- 06:07 am
This paper, which was recently published on-line ahead of print, provides a critical and thought provoking review of current approaches to the rehabilitation of scapula dysfunction, in particular the ‘scapula stability paradigm’. Although clearly not written with neurological patients in mind it nevertheless proposes some key questions about clinical practice and conceptual thinking that are highly relevant to neurophysiotherapists.
Central to the author’s discussion is the concept of stability and whether normal biomechanical definitions of articular stability can be applied to scapulothoracic function given the functional need for movement adaptability of the scapula as part of ‘normal’ function. It is suggested that current clinical practice may have developed an over-emphasis on scapula stability. It also questions the interpretation of scapula muscle activation studies along with the concept of ‘muscle balance’ within the scapula stabilisers.
Motor control is considered which recognises that the nervous system priority is unlikely to be ‘ideal scapula position’ but rather the intended location and action of the hand. The need for system ‘robustness’ in order to deal with movement perturbation is suggested whilst stability is seen as the ability of the scapula to return to its ‘normal’ orientation. It is proposed that the key role of the scapula is to maximise the degrees of freedom for placement of the hand and to facilitate energy transfer (kinetic chain activity) to and from the arm.
This paper both challenges and in many ways supports neurological physiotherapy approaches to move-ment re-education, in particular the requirement for holistic analysis alongside progressive integration of dynamic activity in linked body segments to enable accommodation of a range of functional movement patterns.