Upper trap overuse post RTC repair

Upper trap overuse post RTC repair (Full Version)

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VagusX -> Upper trap overuse post RTC repair (April 3, 2003 5:51:00 AM)
I am interested in any input that can be given about UT overuse. Being that I learned very little to nothing about this phenomena during school and also not finding much info on the web or through co-workers I was interested in seeing some techniques that other people were using to reduce UT overuse and to activate lower trap. So far I have been using mirrors to help my patients visualize their movments focusing on reducing "the cringe" as I call it. Also been working on static scap retractions while flexing the GH jt. If anybody has any research articles available as well I would be greatly appreciative. Thanks everybody. Dan Vagus X

Barrett -> Re: Upper trap overuse post RTC repair (April 5, 2003 4:32:00 AM)
Dan, There are plenty of people on this forum who will probably suggest various methods designed to get the trap to relax in response to heavy pressure or reciprical inhibition. It sounds like you're already attempting some simple learning. Personally, I have no faith in any of these methods. Consider this: The muscle only contracts when the brain tells it to, not in response to weakness elsewhere, lack of awareness or stupidity. You describe something that is happening as the end result of an instinct, and instinct can only help us. Activity such as this is unconsciously motivated and should be allowed to complete its task. The patient will only do this and then relax the muscle in the presence of a therapist willing to express permission and acceptance. Don't wonder why you never learned this in school. I never met anyone who did. See "Body Counseling" and the essays about ideomotor activity on my web site for a great deal more on this. barrettdorko.com

coloradojulie -> Re: Upper trap overuse post RTC repair (April 6, 2003 5:47:00 PM)
I agree the trap pattern is a learned response to injury and now surgery. If the supraspinatus was torn, the first 30 degrees of abduction were compensated for, possibly by the trap elevating the scapula. We wouldn't really want that to continue because it leads to impingement and inferior capsular tightness in the long run. Most patients can't help themselves even with verbal cues etc. but you will find the recruitment range getting later and later as they get stronger. I reinforce as mentioned above quality movement is more important that quantity. I don't agree that we should let patients continue in compensatory ways, because I feel it leads to other consequences down the road. Like our limping patients. Many of whom learned this motor pattern with their injury, yet when brought through gait training work, resolve the limp and wonder "why was I still doing that?" Most things like this are protective, or pain avoiding behaviors, but if left unchecked can persist.

PTupdate.com -> Re: Upper trap overuse post RTC repair (April 6, 2003 6:31:00 PM)
I began a simple yet effective strengthening activity about 7 years ago that has enabled me to gain full active elevation, often with up to 5lbs in the hand, even in persons with a complete tear. Have the person sit in a chair, and then hold their hand, palm up, right next to their ear. Kind of the way a waitress would be holding a tray of food. Then have the person push straight up to the ceiling, and you may need to stand in front and provide a little support with their hand, which will instead want to thrust forward. Give them something moveable with your own hand as you guide their palm skyward. It seems to facilitate some inferior humeral translation, instead of the superior "jam" that it usually does with weakness. One can begin to add weights, and while they may require some help during the concentric push, they can often control the eccentric return on their own. It takes some touch to make them perform at their max, providing the bare minimum of help, but it works quite well. Of course, other techniques, including scapular stabilization, isokinetics, and even NMES help in the program. I have had quite a few patients who have been told they would never functionally raise their arm again, get told by another MD to "go see Duffy, he'll get you raising your arm" John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]

VagusX -> Re: Upper trap overuse post RTC repair (April 7, 2003 6:39:00 PM)
You guys are awesome. My theory, which is not scientific, for decreasing the amount of UT use is to deter an abnormal movement. The diagnosis of the patient in which I was asking this question about was a large labral tear with a small RTC repair. the MD ordered AROM and thats it. So my fealing is that I wanted to restore normal muscular firing as soon as possible. I have another question that is basic but I have been wondering about. When somebody has a surgery what is the main cause for the weakness? I am refering mostly to a repair that involves the labrum. The labrum which I think of being avascular/aneural would not cause an excessive amount of weakness. Is is the invasivness of the surgery or the inflammatory process? I really appreciate all the thoughtful responses. Dan

PTupdate.com -> Re: Upper trap overuse post RTC repair (April 8, 2003 5:15:00 AM)
Dan, The weakness is from both the invasiveness of the surgery (especially if done open as opposed to scope), the trauma, and inflammation. NOIgroup.com will have tons of well written explanations for the neurological basis, and Barrett will have some good explainations as well. Just look at your typical athlete with a knee surgery. One day prior to surgery he is performing SLR with 20lbs easily, one day after he cannot even perform a decent quad set. I am an advocate of actually getting in and viewing the surgery. One cannot appreciate the whole process until he is standing there watching the surgeon digging his finger into the tissue, seperating muscle bundles, fascia and fat. Cauterizing open vessles and fasia, blunt dissecting tissue, chipping away bone for an acromioplasty. It is trauma, and no wonder they are sore and can't/won't move the joint. Just got a new student yesterday who was telling me about his viewing of a total knee, and he now understands their misery when he had to go get them out of bed the nexy day! Duffy [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]

coloradojulie -> Re: Upper trap overuse post RTC repair (April 8, 2003 7:01:00 PM)
My thought on that based on literature and experience, is that pain and inflammation are inhibitory to the surrounding musculature. I suppose this could happen for several "protective" reasons. That is why, the priority of early post surgical rehab, no matter what joint, is pain and inflammation control. Without that, very little can follow.

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