Dr Lori Michener - Who's afraid of scapular dyskinesis?
Jan 24, 2025
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In this engaging discussion, Dr. Lori Michener, a Professor of Biomechanics and a leading physical therapist at USC, shares her expertise on shoulder rehabilitation. She delves into the evolving understanding of scapular dyskinesis and its relationship with shoulder pain. Dr. Michener emphasizes individualized treatment strategies over rigid adherence to scapular positions. The dialogue also covers tendon mechanics, the importance of tailored patient education, and the therapeutic value of attentive listening in physical therapy.
Dr. Lori Michener emphasizes that focusing on building physical capacity through strength training is more beneficial than altering an athlete's natural mechanics.
The reevaluation of scapular dyskinesis indicates that existing asymmetries may not correlate with pain, challenging traditional clinical interpretations of shoulder movement.
Deep dives
Understanding Shoulder Pain Management
Differentiating between biomechanics and coaching is crucial in managing shoulder pain, particularly in baseball players. Applying knowledge from biomechanics labs can optimize performance but attempting to change an athlete's natural pitching mechanics may introduce unintended issues. Dr. Laura Michener emphasizes that building physical capacity through strength training and load management is a more effective strategy than modifying mechanics. This perspective aligns with a consensus that while coaching staff understand acceptable variability in an athlete’s throwing style, altering those mechanics can lead to difficulties and additional injuries.
Reassessing Scapular Dyskinesis and Its Implications
Dr. Michener has shifted her stance on the significance of scapular dyskinesis, challenging previous notions that it directly contributes to shoulder pain. She notes that a wide range of scapular motion is normal, and many individuals exhibit asymmetries without experiencing injury. The extensive variability in scapular motion means that identifying pathological changes related to pain can be complex, as many people with noticeable dyskinesis do not report shoulder pain. This has led to a reevaluation of how clinicians interpret scapular movements in patients and the recognition that some abnormal motions may not correlate with any particular pathology.
The Evolving Understanding of Shoulder Impingement
The concept of shoulder impingement is being reconsidered in light of new evidence indicating that it may not be the primary cause of pain in many patients. Dr. Michener explains that current modeling and ultrasound research suggest impingement does not typically occur past certain degrees of shoulder elevation. This raises questions about the relevance of subacromial impingement as a diagnostic criterion and suggests that pain may arise from loading the tendon rather than mechanical impingement. Understanding pain as a result of tendon sensitivity rather than structural issues allows for a paradigm shift in treatment strategies, focusing on management rather than purely anatomical corrections.
The Role of Loading and Strength in Tendon Recovery
Strengthening exercises play a crucial role in treating rotator cuff-related pain, but the focus should be on muscle performance rather than just peak strength. Recent studies have demonstrated improvements in patients' ability to generate force quickly, which correlates with recovery, rather than simply measuring maximum strength. Effective rehabilitation should also aim to enhance the muscle's functional capacity, aligning with ongoing research about how loading influences tendon health. Dr. Michener points out that many patients may begin improving quickly, but ongoing assessments are critical, as some individuals may require more intensive training to optimize their recovery and mitigate persistent pain.
Dr Lori Michener (Professor of Biomechanics and Physical therapist) is a super expert on shoulder biomechanics and rehabilitation.
Today we talked about: - the role of biomechanics in pain and injury
- whether you need to be concerned with scapular movement/control
- changes in her clinical opinion
- shoulder "impingement" debates and so much more.
More about Dr Michener
The central theme of Michener’s funded research is to define optimal treatment pathways for patients with musculoskeletal shoulder disorders by focusing on characterizing mechanisms, defining classification and management approaches and determining optimal outcomes of care. Specifically, her main research aims are: 1) to elucidate the biomechanical and neurophysiological mechanisms related to the presence of pain and poor recovery, in order to 2) develop classification and management strategies to optimize functional outcomes and simultaneously 3) determine the optimal set of patient outcome measures that comprehensively capture activity limitations and participation restrictions to judge treatment outcomes. She is director of the Clinical Biomechanics and Orthopedic Outcomes Research Laboratory, and directs the development, collection and analysis of patient-rated outcomes and process of care in the USC Physical Therapy clinics, and serves as a resource for clinical research.
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