The "full can" exercise is a popular shoulder prehabilitation/rehabilitation exercise of which I'm not super fond for a number of reasons. That said, if folks are going to utilize it, I think it's important that they understand exactly how to perform the exercise and where they should feel it. Check out today's video to learn more:
Speaking of shoulder performance, I'm excited to announce that Optimal Shoulder Performance - Mike Reinold and my first collaborative product - is now available for the first time as a digital resource. To sweeten the deal, you can get 20% off by entering the coupon code 20OFF at www.ShoulderPerformance.com through the end of the day Sunday.
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With my last post, I kicked off the "Best of 2016" series with my top articles of the year. Today, we'll highlight the top five videos of the year. These videos only include instructional videos, not quick exercise demonstrations.
1. 1-arm TRX Row w/Offset Kettlebell Hold - Every good program includes plenty of horizontal pulling, and this is a way to incorporate a good core stability challenge at the same time.
2. Grip Width for Conventional Deadlift Technique - Getting the grip width right is one of the most important strategies for optimizing your deadlift technique.
3. Hip Extension and the Bulgarian Split Squat - The bulgarian split squat (rear foot elevated split squat) actually takes more hip mobility than you might appreciate, and this excerpt from Functional Stability Training: Optimizing Movement goes into detail on the subject.
4. Tall Kneeling Cable Press to Overhead Lift - This is an older video, but I just uploaded it this year, as it made for a great "Exercise of the Week" inclusion.
5. Rhythmic Stabilizations: Where Should You Feel Them? - Rhythmic stabilizations are a great way to improve rotator cuff timing - but only if they're performed correctly. In this video, I answer one of the most common questions we receive about them: "Where should you feel them?"
I'll be back soon with the top guest posts of 2016!
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Today's guest post comes from my good friend and Elite Baseball Mentorships colleague, Eric Schoenberg. Enjoy! -EC
It is well documented that shoulder pain/injury is a primary reason for lost time in the gym and on the baseball field. Often times, the culprit is not poor exercise selection, but instead poor exercise execution. Most high level performers are going to do the work that we ask them to do, the issue is whether they are practicing getting better or practicing getting worse.
The following three tips will be useful for any strength coach or physical therapist to help ensure optimal function of the shoulder.
1. Understand and Appreciate Relative Stiffness.
There are several examples of relative stiffness around the shoulder that can result in faulty movement, pain and/or decreased performance.
A primary culprit occurs when the relative stiffness of the deltoid is greater than the rotator cuff. The result of this will be superior translation of the humeral head.
This can lead to undersurface rotator cuff tears, biceps tendon irritation, cyst formation, inferior glenohumeral ligament tears, or humeral head abnormalities – all of which are common to throwers.
Consider this when attempting to strengthen the cuff. Check to see if the humerus is in extension, as demonstrated in this photo. This faulty "elbow behind the body" pattern will lead to over-recruitment of the posterior deltoid:
You also want to cue the athlete away from excessive horizontal abduction, as demonstrated in the next photo. Prone external rotation with no support results in increased use of deltoid to support the arm against gravity:
Here it is corrected with support:
More times than not, we see athletes doing the correct exercise with the wrong execution and getting poor results. We want to avoid allowing an athlete to practice getting better at moving incorrectly.
2. Stop rowing so much, especially if your rowing technique is incorrect!
Rowing variations are generally the safest and easiest upper body exercises to program. However, even though a row is usually pain free, it can sometimes lead to patterns that result in injury down the road.
For example: If the rhomboids and lats are too stiff, you will see limited upward rotation of the scapula. Regardless of how much you strengthen the serratus anterior and lower trapezius, these smaller muscles will never match the force production of the lats and rhomboids.
With this in mind, the best “fix” is to increase stiffness and muscle performance of serratus and lower trapezius while simultaneously decreasing the stiffness and use of the lats/rhomboids.
This can be done by modifying the way we row. In this great video, EC discusses how to correct the row and ensure the scapula is moving properly on the ribcage with both phases of the rowing pattern.
In addition, we should program pressing or reaching exercises such as landmines, kettlebell presses, overhead carry variations.
