Neurological Tightness and an Untrained Shoulder
This client injured her shoulder 6-weeks ago while reaching into the back seat of the car to grab a backpack. Upon lifting, she felt immediate pain and has since had pain when bringing her arm up overhead.
Local assessment revealed a limited range of motion in internal rotation, neurological tightness, and no stretch sensation.
External rotation: we had immediate neurological tightness, fear, and closing angle joint pain.
I applied positional isometrics (PAILs) to test whether or not we would get a positive PAILs test, i.e., a wider range of motion. Further, in my experience with cases like this one, this test will help reveal a more severe injury, such as a tear in the labrum or rotator cuff, for instance. Instead of a positive PAILs test, we would get a negative one. Whereby the range would not increase, neurological tightness would not subside, the pain would still be present, and the client would “block” the motion.
Using positional isometrics as our treatment strategy, we were able to decrease the neurological tightness, improve the zone of external rotation to 90 degrees with no closing angle pain, improve internal rotation indirectly, and get a nice stretch into the capsule in internal rotation.
Despite these results, her nervous system was still uneasy about the last few degrees of range of motion in external rotation. Her homework, using this yoga block set-up, keeps her in a safe zone within ~15 degrees of the end ranges, thus still affecting them.
Given the shoulder’s recent injury and the fact that this shoulder and nervous system haven’t experienced the fundamental motions of internal and external rotation, this is her training for the next several days until our next visit.
2xDAILY 25 repetitions in each direction.
Our intent is to experience the fundamental range of motion, to communicate with the CNS and map that sucker, move the shoulder without experiencing pain, and just get used to joint-specific training on their own. This shoulder is so untrained that any bit of good info we give it will gobble it up like a little fat kid.