Home Posts tagged "Optimal Shoulder Performance" (Page 3)

Lose Fat, Gain Muscle, Get Strong: Eric Cressey’s Best Articles of 2010

Show and Go: High Performance Training to Look, Feel, and Move Better - This was obviously my biggest project of 2010.  I actually began writing the strength and conditioning programs and filming the exercise demonstration videos in 2009, and put all the "guinea pigs" through the four-month program beginning in February.  When they completed it as the start of the summer rolled around, I made some modifications based on their feedback and then got cracking on writing up all the tag along resources.  Finally, in September, Show and Go was ready to roll.  So, in effect, it took 10-11 months to take this product from start to finish - a lot of hard work, to say the least.  My reward has been well worth it, though, as the feedback has been awesome.  Thanks so much to everyone who has picked up a copy.

Optimal Shoulder Performance - This was a seminar that Mike Reinold and I filmed in November of 2009, and our goal was to create a resource that brought together concepts from both the shoulder rehabilitation and shoulder performance training fields to effectively bridge the gap for those looking to prevent and/or treat shoulder pain.  In the process, I learned a lot from Mike, and I think that together, we brought rehabilitation specialists and fitness professionals closer to being on the same page.

Why President Obama Throws Like a Girl - A lot of people took this as a political commentary, but to be honest, it was really just me talking about the concept of retroversion as it applies to a throwing shoulder - with a little humor thrown in, of course!

Overbearing Dads and Kids Who Throw Cheddar - This one was remarkably easy to write because I've received a lot of emails from overbearing Dads asking about increasing throwing velocity in their kids.

What I Learned in 2009 - I wrote this article for T-Nation back at the beginning of the year, and always enjoy these yearly pieces.  In fact, I'm working on my 2010 one for them now!

What a Stressed Out Bride Can Teach You About Training Success - I wrote this less than a month out from my wedding, so you could say that I had a good frame of reference.

Baseball Showcases: A Great Way to Waste Money and Get Injured - In case the title didn't tip you off, I'm not much of a fan of baseball showcases.

Cueing: Just One Piece of Semi-Private Training Success - Part 1 and Part 2 - These articles were featured at fitbusinessinsider.com.  I enjoy writing about not only the training side of things, but some of the things we've done well to build up our business.

Three Years of Cressey Performance: The Right Reasons and the Right Way - This might have been the top post of the year, in my eyes. My job is very cool.

How to Attack Continuing Education in the Fitness Industry - Here's another fitness business post.

Want to Be a Personal Trainer or Strength Coach?  Start Here. - And another!

The Skinny on Strasburg's Injury - I hate to make blog content out of someone else's misfortune, but it was a good opportunity to make some points that I think are very valid to the discussion of not only Stephen Strasburg's elbow injury, but a lot of the pitching injuries we see in youth baseball.

Surely, there are many more to list, but I don't want this to run too long!  Have a safe and happy new year, and keep an eye out for the first content of 2011, which is coming very soon!

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Weight Training For Baseball: Best Videos of 2010

I made an effort to get more videos up on the site this year, as I know a lot of folks are visual learners and/or just enjoy being able to listen to a blog, as opposed to reading it.  Here are some highlights from the past year: The Absolute Speed to Absolute Strength Continuum - Regardless of your sport, there are valuable take-home messages.  I just used throwing velocity in baseball pitchers as an example, as it's my frame of reference.

Should Pitchers Overhead Press? - This was an excerpt from Mike Reinold and my Optimal Shoulder Performance seminar (which became a popular DVD set for the year).

Shoulder Impingement vs. Rotator Cuff Tears - Speaking of Mike, here's a bit from the man himself from that seminar DVD set.

Thoracic and Glenohumeral Joint Mobility Drills - The folks at Men's Health tracked me down in the lobby at Perform Better in Providence and asked if I could take them through a few shoulder mobility drills we commonly use - and this was the result.

Cressey West - This kicks off the funny videos from the past year. A few pro baseball players that I program for in a distance-based format created this spoof video as a way of saying thank you.

