Home Posts tagged "Rotator Cuff Exercises" (Page 5)

Exercise of the Week: Building Shoulder Mobility and Stability

In this installment of "Exercise of the Week," I have a drill that combines a few of my all-time favorite shoulder health exercises into one comprehensive approach that gives you a lot of bang for your buck. Check it out:

Also, for more exercises and coaching cues like this, don't forget to check out our Mike Reinold and my new resource, Functional Stability Training of the Upper Body.  It's on sale at a big introductory discount through the end of the week.

fstupper

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Exercise of the Week: Half-Kneeling 90/90 External Rotation Hold

Today’s guest post comes from my friend and colleague, physical therapist Eric Schoenberg. Eric is an integral part of our Elite Baseball Mentorships.

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I have yet to meet a high level baseball player that hasn’t done some form of rotator cuff strengthening exercise. The interesting part is that a high percentage of these athletes don’t actually know where their rotator cuff is and where they should be feeling these exercises. The most common response is the athlete will point to the front of their shoulder. This is also the same spot (biceps tendon, labrum) where all of their pain is when they throw!

In other words, the athlete is doing a “rotator cuff” exercise to help decrease or reduce the risk of shoulder pain, but in turn, ends up actually causing more stress and overuse to their already irritated anterior shoulder.

The ability to properly recruit the rotator cuff works hand in hand with being able to relax/shut down the posterior deltoid, latissimus, and lumbar extensors from overcompensating as an athlete “lays back” into external rotation.
We commonly see athletes/coaches performing the right exercises, but executing them improperly due to faulty recruitment, poor timing, or compensation. In these cases, the athlete looks the part and even appears stable and strong, but are not actually receiving the intended benefit of the exercise. In fact, more times than not, they are potentially making themselves worse.

Enter the ½ kneeling 90/90 External Rotation (ER) Hold. It is a great exercise to teach the baseball player (pitcher or position player) what they should feel and maybe more importantly, what they shouldn’t feel when attempting to build stability and proper alignment in their shoulder.

This exercise is one of many concepts that we discuss in our Elite Baseball Mentorships. With the continued rise in baseball injuries, we have made it our mission to help create an environment for collaborative learning among the leading strength coaches, health care professionals, and pitching instructors/coaches in the world.

Our next Upper Extremity course will be June 15-17, and the early-bird registration deadline is May 15; to learn more, click here

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Exercise of the Week: 1-arm Bottoms-up Kettlebell Waiter’s Walk

In this installment of "Exercise of the Week," I want to introduce you to another great carrying variation you can use to accomplish a number of different objectives.  The 1-arm Bottoms-up Kettlebell Waiter's Walk is one of my personal favorites, and we use it a lot with not only our baseball guys, but also many of our non-baseball clientele.

Those of you who have followed my "Exercise of the Week" series probably notice that this is a progression on a previous drill I introduced, the 1-arm Bottoms-up KB Carry. To bring you up to speed on the "why" behind this kettlebell exercise, here are a few reasons it's a great one:

1. It gets great reflexive rotator cuff activation in light of the bottoms-up position and the subtle perturbations to stability as the individual walks.

2. It teaches an athlete to fully upwardly rotate the scapula (shoulder blade) correctly, which helps us to build stability in an overhead position and solidify the mobility we have.  This is wildly important for overhead throwing athletes, too, as they always lose upward rotation over the course of the competitive season.

3. It creates a challenge to both lateral/rotary and anterior core function.  The individual has to work to prevent excessive lower back arching, as well as side bending.  Being able to get these challenges while still working the shoulder girdle ensures that you get great functional carryover to the real world.

4. Without even knowing it, you're also getting a pretty good grip workout simply from holding the slightly thicker handle of the kettlebell.

In addition to the coaching cues I discuss in the video above, one "outcome" measure for which you'll want to look is the amount of scapular upward rotation present.  You can do that by drawing a line along the medial (inside border) of the scapula, and then checking what angle it creates with a vertical line along the spine.  Your goal is about 55-60 degrees of scapular upward rotation.

KBWW

In a good overhead position, you shouldn't feel it at all in the top or front of your shoulder.  If you do, though, it's a sign that you're probably either lacking scapular upward rotation or don't have sufficient cuff strength to do this correctly.  I always tell athletes that they shouldn't "feel" this in one place; it should feel like the entire shoulder girdle is working synergistically to create good stabilization.

