Last Updated May 2013
What's the mission of the Eclectic Approach? It's to cut out the fluff and enhance your clinical decision making. I can't teach you to be me, but I can teach my go-to patterns that I look at first. Here are my top 5 patterns for shoulder treatment that I examine. Thanks to Brian Lau, DPT, who gave me this idea.
1. Cervical retraction and sidebending to the same side of shoulder pain:
- Left shoulder pain, check cervical retraction with sidebending to the left.
- Most patients with left shoulder pain will be compensating in elevation with upper trap firing prior to scapula setting.
- Then, they repeated "stretch" the left upper trap by pulling the head to the right, losing the ability to load the ipsilateral side.
- Getting to end range on the ipsilateral side makes rapid changes in the cervical spine and anything it may refer to, hence check this and load this first.
2. Loss of shoulder internal rotation:
- Most rapid responders have a major loss of motion in one direction.
- The shoulder impingement often has a loss of internal rotation (IR) greater than most directions (causing pain in elevation, but during the motion in a painful arc).
- Checking passive shoulder extension on the involved side versus the uninvolved will often show a loss ipsilaterally.
- Loaded repeated shoulder IR for HEP often locks in your manual therapy improvements.
3. Loss of thoracic rotation to the same side of shoulder pain:
- Check seated thoracic rotation after a muscle stretch reflex (MSR) test.
- Often, thoracic rotation to the same side as the involved shoulder is limited.
- Work on ipsilateral scapula and thoracic ST patterns.
- Manip if still limited (often will not be after ST work).
- Lock in with repeated ballistic whip thoracic rotation to the side of shoulder or limited side.
4. Lateral upper arm pattern:
- My go-to ST Pattern for the shoulder and radial neurodynamic dysfunction.
- Often has increased tone and mild restrictions.
- Work on ST so lightly that you are just touching and lightly scraping the skin no heavier than as light as possible using either the sharp or dull side of the edge or edgeility tools (or whatever you use).
- This improves often most shoulder motions and the aforementioned radial neurodynamic mobility.
5. Cervical and upper trap patterns on the same side of shoulder pain:
Limited range of motion (ROM) and pain on the left side, treat the agonists, not the antagonists.
- As simple as this message is, it requires a decent amount of unlearning not to "stretch" the antagonist to improve mobility.
- 1-2 minutes per pattern, I may provide the treatment longer and use a bit more force, but I was already on my way to treating lighter.
Just like any pattern, these happen commonly, but are not laws. Check these out on shoulder and general upper quarter pain/dysfunction and you may have a shortcut on your hands.
Do you have patterns you share with patients? Leave a comment below, I’d love to hear from you!
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