Home Posts tagged "Neck Pain"

The Best of 2018: Strength and Conditioning Articles

With 2018 winding down, I'm using this last week of the year to direct you to some of the most popular content of the past 12 months at EricCressey.com, as this "series" has been quite popular over the past few years. Today, we start with the most popular articles of the year; these are the pieces that received the most traffic, according to my hosting statistics.

1. The Study Every Trainer and Coach Should Read and Understand - Good movement matters - and here's the research that helps to demonstrate why.

2. How to Use the Acumobility Ball for Upper Extremity Health and Performance - I'm a huge fan of the Acumobility ball, and in this detailed video-oriented post, I discuss how we utilize it for specific work in the upper body.

3. Crossfit and Confirmation Bias - Write a blog that mentions Crossfit and get great traffic? Go figure.

4. Making Movement Better: Duct Tape or WD-40? - Should you add stability or mobility to fix a problem? Give this article a read to find out.


Source: http://laughingateverydaylife.com/2016/07/duct-tape-vs-wd40/

5. Why You Shouldn't Look Up When You Lift - It drives me bonkers to see lifters looking up at the ceiling during squats, deadlifts, and even arm care exercises. In this post, I discuss why that's the case.

I'll be back soon with another "Best of 2018" feature. Up next, the top videos of the year!

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Why You Shouldn’t Look Up When You Lift

To tuck the chin or not? It's one of the most debated topics in the world of strength and conditioning and sports medicine these days. If you've read any of my stuff (including the detailed presentation, "Nuances of the Neck," in my new resource, Sturdy Shoulder Solutions), you'll know that I prefer tucking it - the so-called "packed neck position" - to preserve a more neutral cervical spine positioning, whether it's on deadlifts, squats, or push-ups.

One of the most common arguments against this packed neck position is that Powerlifter X and Olympic Lifter Y look up during lifts, and they're really strong. I'd encourage you to consider that:

1. Most of your clients/athletes have no interest in being Powerlifter X or Olympic Lifter Y. They just want to be fit, healthy, proficient in their sport. They value quality of life over weight room PRs - so movement quality takes place over absolute loading.

2. Good outcomes don't necessarily equate to good movements, so it's difficult to always draw population-wide conclusions from elite athletes. As an example, Cressey Sports Performance athlete and Cubs pitcher Steve Cishek is an accomplished MLB pitcher, yet he has some "high maintenance" pitching mechanics that you would never teach to another up-and-coming pitcher. He's just found a way to make them work, even if they do put his body in some funky positions. 

 

Slooooooow moooooo Cisshhheekkk. #cspfamily #cubs

A post shared by Eric Cressey (@ericcressey) on

Just because someone is strong doesn't mean that they're getting to those big numbers via the most efficient or healthy avenues.

3. We have no idea what Powerlifter X or Olympic Lifter Y's necks will look (or feel) like in their 60s.

4. Especially under load, it's never a great idea to take one joint close to its end-range at the expense of motion at other joints. A common example is getting too much low back movement when the hips are stiff. Well, when it comes to cervical extension, most people get far too much in the upper cervical region and far too little in the lower cervical spine. So, not all "look ups" are coming from the same place - and some will certainly create more pathology than others.

5. When you go into upper cervical/head extension, you're shortening levator scapulae, which is a downward rotator of the scapula.

If you're looking to set up an overhead squat or snatch, it's probably not a great idea to encourage downward rotation of the scapula when you need upward rotation for quality overhead motion. Here's a video that delves into this a bit further:

6. You're also shortening sternocleidomastoid, which is one of the biggest muscular contributors to chronic headaches.

So do yourself a favor and just tuck your chin a bit. And, if you'd like to learn more about the functional anatomy and unique challenges we face with the neck, be sure to check out Sturdy Shoulder Solutions.

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Acumobility Self Care for the Neck – Part 5

Today is the fifth and final installment of my video series on self care for the neck and upper extremity with the Acumobility Ball. In this edition, I cover the upper traps with a four-minute video, as this approach isn't right for everyone. Don't forget that you can get 10% off on this great soft tissue tool with the coupon code cressey at www.Acumobility.com.

Thanks for sticking with me for all five videos! I hope you enjoyed them and derived some benefit.

