Andy Barker’s Post

Very rarely is strength the answer for shoulder pain. For sure, you are going to need to load the shoulder in shoulder rehab… And use shoulder ‘strengthening’ exercises to do this… But strength is not always the problem? Context is key. Clearly, a post-op shoulder, or a severe shoulder injury that has been immobilised for a period of time, will have lost some strength… And you’ll need to do some strength work as part of the rehab process. But I am more talking about the majority of other shoulder pain patients you see. Like those patient's that have irritated their shoulder, when the pain is not so bad that they have had to stop all activity, but it won’t go away. Patient's with rotator cuff, ACJ, 'impingement' injuries. You see these type of patient's right? What I have found key with shoulder pain rehab, with both patient’s and pro athletes, is that you need to start slow. By slow, I mean that you need to restore your patient’s ability to move well, load and function slowly, and at low intensities, before you progress. A big mistake I see a lot with new grads and shoulder pain, is giving them too much rehab to start with. Often this overloads the shoulder and can actually be detrimental to their recovery. Picking the right exercises and doing them pain-free and doing them well is vital at the start with any shoulder pain patient. Then you can add load and get them strong if that is what they need! This is not just a shoulder thing either. This applies to all injuries… All over the body! Start slow... Progress quick! Hope this helps, Andy Barker The New Grad Physio Mentor PS. Want to learn more about the best way to manage shoulder pain patient's? Then check out my FREE Shoulder Pain PDF Right Here… newgradphysio.com/ #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

Getting on top of shoulder pain (and keeping it at bay) is one of a new grad physio’s biggest challenges! A few shoulder stretches… Scapula stability exercises… Or theraband external rotations don’t cut it for most shoulder injuries. You know what I am talking about, right? Here’s what you need to do instead… #1 Don’t Push Into Pain There are some injuries you can load into pain, like some tendon issues and injuries like a lateral ankle… But shoulders are typically not one of these injuries. The often do not respond well to loading into pain, as they irritate the shoulder, causing an increase in your patient’s symptoms… Something that your patient will not thank you for!!! But don’t get this wrong… This does not mean you have the rest the shoulder and be uber cautious and conservative. Complete the opposite. The shoulder needs to be loaded to get better. You just need to know what exercises to do to find the right balance between loading the injured area… But not push it too far so that you flare up your patients shoulder symptoms. Easier said than done right? Need some help with your shoulder pain patients? Then just send me a DM with the word ’SHOULDER’ and I’ll send you over my most popular shoulder pain resource for FREE. Hope it helps, Andy Barker The New Grad Physio Mentor PS. Keep your eyes out for my next couple of emails that will have some more top tips to help you make sense of... And manage different shoulder pain problems! #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

✨The Humble Pegboard✨ Use of the pegboard in neuro rehab for targeting hand and arm function is indispensable. I’ve been recently using it with a gentleman recovering from left hemiplegia combined with left hemi-neglect. This simple activity has gotten him more engaged in rehab than any other activity so far. Here a few ways I’ve used it to target different goals of his recovery process: ▪️Tie a weight cuff to the affected arm and it helps add some resistance training to that arm which is play-based. ▪️Placing the pegs on the far left to force him to take note of his surrounding on the left. ▪️Simple reach outs in unsupported sitting that are task-based helped in better trunk activation as well as dynamic sitting balance. ▪️Using the right hand to locate the pegs and using the left hand and arm for stability helped gain better weight bearing in supported standing, thus also targeting standing dynamic balance. ▪️Lastly, the humble peg board was the only activity he engaged in several times throughout the day as a self-performed repetitive task. Win-win! Fellow physios who treat neurological caseloads or otherwise, how do yo use the humble pegboard clinically? 💡 💭Let me know your thoughts! 💭 #physiotherapy #stroke #rehabilitation #dubai #recovery #exercise #neurorehab

Let's cut to the chase...
 You do not like treating shoulders, right?

 I know this because it is the joint I get asked the most questions about.

 From finding the right diagnosis...

 Explaining this diagnosis and a prognosis to your patient...

 And knowing what treatments and rehab to use for shoulder pain patients is hard! I blame University!

 Seriously, like me, I bet you were taught to diagnose largely by using special testing.

 Helpful when the tests are good...

 Like the Lachman's test at the knee...

 Or anterior draw test at the ankle...

 But not so good at the shoulder.

 Shoulder special tests are poor.

 They have low sensitivity and low specificity...

 In simple terms meaning they are poor at actually diagnosing what the tests are meant to test...

 Or put another way...

 They are a waste of your time and effort to even use in the first place. If you are reliant upon on special tests to find the right diagnosis with your shoulder pain patients...

 Then you are always going to struggle! 

 The shoulder is a more complicated joint in many ways than other joints like the knee or ankle, due to it's more complex structure and anatomy...

 With so much going on in such a tight space.

 But this does not mean you can’t still get great patient results…

 Even without a clear shoulder diagnosis. All this week I will be giving you some of my biggest tips to help you make sense of shoulder pain symptoms... And giving you some simple strategies to help you get even the most complex shoulder pain patients out of pain... And back to full fitness... Even as a young and inexperienced shoulder physio! Keep your eyes peeled! In the meantime... Get my FREE shoulder pain PDF... ‘5 Breakthrough Steps To Confidently Treat The Shoulder Right Every Time, Avoid Mistakes & Stop You Feeling Less Adequate Than Other New Grads’ Just head to www.newgradphysio.com to download this FREE resource right away. Any problems getting access, just let me know and I will send you a copy over! Hope it helps! Andy The New Grad Physio Mentor #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

Power production, or explosive strength development, is a must for sporting success as it allows the patient athlete to efficiently accelerate during the field or court of play. These sporting qualities are even more important status post ACLr surgery due to ample evidence suggesting deconditioning of all athletic qualities of not only of the uninvolved leg, but to an even greater extent, the involved leg. This is not only because of disuse atrophy of the involved lower extremity, but also because of associated neuroplastic changes in the patient athletes' CNS that cause/contribute to increased muscle inhibition in certain muscle groups (i.e., quads). Altered neuromuscular control resulting in difficulties with muscle sequencing and fear of re-injury can also result in the patient athlete’s reluctance for maximal power generation. While there is a time and place for all interventions, below are some my favorites when working with more advanced patient athletes during the course of their rehab. Which variation is best for a particular patient athlete depends on what the needs are for that patient athlete as well. Feel free to use as indicated or to reach out with questions as needed! Want to learn more about rehabilitating and reconditioning injured athletes back to sport? Check out my courses down below as they accredited for CEUs for PT/PTAs and S & C coaches! Periodized ACL Program: A Reconditioning Masterclass (2.0 CEUs by NSCA) https://lnkd.in/gP7HhcA3 Periodized ACL Program: Rehab to Performance (30 CE credits in 42 states) https://lnkd.in/gEJ-xtm3 #training #physicaltherapy #coaching #learning #sportmedicine #sportsperformance #sportscience #sports #coaching #performance #sportsmedicine #physicaltherapy #rehabilitation #StrengthandConditioning #rehab #fitness #S&C #training #physicalpreparation #PT #health #training #coaching #environment #sportsmedicine #physicaltherapy

