I had a new article published today at T-Nation. As you'll see, it builds on some of the thoughts I published here at EricCressey.com a few weeks ago. Check it out:
I received the following email the other day, and thought my response would make for a good Q&A here:
Q: I recently heard a national level gymnastics coach speak on how he believed shoulder dislocates with a dowel rod (working up to weighted dislocates) are a panacea for shoulder health and strength. I was wondering if you use them with your clients/players, and why or why not?
A: Thanks for your question. In short, the answer would be NO, I would never do shoulder dislocates with a throwing athlete. I discussed why in a previous video that goes into great detail, so rather than reinvent the wheel, here it is! Effectively, shoulder dislocates replicate some of the movements that I outline as problems here.
As a general rule of thumb, as a thrower, it's always better to be too tight than it is to be too loose. WIth that in mind, you always need to ask why you're stretching an area out. If the front of the shoulder feels "tight," it may be from a number of different causes:
1. Protective tension of the biceps tendon (secondary to rotator cuff weakness) - just stretching it out would remove what little anterior stability remains.
2. An injury to the anterior capsule, latissimus dorsi (humeral attachment point), subscapularis, supraspinatus, or biceps tendon - just stretching these areas out will likely exacerbate the injury.
3. Irritate of the nerves that run anterior to the humeral head - nerves don't like to be stretched.
4. True muscular shortness of pectoralis majoror another structure - Effectively, in doing shoulder dislocates, you're throwing all your eggs in this basket.
The only problem? Most throwers already have an insane amount of horizontal abduction and external rotation range-of-motion on their throwing shoulders. They aren't even close to having legitimate tissue shortness that would benefit from stretching. This is something we work hard to drill home in our Elite Baseball Mentorships as one of the most important takeaways from the events.
Now, if we're talking about a regular ol' desk jockey who doesn't throw a baseball (or other sporting implement), play tennis, or swim, then dislocates might have some merit. These individuals likely have some muscle/tendon stiffness that can be stretched out before they get to a point where they might crank on their joint capsule or nerves. I would never use it as a "blanket" recommendation for everyone, though. The only way to know is assess the individual and then plan accordingly.
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There are a lot of people out there who struggle to get the upper back, shoulders, and arms in the right position for the back squat - whether it's because their technique actually causes pain, or simply puts them in a bad technical position. With that in mind, I thought I'd use today's video to touch on why it can be a problem for some folks, and some quick technique modifications you can make to clean things up.
These cues can work hand in hand with a lot of the shoulder mobility drills you've seen here at EricCressey.com and on my YouTube page.
If you're looking for a collection of mobility drills and strength and conditioning progressions - as well as detailed coaching videos like this - be sure to check out The High Performance Handbook, a versatile resource you can tailor to your individual needs and training goals.
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In this installment of "Exercise of the Week," I've got a great drill you can use to improve upper extremity mobility. I originally learned this from Sue Falsone of the LA Dodgers a few years ago.
We've found this to be super helpful not only with folks who have poor thoracic spine mobility, but also those who have limited shoulder flexion and scapular upward rotation. There's a bit of research and anecdotal evidence out there to support the idea that improving thoracic mobility in turn improves scapular upward rotation and glenohumeral (ball and socket) range of motion. Basically, by reducing bad stiffness in one area, it makes it easier to establish good stiffness elsewhere - and that provides for better overall mobility. So, reduced thoracic stiffness = better scapular upward rotation = better ball-and-socket congruency = better arm range of motion.
Internal rotation, in particular, seems to improve the quickest - and that's one reason why we'll always work proximal - positioning breathing, thoracic mobility, scapular control, and soft tissue work - before we ever stretch a throwing shoulder. The glenohumeral joint is somewhat of a delicate one, so you never want to crank on it - especially if you haven't exhausted more conservative options. This fits that bill.
Additionally, some folks with a more adducted scapula positioning will benefit quite a bit from this drill, as it essentially works out to self myofascial release on overactive rhomboids. Get them to relax, and the shoulder blade will move better on the rib cage.
All you need is a doubled tennis ball and some masking or duct tape. Tape two balls together, and then go follow the instructions below.
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I thought you all might like to check out an article I just had published at www.Schwarzenegger.com on the topic of pre-training upper body warm-ups: Warm-ups for Sparing the Shoulders.
Enjoy!
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Since this series was so popular this year, I figured I'd try to squeeze in just one more collection of suggestions before the 2012 wraps up. Here are three more coaching cues for your strength and conditioning programs:
"1. Pull the elbows to your hips."
As I discussed a while back in my Cleaning Up Your Chin-up Technique post, you want to be careful about extending the humerus past neutral at the top position of a chin-up. If the elbow moves behind the body In this position, the humeral head can glide forward, irritating the biceps tendon and anterior capsule. Additionally, the thoracic spine becomes excessively kyphotic, and the scapula may anteriorly tilt, closing down the subacromial space and exacerbating impingement on the rotator cuff tendons. Here’s what the bad looks like:
I’ve found that encouraging athlete to pull the elbows to the hips prevents this excessive humeral extension, and it also makes athletes stricter with their technique; they have to get the chest to the bar instead of just reaching with the chin and creating a forward head posture.
Conversely, if you encourage many young athletes to “just get your chin to the bar,” you get some garbage kipping concoction that looks like Quasimodo on the monkey bars with his pants on fire.
"2. Keep the biceps quiet."
Piggybacking on our previous point, just like excessive humeral extension can create anterior (front) shoulder stress, uncontrolled external rotation can be equally problematic, as the humeral head will once again want to glide forward if it isn’t appropriately controlled by a combination of rotator cuff recruitment and scapular stability.
If an athlete feels external rotations in the front of his shoulder even in what appears to be the correct position, he’s performing them without monitoring humeral anterior glide. If this occurs, I’ll have him place his opposite hand on the front of the shoulder to monitor any kind of anterior glide of the humeral head, and encourage him to “keep the biceps quiet.” I’d say that 90% of the time, athletes are good to go once this correction takes place. In the other 10% of cases, we’ll regress the athlete to supine and prone external rotations, as well as manual resistance “holds” at the 90/90 position.
"3. Try to touch your butt to the ceiling."
The yoga push-up is one of my favorite push-up variations. Just like all other push-up variations, it gives our shoulder blades freedom of movement, which is important when you consider that they’re essentially stuck in place during bench press movements.
I especially like the yoga push-up because it doesn’t just combine protraction/retraction, but also involves near-full humeral flexion. By elevating the humerus further, we force athletes to work on getting more scapular upward rotation.
If you tell an athlete, “Push your butt away from the floor,” you get greater recruitment of serratus anterior and upper trapezius to really get that last bit of scapular upward rotation – and, at the same time, get some good thoracic spine extension.
That wraps up this installment of cues. If you like what you're reading, I'd encourage you to check out the Muscle Imbalances Revealed - Upperseries, which features a collection of outstanding webinars from some really bright guys in the industry. Rick Kaselj, who organized the collaborative effort, has the product on sale at a great discount with a 60-day money-back guarantee. You can check it out here for yourself.
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Last summer, a college pitcher came up to Cressey Performance from the South to train for a month before his summer league got underway. He was seven months post-op on a shoulder surgery (Type 2 SLAP) and had been working his way back. Unfortunately, his arm was still bothering him a bit when he got up to see us.
After the first few days at CP, though, he told me that his arm felt as good as it’s felt in as long as he could remember. He’d been doing a comprehensive strength and conditioning program, but the “impact” stuff for him had been soft tissue work, some Postural Restoration Institute drills, an emphasis on thoracic mobility, and manual stretching into internal rotation, horizontal adduction, and shoulder flexion. From all the rehab, his cuff was strong and scapular stabilizers were functioning reasonably well – which led me to believe that his issues were largely due to tissue shortness and/or stiffness.
This realization made me immediately wonder what he’d been doing in the previous months for mobility work for his arm – so I asked. He then demonstrated the manual stretching series that every pitcher on his team went through every day on the table with their athletic trainer. Each stretch was done for 2x20s – and two of those stretches took him into extreme external rotation and horizontal abduction. I was pretty shocked.
Me: “You’re probably not the only guy on your team rehabbing right now, huh?”
Him: “No; there are actually too many to count.”
Me: “Elbows, too, I’m sure.”
Him: “Yep.”
Want to irritate a labrum, biceps tendon, or the undersurface of the rotator cuff? Stretch a thrower into extreme external rotation and simulate the peel-back mechanism. This also increases anterior capsular laxity and likely exacerbates the internal impingement mechanism over the long-term. To reiterate, this is a bad stretch!
Want to make an acromioclavicular joint unhappy? Stretch a thrower into horizontal abduction like this (again, this is a BAD stretch that is pictured):
Want to irritate an ulnar nerve or contribute to the rupture of an ulnar collateral ligament? Make sure to apply direct pressure to the forearm during these dangerous stretches to create some valgus stress. This is a sure-fire way to make a bad stretch even worse:
These stretches are very rarely indicated in a healthy population – especially pitchers who already have a tendency toward increased external rotation. The shoulder is a delicate joint that can’t just be manhandled – and when you’re dealing with shoulders that are usually also pretty loose (both from congenital and acquired factors), you’re waiting for a problem when you include such stretches. In fact, I devoted an entire article to this: The Right Way to Stretch the Pecs.
Everyone thinks that shoulder external rotation and horizontal abduction alone account for the lay-back in the extreme cocking position.
In reality, though, this position is derived from a bunch of factors:
1. Shoulder External Rotation Range-of-Motion – and this is the kind of freaky external rotation you’ll commonly see thanks to retroversion and anterior laxity:
2. Scapular Retraction/Posterior Tilt
3. Thoracic Spine Extension/Rotation
4. Valgus Carrying Angle
So, how do you improve lay-back without risking damage to the shoulder and elbow?
1. Soft tissue work on Pec minor/major and subscapularis – Ideally, this would be performed by a qualified manual therapist – especially since you’re not going to be able to get to subscapularis yourself. However, you can use this technique to attack the pecs:
2. Exercises to improve scapular retraction/depression/posterior tilt – This could include any of a number of horizontal pulling exercises or specific lower trap/serratus anterior exercises like the forearm wall slide with band.
3. Incorporate specific thoracic spine mobility drills – In most pitchers, you want to be careful about including thoracic spine mobility drills that also encourage a lot of glenohumeral external rotation. However, when we assess a pitcher and find that he’s really lacking in this regard, there are two drills that we use with them. The first is the side-lying extension-rotation, which is a good entry level progression because the floor actually limits external rotation range-of-motion, and it’s easy to coach. I tell athletes that they should think of thoracic spine extension/rotation driving scapular retraction/depression, which in turn drives humeral external rotation (and flexion/horizontal abduction). Usually, simply putting your hands on the shoulder girdle and guiding them through the motion is the best teaching tool.
A progression on the side-lying extension-rotation is the side-lying windmill, which requires a bit more attention to detail to ensure that the range-of-motion comes from the right place. The goal is to think of moving exclusively from the thoracic spine with an appropriate scapular retraction/posterior tilt. In other words, the arm just comes along for the ride. The eyes (and head) should follow the hand wherever it goes.
Again, these are only exercises we use with certain players who we’ve deemed deficient in external rotation. If you’re a thrower, don’t simply add these to your routine without a valid assessment from someone who is qualified to make that estimation. You could actually make the argument that this would apply to some folks in the general population who have congenital laxity as well (especially females).
4. Throw!!!!! – Pitchers gain a considerable amount of glenohumeral external rotation over the course of a competitive season simply from throwing. Sometimes, the best solution is to simply be patient. I really like long toss above all else for these folks.
In closing, there are three important things I should note:
1. You don’t want to do anything to increase valgus laxity.
2. You’re much more likely to get hurt from being “too loose” than you are from being “too tight.” When it comes to stretching the throwing shoulder, “gentle” is the name of the game – and all mobility programs should be as individualized as possible.
3. Maintaining internal rotation is a lot more important than whatever is going on with external rotation. In fact, this piece could have just as easily been named "The Two Stretches Pitchers Shouldn't Do, Plus a Few That Only Some of Them Need."
As you can probably imagine, given that I deal with a ton of baseball players - and the fact that I've written about shoulder pain a ton over the past decade - a lot of people initially come to Cressey Performance because their shoulder hurts. It might be rotator cuff pain, AC joint irritation, or any of a host of other issues, but you'd be surprised at how many similarities there are among the ways that you address most of these issues.
The problem is that pain can throw a wrench in your plans and limit you in your ability to get to exactly where someone needs to improve movement-wise. For instance, you might have someone who has a significant glenohumeral (ball-and-socket) internal rotation deficit, but it's hard to manually stretch them into internal rotation without further irritating a cranky AC joint. Or, someone with a partial thickness rotator cuff tear may be dramatically limited in shoulder flexion, but even shoulder flexion with assisted scapular posterior tilt and upward rotation exacerbates their symptoms. Very simply, you can't just pound round pegs into square holes when it comes to dealing with a delicate joint like the shoulder - and that applies to both asymptomatic and symptomatic shoulders.
To that end, there are three initiatives that I think are the absolute most important places to start in just about every case.
First, I'm a huge advocate of soft tissue work with a skilled manual therapist. In our office, we have a massage therapist and chiropractor who performs both Active Release and Graston. And, we make sure that any physical therapist to whom we refer clients uses manual therapy as an integral part of their treatment approach. Whether you're a regular exerciser or not, tissues can get dense, nasty, and fibrotic, and integrating some hands-on work on the pec minor, posterior rotator cuff, lats, scalenes, sternocleidomastoid, and several other areas can dramatically reduce an individual's symptoms and improve range-of-motion instantly - and that allows us to do more with a corrective exercise program.
