لخّصلي

Scapulohumeral rhythm:
Figure-14: Daynamic Hug for Sterngthen serratus anterior muscle
Figure-15: Elbow in the back pocket’-exercise
Figures-16&17: Serratus punch
Figure-18: Serratus punch
It is commonly accepted that the scapula plays an important role in normal shoulder function. (Cools A. M., 2003) In sports in which demands on the shoulder are extremely

high, the quality of movement depends on the interaction between scapular and glenohumeral kinematics. (Cools A. M., 2003)
Functional stability of the scapula requires optimal positioning, smooth muscular balance in the force couple around the scapula, and correct timing of muscle activity of the scapular rotators (Cools A. M., 2003).
The temporal sequence of recruitment and the level to which each muscle is activated during movement is important to factor in coordinating scapular motion with humeral elevation (Cools A. M., 2003). Because the scapula plays a critical role in controlling the position of the glenoid, relatively small changes in the action of the scapulothoracic muscles can affect the alignment and forces involved in movement around the glenohumeral joint (Cools A. M., 2003). These changes can lead to the tensile overload of the rotator cuff and to impingement symptoms.
In this case, after clinical evaluation a plan of care was made which included strengthening exercises for scapular muscles.
For patients with an imbalance in the scapular muscles, selective activation of the weaker muscle parts with minimal activity in the hyperactivity muscles is an important component in the reduction of the imbalance. Because a lack of activity in the lower trapezius, middle trapezius, and serratus anterior is combined with excessive use of the upper trapezius, the balance ratios UT/LT, UT/MT, and UT/SA are of particular importance.
In addition, the integration of shoulder girdle exercises into a global functional kinetic chain pattern has become a treatment goal in shoulder rehabilitation.
Stretching:
Self-stretching with mindful breathing was created to produce effects in the shortest amount of time in patients with myofascial pain syndrome. (Chaudhary, E. S. et al., 2013).
Self-stretching of the upper trap helps restore movement, decrease muscle spasm and tissue tension, contribute to a reduction in headaches, and help with certain types of recoveries from injury.
Mobilization:
Numerous researchers have examined the impact of using various soft tissue mobilization, but there is no universal treatment plan. Although different rehabilitation techniques and combinations are used by different researchers, the reported results vary (van den Dolder, Ferreira, & Refshauge, 2010; Yeun, 2017)
The protocol included manual soft tissue mobilization techniques combined with massage. Mobilization of the scapula, combined with a massaging of rhomboid major and minor muscles, serratus anterior muscle, and subscapularis muscle (Toteva & Dimitrova, 2022).

When performing the technique, the treated area was mobilized in a certain direction, degree, and pace, allowing simultaneous, effective impact on all massaged tissues. The main idea of this methodology is based on the knowledge that the neurophysiological stimulus of massage and the neurophysiological stimulus of passive movements have a relationship arising from their common point of impact on peripheral receptors located in the musculoskeletal system (Toteva & Dimitrova, 2022).
Home program:
Studies have shown that the use of physical therapy has decreased the costs of treating appropriate diagnoses by 72% while effectively treating the condition. However, exercise and physical therapy remain underused (Wendel, I., And Wyss, J., 2019).
Many patients might need further physiotherapy, the quality of the home-based self- exercises should be supervised (Rouleau D. M. et al., 2009 & Neer C.S.,.2002).