“A Pat on the back, an arm around the shoulder, a praise for what was done right and a sympathetic nod for what wasn’t are as much a part of physiotherapy as life itself.”
The famous American writer, publisher, artist, and philosopher, Elbert Hubbard has said “Responsibilities gravitate to the man who can shoulder them and the power to him who knows how”. How very true it is in the context of the role played by Physiotherapists when it comes to shouldering the responsibility for a better health care delivery. Over and above the metaphoric use of the word, shoulder is a region of the body that has presented a challenge to clinicians for many years. Substantial disability and significant morbidity can result from shoulder disorders. Physiotherapy is often the first line of management for shoulder pain, owing to the sound knowledge of the mechanics and functional anatomy of the shoulder region the physios possess. This issue of PHYSIOTIMES concentrates on those clinical aspects, which may assist the physiotherapists in their practice for assessment, diagnosis and management of various shoulder disorders.
The articles in this issue focuses on physiotherapy interventions for specific clinical conditions associated with shoulder, be it the multi-directional instability of the shoulder or understanding the nuances of rotator cuff disorders or scapular stabiltation, post operative shoulder rehab or the use of closed kinetic chain exercises in adhesive capsulitis. The issue also discusses widely-practiced manual therapy approaches of Mulligan, Mckenzie and Maitland through different articles from respective experts in the field. The cover feature is an interview with the world famous therapist, author and lecturer, Michael Shacklock, known for Neurodynamic Solutions, who was kind enough to share his expertise with all of us through this exchange. The issue also features the second article in the Research and Dry Needling series we have started from the previous edition. The news & event section shares world physiotherapy celebration by some of our readers. I congratulate PHYSIOTIMES Executive Editor. Sagar Naik and Editorial Board Member Dr. Narasimman Swaminathan for their participation in the recent WCPT – AWP congress, held at Taichung, Taiwan. I also congratulate Devdeep Ahuja, our international editor for his recent trip to Vancouver to undertake a certificate program in Functional Capacity Evaluation. I take this opportunity to thank subhanjan das, who has been instrumental in the making of this issue. I also thank all the authors who contributed their expertise. I am sure this issue would help you get a vivid account of shoulder disorders & pass on the benefit of the wisdom shared by expert authors to your patients. Before I sign off, it gives me immense pleasure to share with you that PHYSIOTIMES TEAM Had written a poem titled “I AM A PHYSIOTHERAPIST”, dedicated to physiotherapist on the occasion of the World Physiotherapy Day on 8th September 2013.
I return to writing after a short Sabbatical leave or rather was involved in another project byPHYSIOTIMES which would shortly be completed. I was told that upcoming issue is devoted to Shoulder and I may write something relevant. Usage of the word implies that it is connected with bearing responsibility; another version is to carry the burden physically. In English as well as in Hindi and Indian languages to give shoulder to a dead body while being carried on to symmetry or for cremation (Ka... Read More
Shoulder joint is structured for mobility at the expense of stability. It is a joint with the highest degrees of freedom in human body. The downside to such mobility is the lack of stability. Shoulder instability is defined as the inability to maintain the humeral head in its centred position against the glenoid. While Neer and Foster (1980) first described multi-directional instability (MDI) as anterior and posterior instability associated with involuntary inferior subluxation or dislocation... Read More
Michael Shacklock is a world renowned lecturer, author and founder of the concept of NeuroDynamic solutions. Also well known for his lecturers on pain, the nervous system and manual therapy, he is an articulate, methodical and entertaining presenter who has taught neural mobilization internationally, performs research in the area and presently settled in Adelaide, South AustraliaRead More
Shoulder complex solves its mobility vs stability conflict by distributing its large ROM across all its mobile components. Among them the glenohumeral and scapulohthoracic joints are major contributors whereas the other two articulations of shoulder complex, the acromioclavicular and sternoclavicular joints have key functions in the scapulothoracic motion. These four joints work in a close kinematic chain. The arm needs synchronized action of all these segments to move effic... Read More
Surgery is a skill, in fact, an art intending to correct or alter impairments, normalizing the anatomy to aid functional recovery. It is a specialty where precision is the prime principle, aptly quoted by British surgeon Wilfred Trotter “It is sometimes asserted that a surgical operation is or should be a work of art…” Shoulder arthroscopic surgeries have revolutionized post-surgical status, enabling early functioning. Radical changes in surgery have mandated mo... Read More
Many forms of exercise evolve out of research and practice for stiff shoulder but, the invention strategies based on our traditional values and norms always keeps us ahead. One of its unique kinds is the closed kinetic chain approaches. It can be either therapeutically called as closed kinetic chain exercises or yoga asanas, in particular Hand balancing asanas.Read More
Rotator cuff disorders are one of the commonest sources of shoulder problems, ranging from mild strain causing impingement type symptoms to massive tears with total absence of the cuff and severe loss of function. This can occur in athletes, workers with repetitive overhead activities and the elderly with years of use.
The patients usually present with one of the following entities, each having its own distinct clinical features:
1) The impingement syndrome or supraspinatu... Read More
Introduction: Shoulder pain, reported to be the most common musculoskeletal disorder after spinal pain (Eltayeb et al., 2007) is often recurrent and persistent (Croft et al., 1996; Van der Windt et al., 1996; Van der Windt and Croft, 1999; Winters et al., 1999; Kuijpers et al., 2006, 2007). This article highlights the difficulties in diagnosing shoulder disorders, the need for the classification system in extremities, and provides information on how shoulder pain i... Read More
In present era we adapt a set of similar postural patterns during our work. Majority of people adapt sitting posture and use the computers at workplace. The constant set of postural patterns and position often leads to a common upper quadrant imbalance called as upper crossed syndrome. The term upper crossed syndrome was coined by Dr.VladimirJanda. The upper crossed syndrome is defined as tightness of the upper trapezius, pectoralis major, and levator scapulae and weakness of the rhombo... Read More
Shoulder pain, which is often persistent or recurrent, is one of the major reasons patients consult with primary healthcare providers. Non traumatic shoulder pain has mainly been proposed to be due to either the presence of inflammation or degenerative rotator cuff ruptures (diagnosed during MRI or Sonography) [1, 2]. Although such pathological structures may cause pain, it is also known that similar abnormalities have been found in asymptomatic shoulders due to faulty scapular muscle activat... Read More
Mobilization with movement (MWM) is applicable for the treatment of painful thoracic vertebral and rib dysfunction. A challenge faced by the physical therapist in the application of MWM for thoracic cage dysfunction is the necessity to first rule out such problems as thoracic tumors, inflammatory disease, muscle strains and visceral pathology which can mimic musculoskeletal dysfunction.
Making matters even more difficult is that afferent nociceptive signals arising from the ve... Read More
In the first article of the research series, I discussed means of getting started in research, choosing a research area and development of a research question. This leads the research student on to the development of a research proposal, however, before the final research proposal can be developed, it is imperative that the previous literature in the area is scoped and evaluated to identify the need for the proposed study and establish its context in the specific research area. In this articl... Read More
The leading reference on shoulder rehabilitation, physical therapy of the shoulder, 5th Edition provides complete information on the functional anatomy of the shoulder, the mechanics of movement, and the evaluation and treatment of shoulder disorders. It promotes current, evidence-based practice with coverage of the latest rehabilitation and surgical techniques.Read More