Also, a lot of people will ask if they need to "pack the shoulder down with the lat."  Why you would want to turn your lat on to reach overhead is a puzzle to me, as it limits shoulder flexion and scapular upward rotation, draws the humerus into internal rotation (closes down the subacromial space), and pulls the spine into an extended position (excessive arching).  What folks really should be doing is a subtly posterior tilting the scapula to free up space at the front of the shoulder, and facilitate upward rotation.  It's a flawed movement if you're just cranking the entire shoulder girdle down.  In short, we want lower traps, not lats.

If you're looking to learn more about how I incorporate many different carrying variations in my programming, I'd encourage you to check out my new resource, The High Performance Handbook

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Common Arm Care Mistakes: Installment 2

In our first installment of this series on arm care, I discussed scapular positioning.  In this second installment, I'll cover another big mistake I commonly see throwers make:

Doing a ton of rotator cuff exercises before throwing.

Pre-throwing warm-up approaches constitute a great example of extremes. On one hand, you have the guys who crush an energy drink and do a few arm circles and then go right to throwing - and they're obviously not doing enough.  On the other hand, you have some guys who go through 30 different exercises for the cuff and scapular stabilizers. - and before you know it, it's an hour later and they're exhausted, yet still haven't picked up a ball.  As always, the answer is somewhere in the middle.

We have many examples available across multiple sporting disciplines that show the impact of fatigue on performance and injury risk. At the other end of the spectrum, not warming up sufficiently can be equally problematic. As such, it's about finding the sweet spot for every pitcher.

I generally try to "lump" each of our throwers into one of three categories: tight, loose, or middle-of-the-road.

The tight guys need to go out of their way to extend their warm-ups so that their body temperature is higher before they pick up a ball.  These are the guys who commonly don't hit their best velocity numbers until after the third inning or so.  The goal of the warm-up is primarily to get length (potentially even with some manual stretching, if indicated) - and follow it up by doing a bit of activation work to establish some good stiffness in the right places (anterior core, posterior rotator cuff, scapular upward rotators).  To me, this group requires the longest warm-up, but even still, it's 20 minutes, tops.

The loose guys are the ones who have considerable joint laxity (hypermobility). 

As a result, we really don't need to establish any new range-of-motion; we need to enhance stability in the ROM they already have.  Loose guys are always the most likely to get thrown under the bus with bad arm care programs.  Stretch them, and you'll make them worse or injured.  Do too much cuff or scapular stabilizer work before they throw, and they'll fall off early in terms of velocity and health. With this group, we don't do much ground-based mobility work; we prefer to get them standing up and moving around.  They'll work in movements like prone external rotation to "groove" true external rotation, and get some rhythmic stabilizations, too.

Again, we're talking about 15 minutes at most.

The middle-of-the-road guys are, as you might imagine, a combination of the previous two groups.  They don't need quite as much mobility work as the tight guys, nor do they need quite as much stability work as the loose guys. It's more of a balancing act, but we're still not exceeding 15-20 minutes.

If you're looking for a general guideline on what our guys might do, here's a brief synopsis:

A. foam rolling - 5 minutes
B. mobility drills - 8-10 minutes
C. scapular control drills (wall slide variations, prone trap raises, etc.) - 2 minutes
D. rotator cuff activation drills (prone external rotation, rhythmic stabilizations, and maybe 1-2 sets of band exercises) - 2 minutes
E. easy movement training and sprint build-ups (5 minutes)

As you can see, at most, this takes 24 minutes.  And, this number comes down because not everyone does every exercise.

Exchanging quantity for quality in the warm-up has been one of the most important modifications we've made in the past with injured or underperforming throwers we've seen.  The benefits are due to both the addition of valuable exercises, but more significantly, taking away an excessive amount of unproductive work that's just piling fatigue on top of the rotator cuff before throwing.

With all this in mind, if you're "that guy" who takes forever to warm up, it's probably time to cut back.  As former CSP pitching coordinator Matt Blake joked, "If you need a post-workout shake after your warm-up, you're doing it all wrong."  Start thinking about ways to make the pre-throwing period more efficient - and then get your volume in at a later point in time.

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Improving Thoracic Mobility in Throwers

It goes without saying that all rotational sport athletes need adequate thoracic spine (upper body) mobility in order to create appropriate separation as they work to transfer force from the lower extremity to the upper extremity during swings, throws, shots, and changes of direction.  In a throwing population, however, you need to take some special precautions as you work to build it.

One thing we know about pitchers is that their shoulder external rotation improves over the course of a season, and this likely takes place because the ligamentous structures in the front of the shoulder become looser. In this image of a left shoulder, it would be the area labeled "capsular ligaments:"

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Effectively, the looser one's anterior capsule is, the more external rotation one will have.  The problem, however, is that if this area becomes too loose, the biceps tendon must pick up the slack as an important anterior stabilizer during external rotation.  Additionally, there are many nerve structures at the anterior shoulder that can be irritated because the humeral head isn't controlled.  This is yet another reason why it's not a good idea to stretch a throwing shoulder into external rotation.  In this video, I go into greater detail:

This knowledge gives rise to two thoughts:

1. If we lack thoracic rotation, our arm will drag during the pitching delivery, as it's a means of creating better separation (albeit in the wrong places).  Guys who have quick arms can often make up for it, but still inevitably irritate the anterior shoulder over time.  So, if your thoracic rotation stinks, you'll need to try to find more external rotation in the wrong places.  Additionally, if we lack thoracic extension, we often substitute lumbar extension (lower back arching) to maintain an upright torso.  These guys wind up with low back pain, oblique strains, and hip issues.

2. We can't just throw any thoracic mobility drill at throwers, particularly in the early off-season, when the anterior shoulder is all stretched out and it may be the path of least resistance.  As an example, the kettlebell arm bar might be a great drill for many folks in the population, but I would never use it with a thrower:

Instead, particularly in the early off-season, we need to pick drills that heavily emphasis thoracic movement independent of humeral (arm) movement. Here's a progression we might use over the course of the off-season:

Off-Season Months 1-2 (and during the in-season phase): Supine Alternating Shoulder Flexion on Doubled Tennis Ball, Thoracic Extension on Roller, Rock-Back Quadruped Extension-Rotation

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Off-Season Months 3-4: Side-Lying Windmill, Bent-Over T-Spine Rotation

You'll notice that these options integrate a lot more humeral movement.  In many cases, you can use them earlier in the off-season, but only if they're coached really meticulously to ensure athletes are moving in the right places.

We use these exercises right after our foam rolling and positional breathing drills during the warm-up, and before anything we'd do to directly work on scapular stabilization and rotator cuff strength/timing.  Hopefully, this article gives you a little feel for not just some of the exercises we may use, but also the way we'd program them throughout the competitive season.

If you'd like to learn more about how we manage throwers, be sure to register for one of our Elite Baseball Mentorships.  The next one will take place June 14-16 in Hudson, MA.

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Exercise of the Week: 1-arm Bottoms-Up Kettlebell Carry

I've talked quite a bit in the past about how much I like bottoms-up kettlebell exercises to get great "reflexive" firing of the rotator cuff and scapular stabilizers in a more unstable environment. I'm also a big fan of carrying variations - so it gets me pretty pumped up when I can combine the two!  With that in mind, today, I want to talk about the 1-arm Bottoms-up Kettlebell Carry.

This is an exercise that I really like to utilize with a lot of our baseball players early in the off-season, as it teaches them to relax the latissimus dorsi to allow proper scapular upward rotation to take place.  My two biggest cues are to "keep the biceps quiet" and "don't let the lower back arch."  If you do these two things, chances are that everything else will "click" just right.  Check out this video for a more detailed coaching tutorial:

I like to program 2-4 sets of 30-40yds on each arm. We'll often use this in place of a pressing exercise with our baseball guys, particularly in the early off-season when we're working to establish optimal scapular upward rotation after a long season.  Give it a shot for yourself and you'll find that it'll quickly be a great addition to your strength training programs, whether you're a throwing athlete or not!

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Exercise of the Week: Standing External Rotation to Wall

This week's exercise of the week is a great fit for everyday lifters and baseball players alike, as it builds rotator cuff strength without any equipment.

