Home Posts tagged "Rotator Cuff Exercises" (Page 2)

How Physical Maturity Impacts Pitching Mechanics and Muscular Recruitment

For today's post, I wanted to share with you an excerpt from my popular resource, Sturdy Shoulder Solutions.

In addition to the injury implications of this presentation, I think we also have to consider how much it ties into the concept of accelerating development of young pitchers by getting them strong in the right places. Early strength and conditioning can help to facilitate the proper muscular recruitment patterns (i.e., using lats more than the rotator cuff and biceps) to generate higher levels of velocity.

To learn more about why the minutia often matters so much when it comes to the shoulder girdle, be sure to check out www.SturdyShoulders.com.

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Strength and Conditioning Stuff You Should Read: 6/9/18

Happy Saturday! This edition of "stuff to read"is a few days late in light of the Major League Baseball Draft and release of my new resource, Sturdy Shoulders Solutions. As a quick reminder, it's on sale for $50 off through the end of the day tomorrow (Sunday). You can learn more at www.SturdyShoulders.com.

With it being a shoulder product, I figured I'd use this week to "reincarnate" some upper extremity content from my archives:

Are You Packing the Shoulder Correctly? - Most people don't appreciate the relevant anatomy involved in packing the shoulder, so that may actually utilize the wrong muscles to get the job done. This webinar delves into the topic in detail.

3 Tips for Improving Your Back to Wall Shoulder Flexion - This video demonstrates a few quick and easy cues to improve your capacity for overhead reaching.

Exercise of the Week: Standing External Rotation Holds to Wall - This exercise is a great fit for everyday lifters and baseball players alike, as it builds rotator cuff strength without any equipment.

Top Tweet of the Week

Top Instagram Post of the Week

Have a great weekend!

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Denver, CO Seminar Announcement: June 24, 2018

I just wanted to give you a heads-up on one-day seminar with me in Denver, CO on Sunday, June 24, 2018.

Cressey scapula

We’ll be spending the day geeking out on shoulders, as the event will cover Shoulder Assessment, Corrective Exercise, and Programming.  The event will be geared toward personal trainers, strength and conditioning professionals, rehabilitation specialists, and fitness enthusiasts alike.

Agenda

9:00AM-9:30AM – Inefficiency vs. Pathology (Lecture)
9:30AM-10:15AM – Understanding Common Shoulder Injuries and Conditions (Lecture)
10:15AM-10:30AM – Break
10:30AM-12:30PM – Upper Extremity Assessment (Lab)
12:30PM-1:30PM – Lunch
1:30PM-3:30PM – Upper Extremity Mobility/Activation/Strength Drills (Lab)
3:30PM-3:45PM – Break
3:45PM-4:45PM – Upper Extremity Strength and Conditioning Programming: What Really Is Appropriate? (Lecture)
4:45PM-5:00PM – Q&A to Wrap Up

Location

Landow Performance
7094 S Revere Pkwy
Centennial, CO 80112

Continuing Education Credits

The event has been approved for 0.7 CEUs (7 contact hours) through the National Strength and Conditioning Association (NSCA).

Cost: $199.99 Regular Rate

Click here to register using our 100% secure server!

Note: we'll be capping the number of participants to ensure that there is a lot of presenter/attendee interaction - particularly during the hands-on workshop portion - so be sure to register early, as previous offerings of this evan have sold out well in advance of the early-bird registration deadline.

Looking forward to seeing you there!

Questions? Please email ec@ericcressey.com.

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Checks and Balances in the Shoulder of the Throwing Athlete

For today's guest post, I've collaborated with physical therapist Eric Schoenberg, one of my co-presenters at the Elite Baseball Mentorship. Enjoy! -EC

The #1 reason why a player or team does not succeed in baseball is injury. Today, there is a surplus of information, but at the same time a lack of basic understanding of how to keep a baseball player healthy. When in doubt, you can never go wrong by understanding and relying upon anatomy and quality human movement.

