Q: I've read a lot from you, Robertson, and Hartman about including push-up variations in strength training programs is really important for shoulder health. Unfortunately, whenever I do them, I have pain in my bum shoulder. Any ideas what to do?
A: Well, obviously, there are two things we need to rule out:
1. You may simply have a really irritated shoulder, which (in most cases) means that any sort of approximation or protraction movement could get it angrier, even if it is a closed-chain movement like the push-up that is normally pretty shoulder-friendly. Likewise, if you have a significant acromioclavicular joint injury, the extension range-of-motion at the bottom of a push-up could exacerbate your symptoms. So, obviously, the first step is to rule out if something is structurally wrong with your shoulder, and if so, if the push-up even belongs in your strength training program.
2. Your technique might just be atrocious. If the elbows are flared out, hips are sagging, and/or you're in a forward head posture, simply changing your technique may very well alleviate those symptoms. In a good push-up, the elbows should be tucked to a 45-degree angle to the body, with the hips, torso, neck, and head in a straight line. The muscles of the upper back should essentially "pull" you down into the bottom position:
Once you've ruled out those two issues and still have some annoying issues, there is one more thing you can try: simply elevate the feet. Looking to the research, Lear and Gross found that performing push-ups with the feet elevated significantly increased activation of the serratus anterior (SA).
If we can get more SA recruitment and less pectoralis minor contribution, it keeps us out of a position of scapular anterior tilt, which mechanically decreases the subacromial space through which the rotator cuff tendons pass. In the picture below, think of the area just below the word "acromion" being smaller, and then picture what would happen to the tendons that pass through that region; they get impinged. Serratus anterior (along with lower trapezius) can help prevent that.
That said, I've seen quite a few folks with persistent shoulder pain with bench pressing variations (barbell and DBs) and regular push-ups who were able to do the feet-elevated versions completely pain free in their strength training programs. Obviously, begin with just body weight and see how it goes, but over time, you can start to add resistance and use the single-leg version.
Here's a collection of stuff I encourage you to check out this week:
The Return of BSP - I really enjoyed CP staff member Brian St. Pierre's latest blog post on supplements. Some people just need a smack in the face to wake up from idiocy.
Research links Nicotine to Pre-Diabetes - And you thought that only junk carbs, poor genes, and a lack of exercise makes folks insulin resistant. In reality, it sounds like smoking does as well.
Self-Ankle Mobilization to Increase Dorsiflexion - Here's a cool new video Bill Hartman just posted on ankle mobilizations. I've used stuff like this in the past on my own ankle and it definitely makes the mobilization more effective.
Last week, I published a post on shoulder issues with overhead pressing, and got two good comments as replies:
1. In HS I separated my AC joint during the first game of junior year. I played the rest of the year with out letting it heal, and to this day I have still have shoulder issues (college ball didn't help the issue much either). It seems my shoulder allows me to overhead press/push press/jerk and incline press, but flat bench is out of the question unless I'm using DBs. Is this typical of this type of shoulder injury, or am I an outlier and most individuals show the same symptoms as yourself? Granted we each have different injuries but same local area.2. I have pain doing flat bench presses with barbell and upright rows. Decline barbell press is also sometimes uncomfortable, but incline press and overhead press is working fine.
This is actually pretty typical of acromioclavicular (AC) joint problems. Folks will have problems with exercises like full-ROM bench presses and dips, as they force full humeral extension. Decline bench pressing requires less humeral extension on the eccentric than regular bench pressing and dips, so that would explain the decrease in symptoms.
That said, overhead pressing will usually be okay because it doesn't require so much humeral extension (nothing past neutral). However, some folks will have other related problems (e.g., rotator cuff injury during the AC injury), so both horizontal and vertical pushing movements may become problems.
So, obviously, not all shoulder problems are created equal. However, a lot of the time, they can be treated with similar means: good scapular stabilization movements, a focus on thoracic spine mobility, and dedication to strengthening the rotator cuff and improving soft tissue quality.
As many of you probably already know, I flew out to Indianapolis on Friday night to spend the weekend shooting a new DVD with Bill Hartman and Mike Robertson. Suffice it to say that we are all pleased with how it turned out and excited for the release. Basically, here's what you're looking at...
27 dynamic SELF-assessments (meaning that you can do them yourself - no partner needed)
A Full-on Static Assessment Guide
Approximately 78 corrective exercises for improving mobility and stability - based entirely on the results of the aforementioned assessments. In other words, you assess, and then you are pointed in a specific direction to correct these issues. You'll learn how to integrate some of the exercises from Magnificent Mobility and Inside-Out in comprehensive progressions - plus loads of new drills along the way.