If you're looking for more cutting-edge arm care strategies, be sure to check out Sturdy Shoulder Solutions!

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Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 5

Today marks the fifth installment of a series that looks at the coaching cues we use at Cressey Sports Performance. Here are three more cues we find ourselves using with our athletes all the time.

1. Move the hands in or out to improve your deadlift technique.

When you're learning how to deadlift, understanding hand positioning is really important - but each deadlift variation is unique in terms of what you have to do with your grip.  Check out this video to understand why:

2. Squat between your legs instead of over them.

In the past, I've spoken at length about how stance width impacts where the knees go.  Move the feet out too wide, and the knees have no place to go but in.  Bring them in closer, and it's much easier to get the knees out.  Check out this video for more details:

So, for many folks, bringing the feet in can really help - particularly with the deadlift.  However, squats can be a bit trickier, as the stance coming in can lead to a lot more forward lean and individuals not positioning the torso correctly. Individuals will squat as if they are trying to touch the belly to the quads.  There are, in fact, some accomplished lifters who do this, but their bellies are very big, and the Average Joe isn't fat enough to pull this mechanical advantage off! Most folks wind up turning this approach into a really ugly good morning.

This is why I like the cue of telling folks to squat between the legs instead of over the top of them.  Some people grasp it a lot better than "spread the floor" or "knees out."  They can also understand positionally if you show them a bad set-up followed by a good set-up, like this classic photo (notice how the knees around outside the torso from the rear view):


Source: DaveDraper.com

3. Pretend your biceps is a rotisserie chicken.

This is, without a doubt, the strangest cue I've given.  However, it works.

When we're doing our (shoulder) external rotation variations, we want to make sure the humeral head (ball) is centered in the glenoid fossa (socket), as that is the primary functional of the rotator cuff.  This cue gets the job done:

Looking for more detailed coaching tutorials like this?  Check out Elite Training Mentorship, an extensive online education program that features my staff in-services, exercise demonstrations, and articles - as well as the contributions of several other accomplished fitness professionals.

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3 Coaching Cues for Strength and Conditioning Programs – Shoulder Edition

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 - Upper series, 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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What the Strength and Conditioning Textbook Never Taught You: The World Isn’t All Concentric

As a continuation of this week’s series on things you didn’t learn from a textbook, today I’ll be talking about how we’ve misunderstood muscle actions. As we go through anatomy and kinesiology in the typical exercise science degree, we memorize muscle actions.

The quadriceps extend the knee. The biceps flex the elbow. The teres minor and infraspinatus externally rotate the humerus. You get the point.

The point that many folks don’t get is that this is simply a practice of memorizing concentric muscle actions, and the truth is that this is really only one-third of the picture when it comes to how we move. You see, these muscles are also acting isometrically and eccentrically; sometimes the primary goal is not to shorten, but preserve muscle length, or prevent uncontrolled lengthening. This is a crucial understanding for one to acquire, as poor isometric and eccentric control are the culprits in an overwhelming majority of non-contact athletic injuries.

Our shoulder barks at us because our scapular stabilizers and rotator cuff don’t function correctly to prevent, slow, or limit inappropriate movement. An ACL goes because glutes and hamstrings couldn’t control unrestrained knee hyperextension and hip adduction and internal rotation.

To that end, while you might memorize a muscle’s concentric action first, it’s important to infer from that understanding that it has more implications above and below the joint it crosses. At the subtalar joint, pronation kicks off tibial and femoral internal rotation each time we land from taking a step. The gluteus maximus – as a hip external rotator, abductor, and extensor – plays a crucial role in decelerating this internal rotation and the accompanying hip flexion. In other words, your butt is an anti-pronator! Just watch what happens on the way down in a bowler squat and you’ll appreciate pick up what I’m putting down:

When you start looking at all movement like this, it will have a powerful influence on your ability to help people move more efficiently. With that in mind, I’d encourage you to look over the last strength and conditioning program you wrote and try to consider how the exercises you programmed help to prevent or control unrestrained movement, rather than creating movement. My prediction is that you’ll notice several exercises in there that you might not have included if you’d thought about this beforehand.

For more lessons like this, be sure to check out the Building the Efficient Athlete DVD set, on sale for 25% off through this Saturday at midnight.


 

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