3. Don’t let good lower body days double as “bad” upper body days.
We sometimes see athletes come in complaining about an increase in symptoms following lower body days. They will report something like “I don’t know what I did to my shoulder; I lifted lower body yesterday.”
By now we know that a common cause of shoulder pain is the scapula being too depressed and downwardly rotated.
If an athlete performed deadlifts, back squats, or any lower body exercise where the weight was held by their sides (DB reverse lunges, step ups, RDLs, Bulgarian split squats, etc.), chances are they were feeding the pattern of depression and downward rotation.
Taking this a step further, we commonly see these exercises resulting in postures and stabilization strategies that present with increased lumbar lordosis and anterior pelvic tilt. When this goes uncorrected, scapular alignment suffers. Here’s a look at a reverse lunge with excessive hip extension, lumbar extension, and anterior pelvic tilt:
Remember, there is no “corrective’ in the world that will counteract the stress of carrying 120-pound DBs by your side while training on a lower body day. This does not mean that you shouldn’t program it; instead, it means that we should just be aware of the consequences.
The solution to this is to consider alternate loading strategies (such as a Safety Squat Bar, KB Goblet set-up, or weight vests) that will allow the shoulder girdle to be freed up and positioned more optimally. If we pair this with consistent attention to proper alignment and movement strategies, we can use lower body days as another opportunity to enhance shoulder function.
About the 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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Here's a question I recently received from a reader:
Q: I've been training a couple college guys this month before they go back to school and I had a few questions regarding rhythmic stabilizations. I started implementing them with my pitchers recently and they say they don't feel anything. Should they be? Is there any extra coaching points I'm missing here? Thanks for your time.
A: This video!
To learn more about how I assess, program, and coach at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions.
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I thought I'd use today's post to throw out some thoughts on training the shoulders.
1. In the upper extremity, the assessments are often the solutions, too.
Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.
Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...
...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.
This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?
My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct.
These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.
Just thinking out loud here, though. Fun stuff.
2. Anterior shoulder pain usually isn't "biceps tendinitis."
First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.
Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.
3. Thoracic outlet surgery really isn't a shoulder surgery.
Over the past few years, each time a professional pitcher gets thoracic outlet surgery, you see many news outlets call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."
With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.
Additionally, surgeons usually opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.
Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.
This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.
All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.
4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.
Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...
...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.
5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.
To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter.
With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:
Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.
6. Pre-operative physical therapy for the shoulder is likely really underutilized.
It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).
I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.
For more information on approaches to evaluating, coaching, and programming for the shoulder, be sure to check out Sturdy Shoulder Solutions.
Have a great weekend!
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I just wanted to give you a heads-up on one-day seminar with me in Chicago, IL on Sunday, July 31, 2016.
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
TC Boost Sports Performance
600 Waukegan Road
Unit 108
Northbrook, IL 60062
Continuing Education Credits
The event has been approved for 0.7 CEUs (7 contact hours) through the National Strength and Conditioning Association (NSCA).
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.
In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.
As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,
“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”
As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:
Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:
You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.
For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”
How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.
To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.
Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.
Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).
Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:
Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.
A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.
This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.
With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.
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If you were to spend a day at either the MA or FL Cressey Sports Performance location, invariably, you’d see something that might surprise you: athletes training in spite of the fact that they recently had surgery. On a regular basis, we have athletes referred our way after everything from Tommy John surgeries to knee replacements. They may be on crutches, using an ankle boot, in an elbow brace, wearing a shoulder sling, or even rocking a back brace. Working with post-operative athletes has become a big niche for us; we work hand-in-hand with surgeons and rehabilitation specialists to make sure that we deliver a great training effect in spite of these athletes’ short-term limitations.
Unfortunately, athletes will sometimes run across hyper-protective therapists and doctors who are overly cautious in this period. Certainly, for a period, this is incredibly important, as there are risks of not only the repair being vulnerable to movements and direct pressure, but also it being compromised by infection in the first few weeks. However, in my opinion, it’s absolutely unnecessary to tell an athlete to just take 3-4 months off completely from exercise and instead just “rehab” – and yes, I have heard this before.
