{"id":12378,"date":"2022-10-28T10:48:44","date_gmt":"2022-10-28T08:48:44","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=wiki&p=12378"},"modified":"2022-10-28T10:48:44","modified_gmt":"2022-10-28T08:48:44","slug":"shoulder-symptom-modification-procedure","status":"publish","type":"wiki","link":"https:\/\/www.physiotutors.com\/wiki\/shoulder-symptom-modification-procedure\/","title":{"rendered":"Shoulder Symptom Modification Procedure"},"featured_media":12379,"template":"","class_list":["post-12378","wiki","type-wiki","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":12379,"background_image_alt_text":"Shoulder Symptom Modification Procedure"},"heading":"Shoulder Symptom Modification Procedure (SSMP)","subheading":"Shoulder Assessment","content_editor":"","button_type":"internal_link","button_label":"Check our shop","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Assessment E-Book","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":""},"button_description":"Find this wiki on the Physiotutors platform"},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"

Learn<\/h4>"},"column_right":{"content_editor":"

Shoulder Symptom Modification Procedure (SSMP)<\/h2>\nWe wrote quite an extensive series on shoulder impingement based on Cools algorithm<\/a> from the year 2008. Through the use of several clinical tests, you should be able to identify the underlying pathological mechanism for the shoulder pain your patient is experiencing.\u00a0<\/span>\n\nUsually, the problem with pain provocation tests is that they commonly rate low in terms of specificity. In other words, it\u2019s practically impossible to isolate a single rotator cuff tendon from other structures such as the innervated bursae within the subacromial space, and form a diagnosis from the results.\u00a0<\/span>\n\nThe shoulder symptom modification procedure by Jeremy Lewis (2009)<\/a> looks at shoulder impingement in a way that could be described as mechanical shoulder pain.\u00a0<\/span>\n\nOnce the general assessment process meaning: history taking, ROM, strength tests, and neurological testing is done the clinician and patient will identify the pain-provoking movement or positions<\/span>\n\nFrom there on a four-stage process begins. The painful movement is performed and the clinician applies an algorithm of the following procedures and assesses for symptom modification, in other words: pain reduction.\u00a0<\/span>\n\nMeakins et al. (2018)<\/a> evaluated the SSMP regarding its inter-rater reliability and found a moderate inter-rater reliability of k = 0.47\n
\n\n[embed]https:\/\/www.youtube.com\/watch?v=sYTW7u6ZoCI[\/embed]\n\n<\/div>\nLet\u2019s say flexion of the shoulder is painful.\u00a0<\/span>\n\nOne stage of the SSMP is targeting thoracic kyphosis. If your patient demonstrates increased thoracic kyphosis, techniques to actively extend the T-spine like 'finger on the sternum' can be used,\u00a0 or passive techniques like taping or manual therapy are applied and then the painful movement is reassessed for change in pain. If thoracic maneuvers reduce the pain by 100% the assessment is complete and treatment targeted at the thoracic spine would start.<\/span>\n\n\"Thoracic\n\nIf thoracic modification did not alleviate symptoms 100%, the position of the scapula is altered using manual techniques for simple movements or taping for complex movements. This may happen in several planes for example elevation or protraction, or a combination of movements.\u00a0<\/span>\n\n \n\nThis is different from the scapular assistance test where you are assisting the scapula to move. In scapular modification, you place the scapula in a new starting positing allowing it to move from that position without assistance.<\/span>\n\n\"Scapular\n\nIf winging is apparent, manual stabilization or taping techniques are used. The painful movement is then reassessed.<\/span>\n\nThe third stage concerns the positioning of the humeral head within the glenoid fossa. For example: using a neoprene sling or manual pressure, an AP or PA force is applied and the painful movement is reassessed.<\/span>\n\nFurthermore, the painful movement is executed whilst simultaneously contracting surrounding muscles, for example, the external rotators or humeral head depressors.<\/span>\n\n\"Shoulder\n\n \n\n[cta]\n\n \n\nThere are a couple of orthopedic tests that are used in the SSMP or related to this post that you might find interesting:\n