passive motion and the ability to reproduce joint positions in normal, unstable and surgically repaired shoulders. The authors reported a significant decrease in proprioception and kinesthesia in the shoulders with instability when compared to both normal shoulders and shoulders undergoing surgical stabilization procedures. Smith and Brunoli reported a significant decrease in proprioception following a shoulder dislocation. Blasier et al reported that individuals with significant capsular laxity exhibited a decrease in proprioception compared to patients with normal laxity. Zuckerman et al noted that proprioception is affected by the patient’s age with older subjects exhibiting diminished proprioception than a comparably younger population. Thus, the patient presenting with traumatic or acquired instability may present with poor neuromuscular control that must be addressed.

 

Factor # 6 – Pre-Injury Activity Level

The final factor to consider in the nonoperative rehabilitation of the unstable shoulder is the arm dominance and the desired activity level of the patient. If the patient frequently performs an overhead motion or sporting activities such as a tennis, volleyball or a throwing sport, then the rehabilitation program should include sport specific dynamic stabilization exercises, neuromuscular control drills and plyometric exercises in the overhead position once full, pain free ROM and adequate strength has been achieved. Patients whose functional demands involve below shoulder level activities will follow a progressive exercise program to return full ROM and strength. The success rates of patients returning to overhead sports after a traumatic dislocation of their dominant arm are low. Arm dominance can also significantly influence the successful outcome. The recurrence rates of instabilities vary based on age, activity level and arm dominance. In athletes involved in collision sports, the recurrence rates have been reported between 86-94%.

 

To summarize, nonoperative rehabilitation of shoulder instability has many subtle variations.  To simplify my thought process, I always think of these 6 key factors before I decide what I want to do.   For more information on the rehabilitation of shoulder instability, check out 7-week online CEU program at ShoulderSeminar.com that includes an entire week dedicated to this topic.

ShoulderSeminar.com

I hope these factors help you too.  What other factors do you consider when designing rehabilitation programs for shoulder instability?

What Features Would You Like to See on My Site?

As this website continues to grow in visitors and content, I am always approached by people with great ideas on how to improve the website.  I have had many people recommend certain features that they would like to see on this website.  I have always been hesitant to take away from the educational content with other features, but rather than just guess, why don’t you tell me what you want to see on this website.  I’m torn and not sure if I would add any of these features, but I want to hear from you!

Here are a few features that have been recommended to me, let me know on the quick poll below which that you would like to see added to this site.  You can select multiple answers and even fill in your suggestions at the end.  Feel free to comment to this post with any additional thoughts as well.   Thanks!

  1. Job Openings – this would be an area where you could search for new jobs or post a job opening at your site
  2. CEU Opportunities – this would be an area that you can search for CEU courses coming to an area near you
  3. Rehab Product Store – this would be a fully functional store where you could buy products, very similar to Perform Better and similar sites

[polldaddy poll=”4627351″]

Website Maintanence is Complete!

Wow, that was pretty fast…

They warned it would take 72 hours, but it was more like 72 minutes, but hey I am not complaining.  All is good here at MikeReinold.com and at ShoulderSeminar.com.  This upgrade should make the sites faster and more stable.  If you have any issues or get that “internal server error” please let me know.

Thanks for your patience!

New Contest, Get Well Soon, and Website “May” Be Down This Weekend

Hey everyone, just wanted to post a quick note that I have a new contest and that the website “may” be down Friday-Sunday.  I am migrating to a new server on my hosting account that will “solve” some of the reliability issues with this website and ShoulderSeminar.com, specifically the “500 Internal Server Error” message that I am sure everyone is getting on occasion.  I am saying “may” because that is what they told me, it “may” be down during the upgrade process and “may” be down for up to 72 hours.

What does this mean for you?

  • If you come to this website and it isn’t here for some reason, no worries, it should be back by Monday without issues.
  • I am going to close down new registrations for ShoulderSeminar.com starting tonight until the process is done.  I know subscribers to my newsletter have a special discount that expires this weekend – I “may” extend this for another week if the website is done for too long.
  • If you are a current subscriber to ShoulderSeminar.com, you “may” also not be able to access the website.  Just a heads up.

I will update this post right here when everything is all done, so you can check back here and see if this website or ShoulderSeminar.com is up and running.

New Contest!

Also, I have a new contest coming soon, I won’t give it all away just yet, but let’s just say it involves ShoulderSeminar.com, Facebook, and Fruit Ninja, that is right, Fruit Ninja…  You may want to friend me on Facebook if you haven’t yet as this will be a Facebook only contest!

Get Well Soon!

More importantly – Also wanted to send a quick note to Bob D. at Performance Physical Therapy in RIget better soon!  You have some great co-workers that really care about you!  Best, Mike

Outlines From My SPTS Team Concept Course

image

This past weekend I presented at the Sports Section of the APTA’s annual Team Concept Course in Vegas.  Thanks for all that attended, it was a great turn out.  For those in Vegas, I again apologize for having to leave the conference early.  Unfortunately I was only there for about 14 hours before I had to urgently leave!

I wanted to make the outlines of my talks available so that you could still download and view.  Our outlines were originally due months ago and I made many great changes to my slides that are reflected in these outlines.  They are more updated than those in the course packet. 

I’ll leave this link active for about a week or two so if you are interested you can download here:

Reinold – SPTS TCC 2010 Outlines

I am also trying to get the SPTS to share with me the email list of all the attendees so I can invite you to a free live webinar of my talk on “When to Start Throwing.”  Hopefully they’ll share and if so look out for an email with instructions.  Sorry and thanks again!

~Mike