One key principle to understand in this regard is that there is a tremendous system of checks and balances working at the shoulder girdle to make sure that we control both the big movements (osteokinematics) and subtle joint movements (arthrokinematics) in a small window for health and performance. If we look to anatomy, we can appreciate a very important concept by looking at the attachment points for the deltoid, latissimus dorsi, and pectoralist major: your three biggest prime movers in the upper extremity. You'll notice that all three attach on the shaft of the humerus, not the humeral head. Take a look at their attachment sites on this anatomical chart, and then compare them to where the rotator cuff (supraspinatus, subscapularis, teres major, and teres minor) attach further up on the humeral head.

Source: http://howtorelief.com/humerus-anatomy-bony-landmarks-muscle-attachment/

You can appreciate that all these big muscles attach on the anterior (front) aspect of the humerus, which means that they have powerful pulls into internal rotation that have to be counteracted by fewer, smaller muscles that attach on the posterior (back) aspect of the shoulder.

Here are three specific implications of these anatomical observations that relate to how you manage your throwing athletes:

1. The Deltoid is strong/active enough!

The deltoid works in conjunction with the supraspinatus to form a “force couple.”

Source: www.MikeReinold.com

If the strength, recruitment, or timing of the deltoid is greater than the supraspinatus, then the result will be superior migration of the humeral head in the glenoid. This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.

Tip: Be sure that athletes feel rotator cuff strengthening exercises in the cuff and not the deltoid or biceps.

2. The lat is strong/active enough!

The lat (as it acts on the scapula) is opposed by the serratus anterior, lower trapezius, and upper trapezius to control scapular rotation. Increased relative stiffness of the lat results in excessive scapular depression and downward rotation at rest.

Additionally, if you have decreased activation or muscle performance of the scapular upward rotators and elevators with overhead motion, the outcome will be inferior migration of the glenoid on the humeral head.

This results in superior humeral head stress (chondral defect), undersurface rotator cuff tear, labral pathology, among other structural injuries to the glenohumeral joint.

Tip: Be sure that the athlete’s programs have a good balance of overhead reaching tasks done with proper mechanics and timing of the glenohumeral and scapulothoracic joints.

3. The pecs are strong/active enough!

Pectoralis major's impact on the anterior glenohumeral joint is opposed by the rotator cuff to prevent anterior humeral glide. Effectively, the pec and lats want to pull the ball forward on the socket as the arm goes through gross movements, and the rotator cuff works hard to prevent this gliding at the joint level.

Dominance of pec major over the rotator cuff muscles (namely subscapularis) will play a role in an athlete presenting with anterior humeral glide. We often hear the athlete report “tightness” in the front of the shoulder and their first option is to "stretch it."

This can lead to anterior shoulder pain and potential structural pathology including anterior joint laxity, biceps tendon pathology, and labral pathology – all common injuries in throwing athletes.

Tip: Rather than trying to decrease the “tightness” in the front of the shoulder by aggressively stretching—instead, focus on improving static alignment, proprioceptive awareness, and recruitment of the cuff. If you couple this with some self-massage work, this approach will yield far more favorable results.

In closing, the shoulder joint is happiest when alignment is optimal. Injury will occur if preferred alignment is altered. Examples of altered alignment at rest or with movement are the humeral head is riding too high in the socket, the socket is riding too low on the humeral head, or the humerus is gliding too far forward. The resultant stress to the active or passive restraints of the shoulder leads to injury and loss of playing time. Do yourself (and the players that you work with) a favor and master the basics to help improve success on the field.

Looking to learn more about our unique approach to assessing and managing throwing athletes? Check out the upcoming Elite Baseball Mentorship Upper Extremity Course on January 14-16, 2018. For more information, click here.  The early-bird registration discount ends tonight at midnight.

About the Co-Author

Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship Seminars at Cressey Sports Performance. He can be reached at eric@momentumpt.com.
 

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Should You “Balance” Your Pushes and Your Pulls?