You ARE allowed to round your back when you deadlift And you ARE allowed to round your back when you pick things up off the floor, even if they're heavy Now before everyone loses their minds... I'm not saying that you shouldn't try to optimize your mechanics when lifting heavy things off the ground (pulling the object/bar as close as possible to you, stiffening your trunk/spine to RESIST increased spinal flexion as much as possible while utilizing a strong hip extensor torque/hip hinge, etc) So please don't attack me and say that I'm saying that you shouldn't care about technique (because that's not what I'm saying at all) What I want you to know is that people demonize the spine rounding (flexing) during deadlifting (or lifting things off the ground) when it literally HAS TO FLEX/ROUND Even when it looks like it is not to the naked eye, it is rounding/flexing to a degree (Potvin JR, 1991) Again, to clarify, this does not mean that I am advocating for everyone to go out and purposely round/flex their spine maximally or to throw out technique or mechanics when deadlifting... You still want to try to optimize your biomechanical levers and try to RESIST spinal flexion (using your spinal extensors simultaneously with your hip extensors) as much as possible BUT...I'm simply letting you know that it is OKAY if your spine flexes a little (or even a decent amount) when deadlifting (you will notice that for MOST people, you will be able to visually see this as the weight/load more closely approaches maximal effort) As long as you have slowly built up your tolerance to the load you are lifting and aren't jumping up in weight too quickly (or ignoring warning messages from you body like persistent or increasing pain), you should be fine 🚨 Disclaimer: If you currently notice that forward bending is painful/aggravating, then temporarily limiting the degree in which you bend/flex your spine can definitely be helpful! BUT...this doesn't mean that bending/flexing the spine is BAD or more likely to cause injury in every single person, nor that you should avoid it forever! ⁉️ Questions? Comments? ⬇️ If you need help with your own training and/or rehab: 1️⃣ Work with me 𝟭-𝗼𝗻-𝟭 𝗼𝗻𝗹𝗶𝗻𝗲: I’ll perform a detailed assessment, put together an individualized program based on where you’re currently at and where you want to get to (your goals), and then coach you through the process of getting there ➡️ Tap below and fill out my application form (I’ll respond within 48 hours) ⬇️ https://lnkd.in/gZ5Uey7B 2️⃣ Join over 2000 others in my app: if you don’t need 1-on-1 coaching but need structure, my app includes 𝟭𝟬 𝗳𝘂𝗹𝗹 𝗹𝗲𝗻𝗴𝘁𝗵 𝗽𝗿𝗼𝗴𝗿𝗮𝗺𝘀 and 𝗼𝘃𝗲𝗿 𝟭𝟲𝟬 guided mobility, strength and stability routines within 𝟮𝟱 categorized sections covering the whole body ➡️ Tap below to get full access to my app 𝗙𝗥𝗘𝗘 for your first 𝟳 𝗗𝗔𝗬𝗦 and then 𝟰𝟰% 𝗢𝗙𝗙 ⬇️ https://lnkd.in/g8DHxEVC

INTERNAL IMPINGEMENT 🎯 WHY DOES IT OCCUR? 1) The increase in Horizontal Abduction (elbow moving behind shoulders) creates a pinching/closing angle fulcrum of the deep structures of the posterior shoulder (Infraspinatus, Teres Minor, Posterior Labrum, or bony stress collisions). 
2) Now, add in the Max External Rotation which leads to the bulky greater tuberosity rolling to the back of the shoulder joint, leading to a pinch of the Infraspinatus/Teres Minor tendons into the glenoid rim and labrum 3) When this is done repetitively, those tendons or the labrum will create an inflammatory response and possible damage to the tissue depending on the severity and chronicity 4) Because it is the position and not the contractile force that causes these symptoms, the layback position is often symptomatic regardless on if there is resistance to the movement or not. Muscle testing can commonly test strong with no pain with this condition QUICK TESTS: 1) Have the Athlete bounce into ER with no load or ball and see if a posterior pinching or discomfort is reproduced 2) Bring Elbow in front of shoulder line (Horizontal Adduction), then externally rotate and see if symptoms decrease in comparison 3) FOR CLINICIANS: Perform a posterior humeral Glide with this full layback (similar to Jobe Relocation Test) and see if symptoms decrease ADDRESS THE PROBLEM AT IT’S ROOT 1) Horizontal Abduction is not bad in itself. However, if you cannot make your glenoid (golf tee of the scapula) point behind your shoulders with this motion, you are creating a large pinching fulcrum. Focus on the ability to retract your scapula to midline and on your T Spine/rib mobility in the segments above T7. This will help to orient the Glenoid pointing posterior of midline and keep arm centered in the shoulder joint. We have also talked with Pitching Coaches about the timing of ER and Horizontal Abduction “Loading” and the speed going into layback in the delivery also playing a role in this. This makes a TON of sense, but we will stay in our scope of expertise, which is not pitching mechanics. 
2) Increase Scapular Posterior Scapular tilt and T spine extension to spread out where the layback is coming from and disperse the demands of this position to more stable segments 3) Hammering shoulder strength and stability work during this time will also be a crucial factor and one of the foundational component of the rehab process