Tank Nap - My puppy taking a nap in a provocative position.  What's more cute?

Matt Blake Draft Tracker - CP's resident court jester and pitching instructor airs his frustrations on draft day.

1RM Cable Horizontal Abduction - More from the man, the myth, the legend.

You can find a lot more videos on my YouTube page HERE and the Cressey Performance YouTube page HERE.

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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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Strategies for Correcting Bad Posture: Part 1

This week, I'll feature several strategies for correcting bad posture; you should be able to insert these into your weight training programs quickly and easily for immediate results. Here we go...

1. Train more frequently.

Obviously, in many cases, those with bad posture often simply don't exercise enough, so any motion is good motion.  However, this also applies to regular exercisers who hit the gym 3-4 times per week as well.  Why?

Well, I do a lot of my "corrective" work in my warm-up programming - and the more often you train, the more often you'll have to do your foam rolling and mobility warm-ups.  So, breaking your training program up into smaller components on more frequent days might be the best way to force yourself to do the things that you need the most to correct bad posture.

2. Use daily mobility circuits.

Along the same lines as the "increase training frequency" recommendation, it'll never hurt to repeat your mobility warm-ups during your daily life. If you are someone who is really in need of drastic changes, do your warm-ups twice a day, seven days a week (on top of any static stretching you do).

3. Strengthen the deep neck flexors.

When you get stuck in a forward head posture, the deep neck flexors (muscles on the anterior portion of your neck) really shut down as the sternocleidomastoid, suboccipitals, levator scapulae, scalenes, and upper traps get dense, fibrotic, and nasty.

You can start off by simply doing chin tucks against the wall (put the back of your head up against a wall, then make a double chin without the back of your head losing contact with the wall). Then, you can progress to quadruped chin tucks, a drill I learned from Dr. William Brady.  In this drill, you'll work against gravity as you pull your head into a more neutral cervical spine posture.  Most people will butcher this on their first try by going into hyperextension as they get to the "top" of the movement.

When you get the technique down, you'll actually notice some crazy soreness along the anterior aspect of your neck in the days that following. We usually go with sets of 5-6 reps and a 2-3 second hold at the top of each rep.

4. Go with a 2:1 pulling-to-pushing ratio.

This is a recommendation you see quite a bit, but nobody really talks about how to "smoothly" apply it to a weight training program.  Here are a few approaches I've used in the past:

a. Simply add an extra pulling exercise on the end of a day's session.

b. Pair a bilateral pulling exercise with a unilateral pressing exercise - and do "halves" on each pressing set.  In other words, if I was doing 6x6 chest-supported rows (CSR) with 3x6/side 1-arm incline DB presses (IDP), here's how I'd set it up: CSR, IDP-right, CSR, IDP-left, CSR, IDP-right, CSR, IDP-left, CSR, IDP-right, CSR, IDP-left.

c. Make the pulling exercises in your program the A1, B1, and C1 options, with the pressing as the A2, B2, C2.  And, simply have an extra set of each of the pulling exercises - meaning you just don't return to the pressing exercise for a last set.  This might work out as more of a 3:2 pulling-to-pushing ratio, but you can always tack an extra set or two on at the end to make it work.

I'll be back soon with more strategies for correcting bad posture, but in the meantime, I'd encourage you to check out Optimal Shoulder Performance at www.ShoulderPerformance.com, as this resource features loads of postural correction strategies to complement the ones featured in this series.

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I Get Hitched, So You Save $$$ (and Shoulders)

This Sunday, my fiancee Anna and I officially tie the knot. Also this Sunday, the major league baseball season officially ends - which means my buddy Mike Reinold (head athletic trainer and rehabilitation coordinator of the Boston Red Sox) is going to have some time to do some marriage "maintenance" of his own after lots of long days and travel since the season began in February. So, in honor of the weekend, Mike and I decided that we'd run a sale on our Optimal Shoulder Performance DVD Set.  From now through midnight on Sunday, just head to www.ShoulderPerformance.com, add the DVD set to your cart, and get $30 off the price of the DVD set by entering the coupon code "HITCHED" (no quotation marks) at checkout.

For those of you who may be on the fence about the product, be sure to check out the testimonials and product information on the website - as well as the following: 13 Fun Facts about Optimal Shoulder Performance Video: Should Pitchers Overhead Press?

Again, that's HITCHED at www.ShoulderPerformance.com through this Sunday (10/3) at midnight.

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Nutrition, Medicine Ball Training, and Overhead Pressing for Baseball Players

In honor of the end of the minor league baseball season yesterday, I thought I'd go with a baseball-only theme today for our "Stuff You Should Read." First, though, I thought I'd give you the heads-up that I finally broke down and got a Twitter account, on the recommendation of a few people.  If you're interested in following me, you can do so HERE.

With that out of the way, some baseball articles that may interest you: Athlete Profile: Shawn Haviland - This is a great feature at Precision Nutrition on one of our athletes, Shawn Haviland, who was recently named a California League All-Star after striking out 169 batters in 153.2 innings, with a 3.65 ERA.  Shawn has worked really hard to get where he is, and this article shows just how tough getting in proper nutrition can be during the professional baseball season. Medicine Ball Madness - This piece touches on our unique medicine ball training program.  At some point, I'm going to get around to writing up a detailed resource on this, but for now, this will do.  Suffice it to say that our guys will get a little bit of a break over the next few weeks, and then we'll be destroying a lot of med balls up through the first of the year. Should Pitchers Overhead Press? - The following video is an excerpt from Mike Reinold and my Optimal Shoulder Performance DVD set.  It's a great resource for fitness professionals and rehabilitation specialists alike - especially if you are working with baseball players.

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Case Study: More than Just Rotator Cuff Exercises

I had a one-time consultation client at Cressey Performance yesterday, and when I noticed that he had some interesting stuff going on, it made me realize that I need to do more "case studies" here in the blog. This guy had a history of on-and-off right-sided lower back and left shoulder pain.  Basically, it would act up every once in a while, then calm down when he cut out exercising.  Then, he'd return to training for a bit - only to have another set-back.  It has been one step forward, and one step back for years. Now, if you'd seen this guy move, you'd realize that the lower back and shoulder stuff were clearly closely related.  If you're at all familiar with the Postural Restoration Institute, he was a classic Left AIC pattern: adducted/internally rotated right hip and  abducted/externally rotated left hip - and the compensations working their way up to lead to a low right shoulder and prominent left rib flair.  Everything was definitely related.

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Not surprisingly, he'd been told he had scoliosis previously - but the "interesting" thing about it is that this was an acquired posture.  He hadn't had these when he was a kid; he developed them when he was a rower who was always on the right side of the boat.  If you can acquire them, you can "unacquire" them - but it takes time. We're getting him started on some drills to iron out his hip imbalances, but for the sake of this blog, I wanted to highlight what we saw with his shoulder, as I think it includes some great take-home messages on how to manage shoulder function - both in the presence and absence of pain. If you look at the research, if you look at shoulder total motion (internal rotation + external rotation with the scapula stabilized at 90 degrees of abduction), you should see symmetry between right and left in a healthy shoulder.  The internal and external components may be different between sides (e.g., more external rotation and less internal rotation in a throwing shoulder), but the total motion should be the same.  When it's not, "normalizing" total motion should be a primary goal, whether you're trying to address or prevent shoulder issues. In our case study's situation, here is what we measured with the goniometer: Left: 39° (IR) + 98° (ER) = 137° (TM) Right: 58° (IR) + 109° (ER) = 167° (TM) In other words, it was a 30° total motion deficit, with most of that deficit coming from internal rotation. The logical next step would be to manually stretch the shoulder girdle, right?  Well, certainly, it may be justified.  However, before I go having an athlete crank on a somewhat "delicate" joint, I like to see what we can do to get that area to relax without even touching it. The first thing we did was simply close down that left rib cage flair a bit while flexing his left hip and flexing his left arm overhead.  And, we just left him there to breath for 30 seconds or so.  Then, we remeasured: Left: 44° (IR) + 104° (ER) = 148° (TM) In other words, we got 11° of total motion without ever touching his shoulder.  His body did that work just by getting air in with a new posture (no left rib flair). Next, I simply had him get on all fours and go through a pretty low-key thoracic spine mobilization with his arm gently positioned behind his back so that it was on absolutely no stretch.  He did eight reps on each side, using cervical motion to drive a bit of thoracic extension and rotation and scapular movement.  Then, we remeasured: Left: 46° (IR) + 107° (ER) = 153° (TM) There's another 5° of total motion, and it got us a lot closer to where he needs to be - without ever touching his shoulder. And, the coolest part was that when he stood up, the low right shoulder was markedly less prominent - and it was a positioning that "stuck around" for the rest of his session. Sure, manual stretching of the shoulder is probably warranted for him to get those last 14 degrees, and I don't expect him to maintain all this range indefinitely after this session.  He'll need to be consistent with the movements to regain range bit-by-bit and use his strength training to ingrain it in his movement patterns, but the point is that the less aggressive, seemingly indirect, and self-applied interventions are often the best way to get lasting results.  And, when they work, it makes you realize just how "synced up" our entire body is from head-to-toe. For more information on the best assessments and corrective exercises for the shoulder, check out our Optimal Shoulder Performance DVD Set.

