Upper Extremity Balance
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Transcript of Upper Extremity Balance
Upper Extremity Upper Extremity Balance and Balance and
Stability TrainingStability TrainingPatrick Hills-Meyer, MA, LAT, CSCSPatrick Hills-Meyer, MA, LAT, CSCS
Purpose A brief overview on
balance and stability
Discuss current research in upper extremity (UE) balance and stability training
Discuss current research in core stability
Discuss core stability and how it relates to shoulder (UE) stability
Discuss how to train UE balance and stability
Demonstrate UE exercise progressions both OKC and CKC
Balance The body’s ability to maintain an equilibrium by
controlling the body’s center of gravity over its base of support. (Houglum)
Proprioception The body’s ability to transmit position sense, interpret the
information, and respond consciously or unconsciously to stimulation through appropriate execution of posture and movement. (Houglum)
Proprioception Joint position sense
Appreciation and interpretation of information concerning one’s position and orientation in space
Kinesthesia The ability to appreciate and interpret joint motions
Sensation of force The ability to appreciate and interpret force applied to or
generated within a joint
Proprioception SMS The sensory motor system (SMS) is responsible for
providing awareness, coordination, and feedback to maintain form and stability, thereby serving as a major component of injury free athletic performance. (Tripp)
Research has shown that endurance and SMS control exercises should not focus on single joints. (Tripp)
Joint injury compromises SMS function
Shoulder Balance Range of motion
Flexion/extension Abduction External rotation/internal rotation
Strength Periscapular muscles (pec minor, serratus, levator,
rhomboids, trapezius) Rotator cuff muscles Large muscles (deltoids, biceps, triceps)
Proprioception Joint position sense Kinesthesia Sensaton of force
Stability The state of remaining
unchanged even in the presence of forces that would normally change the state or condition. (Myers)
Glenohumeral stability is the state of the humeral head remaining or promptly returning to proper alignment within the glenoid fossa through an equalization of forces.
(Myers)
Joint stability is mediated by both mechanical and dynamic restraints
Mechanical GH joint capsule and
ligaments, labrum, bony geometry, intra-articular pressure
Dynamic Activation and force
productions by the muscles
Shoulder Stability There is an inherent lack
of bony stability in the glenohumeral joint
Glenoid fossa is 1/3 to 1/4 the surface area of the humeral head. (Borsa)
Stability Dynamic Stability
During overhead activities, the scapular stabilizing and rotator cuff muscles function in a balanced manner to maintain a centered relationship between the humeral head and the glenoid fossa. (Borsa)
Functional joint stability Possessing adequate stability to perform
functional activity and results from the interactions between the mechanical and dynamic restraints. (Myers)
Training with Instability The advantage of an unstable training
environment would be based on the importance of neuromuscular adaptations with increases in strength. (Behm)
A strong stable core provides a solid foundation for the torques generated by the limbs.
The greatest contribution of instability training is to improve core stability rather than limb strength. (Behm)
Training with Instability The purpose of training with instability is not for
significant strength gains, but to try to improve balance, stability and proprioceptive capabilities. (Behm)
Core: Center of the Kinetic Chain
A muscular corset that works as a unit to stabilize the body both with and without movement. (Borghuis)
All motions are generated from the core and translated to the extremities. (Bliss)
The core is central to all kinetic chains in sports activities, control of core strength, balance and motion will maximize all kinetic chains of upper (and lower) extremity function. (Borghuis)
Balance and Core Stability
Maintenance of balance in upright posture is essential in daily activities and sports as well as to he prevention of injury.
