Home Posts tagged "Scapular Stability"

10 Reasons to Use Wall Slides

Today's guest post comes from my good friend and Elite Baseball Mentorships colleague, Eric Schoenberg. Enjoy! -EC

In response to the tweet below and in preparation for the upcoming CSP Elite Baseball Mentorship in June, we decided to put together an article dedicated to the wall slide.

In this article, we will discuss the top 10 findings from a wall slide assessment. In addition, we cover examples of how different coaching cues can benefit the athlete not only in their sport, but more so, in a particular moment in their sport.

This leads to the thought of using the term movement or “moment-specific” training rather than the overused “sport specific” terminology.

Here is the Tweet/question (thanks, Simon). The direct answer will come at the end of the article.

The wall slide was born through the work of Shirley Sahrmann and outlined in her book – Diagnosis and Treatment of Movement System Impairments.

Through many years of work and countless iterations, we have used and modified the pattern to allow for individualization of overhead activity in all body types and sports.

We use the wall slide as an assessment and an exercise every day with our athletes. It should be noted that the wall slide should serve as a bridge to any overhead activity (OH carries, landmine press, etc.) in your programming.

For each assessment finding using the Wall Slide Test, we use individual cues to assist the athlete in creating the desired movement correction. From there, we program the exercise into the warm-up or main program to help develop movement proficiency.

Here are ten reasons we use wall slides in our assessments:

1. Glenohumeral joint range of motion (ROM) – e.g. shoulder flexion

In the image below, we see Clint Capela and Andre Iguodala exhibiting adequate shoulder flexion, however, a slight lack of height, vertical jump, overhead strength, and timing may have resulted in the unfavorable result for AI.


Source: https://www.cbssports.com/nba/news/rockets-vs-warriors-clint-capela-meets-andre-iguodala-at-the-rim-with-incredible-two-handed-block/

2. Scapulo-thoracic joint ROM - e.g. scapular upward rotation and elevation

3. Cervical spine control – e.g. forward head tendency

4. Thoracic spine positioning – e.g. flat, extended vs. kyphotic, flexed

A clear illustration of the need to properly cue the Wall Slide and other overhead activities as it relates to the Thoracic Spine can be seen in the two pictures below.

a. OBJ’s catch shows elite thoracic extension in the overhead position. If Odell was an athlete that was more biased towards thoracic flexion, then his overhead mobility would be more limited and this iconic catch may have never happened. It is important to cue this pattern in the gym if it is required to happen on the field.


Source: https://ftw.usatoday.com/2014/11/odell-beckham-catch-new-york-giants-replay-youtube-vine-gif

b. In contrast, CSP athlete and St. Louis Cardinals All-Star Miles Mikolas does not require thoracic extension when his hand is fully overhead. In fact, he needs to be in a position of thoracic flexion to help deliver the scapula, arm, and hand at ball release. This pattern must also be trained.


Source: https://www.albanyherald.com/sports/cardinals-sign-pitcher-miles-mikolas-to--year-extension/article_7c3fec36-4408-5ce6-a053-3659320329c1.html

Note: This does not mean that Miles does not need thoracic extension to perform his job. It just means that he does not need to be trained into that position when his arm is fully overhead.

5. Lumbar spine positioning – e.g. excessive lumbar extension

6. Lumbo-pelvic stability – e.g. dropping into anterior pelvic tilt

7. Transverse plane alignment – e.g. spinal curvature or pelvic rotation

8. Lat length – e.g. athlete moves into humeral medial rotation at top of wall slide

In another example of the lat impacting overhead motion and movement quality, Rocky Balboa (not a CSP athlete, unfortunately!), shows a pattern of humeral medial rotation with overhead reaching. Interestingly, since his sport is not defined by vertical motion, but more so horizontal motion, Mr. Balboa does not require as much scapular upward rotation as a baseball player.


Source: https://www.phillyvoice.com/lesson-fake-news-faux-call-removal-rocky-statue/

 If we use the Pareto Principle (or the 80/20 rule), general fitness and athleticism should account for 80% of our training. However, the remaining 20% should be tailored to the movements, patterns, and positions that are unique to the athlete’s sport.

9. Motor Control - e.g. faulty scapulohumeral timing, inability to control scapulae eccentrically with arm lowering

10. Faulty activation patterns - e.g. overuse of upper trapezius vs. proper serratus and lower trapezius activation

In summary (and to answer the original question in the tweet above), the overhead reach (wall slide) is helpful to decrease upper trapezius involvement if the exercise is cued to do so. The ability to properly recruit serratus and lower trapezius to assist with scapular upward rotation will lessen the “need” for the upper trap to jump in too much. Remember, the upper trap does need to play a role in this movement, it just shouldn’t be doing all of the work.

As for the “extreme thoracic kyphosis” part…. It is important to first determine if this is a structural or functional issue. If it is structural, it will not change. In this case the wall slide can be used to train within this constraint to assist your client in finding solutions to get overhead. On the other hand, if the kyphosis is functional (meaning it can be changed), then the secret sauce is differentiating weakness, stiffness, shortness, and/or motor control issues as the reason for the kyphosis and difficulty getting overhead. The Wall Slide is a great tool to help tease that out to help your client.

