Here is some of the information I recently shared in my May newsletter. Each newsletter has a specific focus. This month is focused on the shoulders and rotator cuffs. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
NOTE: This will be the final newsletter about Shoulders and Rotator cuffs. I want to thank each of you for your interest in receiving the newsletters. I know many of you are also receiving some of my other newsletters and those newsletter will continue. If you are not receiving the other newsletters and would be interested, please let me know to add you to the list: chronic pain & Fibromyalgia, upper cross and neck, foot & ankle problems, PTSD & trauma, fascia & trigger points, lymph & lymph drainage, cupping, aromatherapy.
STUDIES and ARTICLES
I receive a weekly update on anything published anywhere on the internet that includes information about shoulder and rotator cuff injuries and treatments. I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net
1. Whitney Lowe, on his website for Academy of Clinical Massage, posted a great article titled Hooked on Shoulder Pain which provides an excellent discussion of the subacromial space and impingement.
2. A study, titled Distorted distance perception to reachable points in people with chronic shoulder pain, published in Musculoskeletal Science and Practice in July 2019, suggested: this study aimed to investigate whether people with chronic shoulder pain show perceptual distortions of space and body that may promote protective behavior and concluded: results suggest that distorted perception is not a typical consequence of chronic shoulder pain, however, that it may occur in cases where pain is strongly linked to movement.
3. A study, titled Vibration as an adjunct to exercise: its impact on shoulder muscle activation, published in European Journal of Applied Physiology in May 2019, concluded: the use of vibration as an adjunct to exercise provokes a near-global increase in shoulder muscle activation level. Furthermore, exposure to vibration alters muscular recruitment improving readiness for movement.
4. A study, titled Degenerative rotator cuff tears are associated with a low Omega-3 Index, published in Prostaglandins, Leukotrienes and Essential Fatty Acids in Sept 2019, concluded: Patients with full-thickness degenerative rotator cuff tears had a significantly lower Omega-3 Index than controls without rotator cuff tendinopathy. Whether a lower Omega-3 Index represents an independent risk factor for degenerative rotator cuff tears should be further investigated, e.g. in a longitudinal study.
5. A study, titled Association between physiological and subjective aspects of pain and disability in post-stroke patients with shoulder pain: a cross-sectional study, published in Journal of Clinical Medicine, in July 2019, concluded: Post-stroke patients showed a relationship between widespread pressure pain hypersensitivity with lower pressure pain threshold levels and pain disability perception, suggesting a central sensitization mediated by bilateral and symmetric pain patterns.
6. A study, titled A randomized controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain published in the BMJ Open Sport & Exercise Medicine concludes: Omega-3 polyunsaturated fatty acids supplementation may have a modest effect on disability and pain outcomes in rotator cuff related shoulder pain.
7. A study titled Effects of Wiper Exercise and External Rotation Exercise in Side-Lying on the muscle activity and thickness of the infraspinatus, published in the International Journal of Pharmaceutical Research in March 2019, concludes: This study recommends the wiper exercise is a good indication for the selective and functional strengthening of the infraspinatus muscle while minimizing the posterior deltoid for shoulder dysfunction.
8. A study, titled Effects of Sling exercise with vibration on range of motion, muscle strength, pain, disability in patients with shoulder injuries, published in Physical Therapy Korea in Sept 2019, concludes: The sling exercise with local vibration of 50Hz affected the external rotation of the shoulder range of motion and improved shoulder flexor strength in the patients with shoulder injuries. Therefore, we propose the use of the sling exercise intervention with vibration in the exercise rehabilitation of patients with shoulder joint injuries.
9. A study titled Effect of fatigue and the absence of visual feedback on shoulder motor control in a healthy population during a reaching task, published in Gait & Posture in October 2019, concludes: Muscle fatigue and lack of visual feedback can compromise shoulder kinematics; lack of visual feedback decreased reaching accuracy; lack of visual feedback increased time taken to complete the task; the addition of fatigue did not increase the effect of the lack of visual feedback.