A while back, I posted on social media about how I think the concept of balancing pushes with pulls in your programming is outdated. It received some hefty debate, so I thought I'd delve into the topic a bit further in today's video.

To learn more about how I assess, program, and coach at the shoulder joint, be sure to check out Sturdy Shoulder Solutions.

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Optimizing and Progressing Arm Care

The prone horizontal abduction - also known as a "T" - is well known as a popular arm care exercise that has been around for decades. Unfortunately, it's commonly performed incorrectly. In today's video, I cover the most common mistakes - and then add a progression I like to use with folks once they've mastered the technique. Check it out:

Keep in mind that these cues also apply to "T" drills you perform with bands, TRX, or any other implements as well.  

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Random Thoughts on Sports Performance Training – Installment 29

I didn't get in a May installment of this series, but the good news is that it gave me two months to gather my thoughts for a big June! Here goes...

1. Athleticism is doesn't have to be max effort if you have a strength and power "reserve."

Cressey Sports Performance athlete Logan Morrison is currently second in Major League Baseball in homeruns. I came across this video of #22 on Twitter and it immediately got me thinking:

Hitting bombs in the big leagues - particularly on 95mph sinkers - is really challenging, but that looked absurdly easy. He put some force into the ground, got himself in a good position to succeed, and athleticism "happened."

The only reason this is possible is that he's developed a strength and power "reserve." LoMo is strong - and more importantly, he's a powerful dude. When he throws a medicine ball, in many cases, the entire gym stops and watches because it sounds like he's going to knock the wall down. When you've got a foundation of strength and know how to use it quickly, this kind of easy athleticism happens. It does not, however, happen if you're a) weak or b) strong and not powerful. I'd call LoMo a nice blend on the absolute strength-to-speed continuum.

2. If you're struggling to feel external rotation exercises in the right place, try this quick and easy fix.

One of the reason some throwers struggle to "keep the biceps" quiet during external rotation drills is that they start too close to the end-range for external rotation. A quick strategy to improve this is to simply build a little success in a more internally rotated position. This video goes into more depth:

3. Be cautiously optimistic with new surgical advances.

On a pretty regular basis, we hear about remarkable sports medicine breakthroughs that will revolutionize the way we prevent and treat both acute and chronic diseases and injuries/conditions. Unfortunately, they usually don't live up to the hype. Most of the time, we're talking about a "miracle" supplement or drug, but sometimes, we have to ponder the benefits of a new surgical procedure.

In the mid 1990s, the thermal capsulorrhaphy procedure was introduced to attempt to treat shoulder instability. It gained some momentum in the few years that followed, but the outcomes didn't match the hype in spite of the fact that the initial theory seemed decent (heat can shorten capsular tissues, which would theoretically increase shoulder stability). Failure rates were just too high.

Conversely, in 1974, Dr. Frank Jobe revolutionized the way elbow pain was treated in baseball pitchers - and saved a lot of careers - when he performed the first successful ulnar collateral ligament reconstruction (better known as Tommy John Surgery). More than 1/4 of MLB pitchers have had Tommy John, so you could say that this procedure revolutionized sports medicine even though it's taken decades to fine-tune it.

More recently, a new surgery - the UCL repair with internal brace -  has been gaining some steam as an alternative to Tommy John surgery. The initial results have been very promising, particularly in situations where the patient is a good match (depending on age, activity level, and location and extent of the UCL tear). I've actually seen two of these surgeries in the past week myself. One pitcher (Seth Maness) was able to successfully return to the Major Leagues after having it - but we still have a long way to go to determine if it might someday dramatically reduce the number of Tommy John surgeries that take place. Why? 

Right now, we only have statistics on a limited number of these cases, and they're usually in the high school and college realms. All that is reported on is return to previous level of competition (e.g., varsity baseball). We don't know whether a kid that has it at age 16 is still thriving with a healthy elbow at age 22 during his senior year of college.

Additionally, Seth Maness has really been an 88-90mph pitcher throughout his MLB career. We don't know if this same level of success will be seen with 95-100mph flamethrowers. 

