Movement Dysfunction

• Discusses the movement
• Analyzes specific muscles
• Describes 'normal' requirements

Common Reasons for Poor Movement

• How the person is compensating
• Why the misalignment is occurring

Corrective Solutions

• Tips and tricks to help yourself or your patients

The lower trapezius is an important shoulder stabilizer. When the lower trapezius is weak, the body will search for other muscle groups to help raise the arm overhead. Since the person in the video has a weak lower trapezius muscle, he has resorted to using his obliques and quadratus lumborum (a trunk muscle) to assist with the movement. As he raises his arm, he activates the left external obliques, which causes trunk rotation to the right. Additionally, the quadratus lumborum activation forces the left pelvis toward the rib cage. If the movement was performed properly, the transversus abdominus and obliques should stabilize the trunk and no rotation of the toros would occur. While not seen in this video, another common compensation seen in individuals with lower trapezius weakness is over-activation of the upper trapezius muscles. With this misalignment, people shrug their shoulders toward the ears to perform the movement.

COMMON REASON(S) FOR POOR MOVEMENT:

1. To raise the arm overhead, a person needs to have adequate thoracic extension and rotation range of motion. People with an increased thoracic kyphosis have difficulty reaching overhead and often report pain in the anterior (front) shoulder. Try this on yourself now! Sit in a slouched position and attempt to raise the arm overhead- it will likely be limited and potentially painful. 
2. Many people lack the ability to disassociate their torso from their arms and legs. In other words, they cannot isolate movement in one region of the body as another part moves. This poor ability to disassociate often leads to repetitive stress across the spine. While the man in this video is not having low back symptoms, I would not be surprised if this repetitive pattern eventually led to pain.

SOLUTION/ CORRECTIVE STRATEGIES:

Avoid sleeping on the involved side. Sleeping on the involved side allows the shoulder to roll forward placing a low load, long duration stretch on the lower trapezius muscle. When the muscle is stretched for prolonged periods, it has difficulty functioning normally. Additionally, he was educated on sitting posture while working on the computer each day. 

Find easier/ less demanding positions to strengthen the lower trapezius. A simple strategy includes decreasing the lever arm of the upper extremity or changing the body position. A great starting point is standing against a wall with the arms overhead. In standing, gravity can assist with the movement, decreasing tension placed across the muscle.

COMMON REASON(S) FOR POOR MOVEMENT: 

The gluteus maximus is a primary hip extensor muscle. Due to the size and function of the muscle, it also plays a critical role in hip stability. In the video above, the client demonstrates a poor ability to activate the gluteal muscles. While there is gluteus maximus strength deficits, he also lacks poor timing and activation of the hip extensor. As the man attempts to lift his leg, the gluteus maximus does not engage. As a compensatory strategy, the low back paraspinals and hamstrings dominate the movement. In this particular case, the low back compensates by extending and rotating (as seen by the skin folding and shifting through the pelvis). When performed repetitively, this compensation can be the cause of low back pain.

SOLUTION/ CORRECTIVE STRATEGIES:

A corrective strategy includes focusing on exercises that engage the gluteal muscles while minimizing activation of the dominant surrounding muscles. The supine bridge, for example, is a great exercise to facilitate gluteus maximus activation. When performing this movement, it is essential that the client first engages the transversus abdominus (deep core stabilizers), then engages the gluteus maximus (glute squeeze), then performs a small lift (while avoiding an anterior tilt of the pelvis). This pattern of muscle activation keeps the gluteal muscles engaged and minimizes the over facilitation of surrounding muscles.  

Common reason(s) for Poor Movement: 

The shoulder joint is inherently unstable. When discussing this joint with my patients, I will often use the 'golf ball on a tee' analogy to indicate why it needs stability. Because of this inherent instability, muscles, ligaments, and other connective tissue play a large role in stabilizing the shoulder. In the video above, the individual lacks shoulder motion. As he raises his arms overhead, he is unable to keep his spine locked against the wall. This same pattern occurred every time he lifts his arm overhead. The middle back would continuously overarch to complete the movement. Other mobility restrictions can be seen by his inability to keep the arm in a neutral range of motion. In this instance, his arm maintain contact against the wall.  

Solution/ Corrective Strategies:

Since the middle back was continuously compensating to reach overhead, he was not using his scapular stabilizing muscles to assist with shoulder movements. Retraining included basic scapular strengthening- including middle and lower trapezius strengthening as well as serratus anterior activation. Most importantly, we worked on the same movement pattern seen above. We focused on keeping his spine against the wall while reaching overhead. When his spine lost contact or he experienced any shoulder symptoms, he would return to neutral. 

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