Last summer, a college pitcher came up to Cressey Performance from the South to train for a month before his summer league got underway. He was seven months post-op on a shoulder surgery (Type 2 SLAP) and had been working his way back. Unfortunately, his arm was still bothering him a bit when he got up to see us.
After the first few days at CP, though, he told me that his arm felt as good as it’s felt in as long as he could remember. He’d been doing a comprehensive strength and conditioning program, but the “impact” stuff for him had been soft tissue work, some Postural Restoration Institute drills, an emphasis on thoracic mobility, and manual stretching into internal rotation, horizontal adduction, and shoulder flexion. From all the rehab, his cuff was strong and scapular stabilizers were functioning reasonably well – which led me to believe that his issues were largely due to tissue shortness and/or stiffness.
This realization made me immediately wonder what he’d been doing in the previous months for mobility work for his arm – so I asked. He then demonstrated the manual stretching series that every pitcher on his team went through every day on the table with their athletic trainer. Each stretch was done for 2x20s – and two of those stretches took him into extreme external rotation and horizontal abduction. I was pretty shocked.
Me: “You’re probably not the only guy on your team rehabbing right now, huh?”
Him: “No; there are actually too many to count.”
Me: “Elbows, too, I’m sure.”
Him: “Yep.”
Want to irritate a labrum, biceps tendon, or the undersurface of the rotator cuff? Stretch a thrower into extreme external rotation and simulate the peel-back mechanism. This also increases anterior capsular laxity and likely exacerbates the internal impingement mechanism over the long-term. To reiterate, this is a bad stretch!
Want to make an acromioclavicular joint unhappy? Stretch a thrower into horizontal abduction like this (again, this is a BAD stretch that is pictured):
Want to irritate an ulnar nerve or contribute to the rupture of an ulnar collateral ligament? Make sure to apply direct pressure to the forearm during these dangerous stretches to create some valgus stress. This is a sure-fire way to make a bad stretch even worse:
These stretches are very rarely indicated in a healthy population – especially pitchers who already have a tendency toward increased external rotation. The shoulder is a delicate joint that can’t just be manhandled – and when you’re dealing with shoulders that are usually also pretty loose (both from congenital and acquired factors), you’re waiting for a problem when you include such stretches. In fact, I devoted an entire article to this: The Right Way to Stretch the Pecs.
Everyone thinks that shoulder external rotation and horizontal abduction alone account for the lay-back in the extreme cocking position.
In reality, though, this position is derived from a bunch of factors:
1. Shoulder External Rotation Range-of-Motion – and this is the kind of freaky external rotation you’ll commonly see thanks to retroversion and anterior laxity:
2. Scapular Retraction/Posterior Tilt
3. Thoracic Spine Extension/Rotation
4. Valgus Carrying Angle
So, how do you improve lay-back without risking damage to the shoulder and elbow?
1. Soft tissue work on Pec minor/major and subscapularis – Ideally, this would be performed by a qualified manual therapist – especially since you’re not going to be able to get to subscapularis yourself. However, you can use this technique to attack the pecs:
2. Exercises to improve scapular retraction/depression/posterior tilt – This could include any of a number of horizontal pulling exercises or specific lower trap/serratus anterior exercises like the forearm wall slide with band.
3. Incorporate specific thoracic spine mobility drills – In most pitchers, you want to be careful about including thoracic spine mobility drills that also encourage a lot of glenohumeral external rotation. However, when we assess a pitcher and find that he’s really lacking in this regard, there are two drills that we use with them. The first is the side-lying extension-rotation, which is a good entry level progression because the floor actually limits external rotation range-of-motion, and it’s easy to coach. I tell athletes that they should think of thoracic spine extension/rotation driving scapular retraction/depression, which in turn drives humeral external rotation (and flexion/horizontal abduction). Usually, simply putting your hands on the shoulder girdle and guiding them through the motion is the best teaching tool.
A progression on the side-lying extension-rotation is the side-lying windmill, which requires a bit more attention to detail to ensure that the range-of-motion comes from the right place. The goal is to think of moving exclusively from the thoracic spine with an appropriate scapular retraction/posterior tilt. In other words, the arm just comes along for the ride. The eyes (and head) should follow the hand wherever it goes.
Again, these are only exercises we use with certain players who we’ve deemed deficient in external rotation. If you’re a thrower, don’t simply add these to your routine without a valid assessment from someone who is qualified to make that estimation. You could actually make the argument that this would apply to some folks in the general population who have congenital laxity as well (especially females).
4. Throw!!!!! – Pitchers gain a considerable amount of glenohumeral external rotation over the course of a competitive season simply from throwing. Sometimes, the best solution is to simply be patient. I really like long toss above all else for these folks.
In closing, there are three important things I should note:
1. You don’t want to do anything to increase valgus laxity.
2. You’re much more likely to get hurt from being “too loose” than you are from being “too tight.” When it comes to stretching the throwing shoulder, “gentle” is the name of the game – and all mobility programs should be as individualized as possible.
3. Maintaining internal rotation is a lot more important than whatever is going on with external rotation. In fact, this piece could have just as easily been named "The Two Stretches Pitchers Shouldn't Do, Plus a Few That Only Some of Them Need."
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
If you've read much of my stuff, you've probably come to realize that I'm quite the shoulder geek. With that title comes a lot of questions at seminars and via email, and one of the more common ones is whether I think direct rotator cuff strengthening exercises are necessary for everyone. A lot of coaches say that they aren't essential, but I beg to differ for five reasons. Here's why:
1. Bad Posture - Nowadays, pretty much everyone has rounded shoulders - which means that the scapulae are winged out. When a shoulder blade isn't sitting right, the rotator cuff muscles that attach to that scapula are at a mechanical disadvantage because they are outside of their ideal length-tension relationship for creating force; it's analogous to trying to shoot a cannon from a canoe.
Incorporating some direct rotator cuff exercises not only strengthens muscles that you know will be operating at a mechanical disadvantage, but also educates a lifter about how the scapula should be positioned for ideal shoulder function.
2. Shoulder impingement is a physiological norm. - Research from Flatow et al. demonstrated that everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has direct impingement on their rotator cuff tendons. If you know a region is going to get beaten up regardless of what you do in your life, why wouldn't you opt to strengthen it proactively?
3. Rotator cuff tears are far more common than you think. - In consideration of the previous point, it should be no surprise that rotator cuff tears are actually far more common than one might realize - even if you look at asymptomatic subjects. Connor et al.discovered that on MRI, 40% of asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears. The general population is no different; Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60. And these studies don't even include the ones who are actually in pain! It makes sense to strengthen these areas proactively - even if your shoulder doesn't hurt...yet.
4. Lots of people also have labral tears. - In the past, I've written quite a bit about Active vs. Passive Restraints. In the shoulder, the rotator cuff would be considered an active restraint, as it's something that can be strengthened to improve dynamic stability. The labrum, on the other hand, doesn't get stronger with exercise; it's a passive restraint that provides stability. So, if the labrum is torn or frayed (as it very commonly is in both lifters and overhead throwing athletes), then the active restraints - the rotator cuff tendons - need to pick up the slack.
5. The "Just do normal stuff and the rotator cuff will take care of itself" philosophy isn't working. - That's been tried for quite some time, and nowadays, as a society, we move like absolute crap and - as noted above - have a boatload of issues on MRI even if we're asymptomatic. With respect to the cuff, we've built the deltoids up to the point that they absolutely overwhelm the rotator cuff (particularly the supraspinatus), which is trying to prevent the humeral head from migrating upward into the acromion.
Testing, Treating, and Training the Shoulder - This recap of my seminar with Mike Reinold features ten important takeaways from the day.
You Are What You Absorb - I thought this was an excellent article from John Meadows - both in terms of the background information he provides and the corrective strategies he advocates.
Rollouts: Friend or Foe and Two Anterior Core Progressions - These two video blogs were quite popular when they ran back in 2009.
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It goes without saying that some of the absolute posterior rotator cuff exercises are cable external rotation variations.
Unfortunately - as you may have inferred from the title of this post - not everyone has access to a cable column or functional trainer where exercises like this can be performed. To that end, I thought I'd devote today's post to a few exercises one can substitute to get a very similar training effect without cable access.
Option 1: Elbow-Supported DB External Rotation
This movement parallels that of the cable option, but all you need is a dumbbell and something to prop your upper arm. The only downside is that the resistance just isn't as "continuous" throughout the range of motion - but it's still a good option.
Options 2 and 3: Horizontal Abduction Variations
While the recruitment patterns aren't going to be exactly the same, it's safe to say that you're getting almost all the same benefits when you do horizontal abduction work as with true external rotation work (and likely a bit extra scapular stabilization benefits). Two variations I like:
Prone Horizontal Abduction off Table
Side-Lying Horizontal Abduction (I like to load this one up more eccentrically and focus on really controlling the load on the way down)
Option 4: Side-Lying External Rotations - arm abducted 30 degrees
This movement might not be the most "specific" of all rotator cuff exercises because of the position in which it occurs, but it does give you the best posterior cuff EMG of just about any drill. We use it a ton, especially in those who may have pain with positions requiring more shoulder elevation.
These drills are just the tip of the iceberg in terms of the modifications you can use - and, indeed, what should comprise a comprehensive shoulder health program. However, they should be enough to help you work around the lack of a cable in your resistance training arsenal.
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.
A New Paradigm for Performance Testing - This two-part feature was actually an interview with Bioletic founder, Dr. Rick Cohen. In it, we discuss the importance of testing athletes for deficiencies and strategically correcting them. We've begun to use Bioletics more and more with our athletes, and I highly recommend their thorough and forward thinking services.
A New Paradigm for Performance Testing: Part 1A New Paradigm for Performance Testing: Part 2
I already have a few series planned for 2011, so keep an eye out for them! In the meantime, we have two more "Best of 2010" features in store before Friday at midnight.
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With 2010 winding down, I thought I'd use this last week of the year to direct you to some of the most popular content of the past 12 months here at EricCressey.com, as this "series" was quite popular last year. 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.
5 Reasons You Aren't Getting Stronger - This post came during the launch week of Show and Go: High Performance Training to Look, Feel, and Move Better. With some of the unique programming strategies outlined in Show and Go, it seemed like a good opportunity to outline some of the common mistakes folks make that I really sought to avoid when writing the program.
How to Find Your Fitness Niche - The popularity of this post surprised me. I suppose it means that I have more fitness professionals (and aspiring fitness professionals) reading my blog than I'd previously thought. This piece discusses how I "fell" into my baseball training niche.
Make My Kid Run Faster - Apparently, I'm not the only one who has to deal with the occasional crazy father who tells me how to train his kid!
Clearing Up the Rotator Cuff Controversy - This post discusses my approach to structuring rotator cuff exercises throughout the training week.
The Fascial Knock on Distance Running for Pitchers - This was a fun article to write because it combined a review (of Thomas Myers' presentation at Perform Better) with a summary of my own experiences training pitchers. It's always great to take the perspective of another and see how it meshes with your own philosophy - whether it confirms or refutes what you're doing.
High Performance Training without the Equipment (Installment 1) - I'm glad that I checked back on my statistics to find that this was so popular, as I haven't gotten around to writing any subsequent installments. I'll pick it up soon.
I'll be back soon with the top product reviews of 2010.
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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?
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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