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Acumobility Self Care for the Neck – Part 2

Today, I've got the second video in my series on how we utilize the Acumobility Ball to perform self myofascial release in the upper extremity - and, in particular, the neck. As a reminder, the crew at Acumobility have been kind enough to provide my readers with 10% off by using the coupon code cressey at www.Acumobility.com. Today, we'll talk about the scalenes.

I'll be back soon with another video to keep this series going.

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Acumobility Self Care for the Neck – Part 1

In a recent Instagram post, I discussed how big of a fan I am of the Acumobility ball, and I got a lot of questions about how we integrate it for upper extremity and neck self-care. With that said, I wanted to kick off a series this week with a look at where we start when it comes to implementing this tool. The good folks at Acumobility have been kind enough to provide my readers with 10% off by using the coupon code cressey at www.Acumobility.com.

To kick things off, let's talk about functional anatomy and self myofascial release for the sternocleidomastoid (SCM):

I'll be back soon with a new video to keep this series going.

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How to Use the Acumobility Ball for Upper Extremity Health and Performance

I'm a big fan of utilizing the Acumobility Ball for self-myofascial release. You just need to be very careful to not work too intensely around the more delicate structures of the neck. The good folks at Acumobility were kind enough to set up a 10% off discount for my readers; you can get it by entering the coupon code cressey at checkout at www.Acumobility.com.

Check out this five-part video series on how we integrate this great tool:

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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

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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 from 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

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Shoulder Hurts? Start Here.

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

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Shoulder Pain vs. Neck Pain

Here are a few recommended reads for the week: Shoulder Pain vs. Neck Pain - This old post highlights a simple, but very accurate observation from Mark Comerford. 28 Synergistic Factors for Success - I wrote this article at T-Nation back in 2005, but it still holds water and will make you appreciate how many differen factors are impacting your progress. Too Much Vitamin D? - This great Q&A from Brian St. Pierre addresses this new question that seems to be popping up quite a bit. Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
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Strategies for Correcting Bad Posture – Part 2

Today, we move forward with more strategies for correcting bad posture. In case you missed it, be sure to check out Strategies for Correcting Bad Posture: Part 1.  We pick up with tip #5... 5. Don't overlook a lack of glenohumeral (shoulder) joint internal rotation. When it comes to bad posture, everyone thinks that the glenohumeral joint is only a "player" when it's stuck in internal rotation; that is, the ball - or humeral head - is rotated too far forward on the socket - or glenoid fossa - meaning that the individual just doesn't have adequate external rotation.  And, this is often true - especially in non-athletic populations. However, you'll also very commonly see poor posture folks who present with big glenohumeral internal rotation deficits (GIRD), particularly on the right side (for very legitimate reasons that go well beyond the scope of this article).  This is much more common in athletes, particularly overhead throwers (read more: Static Posture Assessment Mistakes).  When the posterior rotator cuff is stiff/short and there is an internal rotation deficit, we have to substitute excessive scapular protraction (winging) or thoracic flexion/rotation each time we reach for something. So, for many folks, posterior shoulder mobility and soft tissue work is an important inclusion in cleaning things up in terms of appearance, function, and shoulder health.  If - and only if - you've been assessed and it's been determined that you have an internal rotation deficit that compromises your total motion at the glenohumeral joint, you can integrate some gentle sleeper stretches (scapula stabilized!) to get a bit more ROM in the posterior cuff.

6. Don't overlook a lack of glenohumeral (shoulder) joint flexion. The shoulder is a tremendously mobile joint, so we need to appreciate what goes on outside the transverse plane as well. In particular, I see shoulder flexion limitations as a big problem. These limitations may come from the lat, teres major, long head of the triceps, or inferior capsule.  Another overlooked cause can be posterior cuff restrictions; it's not uncommon to see both GIRD and major shoulder flexion limitations on the same side.  As the picture below shows, the infraspinatus and teres minor run almost vertically when the arm is abducted a mere 90 degrees - which means that they're struggling to lengthen fully to allow full shoulder flexion (and abduction, for that matter).