A Written Collection of Warm-ups specific to certain athletic populations
A Complete Guide to Self-Soft Tissue Work - and a rationale for it
A Comprehensive Static Stretching Guide
You know the project is legit because of this picture of Lance, our demonstrator.
First, he's exhausted, which means that there are loads of exercises. Second, he actually ended up with pit stains from the experience, so these aren't just foo-foo exercises; they take things up a notch at the "top" of each progression (particularly if you do them for six hours, as Lance did on Saturday). Third, you just have to love a DVD set that uses a guy with deadlifting bruises on his shins as the model. Talk about attitude!
For more on the weekend, check out Lance's Blog.
Needless to say, we're stoked about this. There isn't a definitive time-table on the product's release, but you can be the first to find out about it by subscribing to my newsletter through the opt-in box on the right sidebar of this page.
I got this question the other day and thought I'd share my response:
Q: When significant improvements in flexibility are either desired or needed, do you have any general suggestions with regard to what method(s) and type of schedule set-up (frequency, duration of session, etc.) would help accomplish this in the most timely and efficient manner possible?
A: As always, my answer would be "it depends." And, more specifically, it depends on whether you are talking about short or stiff tissue.
If a tissue is legitimately short - meaning that it has lost sarcomeres due to chronic immobilization - longer duration holds are ideal. Bill Hartman and Mike Robertson go into great detail in covering this in the Indianapolis Performance Enhancement DVD Set, as I noted HERE.
If you are dealing with someone with capsular issues (outside the scope of practice of the personal trainers and strength coaches out there, in most cases), then you might just leave them alone with 15 minutes of low-load passive stretching (e.g., theraband wrapped around a DB to hold the shoulder in external rotation after a period in a sling). Going back to our "loss of sarcomeres" scenario, if you're dealing with something more muscular-only issues, the least you'll want is five 30s holds throughout the day, in my experience. Or, if feeling bold, you can have people set up for 3x5min holds or 1x15min hold. In both cases, total duration over the course of the day is likely more important than duration per stretch.
If it's stiff, in order to get it to relax, you likely need to train an adjacent tissue that acts as a synergist. A good example would be strengthening the lower traps to take the stress off chronically overused upper traps and the stiff neck that follows. Or, we have activating the glutes to take the stress off the lumbar erectors and/or hamstrings and adductor magnus. Here is a great blog post from Bill Hartman that closely illustrates the point that you don't necessarily have to stretch a muscle to reduce its stiffness.
Of course, you can never go wrong with integrating a good dynamic warm-up program prior to exercise, as this option challenges both range-of-motion and stability to provide a comprehensive training effect in a matter of minutes.
So, in the end, it's different strokes for different folks - at different times, with different issues. Keep an eye out for an upcoming project from Bill, Mike, and I that really delves into this in great detail. It'll be the most comprehensive resource out there for self-assessment and corrective exercise.
If you asked my fiancee (or anyone who knows me well, for that matter), she would tell you that I work all the time. If I'm not training athletes, I'm training myself, reading research, or writing programs or articles about training. My life pretty much revolves around it - and I'd be lying if I didn't say that it is challenging to get to everything.
To be very honest with you, I'd probably make more money if I just stayed home and wrote articles and books all day. It's a direction quite a few folks in this industry have taken, in fact. You'd be surprised at how many well-known internet personalities in the exercise world don't see athletes anymore; they just stay home and write about what life would be like if they actually did train people. Or, they talk about what they used to do when they worked with folks, or what they've seen in the research of late.
Now, I'm all for research. And, given my articles, books, and DVDs, I'm all for sharing knowledge that I've gained. However, I'm a huge believer that you can't add to the body of knowledge unless you are out in the trenches working with people. You'd be surprised at how many researchers and writers could never get results in the real world. Why? Because people - attitudes, emotions, individual differences, etc. - get in the way.
This is why I have so much respect for those who are "in the trenches" and derive a significant portion of their income from in-person training. I enjoy articles, blogs, seminars, and products from guys like Alwyn Cosgrove, Mike Boyle, Mike Robertson, Bill Hartman, Mike Reinold, Jim Smith, Brijesh Patel, Nick Tumminello, and dozens others because these are all guys who are in the real world working to help people. Unlike those who just write, they are constantly getting feedback from clients/athletes on what works and what doesn't; theories don't go untested. If I was a consumer, I'd actually go out of my way to make sure the person writing a book or article was actually seeing clients/athletes before purchasing it.