Understandably, not everyone has access to a qualified manual therapist all the time, so you can always utilize self-myofascial release in the interim. Here, in a video from Show and Go: High Performance Training to Look, Feel, and Move Better, CP massage therapist Chris Howard goes over a quick and easy way to loosen up the pecs:
The second area where you really can't go wrong is incorporating thoracic spine mobilizations. The thoracic spine has direct interactions with the lumbar spine, rib cage, cervical spine, and scapulae; as a result, it has some very far-reaching effects. Unfortunately, most people are really stiff in this region - and that means they wind up with poor core and scapular stability, altered rib positioning (which impacts respiration), and cervical spine dysfunction. Fortunately, mobilizing this area can have some quick and profound benefits; I've seen shoulder internal rotation improve by as much as 20 degrees in a matter of 30 seconds simply by incorporating a basic thoracic spine mobility drill.
That said, not all thoracic spine mobility drills are created equal. Many of these drills require the glenohumeral joint to go into external rotation, abduction, and horizontal abduction in order to drive scapular posterior tilt/retraction and, in turn, thoracic spine extension and rotation. If you've got a cranky shoulder, this more extreme shoulder position usually isn't going to go over well. So, drills like the side-lying extension-rotation are likely out:
For most folks, a quadruped extension-rotation drill will be an appropriate regression:
And, if the hand position (behind the head) is still problematic for the shoulder, you can always simply put it on the opposite shoulder (in the above example, the right hand would be placed on the left shoulder) and keep the rest of the movement the same.
Last, but certainly not least, you can almost always work on forward head posture from the get-go with someone whose shoulder hurts. We start with standing chin tucks, and then progress to quadruped chin tucks.
Additionally, working on cervical rotation is extremely valuable, although teaching that is a bit beyond the scope of this post.
Keep in mind that these three broad initiatives are really just the tip of the iceberg when it comes to a comprehensive corrective exercise plan that would also include a focus on scapular stabilization and rotator cuff exercises, plus additional mobility drills. They are, however, safe entry-level strategies you can use with just about anyone to get the ball rolling without making a shoulder hurt worse in a strength and conditioning program.
For more information on what a comprehensive shoulder rehabilitation program and the concurrent strength and conditioning program should include, check out Optimal Shoulder Performance, a DVD set I co-created with Mike Reinold, the Head Athletic Trainer and Rehabilitation Coordinator of the Boston Red Sox.
The Optimal Shoulder Performance DVD is a phenomenal presentation of the variables surrounding shoulder health, function, and performance. It combines the most current research, real world application as well as the the instruction on how to implement its vast amount of material immediately. After just one viewing, I decided to employ some of the tactics and methods into our assessment and exercise protocols, and as a result, I feel that myself, my staff and my clients have benefited greatly.
Michael Ranfone BS, CSCS, LMT, ART
Owner, Ranfone Training Systems
The other day, I received an email from a Show and Go customer who noticed that the scapular wall slide and the doorway slide were two similar, but not identical shoulder mobility drills included in the program. He asked if I could talk a bit more about the differences between the two - and when to use both.
First, let's have a look at the two exercises. Here's the scapular wall slide:
And, here's the doorway slide:
As the voice-over on the video above notes, the scapular wall slide is an acceptable fit for just about any workout routine. The only exceptions would be those who have upper extremity pain with overhead motions (rotator cuff tears, etc.).
However, we can utilize the doorway slide in certain folks to get to where we want to be a bit faster. More specifically, these folks are the ones who are REALLY immobile in their upper extremity and wouldn't even be able to get their arms back even close to the wall on the wall slides. So, in addition to not making them feel bad about their "tight shoulders", the doorway slide actually allows us to use the doorway as a stretching implement to get a gentle stretch across the anterior shoulder girdle (predominantly pec major and minor). There are three very important coaching points:
1. Don't let the head poke forward, as a forward head posture is simply a substitution for not retracting/depressing the scapulae or horizontally adducting the humerus.
2. Don't crank too aggressively on the shoulders; it should be a subtle stretch. And, it shouldn't be used with those (particularly overhead throwing athletes) who already have increased external rotation and, in turn, more anterior laxity.
3. Make sure to focus on pulling the shoulder blades down and back as the elbows are lowered. You shouldn't have movement of the humerus without movement of the scapula.