These restrictions that can contribute to both faulty compensation patterns in certain positions, as well as overall bad posture chronically.  Let's have a look at what these issues look like in the real world. First, in someone with a shoulder flexion limitation, you'd first want to check them in the supine position, with the knees flexed and back flat (to avoid substituting lumbar extension for shoulder flexion).  Ideally, the arms should rest flat on the table - so this would be a "not-so-hot" result (especially since the arms "fall" to the sides a bit instead of staying in "attempted flexion"):

Next, let's take this same shoulder flexion limitation, and look at what would happen actively.  In the first three reps of the video below, take note of the position of our subject's head at the start and finish of each rep; you'll see that as he "runs out" of shoulder flexion, he substitutes forward head posture.  On the next three reps, after I cue him to keep his cervical spine in a more neutral posture, he has to arch his back excessively (lumbar hyperextension) to complete the movement.

Now, imagine taking this walking disaster (only kidding; I had Dave fake it for the video, as he's actually a finely tuned trained killing machine who can't be stopped by conventional weapons - and he's single, ladies) taking up overhead pressing, Olympic lifting, or just reaching for a glass on the top shelf.  Then, imagine him doing those tasks over and over again. Obviously, the posture will get worse as he reinforces these compensation schemes - but something is going to surely break down along the way; it's just a question of whether it's his low back, shoulder, or neck!

Correcting these issues is easier said than done; as I noted, there are several structures that could be the limiting factor.  However, for those looking for a relatively universal stretch they can use to get a bit of everything, I like the wall lat stretch with stabilization, one piece of a comprehensive (but not excessive and boring) static stretching program included in Show and Go.

7. Don't ignore the thoracic spine. The previous two examples focused exclusively on the glenohumeral joint, but the truth is that it is tremendously dependent on thoracic spine positioning.  Ask any physical therapist, and they'll tell you that if they can get the thoracic spine moving, they can instantly improve glenohumeral joint range-of-motion without even touching the shoulder (this is incredibly valuable with folks who may have stiff glenohumeral joints that can't be mobilized aggressively following shoulder surgery; they need ROM in any way possible).  And, truthfully, you can substitute a lack of thoracic spine extension for the shoulder flexion problems and compensation schemes above, and a lack of thoracic spine rotation can work in much the same way as a GIRD (substitute excessive scapular protraction with reaching tasks).

If you ever want to quickly check to see what limiting thoracic extension does to someone's upper body posture, just put them in supine position and push the sternum/rib cage down - which will bring the thoracic spine into flexion. Watch what happens to the position of his chin, and the size of the "gap" between his neck and the table:

Now, just consider what kind of "yank" this puts on the sternocleidomastoid chronically...

...and you'll understand why a lack of thoracic spine mobility can give people enough neck pain and tension headaches to make Lindsay Lohan's hangovers look like a walk in the park.  And this doesn't even consider what's going on with scalenes, suboccipitals, levator scapulae, subclavius, and a host of other muscles that are royally pissed off!  Also, think about all those folks in your gym doing hours and hours of crunches (especially while tugging on the neck).  Ouch.

For that reason, we need to get our thoracic spine moving - and more specifically, we need to get it moving in both extension and rotation.  I've mentioned in the past that the side-lying extension-rotation is one of my favorites (assuming no symptoms); remember that the overwhelming majority of the range-of-motion is coming from the upper back, not just the shoulder:

Here's another we're using quite a bit nowadays in our folks who have good internal rotation (which we want to keep!):

8. Watch your daily habits and get up more frequently. I'm at 1,140 words for this post right now - plus several pictures and videos.  In other words, some of you might have been hunched over your computer screens trying to figure out what I'm saying for over 20 minutes now - and that's when "creep" starts to set in an postural changes become more and more harmful (both aesthetically and functionally).

With that in mind, make a point of getting up more frequently throughout the day if you have to be sitting a ton.  Likewise, "shuffle" or "fidget" in your chair; as Dr. Stuart McGill once said, "The best posture is the one that is constantly changing."  Now, shouldn't you get up and walk around for a few minutes?

I'll be back soon with Part 3 of this series, but in the meantime, I'd encourage you to check out Show and Go: High Performance Training to Look, Feel, and Move Better, a comprehensive program that includes many of the principles I have outlined in this series.

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