1. TIDBITS and UPDATES Muscle Energy Technique for Subscapularis Shared by Healthy Street on January 10
ASSESSMENT OF SUBSCAPULARIS
The therapist takes the patient's arm to 90 degrees of abduction and 90 degrees of elbow flexion – an assessment in this position is known as the 90/90 test. From this position, the therapist supports the patient's elbow with their right hand and the patient's forearm with their left hand. The therapist then takes the patient's arm into external rotation until a bind is felt. For normal range of motion of the subscapularis, the external rotation should achieve 90 degrees, i.e. the patient's forearm should be parallel to the couch. If there is shortness of the subscapularis, the range of motion will be less than 90 degrees.
MET TREATMENT OF SUBSCAPULARIS
PIR METHOD
The therapist takes the patient's shoulder into external rotation until a bind is felt. From the position of bind, the patient is asked to contract the subscapularis by internally rotating their shoulder. After 10 seconds and on the relaxation phase, the therapist applies traction to the shoulder joint (to prevent an impingement) and slowly encourages the shoulder into further external rotation.
RI METHOD
If the patient has discomfort activating the subscapularis, the antagonistic muscle of the infraspinatus can be activated instead. From the position of bind, the patient is asked to resist external rotation: this will contract the infraspinatus and allow the subscapularis to relax through RI. On the relaxation phase, a lengthening procedure of the subscapularis can then be performed.
🔑 The subscapularis is one of the rotator cuff muscles and is the main medial rotator of the glenohumeral joint. A subscapularis strain can result in referred pain to the area of the deltoid tuberosity.
Reference: MET John Gibbons
Here is some of the information I recently shared in my November newsletter. Each newsletter has a specific focus.  This month is focused on shoulder and rotator cuff information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
STUDIES, ARTICLES, and RESOURCES
I receive a weekly update on anything published anywhere on the internet that includes information about shoulders. I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net
1. A doctoral thesis titled “Is dry cupping as effective as a traditional exercise program in reducing shoulder pain in competitive swimmers”, published on the University of New Mexico digital repository, suggests: Studies have shown that cupping may be able to decrease pain by an average of 20mm of the Visual Analog Scale. This suggests that in the painful shoulder it may be used as an adjunct to exercise therapy but should not replace it as cupping does not address the underlying impairments that swimming induces not he shoulder.Â
2. A study titled “The prevalence of myofascial trigger points in neck and shoulder-related disorders: a systematic review of the literature" published in BMC Musculoskelet Disord in Jul 2018, concludes: Limited evidence supporting the high prevalence of active and latent MTrPs in patients with neck or shoulder disorders. Point prevalence estimates of MTrPs were based on a small number of studies with very low sample sizes and with design limitations that increased risk of bias within included studies.
3. A study, titled “Electrical stimulation in the treatment of hemiplegic shoulder pain: a meta-analysis of randomized controlled trials”, published in American Journal of Physical Medicine & Rehabilitation in Oct 2018, concludes: ES may be an effective pain management methodology for hemiplegic shoulders and may contribute to pain-free range of external rotation as well as ADL recovery. However, these results should be interpreted with caution, given the low number of selected studies and risk of potential bias.
4. A study titled ”Effects of age and sex on shoulder biomechanics and relative effort during functional tasks” published in Journal of Biomechanics in Nov 2018, concludes: Older compared to younger adults had >40% lower isokinetic shoulder abduction strength. The ratio of peak joint torque during six ADLs over the maximal isokinetic torque, i.e., relative effort, was higher in old (approx 52%) compared with young adults (approx. 22%, p<0.05). Relative effort in older adults was over 40% in overhead activities and particularly high in abduction and reaching tasks, over 60%. Healthy older compared with younger adults perform most ADL tasks involving the shoulder joint with nearly twice the level of relative effort. The concomitant reductions in maximal shoulder isokinetic torque and increases in relative effort may be related to the high prevalence of musculoskeletal pain and shoulder dysfunction in old age report in epidemiological studies.Â
5. A study, titled “Influence of thoracic posture on scapulothoracic and glenohumeral motions during eccentric shoulder external rotation” published in Gait & Posture, concludes:Â
6. A study, titled “A randomized controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain” published in the BMJ Open Sport & Exercise Medicine concludes: Omega-3 polyunsaturated fatty acids supplementation may have a modest effect on disability and pain outcomes in Rotator cuff related shoulder pain.