A few years ago, I never would have even thought to make this promise, but the internet certainly changes things. And, that's why I'm promising today that I'll be training athletes for a long time, and the day I stop training athletes is the day that I stop writing and speaking about training, too.
1. It's a fun time of year around Cressey Performance, as all the college guys are starting to roll back in, and the high school baseball playoffs are nearly at hand. Brian St. Pierre was so excited about it that he tried to high five on of our power racks with his forehead. He (and his three stitches) will be featured in the next episode of "When Power Racks Attack."
2. After I mentioned last week that Mike Robertson, Bill Hartman, and I had something in the works, I got several emails (and a stand-up question at the end of my talk at Perform Better last weekend) from people wanting to know what we were scheming up. Suffice it to say that it's a sequel to Magnificent Mobility and Inside-Out, but on a whole new level. If those DVDs were little league, this is going to be big league stuff,
We'll have detailed assessments, progressions, and sport-specific protocols. I guess you could say that it's somewhat of a "choose your own adventure" book where you can take multiple paths; and, in the case of trainers/strength coaches, you can help your clients/athletes out individually. And, there will be a nice tag-along manual. We are hoping to get this kid to sing on the soundtrack, but his agent won't call me back.
Anyway, we've got over three years of accumulated "add-ons" from the initial MM DVD, and it's also the first time the three of us have put all our heads together on a project. Should be very cool - and we are hoping for a mid-summer release date. If you aren't already subscribed to my newsletter, definitely do so (with the feature over to the right of this page) and we'll make sure you're notified right away. You can view a sample of this newsletter by checking out the one from earlier this week: Newsletter 154.
3. Mike Reinold has an awesome blog post series going about Anterior Knee Pain. Whether you're a strength coach, personal trainer, physical therapist, garbageman, orthodontist, or lazy wanker who just lives in his parents' basement, I'd highly recommend you check it out at MikeReinold.com.
4. One of the things I love the most about training pitchers is when they go out in the spring - after a winter of training to improve throwing velocity and prevent injury - and start hitting bombs at the plate. Obviously, it's awesome for their confidence, but just as importantly, it's proof in the pudding that simply enhancing overall athleticism will carry over to just about anything.
If a kid only goes from 78 to 88mph on the mound, he tries to attribute it solely to a change in mechanics or lots of rubber tubing drills for his rotator cuff. However, if he starts hitting 400-foot shots alongside that velocity increase, you know he'll start to appreciate that the extra 20 pounds of meat on his butt, hamstrings, and upper back - and the big strength increases - are all playing a part in that improvement.
That's all. Have a great weekend!
1. It's going to be a quick one this week, as I'm doing some last minute preparations for this weekend's Perform Better Summit in Providence, RI. To all the poor abandoned souls who count on my blog for companionship each Friday, I apologize for not giving our relationship the tender romance it deserves this week.
2. Congratulations to Cressey Performance athlete and Auburn High pitcher Tyler Beede, who threw a no-hitter on Wednesday. Tyler struck out 15 in his complete game performance.
3. I contributed on the fourth installment of Mythbusters at T-Nation this week. It also includes contributions from Chad Waterbury, Tony Gentilcore, and Christian Thibaudeau. Noticeably absent from this esteemed crew of contributors is Mr. Celery - so I thought I'd give him some love.
4. For the foam rolling aficionados in the crowd, here's a great variation to use for those hard-to-reach grundle adductor region. Thanks to Tony Gentilcore for the video:
This is a really important one for those of you in the crowd with a history of groin strains and sports hernias. Hockey players, soccer players, and powerlifters should commit this one to memory.
5. It's official: Mike Robertson, Bill Hartman, and I are filming a new DVD on June 7th. Lots to prepare before then!
To kick off the week, I thought I'd give you a quick heads-up on some stuff you ought to read:
What Your Doc Doesn't Know About Weightlifting - This great piece is from Nikhil Rao, an avid weight trainer who also happens to have recently become a doctor. He shares some excellent insights about how prepared your doctor may (or may not) be to give recommendations to you on exercise and nutrition.
The Proactive Patient - Along these same lines, it'd be worth checking out this article I wrote last year. It talks a lot about things you ought to consider if you're injured and want to get the best care possible.
I've actually got something good in the works along these lines right now, and should be submitting it at T-Nation by the end of the week.
The Indianapolis Performance Enhancement DVD Set - I previously wrote a review about this product HERE, but it seemed like a good idea to give it another mention since it's on sale at 15% off through the end of the day Thursday. Just use the coupon code "HITCHED" at checkout.
