Corrective Exercise: Muscle Imbalances Revealed Review – Upper (Part 3)

Written on September 29, 2011 at 4:29 pm, by Eric Cressey

This marks the third and final installment of my review of Muscle Imbalances Revealed – Upper Body.  In case you missed the first two parts, be sure to check out Part 1 (Dean Somerset) and Part 2 (Jeff Cubos).  In this third installment, I’ll cover the contributions from Tony Gentilcore and Rick Kaselj.  For the record, me combining these two into one installment in no way reflects how I felt about their presentations; I am just getting ready to leave for my anniversary this weekend, and need to cover them both quickly before I head out!

Tony, as many of you know, is a long-time friend of mine and works with me at Cressey Performance – and I’ve been harassing him for years now to put out a product.  He’s a great coach whose ideas and skills deserve to be showcased to a larger audience, and I’m glad that he finally got around to putting his name on something!

That said, it was a little tougher to evaluate Tony because we literally spend so much time together that our brains are very “synced up” – meaning that it’d tough for him to throw something new at me that we haven’t already integrated at CP.  That said, some highlights of Tony’s presentation:

1. I think he did a good job of distinguishing between how we program both reactively and proactively for upper extremity issues at Cressey Performance.  How one trains someone with symptoms is, in many cases, remarkably different from that same individual would be trained in the absence of those symptoms – even if the same movement impairments are present.  This is a crucial area of understanding for trainers who may want to get more involved on the corrective exercise side of things.

2. Tony outlines some of our horizontal pulling and scapular stabilization progressions.  I think the biggest take home is understanding that different people need different progressions.  Some folks with completely imbalanced programs can thrive simply from going to loads more horizontal pulling.  Others may be doing plenty of horizontal pulling, but doing it incorrectly because they lack the appropriate recruitment patterns.  These folks need very targeted scapular stabilization drills to get the ideal “big bang” effect of rowing variations.  The low-level activation drills become the warm-ups to groove the movement patterns, and the horizontal (and vertical) pulling helps to make those patterns part of the bigger picture.

3. Above all else, I feel that the strongest value of Tony’s presentation is in the cues.  If you’re an up-and-coming coach and need to learn some excellent cues to get your clients/athletes to not just pick up movements, but pick them up optimally, then this is a great purchase for you.

4. Last, but certainly not least, Tony provides some sample programming templates to demonstrate how everything fits together in a comprehensive strength training program.  It’s one thing to hear about principles and theories, but another thing altogether to appreciate how they all fit together in a comprehensive strength and conditioning program.  He provides several examples in this regard that’ll help you get comfortable with piecing everything together.

Next up was Rick Kaselj, the man responsible for bringing all these minds together.

Here were some of my favorite points from Rick’s presentations:

1. People seem to think of clavicle as motionless.  In reality, from 0-90° abduction, you only need 5-10° of clavicular upward rotation.  From 90-180° of abduction, you need 20-25° of clavicular upward rotation.  This clavicular movement can be affected by the muscles that attach directly to it (pectoralis major) or by those that indirectly impact it (muscles attaching to the scapula and/or humerus).

Now, think about where most people with acromioclavicular joint pain wind up with symptoms during abduction: the final 30° – which is known as the painful arc.  Any surprise that the symptoms occur at the point where the most amount of clavicular upward rotation is needed?  Nope.

Keep in mind that poor clavicular positioning can also impact sternoclavicular joint function, too.  Double whammy, if you’re “stuck.”

2. Rick did a good job of showing the checks and balances that occur within the rotator cuff musculature.  Shirley Sahrmann has pointed it out in her work, but I think it gets overlooked.

The supraspinatus creates a compression force into glenoid fossa.  The subscapularis, teres minor, and infraspinatus produce an inferior directed translation force on the humeral head.  The infraspinatus and teres minor also externally rotate the humeral head in frontal plane so that the greater tubercle doesn’t clog up the subacromial space.

In other words, you get a pull in, down, and into the “right kind of rotation (external rotation increases the subacromial space, whereas internal rotation closes it down).

One point I’d add to strengthen Rick’s case even further is that the subscapularis also has a posterior pull on the humeral head.  Without adequate subscapularis function during internal rotation, the pectoralis major can take over and draw the humeral head forward, causing anterior joint capsule irritation.

3. Rick’s last presentation focused on the neck, a complex area to understand for most fitness professionals.  He started off by emphasizing to get neck issues checked out, as they can be very serious.  His presentation then emphasized training strategies to prevent neck pain and work around it if it’s present.  Accurately, Rick noted that some of the big players on this front were:

a) breathing – diaphragmatic or overuse of accessory respiratory muscles?

b) posture – forward head posture or neutral spine?

c) tissue quality

d) range of motion (particularly the thoracic spine)

e) strength (particularly the deep neck flexors)

f) scapular stability

g) rotator cuff function

Sometimes, the easiest way to address an issue (or prevent it) is to look at what happens a joint below (or above).  Of course, when you’re dealing with neck issues, always refer out to a qualified professional first.

This wraps up my three-part review of Muscle Imbalances Revealed – Upper Body.  As I’m sure you can tell by now, I’m a big fan of this resource and highly suggest you add it to your library.  It’s on sale at a great price, so don’t delay in picking up a copy if this is up your alley.  With the money-back guarantee Rick’s made available, you can’t go wrong.

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3 Responses to “Corrective Exercise: Muscle Imbalances Revealed Review – Upper (Part 3)”

1. nick Says:
   September 29th, 2011 at 4:44 pm

   i agree completely eric. i got muscles revealed the other day and was impressed with the whole thing. Interstiing to mention the clavicle. as a kid i broke mine ( and its shorter on that side), have felt it had more to do with my scapula/neck issues. any advice on activation/mobility & stretches for a shortened clavicle ( dominant side)? thanks nick

2. Mike Says:
   September 30th, 2011 at 5:58 pm

   Eric, could you explain how the subscapularis has a posterior pull on the humeral head based on its attachment points? thanks

3. Fraser Dods Says:
   October 1st, 2011 at 8:47 am

   Eric, small point of clarification. The classic shoulder “painful arc” occurs between ~80 – 110 degrees of shoulder abduction as the greater tuberosity migrates upward towards the acromion to impinge the subacromial space before the humeral head drops as the arm moves >120 degrees to once again “clear” the subacromial space.
   Acromioclavicular issues are, as you suggest, exposed in the last 30 degrees of abduction, or even earlier in horizontal adduction (cross flexion).