It’s time for this month’s installment of my random thoughts on sports performance training. In light of my ongoing sale on my Sturdy Shoulder Solutions resource, I thought I’d focus this edition on the shoulder.

1. If you want a healthy shoulder, getting tobacco products out of your life is a good place to start.

The research is pretty clear: smoking is a bad idea (and an independent risk factor) if you’re looking to stay healthy from a musculoskeletal standpoint, or have a good outcome in rehabilitation (whether conservative or post-surgical) . Here’s an excerpt from a recent study with an excellent review of the literature:

“Cigarette smoking adversely affects a variety of musculoskeletal conditions and procedures, including spinal fusion, fracture healing, surgical wound healing, tendon injury and knee ligament reconstruction. More recently, smoking has been suggested to negatively impact rotator cuff tear pathogenesis and healing. Tobacco smoke contains nicotine, a potent vasoconstrictor that can reduce the blood supply to the already relatively avascular rotator cuff insertion. Furthermore, carbon monoxide in smoke reduces the oxygen tension levels available for cellular metabolism. The combination of these toxins may lead to the development of attritional rotator cuff tears with a decreased capacity for healing.”

Many times, we’re looking for the best exercise, rehabilitation protocol, soft tissue treatment, or volume amounts – but we really ought to be looking at lifestyle factors.

With a large baseball readership on this site, the logical next question: are these harmful effects also noted with smokeless tobacco (i.e., dip/chew)? The research is somewhat sparse, as it’s harder to study a younger, active population than a bunch of middle-aged post-operative rotator cuff patients. However, it’s hard to believe that the aforementioned carbon monoxide implications would cause 100% of the issues and that the nicotine would serve as just an innocent bystander. So if you’re looking to check every box in your quest to stay healthy, it’s not a bad idea to lay off the dip.

And, if healthy tendons aren’t enough to convince you, do yourself a favor and read this article by Curt Schilling.

2. The 1-arm, 1-leg landmine press isn’t a mainstay in your training programs, but can be a perfect fit in a few circumstances.

This looks like kind of a wussy exercise, but I actually really like it in two circumstances.

a. It’s awesome in a post-surgery period when you can’t load like crazy, but still want folks to be challenged in their upper extremity progressions. The single-leg support creates a more unstable environment, which means that antagonist activity is higher and there is more work going to joint stability than actual movement. In other words, it makes pressing safer.

b. Once we get to the inseason period, it allows us to check two boxes with a single exercise: single-leg balance and upper body strength (plus serratus activation/scapular upward rotation).

3. Posterior pelvic tilt increases lower trap activation.

I’ve written about it a lot in the past: core positioning has an incredibly important impact on shoulder function. Check out this study on how reducing anterior pelvic tilt increases lower trapezius activation during arm elevation and the return from the overhead position.

In my experience working with extension-rotation athletes (particularly baseball players), one of the biggest risk factors for shoulder injury is when the lower trapezius can’t keep up with the latissimus dorsi. Just consider the attachment points of the lat in the picture below; as you can imagine, if you posteriorly tilt the pelvis, the lat is inhibited, making it easier for lower trap to get to work.

The lower trapezius is very important for providing posterior tilt (slight tipping back) of the scapula and assisting in upward rotation. These two functions are key for a pitcher to get the scapula in the correct position during the lay-back phase of throwing.

By contrast, the lat has more of a “gross” depression effect on the scapula; it pulls it down, but doesn’t contribute to posterior tilting or upward rotation. This might help with an adult rotator cuff pain patient who has an aggressive scapular elevation (shrug) substitution pattern, but it’s actually problematic for a thrower who is trying to get his scapula up and around the rib cage to make sure that the ball-on-socket congruency is “flush” when it really matters: the maximal external rotation position.

As such, you can say that the lat and lower trap “compete” for control of the scapula – and the lat has a big advantage because of its cross-sectional area and multiple attachment points. It’s also much easier to train and strengthen – even if it’s by accident. Upper body work in faulty core positioning (in this case, too much anterior pelvic tilt and the accompanying lumbar extension) shifts the balance to the lats.

We’ll often hear throwers cued “down and back” during arm care drills. The intention – improving posterior tilt via lower trap activation – is admirable, but the outcome usually isn’t what’s desired. Unless athletes are actually put in a position of posterior tilt where they can actually feel the lower traps working, they don’t get it. Instead, they pull further down into scapular depression, which feeds the lat-dominant strategy. This is why we teach almost all our throwers to differentiate between depression and posterior tilt early on in their training at Cressey Sports Performance.

If you’re looking to learn more about how I assess, program, and coach at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions. Learn more at www.SturdyShoulders.com.