SHOULDER INSTABILITY

‘Bottom walking’ drills that encourage facil- itation of the gluteals and steps over obsta- cles will encourage trunk extension with appropriate gluteal activity and weight transfer to allow ‘optimal movement’ of the upper limb rather than the hamstring dom- inant, poor pelvic control, upper limb ‘fixed’ pattern that we often observe.

SUMMARY Patients with muscle patterning instabili- ty are a management challenge however; appropriate rehabilitation will achieve symptomatic improvement in up to 88% of patients (3). Tools such as The Stanmore Triangle promote increased understanding and recognition of this clinical presentation and help guide appropriate management. Patients with muscle patterning instability must not have inappropriate surgery and will fail exercise programmes based on strength- ening of the shoulder stabilisers. Effective rehabilitation must aim to re-educate optimal motor performance by addressing abnormal muscle sequencing. The thera- pist must consider all aspects of proprio- ception and motor control in devising effective rehabilitation strategies.

THE AUTHORS Jo Gibson is a clinical physiotherapy spe- cialist based at the Liverpool Upper Limb Unit and a partner in private practice. She lectures nationally and internationally about rehabilitation of the shoulder. Her research interests are shoulder instability and motor learning. Jo is co-author of the GOST booklet, a Guide for Orthopaedic Surgeons and Therapists outlining postop- erative management of shoulder patients. She was one of the co-founders of the First International Congress of Shoulder Rehabilitation which took place in Washington DC last year. Jo is currently squad physiotherapist for the GB Endurance Riding Team.

Joanne Elphinston B.Phty MA MCSP is an Australian physiotherapist, lecturer, author and performance consultant. She lectures internationally on applied stability con- cepts for performance and rehabilitation, and provides consultancy on the subject for national sporting bodies in sports including golf, tennis, kayak, rowing, track, swim- ming and badminton.

References 1. Guanche CA et al. The synergistic action of the capsule and other shoulder muscles. American Journal of Sports Medicine 1995;23:301-30 2. McAuliffe TB, Pangayatselvan T, Bayley I. Failed surgery for recurrent anterior dislocation

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International Shoulder group. Sept 4-6, 2000, Newcastle-upon-Tyne, UK 16. Shumway-Cook A, Woollacott MH. Motor Control; Theory and Practical Applications Second Edition. Lippincott, Williams and Wilkins 2001. ISBN 068330643X 17. Gibson JC et al. Expanded assessment in Multidirectional Instability: An aid to planning reahabilitation?

Proceedings of the

International Congress of Shoulder Surgery Washington DC 2004. 18. Hodges PW, Richardson CA. Feed forward con- traction of transversus abdominus is not influenced by the direction of arm movement. Experimental Brain Research 1997;114:362-370 19. Bullock-Saxton JE. Local sensation changes and altered hip muscle function following severe ankle sprain. Physical Therapy 1994;74:17-31 20. Myers TW. Anatomy Trains: Myofascial meridians for manual and movement therapists. Churchill Livingstone 2001. ISBN 0443063516 21. Kibler WB. Shoulder rehabilitation: princi- ples and practice. Medicine and Science in Sports Exercise 1998b;30:S40-S50 22. Myers JB, Lephart SM. Sensorimotor deficits contributing to glenohumeral instability. Clinical Orthopaedics and Related Research 2002;400:98-104 23. Mottram SL. Dynamic stability of the scapu- la. Manual Therapy 1997;2(3):123-131 24. Comerford MJ, Mottram SL. Functional sta- bility retraining: Principles and strategies for managing mechanical dysfunction. Manual Therapy 2001;6(1):3-14 25. Takwale VJ, Calvert P et al. Involuntary positional instability of the shoulder in adoles- cents and young adults: Is there any benefit from treatment? The Journal of Bone and Joint Surgery 2000;82-B(5):719-723 26. Riemann BL and Lephart SM. The sensori- motor system, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability. Journal of Athletic Training Jan-Mar 2002;37(1):80-84 27. Lephart SM and Henry TJ. The physiological basis for open and closed kinetic chain rehabil- itation for the upper extremity. Journal of Sport Rehabilitation 1996;5:71-87

Figs 14-23 are based on exercises from Joanne Elphinston’s new edition of ‘The Core Workout’ ISBN 0953985911. To order telephone 0870 6070381 or online at www.physique.co.uk

FURTHER READING ■ Carriere B. The Swiss Ball: Theory, Basic Exercises and Clinical Application. Springer 1998. ISBN 3540611444

■ Elphinston J and Pook P. The Core Workout: A Definitive Guide to Swiss Ball Training for Athlete’s, Coaches and Fitness Professionals. Core Workout 2004. ISBN 0953985911

■ Lephart SM and Fu FH Eds. Restoration of Proprioception and Neuromuscular Control of the Unstable Shoulder. Human Kinetics 2000. ISBN 0880118644

■ Posner-Mayer J. Swiss Ball Applications for Orthopaedic and Sports Medicine: Ball Dynamics International 1995. ISBN 0964534142

■ Shumway-Cook A and Woollacott MH. Motor Control; Theory and Practical Applications 2nd Ed. Lippincott, Williams and Wilkins 2001. ISBN 068330643X

www.sportex.net