The scapula functions as a bridge between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability of the neck/shoulder region. The association between abnormal scapular positions and motions and glenohumeral joint pathology has been well established in the literature, whereas studies investigating the relationship between neck pain and scapular dysfunction have only recently begun to emerge. Although several authors have emphasised the relevance of restoring normal scapular kinematics through exercise and manual therapy techniques, overall scapular rehabilitation guidelines decent for both patients with shoulder pain as well as patients with neck problems are lacking. The purpose of this paper is to provide a science-based clinical reasoning algorithm with practical guidelines for the rehabilitation of scapular dyskinesis in patients with chronic complaints in the upper quadrant.
The shoulder is at high risk for injury during overhead sports, in particular in
throwing or hitting activities, such as baseball, tennis, handball, and volleyball.
In order to create a scientific basis for the prevention of recurrent injuries in
overhead athletes, four steps need to be undertaken: (1) risk factors for injury and
re-injury need to be defined; (2) established risk factors may be used as
return-to-play criteria, with cut-off values based on normative databases; (3) these
variables need to be measured using reliable, valid assessment tools and procedures;
and (4) preventative training programs need to be designed and implemented into the
training program of the athlete in order to prevent re-injury. In general, three risk
factors have been defined that may form the basis for recommendations for the
prevention of recurrent injury and return to play after injury: glenohumeral
internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength
of the external rotators; and scapular dyskinesis, in particular scapular position
and strength.
These findings might provide insight into the relation between GIRD and subacromial impingement but future studies are needed to determine clinical implications.
48Purpose: Shoulder pain is a common disorder. Despite growing evidence of the importance of 49 physiotherapy, in particular active exercise therapy, little data is available to guide treatment.
50The aim of this project was to contribute to the development of an internationally accepted 51 assessment and treatment algorithm for patients with shoulder pain.
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