𝗔𝗖𝗟 𝗜𝗻𝗷𝘂𝗿𝘆 𝗣𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗼𝗻: 𝗕𝗢𝗦𝗨 𝗟𝘂𝗻𝗴𝗲𝘀⁠ 𝗪𝗵𝗶𝗰𝗵 𝗺𝘂𝘀𝗰𝗹𝗲𝘀 𝗱𝗼𝗲𝘀 𝘁𝗵𝗶𝘀 𝗲𝗻𝗴𝗮𝗴𝗲? Quadriceps, Hamstrings, Gluteus Maximus, Calf, Core⁠ 𝗪𝗵𝘆 𝗶𝗻𝗰𝗹𝘂𝗱𝗲 𝘁𝗵𝗶𝘀 𝗲𝘅𝗲𝗿𝗰𝗶𝘀𝗲? Incorporating lunges into your routine enhances awareness of the gluteal muscles and fosters stability during closed chain movement patterns. By introducing the BOSU for added instability, athletes can refine proprioception and optimize knee positioning on less stable surfaces.⁠ 𝗛𝗼𝘄 𝗱𝗼𝗲𝘀 𝗶𝘁 𝗯𝗲𝗻𝗲𝗳𝗶𝘁 𝗺𝗲? Strengthening muscles both above and below the knee joint is crucial for maintaining overall knee stability. This exercise is particularly valuable for ACL rehabilitation, aiding in the prevention of undesirable movement patterns like knee valgus and enhancing balance during physical activities.⁠ -⁠ -⁠ -⁠ #physicaltherapy #physicaltherapist #sportsinjury #physicaltherapystudent #physios #chicagoPT #sportsphysio #strengthcoach #doctorofphysicaltherapy #spt #sportsmedicine #aclrecoveryclub #sportsinjury #physiotherapist #physiotherapy #acltear #aclreconstruction #aclsurgery #acl #aclrehab #dpt #sportsrehab #athletictraining #performancetraining #sportstherapy #sportsperformance #injuryprevention #sportstraining #aclrecovery #chitown

A very common problem during a rehabilitation program for injury is when you get to that point that you do not have pain but you know your body is only one small step away from losing stability and control putting you at risk of going backwards. Trying to force your way through with strength methods is risky, but sticking with easy isolated mobility and floor based stability exercises achieves very little too. It is at this point I regularly use a training technique called REACTIVE NEUROMUSCULAR TRAINING (RNT for short). This is where a small amount of resistance is applied to a faulty movement that “feed the mistake” and therefor forces the body to make a correction. This can be a very frustrating phase to work through but extremely rewarding if you spend the time to work through it. In this article I will explain how I use several versions of this technique to rehabilitate injuries and even improve sporting performance! https://lnkd.in/g3XNBF3D #functionalmovement #stability #corestability #injuryprevention #injuryrecovery

I feel like ACL re-tear rates can be reduced, if we could address this critical oversight that ACL athletes and their team (physical therapist/athletic trainer/strength coach) often make when returning to sport, is neglecting to focus on: ☑️ Developing lateral control ☑️ Lateral movement ☑️ Change of direction ☑️ Acceleration/Deceleration ☑️ Fly sprints ☑️ Lateral agility ☑️ Posterior strength/control. These elements are crucial for overall performance and injury prevention, yet they are frequently overlooked. Improvement in biomechanics = reduced risk and improved performance If you’re looking to RETURN 2 PLAY after ACL surgery and fear you’re falling behind. I can help either in-person or online. https://lnkd.in/enyiXD29 #aclrehab #aclsurgery #aclrecovery #acltear #aclreconstruction #TeamACL #postrehab #restoringathletesdaily #returntosport #returntoplay #Return2Play Team ACL SPORTS REHAB FLA