Stabilization of the trunk is crucial for maintaining static or dynamic balance, especially to provide a solid base when attempting to exert forces upon external objects
Core Stability The ability to control the position and motion of the trunk
over the pelvis to allow optimum production, transfer and control of force and motion to the terminal segment in integrated activities. (Hibbs)
To increase core stability, exercises must be performed that stimulate the movement patterns of a given sport
Greater core stability provides a foundation for greater force production in the upper (and lower) extremities. (Willardson)
Stability Ball Training Recommended that programs exclude, or limit use of
stability ball as they do not appear to provide sufficient stimulus for improving muscular strength or hypertrophy. (Nuzzo)
Difficult to increase intensity through external loading
Include structural multi-joint exercises instead
Injury to the shoulder To the stabilizing structures of the shoulder results in
mechanical instability
Injury not only disrupts the mechanical stabilizers, but also causes sensorimotor (SMS) deficits
The combination of mechanical and sensorimotor alterations contribute to functional instability
Injury Cycle
(Tripp)
Injury to the shoulder Studies show that instability of the shoulder lead to
harmful effects on proprioception. (Myers) Osteoarthritis, increased nocioceptor activity, subacromial
impingement In addition to proprioceptive deficits, muscle activation
alterations are also present leading to further instability
Evidence for SMS restoration via surgical interventions: Tension in the GH joint (capsule and ligaments) leads to
mechanoreceptor stimulation Repopulation of mechanoreceptors following surgery
Injury Rehabilitation Inflammation, spasm and pain reduction
Restore ROM (balance)
Proprioception
Restore Strength
Return to functional (sport specific) activity
Restore ROM (balance) Optimal flexibility of the
inferior and posterior joint capsule enables the humeral head to roll and spin properly against the glenoid fossa during abduction and flexion. (Ronai)
Inferior capsule stretch
Posterior capsule stretch (cross over and sleeper)
Proprioception Dynamic stabilization is
paramount in restoring functional joint stability and should focus on restoring both coordinated muscle activation patterns during functional tasks as well as muscle coactivation and the resulting force coupling restraint
http://www.ptproductsonline.com/issues/articles/2007-11_01.asp
Proprioception Both open and closed kinetic chain exercises have been
shown to cause improvements in joint position sense at the shoulder. (Myers)
Closed kinetic chain UE activities facilitate coactivation of the muscles around the shoulder increasing functional joint stability.
An increase in joint stability is obtained by creating greater joint congruency and stimulation of mechanoreceptors.
Shoulder (UE) Stability Program
Improve strength and endurance of the periscapular and rotator cuff muscles
Good posture and technique
Proper flexibility
Proper progressions
Based on current literature, free weight exercises performed while standing on stable surface should be the primary training modality to develop core stability and enhance sports performance in healthy athletes. (Willardson)
UE Progressions Use both OKC and CKC
Use sport specific skills
PNF-Rhythmic Stabilization OKC to CKC
Co-contraction with out movement to movement on stable, then unstable surfaces
Eyes open to closed
Active repositioning
Body weight to med balls
Short to long distance
Scapular Stability Exercises
(Jeran)
“The Six Pack”
(Jeran)
Basic Rotator Cuff Internal rotation External rotation “Full can”
Core Endurance Training (The 5 Endurance Tests)
(Bliss)
Closed Chain Exercises Stability ball push up Push up with single arm
support BOSU push up BOSU rocking
Closed Chain ExercisesStairmaster Hand Walking PB Hand Walk Outs
Closed Kinetic Chain Endurance Test
(Schulte-Edelmann)
Closed Chain Exercises
Open Chain ExercisesOne Arm Shoulder Press One Arm Row
Open Chain ExercisesBus Driver, Rock Star Triple Extension Press
Open Chain ExercisesHang Clean Snatch
Open Chain ExercisesPlyo Toss Wall Toss
Open Chain Exercises
References Behm D. and Anderson K. The role of instability with
resistance training. Journal of Strength and Conditioning Research. 20(3):716-722. 2006.
Bliss L. and Teeple P. Core stability: The centerpiece of any training program. Current Sports Medicine Reports. 4:179-183. 2005.
Borghuis J., Hof A., and Lemmink K. The importance of sensory-motor control in providing core stability. Sports Med. 38(11):893-916. 2008.
Borsa P., Laudner K., and Sauers E. Mobility and stability adaptations in the shoulder of the overhead athlete. Sports Med. 38(1):17-36. 2008.
References Hibbs A., Thompson K., French D., et al. Optimizing
performance by improving core stability and core strength. Sports Med. 38(12):995-1008. 2008.
Houglum P. Therapeutic Exercise for Athletic Injuries. (1st ed.) Champaign: Human Kinetics, 2001. pp. 268-283, 566-655.
Jeran J. and Chetlin R. Training the shoulder complex in baseball pitchers: A sport-specific approach. Strength and Conditioning Journal. 27(4):14-31. 2005.
References Myers J., Wassinger C., and Lephart S. Sensorimotor
contribution to shoulder stability: Effect of injury and rehabilitation. Manual Therapy. 11:197-201. 2006.
Nuzzo J., McCaulley G., Cormie P., et al. Trunk muscle activity during stability ball and free weight exercises. Journal of Strength and Conditioning Research. 22(1):95-102. 2008.
Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal. 27(4):36-45. 2005.
References Schulte-Edelmann J., Davies G., Kernozek T., and
Gerberding E. The effects of plyometric training of the posterior shoulder and elbow. Journal of Strength and Conditioning Research. 19(1):129-134. 2005.
Tripp B., Yochem E., and Uhl T. Functional fatigue and upper extremity sensorimotor system acuity in baseball athletes. Journal of Athletic Training. 42(1):90-98. 2007.
Willardson J. Core stability training: Applications to sports conditioning programs. Journal of Strength and Conditioning Research. 21(3):979-985. 2007.