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  • Shoulder Injuries

    Shoulder Injuries

    Yesterday, I saw a woman for the first time who has a work related shoulder injury. She was not sent to me through workman’s compensation, she is paying out of pocket. Her doctors have been telling her that her pain and limited ROM are psychosomatic. One of the physical therapists she was sent to told the doctor she had real pain. So they agreed to an MRI and found a separated bicep tendon and small rotator cuff tear.

    They did surgery, which, in medical terms, was a success. Problem was she could not lift her arm above 90 degrees into flexion or abduction. Once again the workman’s compensation doctors told her the issue was psychosomatic. I met her at a networking meeting and worked on her for the first time yesterday.


    I tested the ROM in her right glenohumeral joint passively and actively. Her range was the same passively and actively. I felt the movement of the humerus as she moved her arm and could feel the humerus shift when she hit about 70 degrees into flexion. This is when she began to feel the pinch and her movement became restricted. Palpation told me several things. Her scapula was immobile. The inferior angle of the scapula did not move in any direction. The short head of her bicep was extremely tight. Serratus anterior was thick along the 5-8 rib and the tissue did not move. Latissimus dorsi was taut through the axilla and across the inferior angle of the scapula.

    I worked with the position of her humerus to change the tracking of her glenohumeral joint. I did a combination of SMRT positions for her scapula, moving her inferior angle toward the rib cage while doing a position for latissimus and shifting rib 5-7 for serratus anterior. Within 30 seconds her scapula moved, . The ability of the scapula to move would allow for upward rotation of the scapula when she did shoulder flexion.

    But, I thought it possible that she was also limited by the shortening of the short head of the bicep. The short head tendon of the bicep and the fibers that were continuous with the short head tendon were not elongating during active shoulder flexion. I went to her elbow. She told me she had been having elbow pain that felt like her forearm was being pulled into her chest.

    SMRT Works

    I used SMRT to do very specific work on the bicep. I believed that in the re-attachment of the long head of the bicep the fibers of the muscle continuous with that tendon had been permanently elongated. This had led to a shortening of the bicepital muscle fibers continuous with the short head tendon. By working with the position of the radius, the position of the coracoid process, and the elongation of the lateral fibers of the bicep muscle, she gained more space in the humeroradial joint, the radius had better range of motion, and the fibers of the bicep had more balance (i.e. the short head fibers were longer and the long head fibers were more active).

    I had her actively move her arm into flexion at the shoulder. She moved slowly, anticipating the pain, until her range stopped. I asked her if she had pain. She said very little. I asked to turn and look at her arm, which was at about 165 degrees. She was amazed and very happy. As I was checking her out, she said, “I’m impressed. One session with you and I feel better and move better than I have with anyone else.”

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