Home Posts tagged "Shoulder Pain"

How Bench Press Technique Impacts Shoulder Health

We often hear that an elbows-tucked bench press technique is more shoulder friendly than an elbows-flared approach. Nobody really ever seems to discuss why this is the case, though - so I thought I'd devote today's video blog to it:

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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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Random Thoughts on Sports Performance Training – Installment 26

It's time for the January edition of Random Thoughts on Sports Performance Training. Before I get to it, though, just a friendly reminder that today is also the last day of the introductory $50 off sale on Cressey Sports Performance Innovations. Don't miss out on this chance to get our new resource at a great price. You can learn more HERE

CSPInnovations-02-2

Since my presentation is "Scapular Control: Implications for Health and High Performance," I thought I'd take an upper extremity approach to this month's cues.

1. If you want to relax the neck, talk or exhale.

One of the biggest mistakes I see athletes make when they're doing upper body work is aggressively recruiting the muscles surrounding the neck. In particular, we know that a hypertonic sternocleidomastoid (SCM) and scalenes can be implicated in not only neck pain, but also headaches and thoracic outlet syndrome.

tos3

In most cases, simply telling an athlete to relax or repositioning their head/neck will get the job done. However, another strategy you can employ is to have them exhale through the exertion phase, or simply talk during the set.  Both the scalenes and SCM are accessory muscles of inhalation and this forces them to relax a bit so that you can build tension where you really want it.

2. When it comes to scapular control, nothing beats kinesthetic awareness coaching cues.

As I've written at length in the past, I'm a big believer in categorizing all athletes by their dominant learning styles: visual, kinesthetic, and auditory.

Visual learners can watch you demonstrate an exercise, and then go right to it.

Auditory learners can simply hear you say a cue, and then pick up the desired movement or position.

Kinesthetic learners seem to do best when they're actually put in a position to appreciate what it feels like, and then they can crush it.

My experience with teaching scapular positioning has been that option #3 - actually putting someone in the position you want - is the quickest and easiest way to teach someone about scapular positioning. This is likely because:

a. The scapula is a unique bone with some unique movements (upward/downward rotation, anterior/posterior tilt) that aren't familiar to most people

b. You're always wearing a shirt when demonstrating drills, which makes it harder to see these subtle movements as they occur.

When in doubt, put a shoulder blade in the position you desire and then ask an individual to hold it and own it.

3. Uncontrolled end ranges are bad for the scapulothoracic joint, just like every other joint.

Here's something to consider...

We know that if you repeatedly flex and extend the spine to its end-ranges, you'll eventually wind up in trouble - whether it's a herniated disc, stress fracture, or some other pathology.

We also know that if you repeatedly hyperextend an elbow, you'll eventually wind up with loose bodies in the joint, early osteoarthritis, or a torn ulnar collateral ligament.

The point is that it's important to have sufficient range of motion - and stability in that ROM - but not excessive ROM. Hanging out at any end range probably isn't a good idea.

Interestingly, though, we overlook the fact that the scapulothoracic joint - the interaction of the shoulder blade with the rib cage - is subject to these rules. In particular, one issue that sometimes emerges is an excessive "military posture" of scapular adduction (toward the midline) and depression when folks are cued "down and back" without understanding what it really means.

adductedscap-300x162

These athletes often get neck/upper back flare-ups when they do a lot of deadlifting, carries, or even too much horizontal pulling. The shoulder blades are so far pulled back that it becomes a faulty stabilization strategy instead of a strong base from which to perform.

4. A PVC dowel is a super affordable way to do a lot of great things for your upper body work.

I was looking at a program I wrote for one of our pro guys yesterday, and realized that we used the PVC dowel for three different exercises in a single training day. That's as much as barbells and dumbbells - but you can buy the piece of PVC for around $1. You won't find a piece of training equipment that offers that kind of bang for your buck - and this realization made me think back to this video CSP coach Greg Robins filmed a few years ago. These options are really just the tip of the iceberg, too:

Have a great Sunday - and don't forget about the CSP Innovations sale that ends tonight! Learn more HERE

lineup-1   

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3 Tips for Improving Shoulder Health and Performance

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.

55-deltoid-pull

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:

humeralextension

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:

proneer1

Here it is corrected with support:

proneercorrected

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.

ScapularDownwardRotation-300x225-2

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:

revlunge

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.

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 December 18-20. For more information, click here. Don't delay, though; the early-bird registration deadline is November 18.

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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How Lower Body Exercises Can Impact Upper Body Function

A few months ago, I published a blog called Making the Case for Training in the Post-Surgery Period. In short, it discussed how we are almost always dealing with athletes who are training during their rehabilitation periods. In many cases, this is strictly working around the issues while they're going through physical therapy.

In writing these programs, one recognizes that it's actually far easier to write a program for a post-op lower body issue than it is for a post-op upper body scenario. Very simply, because most strength and conditioning exercise selections work "from the ground up," there are many more ways that lower extremity exercises can impact upper body drills than vice versa. Today, I'll outline some examples.

1. Grip work.

There is grip involvement in deadlifts, various dumbbell single-leg exercises, and even squatting exercises that require an athlete to grasp the bar. Particularly in the case of elbow issues, too much grip work can become a real problem. For example, in the 4-8 month period after Tommy John surgery, it's not uncommon for athletes to experience discomfort in the common flexor tendon region - and it usually has to do with the cumulative stress of gripping during strength training and rehab work on top of the intensification of the throwing program. Some doctors have surgical approaches that are a bit "rougher" on the flexor tendon, too. In these scenarios, you're best off working predominately with lower body drills that don't involve a lot of grip work.

2. Front rack position with acromioclavicular (AC) joint issues. 

When you want an AC joint issue to calm down, there are really three big rules: 

a. Avoid reaching across the body (horizontal adduction, like a cross-body stretch)

b. Avoid reaching behind the body (full extension, like in a dip)

c. Avoid direct pressure to the area (particularly because it has very little muscle mass to cushion it)

Gray326-4

With respect to "C," the front squat set-up is an absolute no-no. The pressure on the bar across the shoulder girdle can really take an upset AC joint and make it markedly worse. And, since this is in many cases an injury that we’re just “waiting out,” simply training through it will only makes things worse long-term.

HandsFreeRack

Therefore, deadlift variations, single-leg variations, and back squats (assuming no other related problems) are likely better bets. That said, we generally use the safety squat bar and giant cambered bar exclusively with those who present with AC joint problems.

3. Back squat position with internal impingement.

Internal impingement (also known as posterosuperior impingement) is a broad diagnosis most common in overhead throwing athletes. In the late cocking phase of throwing (or swimming, tennis, etc.) - which involves external rotation and abduction - the humeral head tends to translate superiorly (up) and anteriorly (forward) relative to the scapula.

layback

These issues are magnified by poor scapular control, weakness of the rotator cuff, insufficient thoracic mobility, loss of tissue extensibility around the shoulder girdle, and in some cases, structural changes. The end result is that the biceps tendon, labrum, rotator cuff, glenohumeral ligaments, or nerves that pass the anterior aspect of the shoulder get irritated. The term "internal impingement" really just explains the pain-provoking position, not the specific diagnosis. Generally speaking, the pain is purely mechanical in nature; it won’t bother an athlete unless the “apprehension” position (full external rotation at 90+ degrees of abduction) is created.

Just about every overhead athlete is constantly "flirting" with internal impingement problems, so my feeling is that it's best to just avoid this "at-risk" position in the weight room - and that's why we don't back squat any of our overhead throwing athletes. And, we certainly wouldn't use a back squat with anyone with symptomatic internal impingement.

backsquat

4. Giant cambered bar with scapular anterior tilt, humeral anterior glide, and forward head posture.

The giant cambered bar is an awesome option for avoiding the "at-risk" abducted, externally rotated position that often gives overhead athletes problems, but it can create a problem with athletes who are prone to scapular anterior tilt, humeral anterior glide, and/or forward head posture. Because of the positioning of the hands, the elbows are driven a bit behind the body, which can cause the shoulder blade to dump forward and "ball" to glide forward on the socket. You may also see the head shoot forward.

GCB

That said, these faults can be easily minimized with good cueing. However, I wouldn't recommend using this bar with an athlete who has a big predisposition toward any of the three issues.

5. Scapular depression from holding heavy weights in the hands.

The deadlift can be an awesome exercise for improving poor posture - but not in all cases. Specifically, whenever we have an athlete who sits in too much scapular depression and downward rotation (more info on that HERE), we'll avoid holding really heavy weights in the hands for lower body training.

ScapularDownwardRotation-300x225-2

Our goal is to teach the shoulder blades to sit a little higher at rest, and functionally get higher when the arms need to go overhead. We don't want all our lower body work competing against that. During this time period, it's best to go with squatting variations, barbell supine bridges/hip thrusts, DB/KB goblet set-ups, sled work, the front squat grip, glute-ham raises, and anything else your imagination yields - as long as it doesn't tug the shoulder blades down.

There are many more considerations for how lower body work impacts upper body function, but these are definitely the five I most frequently encounter that you should keep in mind.

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Chicago Seminar Announcement: July 31, 2016

I just wanted to give you a heads-up on one-day seminar with me in Chicago, IL on Sunday, July 31, 2016.

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

TC Boost Sports Performance
600 Waukegan Road
Unit 108 
Northbrook, IL 60062

tcboost

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

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

Click here to register using our 100% secure server!

Looking forward to seeing you there!

Questions? Please email ec@ericcressey.com.

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Understanding Scapular Positioning in the Throwing Motion

Today's guest post comes from Cressey Sports Performance - Massachusetts pitching coordinator, Matt Blake (@Blake_Matt). Matt is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC 

At a recent conference, Eric Cressey gave a presentation that tackled the importance of baseball professionals understanding scapular mechanics and the integral role they play in the throwing athlete’s kinetic chain. Eric Schoenberg also recently showed a great drill to incorporate scapular motion into the kinetic chain of activity. Given that I’m the third member of the Elite Baseball Mentorships team with these two, I figured I might as well chime in to highlight its importance from my perspective as well.

This is an important discussion to have because it can help demonstrate the need for all phases of development to work together to keep the high-level thrower operating on all cylinders. If we’re all speaking the same language, we can work to build the athlete’s awareness for their overall movement and integrate the education from the warm-up through the initial phases of the throwing progression.

If we’re all saying different things to the athlete using our own jargon, it’s easy for them to misinterpret the carryover of certain drills, exercises, and concepts across channels. If we all lay down similar verbiage in our conversations with the athlete regarding their prehab work, dynamic warm-up, strength training and throwing motion, it makes it a lot easier for them to appreciate the importance each piece holds in the puzzle.

In order to get started, let’s look at where the scapula is positioned and introduce its fundamental movements so we can begin to appreciate its role in the kinetic chain.

scaps1scaps2

When looking at the scapula’s position and actions, you have to acknowledge the importance of its relationships with the rib cage and the humerus. These relationships are integral in tying the torso and the arm action together in a high-level throw. These interactions between the thoracic region, scapula and humeral head may be the most overlooked or misunderstood components of the delivery – especially for the average coach who has no anatomical background.

The degree of misunderstanding is mainly because the actions are so subtle and can’t be fully appreciated when the athlete throws with their shirt on. This is why its so vital to have a strength/rehab professional in the mix, who can provide a shirtless scapular screen to give us a baseline on where the scapula lies at rest and how it functions in relation to the movement of the arm.
 

Once you can identify how an athlete presents, you can begin to build a more individualized corrective movement progression. This will serve to help the athlete identify and turn on the appropriate movement patterns to keep the humeral head flush with the scapula through its full range of motion. This is essential in the throw, because of the importance of a “clean” arm action to help alleviate some of the stress involved in the high-level motion. For demonstration sake, here’s an example of a HS pitcher, who throws 88-91, with a relatively efficient arm action for his age.

The ability to create elite levels of hand-speed in a durable manner can be won or lost based on how the humeral head functions in conjunction with the scapula. In my mind, this is the crux of the delivery, where you need to be able to tie the “whip-like” arm action into the sequential actions of the torso.

As the thrower engages his landing position, the kinetic forces of the delivery are beginning to flow up through the chain towards the scapula and arm. It’s crucial at this point for the arm to get set up in a sound position to optimize control of the (glenohumeral) joint in an effort to handle the energy that’s about to drive through that portion of the chain towards release. The “optimal” timing of this set-up will be dictated by how the athlete sequences hip and torso rotation, as well as how much laxity they present with, etc. - but for the sake of discussion, we’ll say landing is a crucial checkpoint.

From here, the key actions that we’re going to break out today are upward rotation and protraction. This isn’t to say that they are more important than the other actions, but throughout the season, throwers tend to lose upward rotation from the stress of the throwing motion. With that in mind, let’s identify what it is and how it works with protraction to aid the durability of the high-level delivery.

This concept is something that EC has written and produced videos about countless times over the years, but it continues to be a point that needs to be reiterated time and again. For those who haven’t seen it, this is a great video to consider in this discussion.

From this video, we’ll take it a step further, so you can visualize how this actually plays out in the throwing motion itself.

As you can see, there is a considerable amount of range of motion and control that needs to be in place if you expect to keep the humeral head “centered” from lay-back through the entirety of the deceleration phase. The challenge here is that we can’t always see how the arm action is working with the shoulder blade. One way to combat this is via communicating with your athletes about where they feel their soreness the day after throwing.

Generally speaking, I like to have guys tell me they’re sore near the medial border of the scapula, in the meat of back, where the scapular retractors are eccentrically controlling the scapula as it moves away from the mid-line. If guys are sore near the back, top, or front portion of the shoulder joint itself, then we’re probably getting too much “joint-play” and the humeral head is gliding and translating away from the center of the socket too much during the throw.

If these other patterns of soreness are presenting somewhere along the line, either the rotator cuff wasn’t doing its job, the scapula wasn’t working in sync with the humeral motion, or the thrower’s motion in general is putting them in positions that aren’t utilizing the correct patterns. In this case, let's assume that we did have a “good” post-throwing stress pattern.

Once we’ve identified that we are using scapular upward rotation and protraction to our benefit to control the socket, now we need to work extremely hard to counteract the eccentric damage associated with these actions. This is where the recovery protocol and the warm-up itself are crucial on a daily basis to make sure we’re getting back both the range of motion that we need, as well as activating it correctly before we begin to throw again.

To learn more about how physical assessment, strength and conditioning principles, video analysis, and drill work for the pitcher fit together, be sure to check out one of our Elite Baseball Mentorships. Our next event will be held January 17-19, 2016 at Cressey Sports Performance in Hudson, MA. The early-bird registration is December 17, 2015. For more information, check out www.EliteBaseballMentorships.com.  

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Troubleshooting the Side-Lying External Rotation

The side-lying external rotation is one of the most popular rotator cuff exercises in rehabilitation and "pre-habilitation" history, but in spite of its apparent simplicity, there are a few common mistakes I see folks make with it. Check out today's video to learn more:

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Exercise of the Week: 1-arm Serratus Wall Slides with Med Ball

It's been a while since I posted a new "Exercise of the Week" feature, but to atone for the wait, I've got a great one for you. I actually came up with this one myself while brainstorming a bit during my own warm-up a few weeks ago.

Serratus anterior is an incredibly important muscle for shoulder health, as it is really the big player in making sure there is a "rotation" component to scapular upward rotation (watch this video first if you need more information on that). Long story short, as you can tell from the picture below that depicts its positioning and line of pull, serratus anterior is hugely important for healthy shoulder function. This is particularly true in movement patterns involving reaching, whether it's out in front or overhead.

serratus

Loss of serratus anterior function is incredibly common in those with shoulder pathology, but we also see it really commonly in those who are pain-free but don't move well. To that end, we like to include specific serratus anterior targeted drills in our warm-ups and as low-key "fillers" between heavier compound lifts during our training sessions.

The research has demonstrated that serratus anterior recruitment is highest when you have more than 90 degrees of shoulder flexion, and this assertion really recognizes that this muscle does far more than just protract the shoulder blade; it is a key upward rotator. As such, we train it to assist that function:

Coaching Cues

1. Make sure the athlete is not in a heavily extended (arched lower back) posture, and don't allow forward head posture.

2. If range of motion allows, reach behind the back with the opposite hand to monitor the position of the inferomedial (inside/bottom) border of the scapula. It should stay "snug" to the rib cage, not wing off.

3. Think of "wrapping" the scapula to the armpit as the arm goes up. I'll usually manually guide the shoulder blade with my hands as I'm first instructing this. You can usually see if the movement is sufficient through an athlete's shirt.

4. Actively push the medicine ball into the wall the entire time. In addition to training the protraction function of serratus anterior, you'll also likely get some reflexive rotator cuff recruitment. This is a 4-pound med ball, but you can really work anywhere from one pound to six pounds.  

5. The athlete should only feel this along the scapula near arm pit (reference the anatomy picture above for a frame of reference). There should be no anterior shoulder discomfort. If there is, it's a sign of one of two things:

a. Pectoralis minor taking over to protract with anterior scapular tilt
b. Excessive movement of the humerus (upper arm) without sufficient scapular movement

5. Don't force upward range of motion. The arm really shouldn't get above 140-150 degrees, and most people don't even need to go this far. Note that the medicine ball doesn't say in the hand the entire time; it rolls to the elbow. This is a great ROM "check" that tells you how far up you should go.

6. Control things down slowly; don't yank to the bottom.

7. For added benefit, you can add a full exhale at the top of each rep to help solidify the pattern.

I'll generally program this for sets of 6-8 reps on each side. 

If you're looking for some more serratus anterior programming options and detailed coaching cues, check out this video:

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Avoid this Common Wall Slide Mistake

Those of you who have followed my work for any length of time surely know that I'm a big fan of including wall slide variations to improve scapular (shoulder blade) control. To get the benefits of these drills, though, it's important to use the right technique. Here's one mistake we commonly see, especially in really "tight" athletes who have a lot of stiffness in their lats to overcome:

Apologies for the contribution from Cressey Sports Performance mascot Tank Cressey at the 1:05 mark! This guy thought it'd be a good idea to bark hello to the UPS guy in the middle of my video.

TankTrapBar

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LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
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