preparing for action

[nari]

Has anyone noticed that, with a painful shoulder of uncertain aetiology, it helps a lot to consciously brace the scapula before reaching?

It limits the distance so that we need to adjust the body's inclination to make up for it, but the pain is much less. As reaching is a classical painful movement, I find this simple action can be taught to patients so their ADLs are easier to perform.

It does make good sense, of course, as we do not usually initiate shoulder girdle action before the long lever movement of reaching.

I like the concept of short and long levers, and use short levers (fully flexed elbow)a lot where abduction/flexion/ER is painful. It enables the joint and surrounding tissues to be moved rhythmically with a minimum of pain, and then they can move into neural territory by gradually extending the elbow.


Nari

[bernard]

Nari,

Please explain ADL?

[nari]

Oh dear, here I go assuming abbreviations are known world-wide!
Sorry.
(Though I should know better, as the USA PTs use many abbreviations that I have no idea of).
ADLs = Activities of Daily Living.

Nari

[nari]

Bernard
Thanks for adding ADLs to the abbreviation thread.

A warm-up? Possibly. I see it as eliminating the tension on all three nerves so the movement at the shoulder can occur without pain, and then gradually introducing tension so that it is more acceptable to the brain.
A less loaded arm, reduced tension centrally in the arm, and a relaxed movement.
That is, assuming there is no cranky pathology lurking in the shoulder territory. I find that true pathology producing painful movements is quite uncommon in the patients I see. The calcified tendons, OA, rip/torn muscle/s often mislead; they may be there on US, but do not necessarily act as the major source of pain.
Something from the past I have never forgotten; in the late 1980s our senior outpatients physio wanted to organise a course on treatment of shoulders, and out of 14 current "shoulder" patients, none had pain from the shoulder - all pain was referred from the spine. Eventually she found one, just in time....

Which goes to show that we need to treat the process, not the diagnosis.


Nari :wink:

[emad]

Hi Nari :

you are absolutely right ,but we need to clearly ,accuratly define what is the process :!: :idea:

cheers
emad :)

[nari]

emad

Quite true, but that is going to depend on the neuroscientists' results from all their ongoing work.

In the meantime, we can try, and get good results, some failures, and learn as we go.

Something does not have to be clearly understood before putting into practice; look at McKenzie and Maitland - neither could adequately explain why their methods work (and we still do not know why mobilisation makes a 'joint' feel better, not do we know where the pain of a disc protrusion comes from) but that did not stop whole nations of physios rushing to try it all out.

If we wait for pure evidence - we remain in the dark ages.


Nari

[emad]

Hi Nari :
you wrote
In the meantime, we can try, and get good results, some failures, and learn as we go.
that is called Reflection


Bernard :
i like your words

If pain must arrive, it arrives slowly if you move slowly

cheers
emad