Recent E-mails

On Terminology used in the Impingement and Instability Manual…

I recently attended the I&I course and, in reviewing the information with my PRI co-workers,realized that terminology and what appear to be contradicitons in the written material have confused us.
The first thing I’d like to clarify is terminology on scapular position and movement from the manual.

1) The manual uses both ‘protraction/retraction’ and ‘abduction/adduction’. Historically these terms are used interchangeably and refer to the movement of the scapula on the thorax in a medial/lateral direction, following the contour of the ribs. The manual seems to use ‘abd/add’ to describe a component of pro/retraction. Is this correct? Why do you use both as they don’t occur as two separate movements that the scapula can do?  You also describe a Type III as being ‘retracted’, then define that as an ‘appearance’ of retraction because the left rib cage is more ‘posterior’ than the right.  Do you mean because of a left rotation of the ribcage (spine) and if so, are all of the ribs rotated, or do you mean a position of rib ER, and if so, which ribs?

2)  Under the Treatment Guidelines for Type I: #2 is Integration of ipsilateral upper trunk rotaion with the LEFT low trap. Which side are you talking about? Ipsilateral to what, and rotation in which direction?) The exercises are then all for the RIGHT low trap and triceps, so I don’ know what he really means. Under #4, he again uses ipsilateral and contralateral and doesn’t indicate what the reference side is.

1)  Protraction and retraction refer to the movement along the ribs.  Abduction and adduction is movement of the scapula away from the spine and towards the spine.

In the manual it is stated like this:

Translatory motion
                Upward/downward (elevated/depressed)
                Forward movement of linear translation away form vertebral column, rotation of scapula around the end                                                                                                             of the clavicle (winging) and anterior movement of the lateral end of the clavicle

You can abduct and adduct your arm and scapula without protracting or retracting.  A type III scapula is in an abducted state, shoulder is usually slightly higher (Right BC Pattern) or in an abducted position, because of the spine orientation to the right in this pattern and because of upper trap, clavicular head of SCM and levator scap co-activity. 

Abduction and adduction do not have to occur with protraction and retraction.  The scapula would protract and abduct and retract and adduct at the same time if the “contour of the ribs” were the same on each side.  Which we are certain, they are not. 

Type III on the left are more in a posterior or backward position of linear translation toward the vertebral column that is further away from the spine than their counter part on the right – primarily because of a larger more expanded posterior mediastinum on the left and because of the right rib cages positional influence on positioning the right scapula in a more protracted state.  If the right thorax was normally inflating the right scapula would abduct on active protraction. 

2)  Type I’s are most often seen on the right side so ipsilateral is referring to the right side.  
        “Enhance ipsilateral apical expansion” – right side
        “Integrate ipsilateral upper trunk rotation with left low trap” – right trunk rotation with left low trap
        “Facilitate contralateral thoracic abduction and ipsilateral thoracic adduction with ipsilateral low trap” – left thoracic abduction with right thoracic adduction and right low trap

Every exercise we have in the shoulder program could be considered a right low trap/tricep activity.  In the list provided on page 80 under Type I treatment guidelines, we have went through and picked activities that would also engage the left low trap with the right low trap.  The reason it is labeled a “right low trap and tricep” is because all of them have a right low trap and right tricep component to them.