THE USE OF POSTURAL RESTORATION FOR TREATMENT OF CHRONIC ROTATOR CUFF PATHOLOGY: A CASE REPORT

Int J Sports Phys Ther. 2020 Oct;15(5):832-839. doi: 10.26603/ijspt20200832.

Abstract

Background and purpose: Postural Restoration Institute® (PRI) theories and rehabilitation techniques focus on restoring balance to anatomical systems. Common postural asymmetries can present in athletes as dysfunctions and limitations. The purpose of this case report was to examine the use of PRI exercises and theories to address pelvic alignment, along with core stabilization, during treatment of shoulder dysfunction in a collegiate volleyball player.

Case description: A 22-year-old female volleyball athlete reported unresolved right rotator cuff tendinopathy. She presented with bilateral rib cage flare, anterior pelvic tilt, and bilateral ROM differences in hip and shoulder internal and external rotation. PRI® special test findings included a positive left and right Adduction Drop Test (ADT), positive left Extension Drop, and Hruska Adduction Lift test (left=2, right=3) indicating posterior exterior chain (PEC) pattern of dysfunction. The traditional shoulder rehabilitation program from the previous season was eliminated and a PRI based intervention was performed. Intervention exercises included the 90/90 dead bug diaphragmatic breathing, 90/90 hamstring hip lift, and right sidelying respiratory left adductor pull back. Exercises were performed as three sets of ten diaphragmatic breathing repetitions, a minimum of three times weekly prior to activity.

Outcomes: Likert scale ratings of pain decreased from a six pre-intervention to two. The left hip gained 10° of internal rotation and the right hip gained 14° of external rotation. Right shoulder internal rotation increased 15°. Hruska Adduction Lift improved to a four bilaterally (right by day 24, and left by day 31). Left extension drop test was negative following day 17.

Discussion: PRI® exercises focusing on core and pelvic stability translated to improved hip and shoulder ROM, and decreased shoulder pain associated with rotator cuff tendinopathy. By treating pelvic alignment with the PRI® exercises, the ROM imbalance and pain at the shoulder joint were addressed.

Conclusion: Incorporating PRI exercises and theories into the rehabilitation program of a volleyball player was useful in addressing underlying imbalances throughout the kinetic chain.

Level of evidence: 3b.

Keywords: Breathing exercises; Postural Restoration; rotator cuff pathology; shoulder; volleyball.