This comprehensive course will provide the knowledge and skills to master the shoulder in clinical practice, and will span from current literature, pathologies, and injury mechanisms, to clinical reasoning, evaluation and management. The participant will learn how to differentiate between treating functional and structural pathology, and how to best integrate manual therapy and exercise to improve patient outcomes and restore optimal function within an evidence informed, movement-based model.

After attending this program, participants will learn:

• Defining a framework of multi-modal, patient centred, and mechanisms-based model of clinical reasoning.
• A clinical and evidence based update on the anatomy and biomechanics of the shoulder complex Patho-anatomy, injury mechanisms and patho-mechanics.
• Review of the common, and not so common clinical conditions of the shoulder, including:

1. The Rotator Cuff: Tendinopathies and Tears

2. Instability: Multidirectional Instability, Bankart Lesions, SLAP Lesions

3. Acromioclavicular Joint: Distal Clavicular Osteolysis, ACJ Arthrosis
4. Frozen Shoulder

5. Peripheral Nerve ‘Entrapments’, Nerve-Related Shoulder Pain, and the Neurogenic Frozen Shoulder

6. Sternoclavicular Joint Dysfunction: Instability and Subluxation
7. Classifying and defining scapular dyskinesis
8. Comprehensive and evidence-informed examination of the shoulder
9. Optimal loading and rehabilitation strategies for the irritable, non-irritable, and degenerative patient presentations

Online Content Outline:

Module 0: The Mechanism Mapping Framework

Module 1: Functional Anatomy

Module 2: Injury Mechanisms, Pathology & Pathomechanics

Module 3: Kinesis and Dyskinesis of the Shoulder Complex

Module 4: Evaluation of the Shoulder in Clinical Practice

Module 5: Interventions Mechanism Mapping

Module 6: Managing the Shoulder in Clinical Practice

In Person Course Outline:

Section 1: Irritable Rotator Cuff Tendinopathy
Note: Irritable and non-irritable tendinopathies and the management thereof presume the possibility of non-operable partial tear.

• Theory: pathophysiology of cuff tendinopathy, clinical decision-making for a partial tear
• Principles and Goals: Back-Door Rehab, Reduce Sensitivity, Avoid Provocative Patterns
• Applications – Exercise: Pain-Free Patterns – Cardio, Standing Row, Split Stance Row, Deadlift, Carry, Goblet Squat, Motor Control, Isometric Loading (specific to the tendon)
• Applications – K-Tape
• Modalities: Class 4 Laser

Section 2: Non-irritable, Chronic Rotator Cuff Tendinopathy

• Theory: ID the perpetuating factors
• Principles and Goals: ID Primary Barriers to Recovery, and meaningful tasks, Identify Key Metrics – functional thresholds of stamina, strength, speed
• Applications – Exercise: Pain-Free Patterns – Cardio, Standing Row, Split Stance Row, Deadlift, Carry, Goblet Squat, Motor Control, Isometric Loading (specific to the tendon)
• Applications – STM for Primary Constraint
• Modalities: SWT

Section 3: Degenerative Tendinopathy, Massive Rotator Cuff Tear & GHJ OA 

• Theory: Prognosis Limited Rehab
• Principles and Goals: Optimize everything ‘else’, movement pattern retraining, functional threshold, build capacity
• Applications – Exercise: Thoracic Mobility, Stability, Strength.
• Applications – STM for Primary Constraint
• Modalities: SWT 

Section 4: Primary Scapular Dyskinesis, Motor Control Dysfunction with Secondary Tendinopathy

• Theory: Causes and Patterns of Scapular Dyskinesis
• Principles and Goals: Motor Control Retraining – Inside Out and Pattern-Specific Retraining
• Applications – Exercise: Supine 3mo, Supine mo with Weight, Quad Rock, Bear, Transitions from 3 mo supine to 5 mo side lying, to low oblique sit, push, pull and reach.
• Applications – STM for Primary Constraint
• Modalities: SWT
  

Section 5: Frozen Shoulder, Adhesive Capsulitis of Unknown Origin

• Theory: pathophysiology, anatomy and Bx of frozen shoulder
• Principles and Goals: 
  Irritable phase: back door rehab, optimize everything else, pain free movement, lifestyle management
  Non irritable: capsuloligamentous specific movement, mobilization and end rage loading, hanging
• Applications – Manual assisted mobilization and end range loading, exercise
  

Section 6: Apparent Frozen Shoulder with Neurodynamic Signs

• Theory: Plausible Mechanisms
• Principles and Goals: neurodynamic evaluation (r/o the spine, neurodynamic tests, palpation)
• Applications – Manual therapy and exercise: Neurodynamic Sliders + exercises included in frozen shoulder rehab
  

Section 7: Sternoclavicular Joint Subluxation, ft primary motor control dysfunction and secondary to trauma / injury

• Theory: anatomy and Bx of the SCJ
• Principles and Goals: Relaxation over Movement, Movement Control, Joint Centration Specific Patterns
• Applications – Exercise: 5 mo side lying, low kneeling, quad rock, bear, push and pull
• Applications – STM for Primary Constraint
• Modalities: SWT

 Section 8: Instability: Non-operative management of Capsuloligamentous / Capsulolabral Tear (ie Bankart Lesion)

• Theory: review of pathoanatomy and considerations for operative vs non-op management
• Principles and Goals: Motor Control, Stability, Stamina, Strength, Training Through Range, Exposure Training
• Applications – Practitioner Assisted: rhythmic stab, active-assisted ROM, isometric loading, ball 0’s / 8’s infinity, Czech and Turkish Get Up, Progressive Angle Pressing and Reaching
• Applications – STM for Primary Constraint
• Modalities: SWT

Section 9: Instability: Non-operative management of multi-directional instability secondary to hypermobility syndrome (capsuloligamentous laxity)

• Theory: hypermobility syndrome assessment and considerations
• Principles and Goals: Motor Control, Stability, Stamina, Strength, Training Through Range, Exposure Training
• Applications – Exercise: Thoracic Mobility, Stability, Strength.
• Applications – STM for Primary Constraint
• Modalities: SWT

Section 10: Non-operative management of SLAP Tear

Section 11: Long Head Biceps Tendinopathy and the Rotator Interval

• Theory: review of pathoanatomy and considerations for operative vs non-op management
• Principles and Goals: n/a.
• Applications – Exercise: Anterior Cuff, Rotator Interval Progressive Isometric Loading, same as above for tendinopathy – push, pull, carry, squat, DL
• Applications – STM for Primary Constraint
• Modalities: SWT

Section 12: ACJ, including review and management of distal clavicular osteolysis

• Theory: review of pathoanatomy and considerations for operative vs non-op management
• Principles and Goals: Motor Control and Movement Pattern Retraining, Back Door Rehab, Load Management
• Applications – Exercise: Thoracic Mobility, Stability, Strength.
• Applications – K Tape
• Modalities: SWT