The 40-year-old, competitive tennis player reports to you that she has had shoulder pain since the first of the tennis season. She is now unable to serve without pain. She has pain in the beginning of her warm-ups but before the match begins, the pain goes away about two hours after her match, her pain is significant. The pain is in the deltoid insertion.. The doctor has ruled out primary impingement and feels that the course of rehabilitation is necessary before the patient returns to play. On examination of the patient has full range of motion except that she lacks about 20 % external rotation. Pain occurs in the end range of movement and about 90° of elevation. She has a rounded shoulder posture. Her glenohumeral rotators and abductors are weak and painful. She has weakness in the lower traps and rhomboids.. You currently believe that posture is a contributing factor to her problem. What instructions when you get her to relieve the cause? What exercises will reinforce your efforts to change her posture? It’s been incorrect for some time, what soft tissue changes would you expect on this patient and what will need to be treated?
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