Patrick BERDOULET,
PHYSIOTHERAPIST, BORDEAUX, FRANCE.
Shoulder pain is common: 20% of the population claim to suffer from shoulder pain. Tendinopathies, bursitis and partial or total ruptures of the rotator cuff are a real public health problem.
Biomechanically, the rotator cuff is a set of 4 muscles inserted on the scapula: the supraspinatus, the infraspinatus, the teres minor and the subscapularis muscles. The function of the cuff is to center and stabilize the humeral head on the glenoid.
The rotator cuff opposes to the upward translational forces generated by the long portion of the triceps, the short portion of the biceps, the coraco brachii, the deltoid and the pectoralis major: a balance between those 2 groups will ensure the smooth running of the glenohumeral joint.
It will also be necessary to take into account the dynamic role of the scapulothoracic, which can be disturbed with an impairment of the cuff, an acromioclavicular stiffness, a contracture or a retraction of the pectoralis minor associated with a deficit of the lower trapezius (= dyskinesias). Motor inhibitions will also cause feedforward disturbance.
The treatment of a painful shoulder requires a precise clinical examination by evaluation of the cervical spine, glenohumeral mobility, posture, decentrings, impingement tests and tendon tests, of the scapulothoracic.
Are those tendinous tests really reliable? Can we really isolate a structure (specificity, sensitivity)?Should we use the symptom modification procedure taking into account bio-psycho-social factors (Jo Gibson, Jeremy Lewis) or evaluate the emotional symbolism?
Given those various clinical approaches, shoulder pathologies require in any case a rehabilitation treatment: a first manual treatment will evolve gradually, with a more global vision, by solicitingthe muscles of the trunk, the stabilizers of the pelvis and lower limb muscles.
The shoulder complex never works in isolation but is totally integrated into the musculoskeletal system.
That therapeutic choice can lead us to a complementary tool such as the HUBER 360® where we can work on the shoulder in and through the body in motion using the muscle chains: an efficient kinetic chain will provide the possibility of a competent energy transfer during the movement avoiding a negative impact of the force transfer to the adjacent segments (KIBLER).
According to the different trajectories of the platform and thanks to the sensors we can complete the manual work of recovery at the beginning of the mobility, especially after surgery, by an integration of that gain at the level of motor inhibitions.
Gradually, the patient’s rehabilitation will focus on static strengthening of the cuff in RE1, RE2 and RE3, compression and then dynamic work associated with work on the muscles of the trunk and lower limbs thanks to the various trajectories of the platform with correction of the posture and with visual feedback from the target improving the recruitment of the axioscapular muscles.
The HUBER 360® will intervene on the neuro-motor reprogramming by using the Feedforward by a proprioceptive work with the use of a Klein ball, a Bosu on the platform and with fixed point inversions. Depending on the delay, a numerical evaluation of the strength of the rotators can be made and thus adapt a percentage workout.
HUBER 360® is a powerful complementary tool in that global approach of the shoulder by a work in kinetic chains allowing a greater recruitment than an analytical work on isokinetic apparatus evaluating the strength of a muscular group (Doctor Portero) and especially in the overhead activities.
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