7. A study titled “Does altering sitting posture have a direct effect on clinical shoulder tests in individuals with shoulder pain and rotator cuff degenerative tears?” published in Physical Therapy Oct 2018 concludes: Changing posture while sitting did not directly affect pain provocation and pain levels during performance of three clinical shoulder tests (Neer, Hawkins-Kennedy, empty can) in subjects with shoulder pain and Rotator cuff degenerative tears.Â
8. A study titled “Increased risk of adhesive capsulitis among patients with gout: A nationwide population-based matched-cohort study” published in the International Journal of Rheumatic Diseases in Oct 2018 concludes: gout is an independent risk factor for developing Adhesive capsulitis.
9. A study titled “Diagnostic accuracy of the scapular retraction test in assessing the status of the rotator cuff” published in Orthopedic J Sport Med in Oct 2018 concludes: the SRT can accurately be used to clinically assess the status of the rotator cuff. This physical examination maneuver was found to be accurate, sensitive, and specific in diagnosing full-thickness RCTs. Additionally, our results indicate that it is equally as accurate to predict an intact rotator cuff tendon.
10. A study titled “Immediate effects of soft tissue massage on posterior shoulder muscle tightness: a preliminary study” published in Physical Therapy Kor concluded: Sort tissue massage on posterior shoulder muscle tightness is an effective method to increase acromiohumeral distance and range of motion in the horizontal adduction and internal rotation of the glenohumeral joint.
VIDEOS
Dr. Randale C. Sehrest provides a great anatomy review of the shoulder in his youtube video, Shoulder Anatomy Animated Tutorial.
Dr. Evan Osar provides a great video describing and demonstrating a strengthening exercise for Serrates Anterior.
 Dr. Stephen Fealy gives a brief overview of two different types of Labral injuries: Shoulder Labrum Tears: An Overview
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific bodywork topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The seven main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, cupping/lymphatic drainage, adult learning and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
1.Massage Offerings gives a good explanation and demonstration of a Levator Scapulae stretch.
2.Paula Nutting offers a video demonstrating Muscle Energy Technique for shoulder rotators and a video showing a great stability exercise for the shoulder
3.Jonathan Kuttner, MD, presents a CE course through Niel Asher titled Rotator Cuff Injuries which includes: easy-to-digest but comprehensive overview of the rotator cuff, common rotator cuff injuries, with a focus on trigger points and trigger point treatment protocols. The (140-page course text is fully illustrated and supported by 14 video classes that cover the anatomy, the evidence, and trigger point therapy protocols.)
I receive a weekly update on anything published anywhere on the internet that includes information about rotator cuffs and shoulders. Â Much of it is personal blogs, stories about athletes that are injured, etc., but some of the information can be helpful to practitioners. Â I try to glean the best of the information and provide a brief synopsis of the information and a link to find the full item yourself. Â If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net
1.Erik Dalton, on his blog page, offers an article titled “Bone on Bone - Treating Frozen Shoulder and Shoulder Impingement Syndrome which also includes a video case study.
2.Niel Asher offers an explanation and description of 5 shoulder stretches that can be done by clients.
3.A study, published in J Manipulative Physiol Ther in Jan 2017, titled Comparing Trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: a randomized clinical trial concluded: both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than Manual Pressure in the treatment of myofascial neck/shoulder pain.
4.A study published in J Sport Rehabil in May 2017, titled Infraspinatus isolation during external rotation exercise at varying degrees of abduction, concluded: ER should be performed in 0 degrees of abduction in order to maximize infraspinatus isolation. Slight abduction, such as placing a towel under the humerus, as recommended by some clinicians, may improve patient comfort, but did not increase infraspinatus isolation in this study.
5.A study in Clin Biotech (Bristol, Avon), in Jun 2017, titled The effect of a rotator cuff tear and its size on three-dimensional shoulder motion concluded: the massage posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.
6.A study in J Sci Med Sport in Aug 2017, titled Shoulder muscle activation patterns and levels differ between open and closed-chain abduction concluded: open-chain abduction is required to facilitate the stabilizing role of the rotator cuff and axioscapular muscles, in response to middle deltoid activity. Closed-Chain exercises may enable full range shoulder abduction earlier in rehabilitation programs, with an inherent stability and less demand on the rotator cuff.