With this in mind, I wanted to outline six reasons I think strategically implemented strength and conditioning work in the post-surgery period is incredibly important.
1. It’s important to make an athlete feel like an athlete, not a patient.
There is a different vibe in a physical therapy clinic or training room as compared to a strength and conditioning setting. This isn't intended to be a knock on rehabilitation specialists, but athletes would rather hang out in the latter realm! And, while great therapists make rehabilitation upbeat and keep the athlete's competitive psyche engaged, getting back into the gym affords a big mental boost - a break from their current physical reality - for athletes.
Speaking of mental boosts, I won't even bother to highlight the favorable impacts of exercise on mood and the reduction in risk of a wide variety of chronic diseases. Suffice it to say that there are a ton, and it's important that athletes continue to have these benefits during their rehabilitation period. If you really want to dig deeper, I'd highly recommend this recently published meta-analysis: Exercise as a treatment for depression.
2. Small hinges swing big doors in terms of behaviors.
Most people eat healthier when they train. Whether this is conscious or subconscious is dependent on the individual, but it's something I've seen time and time again.
Likewise, many student athletes perform better in the classroom when exercising regularly, and struggle to stay on task when they’re given too much free time.
What's my point? Effectively, training pushes out certain bad behaviors. Likewise, on a physiological level, it supports better brain activity that makes for more productive members of society.
3. Injuries don’t occur in isolation.
Pitchers don’t just blow out their elbows because of functional deficits at the elbow. Rather, the elbow usually gets thrown under the bus from a collection of physical deficits all along the kinetic chain. As an example, Garrison et al (2013) demonstrated that players with ulnar collateral ligament tears scored significantly worse on the Y-balance test than their healthy peers.
With this in mind, it would be silly to spend months and months only focusing on rehabilitating the arm to the exclusion of the rest of the body. Unfortunately, physical therapists only have so much time with athletes because of insurance restrictions, so they may not get to these important complementary rehabilitation approaches. This is a great place for a competent strength and conditioning professional to pick up the slack.
4. Training improves body composition, which facilitates a number of favorable outcomes.
It drives me bonkers when I hear about an individual dropping a bunch of muscle mass and gaining substantial body fat during the post-surgery period. This should never happen.
Just as a healthy body composition will help a grandfather avoid setbacks following a hip replacement, having a good strength-to-body weight ratio will increase the likelihood that a college soccer player will avoid setbacks after a meniscal repair.
These benefits aren't just conferred to weight-bearing scenarios. Remember, obesity is arguably the biggest limitation to diagnostic imaging accuracy. In other words, if you have a setback in your rehabilitation and need an MRI or x-ray, being fatter makes it hard for your radiologist to give you an accurate reading. An ounce of prevention is worth a pound of cure.
5. Exercise facilitates motor learning improvements.
When rehabbing, you’re trying to acquire new, favorable movement patterns. Research (good reads here and here) has demonstrated improved motor learning when new tasks are introduced alongside exercise (particularly aerobic exercise).
Maintaining a robust aerobic system and solid work capacity makes rehabilitation efforts more effective.
6. Contralateral strength training has carryover to immobilized limbs.
Via a mechanism known as cross-transfer (or cross-education), an untrained limb's performance improves when the opposite limb is trained. As an example, if you have knee surgery on your right leg, but do what you can do to safely train your left leg while your right knee is immobilized, you'll still get carryover to the post-surgery (right) side. It won't do much to attenuate the atrophy of muscle mass on an immobilized limb, but it will absolutely reduce the fall-off in strength, power, and proprioception. Effectively, it's "free rehab" that offers a huge leg up with respect to return to play.
As an aside, research on cross-transfer from Hortobagyi et al has demonstrated that the strength carryover seems to be stronger with eccentric exercise, so prioritizing this approach seems to have extra merit.
Some Important Notes
Before I sign off on this one, I should be clear on a few things:
1. Not every trainer and strength and conditioning coach is prepared to take on every injury.
If you’ve never heard the word “spondylolysis,” you shouldn’t be programming for a kid in a back brace. And, if you don’t know the difference between an ulnar nerve transposition and an ulnar collateral ligament reconstruction, you’re not ready to take on a post-op baseball elbow. Don’t be a cowboy.
2. Effective post-operative training mandates outstanding communication.
You should be speaking on a regular basis with the physical therapist or athletic trainer who is overseeing the rehabilitation plan. They’ll let you know if an athlete is prepared for progressions, and also to help you avoid overlapping with what they do in the rehabilitation sessions. I’d even encourage you to sit in on some of their rehabilitation sessions not only to monitor progress, but also as continuing education.
3. When in doubt, hold athletes back.
One of my graduate school professors, Dr. David Tiberio, once said that physical therapists “should be as aggressive as possible, but do no harm.” I’ll take this a step further and say that fitness professionals conditioning “should be conservative and do no harm” during the rehabilitation process. It’s our job to maintain/improve fitness and facilitate return-to-play, but in no way set back the recovery process. In short, let the rehab folks take all the chances when it comes to progressions.
4. Remember that progressions occur via many avenues.
Progressions don’t just come in terms of exercise selection, but also absolute loading, speed of movement, volume, frequency, duration, and a host of other factors. You need to keep all of them in mind when programming and coaching, as even one factor that is out of whack can set a rehabilitation program back. Additionally, there will be times when stress in one area goes up, which means it must be reduced in another area. As an example, during rehabilitation from Tommy John surgery, the stress on the medial elbow increases when an athlete begins throwing at the 4-6 month mark, and many athletes will benefit from a reduction in the amount of gripping they do in their strength training and rehabilitation programs.
5. Watch for "accidental" stabilization demands.
Many muscles work reflexively, with the rotator cuff being the absolute best example. After a shoulder surgery, you have to be careful training the opposite side too soon (or with too much loading) because the cuff on the surgery side can turn on reflexively. As the aforementioned cross-transfer effect dictates, it's not as simple as right vs. left training effects; our nervous system governs everything - and in curious ways.
Wrap-up
I hope that in publishing this article, I made a strong case for the importance of appropriate exercise during the post-surgery period. Remember that what is "appropriate" will be different for each individual, and should be determined via a collaborative effort with input from a surgeon, rehabilitation specialist, strength and conditioning professional, and the athlete. And, it should always be a fluid process that can be progressed or regressed based on how the athlete is doing.
For the fitness professionals out there, if you're looking for more information, here are a few good reads:
With all our Major League Baseball affiliated athletes having left for spring training, things are a bit quieter at Cressey Sports Performance.
At this time of year, I always like to look back and reflect on the offseason and some of the lessons we've learned. Invariably, it leads to a blog of random thoughts on sports performance training! Here are some things that are rattling around my head right now:
1. Just getting a baseball out of one's hand improves shoulder function - even if an athlete doesn't actually do any arm care or "corrective exercises."
If you look at the glenohumeral joint (ball-and-socket of the shoulder), stability in a given situation is essentially just a function of how well the ball stayed in good congruency with the socket. This congruency is governed by a number of factors, most notably the active function of the scapular stabilizers and rotator cuff. This is what good arm care work is all about.
However, what many folks overlook is that there are both passive (ligamentous) and active (muscular) structures that dramatically influence this congruency. In the throwing shoulder, we're talking predominantly about the inferior, middle, and superior glenohumeral ligaments and long head of the biceps tendon; collectively, the provide anterior (front) stability to the joint so that the ball doesn't fly forward too far in the socket in this position:
These ligaments and biceps tendon are always working hard as superior (top) stabilizers of the joint at this point, especially in someone with a shoulder blade that doesn't upwardly rotate effectively. By the end of a long season, these ligaments are a bit looser and the biceps tendon is often cranky. Good arm care exercises shifts the stress to active restraints (cuff and scapular stabilizers) that can protect these structures.
What often gets overlooked is the fact that simply resting from throwing will improve shoulder function in overhead athletes. When you avoid a "provocative" position and eliminate any possibility of pain, joint function is going to improve. And, ligaments that need to stiffen up are going to be able to do so and offer more passive stability.
This is a huge argument in favor of taking time off from throwing at the end of a season. It's effectively "free recovery" and "free functional improvements." Adding good arm care work on top of abstaining from throwing makes the results even better.
*Note: this isn't just a shoulder thing; the ulnar collateral ligament at the elbow can regain some passive stability with time away from throwing as well.
2. Coaches need to find ways to be more efficient - and shut up more often.
Each year, we start up three intern classes at both the Florida and Massachusetts facilities. As such, we have an opportunity to interact with approximately 30 up-and-coming strength and conditioning coaches. Mentoring these folks is one of my favorite parts of my job - and it has taught me a lot about coaching over the years.
Most interns fall into one of two camps: they either coach too much (the "change the world" mentality) or too little (the "don't want overstep my bounds" mentality). This is an observation - not a criticism - as we have all "been there" ourselves. I, personally, was an over-coacher back in my early strength and conditioning years.
The secret to long-term coaching success is to find a sweet spot in the middle. You have to say enough to create the desired change, but know when to keep quiet so as to not disrupt the fun and continuity of the training process. My experience has been that it's easier to quickly improve the under-coacher, as most folks will develop a little spring in their step when it's pointed out that they're missing things. That adjustment usually puts them right where they need to be.
The over-coacher is a different story, though. It's hard to shut off that "Type A" personality that usually leads someone in this direction. My suggestion to these individuals is always the same, though:
Don't let the game speed up on you. Before you say anything, pause - even take a deep breath, if you need to - and then deliver a CLEAR, CONCISE, and FIRM cue. Try to deliver the important message in 25% as many words as you normally would.
The athletes don't get overwhelmed, but just as importantly, the coach learns what the most efficient cues are. You might talk less, but you actually deliver more.
3. Use the "hands and head together" cue with rollouts and fallouts.
One of the biggest mistakes we'll see with folks when they do stability ball rollouts is that the hands will move forward, but the hips will shoot back. This reduces the challenge to anterior (front) core stability, and can actually drive athletes into too much lumbar extension (lower back arching). By cueing "hand and hips move together," you make sure they're working in sync - and then you just have to coach the athlete to resist the impacts of gravity on the core.
You can apply this same coaching cue to TRX fallouts, too:
4. Ages 28-30 seems to be a "tipping point" on the crappy nutrition front.
I should preface this point by saying that there is absolutely nothing scientific about this statement; it's just an observation I've made from several conversations with our pro guys over the winter. In other words, it's purely anecdotal, but I'd add that I consider myself one of the "study" subjects.
We all know that many young athletes seem to be able to get away with absolutely anything on the nutrition front. We hear stories about pro athletes who eat fast food twice a day and still succeed at the highest levels in spite of their nutritional practices.
One thing I've noticed is that I hear a lot more observations about "I just didn't feel good today," "my shoulder is cranky," or any of a host of other negative training reports in the days after a holiday. The pro baseball offseason includes Halloween, Thanksgiving, Christmas, New Year's Eve/Day, and Valentine's Day. Perhaps unsurprisingly, these observations almost always come from guys who are further along in their career - and as I noted, it's something I've felt myself.
If you eat crap, you're going to feel like crap.
Why does it seem to be more prevalent in older athletes? Surely, there are many possible explanations. More experienced athletes are usually more in-tune with their bodies than younger ones. Recovery is a bigger issue as well, so they might not have as much wiggle room with which to work as their younger counterparts. Older athletes also generally have more competing demands - namely kids, and the stress of competing at the highest levels - that might magnify the impacts of poor nutrition.
Above all, though, I think the issue is that many young athletes with poor nutritional practices have no idea what it's like to actually feel good. They might throw 95mph or run a 40 under 4.5 seconds, but they don't actually realize that their nutrition is so bad that they're actually competing at 90-95% of their actual capacity for displaying and sustaining athleticism. It's only later - once they've gotten on board with solid nutrition - that they have something against which they can compare the bad days.
Again, this is purely a matter of anecdotal observations, but as I've written before, everyone is invincible until they're not. As coaches, it's our job to make athletes realize at a younger age the profound difference solid nutrition can make. We can't just sit around and insist that they'll come around when they're ready, as that "revelation" might be too late for many of them.
Speaking of nutrition, today is the last day to get the early-bird registration discount on Brian St. Pierre's nutrition seminar at Cressey Sports Performance - MA on April 10. Brian is the director of performance nutrition for Precision Nutrition, and is sure to deliver a fantastic learning experience. You can learn more HERE.
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Today's "Exercise of the Week" guest post comes from Lee Boyce. Enjoy! -EC
One of the basic exercises that people are taught to practice for improved shoulder rotation, upper back activation, scapular mobility and anterior muscle release as a by-product is the standard scapular wall slide. To do them, a lifter would simply stand with the heels, butt, upper back, shoulders and full arms and hands against the wall, reduce the lower back arch, and slide the hands up and down, mimicking a full shoulder press movement pattern.
Regressing this movement is as simple as taking the feet a few inches away from the wall and assuming position otherwise. Progressing this movement, however, is another story.
The problem is that people adapt quickly to an unloaded mobility drill, and because of this, the wall slide can become another non-transferrable “skill” that doesn’t carry over to generally improved posture or performance. Moreover, depending on whether the humerus is properly nested in the glenoid fossa to begin with, the wall slides themselves may always pose a problem from a biomechanical perspective. To help this cause, adding some mild resistance can “remind” the muscles of the rotator cuff to center the humeral head in the socket and create a much more effective external rotation position. Plus, using a neutral grip via ropes (as compared to a palms-forward grip) creates a much more ideal (and shoulder friendly) environment for external rotation that can act to counter anterior shoulder glide.
For resisted scapular slides, I like using a cable pulley, and performing the lift from a seated position. It’s a bit easier for a lifter to focus on avoiding back hyperextension, which is a common compensation pattern when lifters have insufficient shoulder mobility.
This movement creates a force angle that works against the standard slide pattern, so keeping the hands and arms moving along the same plane becomes a much more challenging task for the scapular muscles. It’s easy to “let up” and allow the hands and arms to drift forward. To view the movement in action, watch the video below.
Coaching Cues
1. Have the athlete sit squarely on a box or bench. The closer parallel the box puts him in, the better.
2. Set up the cable pulley and ropes in a position just above head level. This way, at the top position, the force angle won’t be strictly downward, and there will be ample tension throughout.
3. If the lifter is still novice or intermediate level as far as shoulder mobility and control goes, a neutral grip is recommended for reasons mentioned above. If the lifter is more advanced, he can feel free to pinch-grip between the thumb and first finger, and face the palms forward.
4. During the movement, avoid slipping into lower back hyperextension; maintain thoracic region extension; and be sure to maintain neutral head posture. Also, avoid letting the elbows fall out of line with the hands in the vertical plane.
5. Your target areas are the rotator cuff muscles, rear deltoids, and lower traps (as you raise the weight further overhead). When you start feeling this in other areas like the biceps and upper traps, readjust positioning and continue.
6. The exercise is very specific, so it shouldn’t take much weight for it to be effective. 15-20lbs of resistance on most machines is usually plenty.
7. The movement won’t work if it’s done in a rush. Think of a 2121 tempo as a solid guideline.
8. Use higher reps to build up the muscular endurance of these muscle groups.
9. Your range of motion should replicate your typical dumbbell shoulder press – meaning the rep begins very close to the shoulder level, and ends at a full arm extension overhead.
10. Through the movement, remember to keep the hand separated (pull the rope handles apart) as much as possible. Doing so keeps the upper back engaged, avoids internal rotation, and keeps the hands stacked over the shoulder, where they belong.
About the Author
Lee Boyce (@CoachLeeBoyce) is a strength coach, writer, and former collegiate level sprinter and long jumper, based in Toronto, Canada. In 2013, he was named to the training and treatment staff for team Jamaica at the Penn Relays . He’s regularly featured in the largest fitness publications as a writer. Visit his website at www.LeeBoyceTraining.com or check him out on Facebook.
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