If you want more information about this and many other aspects of the approaches that we utilize to manage the overhead athlete, please consider joining us June 23-25 at our Elite Baseball Mentorship program at CSP in Hudson, MA. The early-bird registration deadline is May 23.

This Cressey Sports Performance Elite Baseball Mentorship has a heavy upper extremity assessment and corrective exercise focus while familiarizing participants with the unique demands of the throwing motion. You’ll be introduced to the most common injuries faced by throwers, learn about the movement impairments and mechanical issues that contribute to these issues, and receive programming strategies, exercise recommendations, and the coaching cues to meet these challenges. For more information, click here.

About the Author

Eric Schoenberg (@PTMomentum) is a physical therapist and strength coach located in Milford, MA where he is co-owner of Momentum Physical Therapy. Eric is addicted to baseball and plays a part in the Elite Baseball Mentorship courses at Cressey Sports Performance. He can be reached at eric@momentumpt.com.

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Exercise of the Week: Landmine Squat to 1-arm Press

Anyone who's followed this blog for any length of time knows that I'm a big fan of landmine presses for a number of reasons:

1. As a "free scapula" pressing exercise, they're an effective way to train scapular upward rotation.

2. They're much more shoulder friendly than overhead presses.

3. They provide a great core stability challenge.

4. You can implement a lot of variety in terms of stance (tall/half-kneeling, standing, split-stance, rotational, etc) and lower body contributions. This week's feature is a great highlight in this regard:

This drill fits well as a first exercise on a full body day and pairs well with horizontal or vertical pulling. I really like it late in the offseason when we're trying to keep sessions a bit shorter and get extra bang for our training buck. I'd do sets of 3-5 reps per side.

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Exercise of the Week: Glute-Ham Raise with Banded Reach

If you've followed this blog for any length of time, you'll know that I'm a big fan of training the posterior chain and also working on getting serratus anterior firing to improve scapular upward rotation. So, you can imagine how excited I am to present to you an exercise of the week video that hits both. Thanks to Mets pitcher Noah Syndergaard for the demo: 

I like this exercise as a first or second assistance exercise on a lower body day, or as part of a full body day. I love it when the late offseason rolls around and athletes have built up a solid foundation of strength, and are ready for more advanced arm care progressions. It's a game changer if you have an athlete who is heavily lordotic (arched back) with downwardly rotated/depressed shoulder blades and a flat thoracic spine (upper back). Enjoy!

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Exercise of the Week: Quadruped 1-arm Trap Raise to Swimmer Hover

I recently started implementing the quadruped 1-arm trap raise to swimmer hover with some of our baseball guys, and it’s quickly become one of my favorites.

This drill addresses several important needs in a throwing population:

1. scapular posterior tilt

2. scapular upward rotation

3. tissue extensibility of the long head of the triceps and lat

4. the quadruped (all fours) position really reaffirms the good convex-concave relationship between the scapula and rib cage

You should not feel this at all in the front or top of the shoulder. Rather, the movement should be felt in the lower traps (mid back) and serratus anterior (add a full exhale at the top of each rep to intensify that activation). Some individuals will feel a good stretch through the triceps.

To learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out Sturdy Shoulder Solutions.

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Case Study: Shutting Down Scapular Depression

I just posted this little "challenge" on Instagram. What do you see? 

I see some of the lowest shoulders in history. This is a well-muscled guy who looks like his upper traps are non-existent because he sits in such significant scapular depression. Take note of the angle of his clavicles; normally, they should have an upslode from the sternoclavicular joint to the acromioclavicular joint, but in this case, they're actually downsloped. Wherever the scapula goes, the collarbone follows. In this presentation, expect to see tissue density in lats, subclavius, and scalenes (among other areas).

The most interesting discussion point, though, is what to do about that upper trap tightness. That tightness is protective tension: his body doing anything it possibly can to avoid dropping any lower into scapular depression. The upper traps are working to elevate the scapula against gravity all the time. If you give him a bunch of massage and stretching, it's like picking a scab; he'll feel better for 15 minutes, and then in rougher shape over the long haul. You never want to stretch out protective tension.

He'd had previous bouts of unsuccessful physical therapy, and while I had the benefit of hindsight here, it was clear that the unifying theme of these approaches was an emphasis on the one-size-fits-all "pull the shoulder blades down" cue that gets thrown around all too much and usually leaves this presentation in a tough spot while helping a lot of senior citizen rotator cuff pain cases. You can't one-size-fits-all cues because everyone moves differently.