7.A study in Med Probl Perform Art in Sep 2017, titled Effect of Arm Position on Width of the subacromial Space of Upper String Musicians, concluded: The acromial-humeral distance measurement decreased in the playing positions compared to resting positions. Treatment interventions that help musicians maximize the width of their subacromial space might help reduce the prevalence of shoulder pain in this population.
In the Alternative Health Care Arena
NONE IN THIS ISSUE
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The five main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
1.A youtube video, uploaded May 5, 2011, by Whole Health Partners, is an excellent review of the anatomy and cause of Frozen shoulder and the focus for relief. Frozen Shoulder - “The True Cause”.Â
2.Walter Fritz offers several stretches for shoulders and neck
3.Paula Nutting offers a myofascial release stretch for frozen shoulder in a youtube video: Frozen shoulder stretching options.
4. An article published in Know Surg Sports Traumatol Arthrosc in Nov 2016, titled Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side concluded: "the subacromial bursa appears well vascularized. The results of the present investigation showed that blood supply to the subacromial bursa at the caudal part and rotator cuff tendons on the bursal side was linked to the same arteries. The subcoracoid artery supplied interval rotator structures close to the caudal bursa."Â
5. An article, published in the European Journal of Orthopedic Surgery & Traumatology In April 2017, titled The clinical anatomy of the insertion of the rotator cuff tendons concludes: "The rotator cuff insertions according to most anatomical texts are described as being separate from one another. However, clear fusion of the tendon fibers exists with prior studies showing this interdigitation forming a common, continuous insertion onto and around the lesser and greater tubercles of the humerus…collectively, these findings indicate and strengthen evidence towards the notion that the rotator cuff muscles/tendons and the internal capsule are one complete and inseparable unit/complex….Functions of one rotator cuff muscle are not necessarily isolated but instead can be influenced by surrounding muscles as well.”
I receive a weekly update on anything published anywhere on the internet that includes information about rotator cuffs and shoulders. Â Much of it is personal blogs, stories about athletes that are injured, etc., but some of the information can be helpful to practitioners. Â I try to glean the best of the information and provide a brief synopsis of the information and a link to find the full item yourself. Â If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net
1.An article by Bahram Jam, published on the Advanced Physical Therapy Education Institute’s site, titled New Paradigms in Rotator Cuff Retraining concludes: “Rotator cuff strengthening exercises are frequently prescribed to address various shoulder dysfunctions and pain syndromes. The primary function of the rotator cuff muscles is to compress, stabilize and provide fine tune control at the glenohumeral joint. Most exercise programs focus on general strengthening and not on the fine tune control function of these muscles. The purpose of this article is to introduce clinicians to new concepts in rotator cuff retraining that focus on therapeutic exercises to assist these muscles in regaining their functional role as dynamic stabilizer son the glenohumeral joint.”
2.A study, published in Physiotherapy Jun 2017, titled Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: a randomized controlled trial concluded “open chain resisted band exercises, closed chain exercises and minimally loaded range of movement exercises all seem to be effective in bringing about short-term changes in pain and disability in patients with rotator cuff tendinopathy.”
3.A study published in J Hand Ther Nov 2016, titled Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: a randomized controlled trial, concluded: "addition of a structured RC strengthening program to TENS and joint mobilization in the treatment of adhesive capsulitis resulted in improvement in pain, ROM and function."Â
4.A study in Orthopedics in May 2017, titled Simvastatin exposure and rotator cuff repair in a rat model concluded: "simvastatin is a common medication prescribed for hypercholesterolemia that accelerates local bone formation…This study was conducted to investigate whether local and systemic administration of simvastatin increased tendon-bone healing of the rotator cuff as detected by maximum load failure…The use of systemic and local simvastatin offered no benefit over control groups."
5.A study published in the J Occup Environ Med in Feb 2017 (and repeated in numerous blogs and newspapers) titled Association between cardiovascular disease risk factors and rotator cuff tendinopathy: a cross-sectional study found: “Recent evidence has found potential associations between cardiovascular disease risk factors and common musculoskeletal disorders. We evaluated possible associations between risk factors and both glenohumeral joint pain and rotator cuff tendinopathy…Individual risk factors were associated with both outcomes. Combined, CVD risk factors demonstrated a strong correlation with glenohumeral joint pain and an even stronger correlation with rotator cuff tendinopathy. Results suggest a potentially modifiable disease mechanism.” The theory is decreased blood supply leads to pain and degeneration.
6.A six page illustrated handout is available to educate people about exercises to use for recovery after rotator cuff injury, or to strengthen their shoulder. This handout may be printed or downloaded from Health Information Translations for personal, non-commercial use. The handout is available in English, Spanish and Somali.Â
7. A study published in J Bodyw Mov Ther in 2012, titled Therapeutic effects of traditional Thai massage on pain, muscle tension and anxiety in patients with scapulocostal syndrome: randomized single-blinded pilot study summarized “the purpose of this study was to investigate the therapeutic effects of traditional Thai massage on pain intensity, pressure pain threshold, muscles tension and anxiety associated with scapulocostal syndrome…results indicated that the Thai massage group showed a significant improvement in all parameters after the first treatment session.”
In the Alternative Health Care Arena
1.Published in J Sci Med Sport, the article Effects of scapular taping on the activity onset of scapula muscles and the scapular kinematics in volleyball players with rotator cuff tendinopathy, concludes: scapular taping may enhance the neuromotor control of the scapular muscles. Whether it provides adequate support for normal scalar kinematics during arm movement in athletes with RC tendinopathy await for further studies.”
2.Published in J Rehab Med Mar 2017, the article Effects of Kinesio taping for stroke patients with hemiplegic shoulder pain: a double-blind, randomized, placebo-controlled study concluded: stroke patients with hemiplegic shoulder pain can experience greater reductions in shoulder pain and disability index, pain, and improvement in shoulder flexion, external and internal rotation after 3 weeks of kinesio taping intervention compared with sham kinesio taping. Kinesio taping may be an alternative treatment option for stroke patients with hemiplegic shoulder pain.”
3.Published in J Manipulative Physic Ther Jan 2017, the article Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder pain: A Randomized Clinical Trial, concluded: the aim of this study was to investigate short-term and long-term treatment effects of dry needling and manual pressure technique with the primary goal of determining of dry needling has better effects on disability, pain, and muscles characteristics in treating myofascial neck/shoulder pain in women. .. Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than manual pressure in the treatment of myofascial neck/shoulder pain.
4.Published in Orthop Traumatol Surg Res in May 2017, the article Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions, concluded: prolotherapy is an easily applicable and satisfying auxiliary method in the treatment of chronic rotator cuff lesions.
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The five main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
1. Walt Fritz shares a youtube video “MFR for the Anterior Shoulder and Intercostal Regions”. This is a short demonstration.
2.Paula Nutting posted a video on youtube, “Glenohumeral Treatment Techniques for shoulder pathology” focused on musculoskeletal treatment.
3.Paul Ingraham, published a self-help manual for people suffering from adhesive capsulitis (Frozen Shoulder Guide) on PainScience.com.
1.
An article by Bahram Jam, titled New Paradigms in Rotator Cuff Retraining, can be found on the APTEI website. Abstract: Rotator cuff strengthening exercises are frequently prescribed to address various shoulder dysfunctions and pain syndromes. The primary function of the rotator cuff muscles is to compress, stabilize and provide fine tune control at the glenohumeral joint. Most exercise programs focus on general strengthening and not on the fine tune control function of these muscles. The purpose of this article is to introduce clinicians to new concepts in rotator cuff retraining that focus on therapeutic exercises to assist these muscles in regaining their functional role as dynamic stabilizers of the glenohumeral (GH) joint.
2. A study, published in Evidence-Based Complementary and Alternative Medicine in 2013, titled Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis, by Kong, Zhan, Cheng, Yuan, Chen and Fang, Evaluated “the effectiveness of massage therapy for neck and shoulder pain.”
3.  A study, published in Journal of Manipulative Physiologic Therapy in 2010, by Bergman, Winters, Groenier, Meyboom-deJong, Postmen and Ven der Heijden, titled Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial, found “manipulative therapy, in addition to usual care by the general practitioner, diminished severity of shoulder pain and neck pain and improved shoulder and neck mobility.”
4.  An article, by John Borstad and Christopher Woeste, The role of sensitization in musculoskeletal shoulder pain, published in Brazilian Journal of Physical Therapy in 2015, found “peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the reports. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for it presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.”
5.  A study, published in the Journal of Bodywork & Movement Therapy in Jul 2016 by Gordon, Andrasik, Schleip, Birbaumer and Rea, “Myofascial trigger point release (MTR) for treating chronic shoulder pain: A novel approach” concluded “MTR resulted in clinically significant improvements in the primary measures of pain, objective mechanical tissue properties, and secondary measures in patients with chronic shoulder pain.”
6.  A study published in the Journal of Shoulder & Elbow Surgery in May 2016, “scapulohumeral rhythm relative to active range of motion in patients with symptomatic rotator cuff tears,” concluded: patients who reached at least 85 degrees compensated for the loss of glenohumeral motion by increased scapulothoracic contribution, suggesting that structural damage interferes with motion mechanics. In contrast, patients who reached less range of motion underused the scapulothoracic joint, which is likely to create subacromial impingement at low arm elevation, A patient’s maximal range of motion without pain may indicate a pattern of scapulohumeral rhythm alteration.”
7.  A study, published on Dovepress from the Journal of Inflammation Research, title Vitamin D and the immunomodulation of rotator cuff injury, concluded: In the tendon-to-bone healing process, vitamin D has been shown to successfully influence bone and muscle healing, but more research is needed to delve into the mechanisms of vitamin D as a factor in skeletal tendon health and healing.
8.  Dejaco, Habets, van Loon, van Grinsven, and Van Cingel published the results of a study, Eccentric versus conventional exercise therapy inpatients with rotator cuff tendiopathy: a randomized, single blinded, clinical trial, in Knee Surgery, sports traumatology, arthroscopy, which concluded: A 12-week-isolated eccentric training programme of the rotator cuff is beneficial for shoulder function and pain after 26 weeks in patients with rotator cuff tendinopathy. However, it is no more beneficial than a conventional exercise program for the rotator cuff and scapular muscles. Based on the results, clinicians should take into account that performing two eccentric exercises twice a day is as effective as performing six concentric/eccentric exercises once a day in patients with rotator cuff tendinopathy.
In the Alternative Health Care Arena
1.  Published in Acupuncture Medicine in Jun 2016, the study “randomized controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain" concluded “beneficial effects of contralateral acupuncture in the treatment of chronic should pain, both in terms of pain and function.”
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The five main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
1. An article published in Journal of Anatomy in Jan 2016, titled Fascial bundles of the infraspinatus fascia: anatomy, function, and clinical considerations is an in-depth looks at the connective tissue.
2. A book, published by the Department of Health and Human Services, the Agency for Healthcare Research and Quality, published a report, Nonoperative and Operative Treatments for rotator Cuff Tears: Future Research Needs in 2013, evaluated studies from 1990 through 2009 on interventions and their effectiveness.
3. A study published in the Journal of Bodywork & Movement Therapies in 2012, Therapeutic effects of traditional Thai massage on pain, muscle tension and anxiety in patients with scapulocostal syndrome; a randomized single-blinded pilot study is investigating the therapeutic effects of traditional Thai massage on pain intensity, pressure pain threshold, muscle tension and anxiety associated with scapulocostal syndrome.
4. Erik Dalton provides a very good explanation of joint misalignment in the shoulder in an article titled “The Wobbly Wheel Syndrome”.
5. A study published in the Journal of Neurological Sciences in Feb 2016, Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury, by Voe, Harris, Zhao and Barbe found three outcomes; therapy on rats over a 12 week repetitive motion task reduced adverse behaviors and improved task performance, manual therapy attenuated increases in collagen deposition in forearm tissues, including nerve, and investigation of manual therapy as a preventive for hand and wrist woe-related musculoskeletal disorders is indicated.
6. Rayner & Smale is a blog targeted towards Physiotherapists and other practitioners who are interested in learning about the latest evidence-based research. They have several blog posts focused on Shoulder Impingement Syndrome: The Role of the scapula in Shoulder Impingement Syndrome: Part 1, The role of the scapula in Shoulder Impingement Syndrome: Part 2, Scapula rehabilitation-Which exercise to Choose, and Shoulder Symptom Modification Procedure-Picking the Right Shoulders to Treat.
7. GuerrillaZen Fitness has a video showing a subscapularis self-release technique and a self-stretch that can be provided to patients for homework.
8. Paula Nutting gives a great demonstration of a Muscle Energy technique for treatment of Glenohumeral pathology on youtube.
9. A really nicely done video can be found on youtube that shows the rotator cuff muscles. There is no sound but none is needed. Anatolia cuff dei rotatori—Anatomie Rotatorenmanschette—Rotator Cuff Anatomy from the Ticinosthetics GainzSchool.
10. SHOULDER IMPINGEMENT SYNDROME is also known as SWIMMER’S SHOULDER or THROWER’S SHOULDER in the literature.
11. Dr. Evan Osar of Fitness Education Seminars, has a great video showing a powerful exercise for rotator cuff, rotator cuff injury, shoulder impingement syndrome that focuses on stabilization and centration.
1. A study titled A Multi-modal treatment approach for the shoulder: A 4 patient case series, by Mario Pribicevic and Henry Pollard, and published in Chiropractic & Osteopathy in 2005, combined Soft tissue therapy ischemic pressure and cross-friction massage, 7 minutes of phonophoresis with 1% cortisone, diversified spinal and peripheral joint manipulation and shoulder girdle muscle exercises for 4 clients diagnosed with shoulder impingement syndrome. All four subjects at the end of the treatment protocol were symptom-free with all outcome measures being normal. At 1 month patients continues to be symptom-free.
2. An article published in Physical Therapy by Dianne Jewell, Daniel Riddle and Leroy Thacker, Interventions Associate with an Increased or Decreased Likelihood of Pain Reduction and Improved Function in Patients with Adhesive Capsulitis: A Retrospective Cohort Study, includes a review of RCT’s and systematic reviews with a focus on various physical therapy treatments: laser, exercise, ultrasound, deep friction and Cyriax mobilization, heat and exercise.
3. A study from 2002, published in Occupational and Environmental Medicine titled Work environment and neck and shoulder pain: the influence of exposure time results from a population based case-control study studies associations between long term and short term exposure to different work environmental conditions and the incidence of neck or shoulder pain.
4. A study by Bergman, Winters, Groenier, Meyboom-de Jong, Postmen, and van der Heijden, Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial, published in Journal of Manipulative & Physiological Therapeutics in 2010 examines the effect of manipulative therapy on the shoulder girdle when added to usual care provided by the general practitioner.
5. “From these six published analyses of somatosensory function, sensitization appears to be a regularly occurring phenomenon in individuals with unilateral shoulder pain.” This statement is the premise for a study published in Brazilian Journal of Physical Therapy in Jul 2015
6. Dr. Andreo Spina addressed the concept of scapular mobility vs. “stability” and offers a demonstration of the Scapular End-Range Rotations exercise to increase functional mobility in a youtube video.
7. A video made at the Vancouver Fascia Congress in 2012, Vancouver Fascia Congress Shoulder Study—Myofascial Trigger point release shows the results of a pilot study, Assessment of Myofascial Trigger Point release with a novel Myometer (myotonPRO) in addition to an algometer.
8. A study published in Orthopedic Journal of Sports Medicine in May 2015, Structural Characteristics are not associated with pain and function in rotator cuff tears: The ROW cohort study, found pain and functional status were not associated with tear size and thickness, fatty infiltration or muscle atrophy.
9. Superior labral tears are diagnosed with high frequency using MRI in 45-60 year olds with asymptomatic shoulders, indicating these may be normal age-related findings. Orthopedic Journal of Sports Medicine, Jan 2016: High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients with Asymptomatic Shoulders.
10. Exercise seen as key in the treatment of Subacromial Shoulder Impingement Syndrome. Study published in Physical Therapy Mar 2016: Physical Therapists’ Perceptions and use of exercise in the Management of Subacromial Shoulder Impingement Syndrome: A Focus Group Study.
11. A pilot study to evaluate the short-term effect of kinesio taping (KT) on pain and motor ability of hemiplegic shoulder pain was published in the International Journal of Rehabilitation Research in Apr 2016 (Effect of kinesis tape application on hemiplegic shoulder pain and motor ability:a pilot study.
12. Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature, published in International Journal of Sports Physical Therapy in Apr 2016 presents an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries.