The Problem
This was a brand new client of mine that was seeking help for his lack of shoulder range of motion from a collar bone break. He had informed me it was a snowboard injury and this was actually the second time his collar bone broke. He provided me with past imaging and to my relief, it was never a compound break. He was in a sling for a couple of weeks and he followed the natural healing course. I think what added to his stiff shoulder was he did not do much physical therapy to restore the strength and mobility. According to him, he more or less went back to normal weight training and that is when he found his lack of range of motion on his left arm.
The Assessment
I performed shoulder impingement and rotator cuff mobility tests. The most outstanding test was the overhead test. He described it as “physically stuck” trying to get his arm up from his quad. I identified that his shoulder was “stuck” in internal rotation and that is where I started with him.
The Solution
I informed my client that our main goal today was to restore his shoulder rotation by allowing his shoulder to externally rotate again. We needed to restore the spacing in your shoulder I told him and started with the big muscles first: chest and front delt. I later addressed his pec minor, sub scap and teres. I re-tested and he responded really well to that alone, but it was not up to my standards. I performed more tests specifically on his infraspinatus and found out that part of the rotator cuff needed to be addressed. It dawned on me that his arm position from being in a sling for weeks was the biggest issue. Of course the infraspinatus would be compromised in this position. I addressed this after I identified this and we achieved the range of motion I felt good about.
Conclusion
Understanding his arm position while in the sling was key. His arm was literally in this permanent internal rotation with no activity for several weeks. All in all, the result we achieved with one session was great. He was visibly happy after being able to move his arm above his head without much issue. I did recommend mobility and strengthening homework for his rotator cuff specifically to ensure his shoulder range of motion stays healthy.
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