We modified his training to avoid anything with heavy weights tugging the shoulders down (no deadlifts, walking lunges, farmer's walks, etc.) and instead trained the lower body with lots of front squat and goblet set-ups, plus sled work, glute-ham raises, and barbell supine bridges/hip thrusts. We cut back on lat dominant upper body work and instead chose drills like push-up variations and landmine presses that drove scapular upward rotation (and even prioritized elevation, which is borderline heresy in some rehab circles). We got his arms overhead more often during the warm-ups and integrated some manual therapy in the areas I noted earlier. I even encouraged him to do less unsupported sitting at work, too, because his upper traps were competing against gravity all the time (yes, there are actually times that standing desks make things worse).

Today, two weeks to the day after the evaluation, he's feeling significantly better - and training hard. Posture is the interaction of structure and function, and if you can't identify aberrant postures, you're simply guessing with how someone is going to respond to a given exercise.

Interested in learning more about what I look for when evaluating the upper extremity - and how my findings drive our programming and coaching cues? Check out Sturdy Shoulder Solutions (which is on sale for $50 off through Sunday at midnight) at www.SturdyShoulders.com.

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Strength and Conditioning Stuff You Should Read: 6/15/18

It's been a quiet week here on the blog because I'm still recovering from last week's Sturdy Shoulder Solutions product launch and the barrage of college athletes who are all starting up at CSP at the same time. Luckily, I do have some good content from around the 'net for you:

Pat Rigsby on Building Your Ideal Fitness Business - Pat Rigsby is the man. I got this email from Mike Robertson in my inbox this morning and cleared time in my schedule to listen to this podcast right away. He always has great business insights for fitness professionals.

10 Strength and Conditioning Lessons from Friends, Mentors, and Colleagues - This is a great compilation from my buddy Todd Hamer, who's been a mainstay in the college strength and conditioning field for as long as I can remember.

Lessons Learned from a Bum Elbow - I posted this story on my Facebook page the other day, and there are a lot of lessons in here for fitness professionals and rehabilitation specialists, especially those who deal with throwing athletes.

Top Tweet of the Week

Top Instagram Post of the Week

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Strength and Conditioning Stuff You Should Read: 4/27/18

It's a rainy day in Massachusetts - which is the perfect time to compile some recommended reading for the week. Check it out:

Diagnosis and Treatment of Movement Impairment Syndromes - I'm throwing this one in there because it's probably been the single most influential book on my development as a coach. It was first published 17 years ago, but I still finding myself referencing it regularly - including this week. If you're in the fitness or rehabilitation worlds, give it a read.

Behold the Transformation of Noah Syndergaard - This was an excellent Sports Illustrated article that took a look at the pitch selection modifications that Cressey Sports Performance athlete and Mets pitcher Noah Syndergaard has made over the years.

Are Health and Aesthetics Mutually Exclusive? - A question I got this week reminded me of this blog I wrote back in 2014, so I thought I'd bring it back to the forefront.

Top Tweet of the Week

Top Instagram Post of the Week

 

On the left, you’ll see one of the biggest mistakes we see with the landmine press: the scapula (shoulder blade) dumps forward at the bottom position - and it winds up setting an individual up for not being able to upwardly rotate the scap during the pressing phase. 🤔 In the position of “elbows close to the side,” you’re right in the line of pull of the lats and pec minor, which both directly or indirectly oppose upward rotation and good overhead motion. These suckers like to turn on and stay on. 👎 With that in mind, getting the elbow off the side can be a game changer for driving good scapular motion around the rib cage. Note how much “cleaner” the shoulder blade moves in the video on the right. A cue i like on this front is to “draw half of the letter U.” 👍 Thanks to @lala_salt for the Stella demos! #cspfamily

A post shared by Eric Cressey (@ericcressey) on

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Optimizing and Progressing Arm Care

The prone horizontal abduction - also known as a "T" - is well known as a popular arm care exercise that has been around for decades. Unfortunately, it's commonly performed incorrectly. In today's video, I cover the most common mistakes - and then add a progression I like to use with folks once they've mastered the technique. Check it out:

Keep in mind that these cues also apply to "T" drills you perform with bands, TRX, or any other implements as well.  

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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

CSPInnovations-02-2

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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Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 14

I haven't posted an update to this popular coaching cues series since December, so I figured this article was long overdue. Here are a few coaching cues we use regularly with our clients at Cressey Sports Performance:

1. "Keep your hips in the hallway."

Birddogs are a fantastic exercise for building core stability and educating individuals on how to differentiate between hip and lumbar spine (lower back) movement. Usually, though, folks just discuss differentiating these motions in the sagittal plane, so the focus is on hip flexion/extension vs. lumbar flexion/extension. In the process, a lot of folks overlook what is going on in the frontal and transverse plane. A lot of side-to-side movement is a good sign that the athlete doesn't have sufficient rotary stability (control of the center of mass within a smaller base of support).

A cue I've found to work great is to put my hands about 1" outside the hips on both sides, and to cue the athlete, "Keep your hips in the hallway." If the outside of the hips contact my hand, it's a sign that they've lost control of the frontal and transverse plane.

2. "Scaps to the sky."

We coach our wall slides with upward rotation and lift off a bit differently for just about everyone that comes through our doors. