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Increasing Client’s Muscular Power Research Paper
Increasing, Client’s , Muscular, Power, Research, Paper
For my final project, I want to focus on increasing a client’s muscular power. There will be some element of increasing strength as well, but the main focus will be on power. In addition to increasing power, I will also build into the program balance and agility training.
The three tests that I will be using are: Sahrmann core stability test (Gibson, Wanger, & Heyward, 2019) for core stability, standing long jump (Gibson, Wagner, & Heyward, 2019) for lower body power, and lastly the kneeling chest pass (Aipa, 2017) for upper body power. These tests will provide a baseline for the client’s muscular power and core stability, which is needed to generate power in the limbs.
There will be a total of five training days per week, broken down as follows:
Each workout session will train both upper and lower body, but more emphasis will be given to the lower body and core muscle groups, as that is where both power and balance are generated.
Based on the updated information, I have begun to narrow my differential diagnoses to swimmer’s shoulder/impingement, slap tear, rotator cuff tear.
Swimmer’s shoulder/impingement – Starkey and Brown (2015) and Tovin (2006) agree that swimmer’s shoulder, or internal impingement occur as the result of the rotator cuff tendons being compressed against the glenoid. Additionally, Starkey and Brown (2015) describe this type of impingement as “posterosuperior” (p. 667), which would fit the description of where the patient feels the pain (right on top of the glenohumeral joint to slightly posterior).
This can be the result of overuse (Starkey & Brown, 2015), and if the patient has never swam 2.4 miles before and started training to do so, then he is likely experiencing overuse through that area.
Slap tear – the area that the patient describes the pain is close to the where the labrum lies. This is the only thing that makes me think this could be the injury, as the patient reported no popping or clicking.
Rotator cuff tear – Harvard Medical School (2018) identifies repetitive reaching, such as swimming, as a mechanism to rotator cuff tears. Pain may be felt as the arm is lifted up and out and may even present itself at night (Harvard Medical School, 2018). The patient does have pain lifting his arm up and out of the water, and he did report pain at night, which makes me think that we have to consider a rotator cuff tear a possibility.
I would perform a posture assessment during the exam. If his shoulders are rounded forward, that could indicate tight chest muscles, which would alter scapular positioning, which could cause impingement-type symptoms (Cools et al., 2014). In addition to the posture assessment, I would have the patient actively abduct the arm. If there is a rotator cuff tear, then shoulder elevation and possibly lateral trunk flexion to the opposite side would be observed as compensatory movements.
After receiving the new information from our patient, I still feel as though Swimmer’s shoulder/impingement is a serious consideration for the cause of his pain. Hersh (2018) states that when dealing with a shoulder impingement, a patient is likely to have a constant pain in their arm.
This pain can be described as minor but constant according to Hersh. Additionally, Hersh characterizes this condition as having “night” pain, which also seems to coincide with our patient’s description. When we consider his training program, it is easy to see that our patient may be doing too much too soon. As Hersh further points out, shoulder impingements generally result from overuse.
After review, there are a few conditions I think we should eliminate as likely causes of our patient’s pain. The following are the conditions I would eliminate from our differential list: Torn Rotator-Cuff, Ruptured Tendon, Bone Fracture, and Dislocation. With these conditions, I do not feel our patient would continue swimming.
I am also inclined to remove SLAP as a potential cause of the patient’s pain. Cluett (2019) explains that patient’s experiencing SLAP tears often complain that the pain is “deep”. In opposition, our patient complains of a pain that is more superficial.
My new list of possible diagnosis after the new information provided is as follows:
In order to further determine the cause of our patient’s pain, I think we need to consider the use of imaging and undergo a barrage of range of motion and strength tests. By conducting an x-ray, we can further eliminate arthritis as a cause while also determining an impingement. Additionally, by undergoing a variety of range of motion and strength tests, we can determine if there are weaknesses or tightness located in specific areas. This would help us determine if a condition like Upper cross syndrome is possible.
My original differential was shoulder impingement, rotator cuff tendinopathy, and biceps tendinopathy. With the updated information I would consider biceps tendinopathy to be less likely due to the pain felt superior and posterior on the shoulder. The two diagnoses of shoulder impingement and rotator cuff tendinopathy are still possible. I would add glenohumeral instability due to the possibility of overuse causing laxity and decreased subacromial space (Allegrucci, Whitney, & Irrgang, 1994).
According to an article by Matzkin, Suslavich, & Wes (2016), the exam should consist of a postural exam looking at the neck, thoracic spine, and scapular position. The exam should also include cervical spine and shoulder ranges of motion as well as comparing shoulder strength bilaterally.
Scapulohumeral rhythm should also be assessed due to the possibility of scapular dyskinesis (Matzkin, 2016). Some tests for impingement are Neer’s test, Hawkins Kennedy, Impingement sign (Vizniak, 2020). Some tests for rotator cuff tendinopathy are the empty can test, Codman’s arm drop, and internal rotation lag sign (Vizniak, 2020).
Some tests for glenohumeral instability are load and shift (anterior and posterior), sulcus test, Faegin’s test, relocation test, and Norwoods posterior drawer test (Vizniak, 2020). I would also go through the mechanical diagnosis and therapy shoulder and cervical exam.
There is a possibility of shoulder pain that comes from the cervical spine which can be ruled in or out with end range loading. Shoulder end range loading can also be used to classify the patient’s condition. It has been shown that even when patient’s had positive impingement and rotator cuff tests that end range loading treatments had positive results (Kidd, 2013).
Based on the new information that was provided for our patient’s history, I would be leaning more towards shoulder impingement, rotator cuff strain, and rotator cuff tendinopathy. Shoulder impingement would still be in my differential partially because the location of the pain can correlate with this diagnosis.
The patient also reports he is experiencing sharp pain during the front crawl. This swimming style requires a variety of movements, with a few important ones being abduction and adduction. If these movements were the cause of pain, this would correlate with shoulder impingement. Rotator cuff strain would still be in my differential because of the patient’s increase in activity.
The patient does not have a history of swimming frequently, and since he has started training for his triathlon he has increased his swimming frequency to three times per week for at least 30-60 minutes. Since the patient doesn’t have a prior history of swimming this much, this opens to the door for an increased amount of stress to be placed on these joints during the activity.
I initially was thinking bicipital tendinopathy during last week’s assignment, but I would remove that from the differential. Bicipital tendinopathy patients would complain of pain more in the anterior aspect of their shoulder, and not the superior/posterior aspects (Vizniak, 2015).
With this being said, I think tendinopathy could still be a potential diagnosis so I would agree with the differential of rotator cuff tendinopathy. This diagnosis has the potential to affect our patient due to his increase in activity and repetitive motions. As far as the exam goes, I would begin with shoulder ranges of motion.
By assessing active, passive, and resisted ranges of motion we would be able to not only pinpoint which movements are provocative, but we would also be narrow down which type of tissue was involved. Since the patient is denying radiation, neurological exams would not be required but could still be completed to effectively rule out other conditions that weren’t mentioned in the differential.
Orthopedic assessment would include tests such as Neer’s test, Hawkins-Kennedy test, empty can test, Codman drop arm test, Apley scratch test, and Yocum’s test (Vizniak, 2015). These were just a few of the orthopedic tests that could be used in this case. Positive results from the Neer’s, Hawkin-Kennedy, empty can, and Codman drop arm tests would help support the diagnosis of shoulder impingement syndrome (Vizniak, 2015).
In regards to the rotator cuff strain and tendinopathy, tests like Apley scratch test, Yocum’s test, and Codman drop arm test could be used to help with these diagnoses (Vizniak, 2015). With a rotator cuff strain it would be expected for the patient to demonstrate an increase in pain with resisted ranges of motion, indicating more of a muscular involvement (Vizniak, 2015).
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