Dr. Jeffrey Dugas has become known as "the guy" when it comes to these procedures, and I loved the fact that he reiterated "cautious optimism" in his webinar at the American Sports Medicine Institute Injuries in Baseball course earlier this year. If this gets rolled out too quickly and in the wrong populations, the failure rate could be significantly higher and give an otherwise effective surgery a bad name.  I think it's important for all of us to stay on top of sports medicine research to make sure we don't miss out on these advancements, but also so that we know to be informed consumers so that we don't jump behind new innovations without having all the information we need.

Speaking of the ASMI Injuries in Baseball Course, it's on sale for $100 off through this Sunday, June 24, at midnight. I've enjoyed going through this collection of webinars, and I'm sure you will, too. You can check it out HERE.

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Washington, DC Seminar Announcement: September 17, 2017

I just wanted to give you a heads-up on one-day seminar with me in Washington, DC on Sunday, September 17, 2017.

Cressey scapula

We’ll be spending the day geeking out on shoulders, as the event will cover Shoulder Assessment, Corrective Exercise, and Programming.  The event will be geared toward personal trainers, strength and conditioning professionals, rehabilitation specialists, and fitness enthusiasts alike.

Agenda

9:00AM-9:30AM – Inefficiency vs. Pathology (Lecture)
9:30AM-10:15AM – Understanding Common Shoulder Injuries and Conditions (Lecture)
10:15AM-10:30AM – Break
10:30AM-12:30PM – Upper Extremity Assessment (Lab)
12:30PM-1:30PM – Lunch
1:30PM-3:30PM – Upper Extremity Mobility/Activation/Strength Drills (Lab)
3:30PM-3:45PM – Break
3:45PM-4:45PM – Upper Extremity Strength and Conditioning Programming: What Really Is Appropriate? (Lecture)
4:45PM-5:00PM – Q&A to Wrap Up

Location

Beyond Strength Performance NOVA
21620 Ridgetop Circle
Suite 100
Dulles, VA 20166  

Continuing Education Credits

The event has been approved for 0.7 CEUs (7 contact hours) through the National Strength and Conditioning Association (NSCA).

Cost:

SOLD OUT! Please email ec@ericcressey.com if you'd like to be added to the waiting list in case a spot opens up.

Note: we'll be capping the number of participants to ensure that there is a lot of presenter/attendee interaction - particularly during the hands-on workshop portion - so be sure to register early, as the previous offering sold out well in advance of the early-bird registration deadline.

Looking forward to seeing you there!

Questions? Please email ec@ericcressey.com.

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New York Seminar Announcement: August 20, 2017

I just wanted to give you a heads-up on one-day seminar with me in New York on Sunday, August 20, 2017.

Cressey scapula

We’ll be spending the day geeking out on shoulders, as the event will cover Shoulder Assessment, Corrective Exercise, and Programming.  The event will be geared toward personal trainers, strength and conditioning professionals, rehabilitation specialists, and fitness enthusiasts alike.

Agenda

9:00AM-9:30AM – Inefficiency vs. Pathology (Lecture)
9:30AM-10:15AM – Understanding Common Shoulder Injuries and Conditions (Lecture)
10:15AM-10:30AM – Break
10:30AM-12:30PM – Upper Extremity Assessment (Lab)
12:30PM-1:30PM – Lunch
1:30PM-3:30PM – Upper Extremity Mobility/Activation/Strength Drills (Lab)
3:30PM-3:45PM – Break
3:45PM-4:45PM – Upper Extremity Strength and Conditioning Programming: What Really Is Appropriate? (Lecture)
4:45PM-5:00PM – Q&A to Wrap Up

Location

Solace NY
38 East 32nd St.
New York, NY 10016

Continuing Education Credits

0.7 CEUs (7 contact hours) through the National Strength and Conditioning Association (NSCA)

Cost:

SOLD OUT! Please email ec@ericcressey.com to get on the waiting list.

Note: we'll be capping the number of participants to ensure that there is a lot of presenter/attendee interaction - particularly during the hands-on workshop portion - so be sure to register early, as the previous offering sold out well in advance of the early-bird registration deadline.

Registration

SOLD OUT!

Looking forward to seeing you there!

Questions? Please email ec@ericcressey.com.

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Making Sense of Exercise Contraindications

I've got a wonky shoulder. Actually, the term "wonky" probably doesn't do it justice. As of a MRI in 2014, here's what I've got:

"There is a high-grade partial thickness articular surface tear of the posterior fibers of the supraspinatus that measures 15 mm AP x 15 mm RL. The undersurface tendon fibers are delaminated and retracted 15
mm.

"There is a high-grade partial-thickness cartilage defect over the posterior medial aspect of the humeral head
(near the posterior-superior labrum) with cartilage flap formation that measures 8 mm SI x 5 mm AP."

That was about three years ago, and it may be worse now. The truth is that it started with internal impingement during my high school tennis career, and gradually progressed over the years. In comparing the 2014 MRI to one I'd had in 2003, you see that the damage has progressed (as expected), but the symptoms have actually gotten substantially better.

My (occasional) pain is your gain, though. You see, the symptoms (or lack thereof) can actually teach us a lot about how we view contraindicating exercises.

I can bench press as heavy as I want with zero issues. Pull-ups, rows, pullovers, overhead carries, landmine presses, Turkish get-ups are all completely asymptomatic. They're in my safe exercise repertoire.

And, as long as I don't go crazy with volume or intensity, I can throw a baseball just fine. I long-tossed out well over 200 feet with my pro guys consistently this offseason and it wasn't a problem.

Overhead pressing is weird for me, though. If I tried to push press 135 pounds, my shoulder would hate me for the next 6-8 weeks. Interestingly, though, if I keep the weight lighter, stick to dumbbells in the scapular plane, control the tempo, focus on perfect technique, and don't go crazy with volume, overhead pressing actually makes my shoulder feel better. I'll work it in as an assistance exercise every other month.

 

 

Thanks to a chronic partial thickness rotator cuff tear, overhead pressing is weird for me. If I tried to push press 135 pounds, my shoulder would hate me for the next 6-8 weeks. Interestingly, though, if I keep the weight lighter, stick to dumbbells in the scapular plane, control the tempo, focus on perfect technique, and don't go crazy with volume, overhead pressing actually makes my shoulder feel better. I'll work it in as an assistance exercise every other month. This reminds us that we shouldn't just contraindicate exercises, but rather specific SCENARIOS. You won't change a person's anatomy, but you can certainly change the training stimulus to accommodate that anatomy. Check out today's post at www.EricCressey.com/blog for more info. #cspfamily #rotatorcuff #overheadpress #shoulderpain #shoulderworkout

A post shared by Eric Cressey (@ericcressey) on

Interestingly, though, back squatting is what destroys my shoulder the most. This is consistent with an internal impingement diagnosis, but doesn't make a whole lot of sense when you consider that I can throw pain-free. Even if I just try to put a 45-pound barbell on my shoulders, it lights my shoulder up in a very bad way.

This weird collection of symptoms can actually teach us three really big lessons, though.

1. Everyone's symptoms and provocative patterns are completely different.  Two people might have a very similar medical diagnosis, but dramatically different safe exercise repertoires.

2. Too often, we contraindicate simply contraindicate exercises. In reality, we should be looking much broader, considering factors such as absolute loading, tempo, volume, and exercise technique.

[bctt tweet="We should contraindicate people from exercises, not exercises for people."]

3. An individual's "safe" exercise repertoire may evolve over time due to changes in movement quality, tissue quality, recovery capacity, and structural integrity. Our programming needs to evolve to accommodate those changes, too.

Certainly, some exercises are inherently bad and not worth the risk, but it's important to evaluate each individual and situation individually to make the determinations on all those "middle of the road" exercises that deliver great training effects and make strength and conditioning fun.

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