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Related Posts

Shoulder Range-of-Motion Norms Mobilizing the Throwing Shoulder: The Do and Don't

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Random Tuesday Thoughts: 7/27/10

1. I haven't done a "Random Friday Thoughts" blog in a while, so in the spirit of randomness, I thought I'd throw you a curveball and kick off the week with some Tuesday random thoughts. 2. Last week, I booked two plane tickets to Halifax, Nova Scotia for my fiancee and I.  She's a bridesmaid in a wedding up there in a few weeks, so I'll be making the trip as well.  As part of being what amounts to a "third wheel" for the weekend (the only people I know other than Anna in the entire wedding are the bride and groom), I'll have quite a bit of downtime while in the area.  Any readers out there have any suggestions for what to do in Halifax?  It's not hockey season, and I don't drink Molson, so I'm at a bit of a loss...

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Also, just out of curiosity, when did one have to sell off all his/her internal organs in order to afford a flight to Halifax?  Roundtrip airfare was over $1,500, and Air Canada followed up with an email that said, "We also mandate that you name your first child after us." 3. I wrote a guest blog for Men's Health last week; check it out: A Quick Fix for Stiff Shoulders. 4. Also on the writing note, I've written a few guest chapters lately.  The first was a strength and conditioning chapter for an upcoming pitching book for young baseball players and their parents.  The second (which is still a work in progress) is a chapter for a new IYCA project.  So far, it's coming along really well - and I'm really honored to be on-board for this with a group of really talented guys who are trying to do something very special. 5. Tonight (Tuesday), Boston Red Sox Head Athletic Trainer (and Optimal Shoulder Performance co-creator) Mike Reinold is hosting a free webinar: "What's New for 2010."  Click here for more information.

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6. Speaking of Mike, he had a great post last week about Epicondylitis and Cervical Radiculopathy.  It's a great adjunct to my "Understanding Elbow Pain" series from back in May.  If you missed it, here's a link to the sixth (final) installment (and you can link back to the previous five). 7. I realized the other day that there is one big thing I've always considered in our training programs for pitchers, but failed to mention on this blog: they need both open- and closed-chain hip mobility, as the right and left hips must rotate independently of one another during the stride to the plate. Here's a good example:

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You can see that Beckett is just short of stride foot contact here - which means that he's at just about maximal hip external rotation on the lead leg...in open chain motion.  The femur is rotating on the acetabulum.

Meanwhile, he's riding out his trailing leg...in closed chain motion.  The acetabulum is rotating on the femur.

As such, adequate mobility training for pitchers should include a combination of both open- and closed-chain drills, although I'd say that the majority should be closed-chain. 8. Today's Mike Robertson's birthday; head over to RobertsonTrainingSystems.com and show him a little love. Please enter your email below to sign up for our FREE newsletter.
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Swimming for Pitchers?

Last week, I had three separate pitchers ask me what I thought about swimming between starts.  My answer was pretty straightforward: I am not a fan at all.

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There are several reasons for my contention with this as a useful modality. Like pitchers, swimmers have some of the most dysfunctional shoulders in the entire sporting world; they have glaring scapular instability, big internal rotation deficits, and insufficient dynamic stability. Sound familiar?  These are the exact same things we work to address too keep our pitchers healthy. For me, cross-training is about getting athletes out of pattern overload - not finding a similar means of reinforcing imbalances.  Telling a pitcher to go swim is like encouraging a distance runner with a bum Achilles tendon to go jump rope instead.  It's an epic fail waiting to happen.

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When it really comes down to it, I’d rather have guys actually throwing if they are going to develop imbalances.  Pattern overload might as well give you improved motor control and technical precision if it's going to increase your susceptibility to injury! Speaking of specificity, the energy systems demands of swimming (longer distances, usually) don't reflect what we see in pitching (short bursts of intense exertion).  So, the arguments are in many ways similar to my contention with distance running for pitchers. And, more anecdotally, while incredible athletes in the pool, most of the swimmers I have encountered have been far less than athletic on solid ground, presumably because the majority of their training takes place in the water, where stability demands are markedly different.  I'd much rather see supplemental baseball training take place with closed-chain motion on solid ground - just like it does in pitching.

Finally, I'd like to see pitchers lift more - because they simply don't do enough of it during the season.  With limited time between outings, it's important to get in the most important stuff first - and I just don't see swimming as "important" when compared to flexibility training, soft tissue work, the throwing program, and strength training.

I'm sticking to my guns here.  I'd much rather see pitchers doing what I outlined HERE between starts, as it keeps them strong, gets them moving in ways that don't further ingrain imbalances, and avoids conflicting with the metabolic demands on pitching. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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AC Joint Impingement vs. “Regular” Shoulder Impingement

I've seen a few acromioclavicular (AC) joint impingement cases at our facility in the last couple of weeks and thought it'd be good to do a quick blog to talk about how different they are from "regular" (external) shoulder impingement cases.  And, it is a very important differentiation to make. I've already written at length about AC joint issues in Getting Geeky with AC Joint Injuries: Part 1 and Part 2.  And, I kicked out a two-part series called The Truth About Shoulder Impingement; here are Part 1 and Part 2. While I talk a lot about the symptoms for both, several provocative tests for these issues, and training modifications to avoid exacerbating pain under these conditions, there was one important "differential assessment that I missed."  Mike Reinold actually taught me it as we were planning the Optimal Shoulder Performance DVD set.

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Just paying close attention to (and asking about) where folks have their pain during overhead motion can tell you quite a bit.  In an external impingement - where we're talking about the rotator cuff tendons and bursa rubbing up against the undersurface of the acromion - you'll usually get pain as folks approach 90 degrees of abduction (arm directly out to the side).  That pain will persist as they go further overhead, and in my experience, start to die off as they get to the top.

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Conversely, for those with AC joint impingement - what is essentially bone rubbing up against bone - you see a "painful arc" only at the last portion of abduction:

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You can usually confirm your suspicions on this front with direct palpation of the AC joint and checking to see if folks have pain when reaching across the chest.

Much of the training modifications will be the same for these two conditions, but there are also going to be several key things that should be managed completely differently.  For instance, front squatting someone with an AC joint issue would not be a good idea due to the direct pressure of the bar on the AC joint; it would, however, be just fine for most cases of external shoulder impingement.  In another example, some serious AC joint issues are exacerbated even by just doing the end-range of a rowing motion (to much shoulder extension/horizontal abduction) - whereas even folks with full-blown rotator cuff tears can generally do rows pain-free.

Assess, don't assume!

For more information - including loads more assessments like these - check out the Optimal Shoulder Performance DVD set.

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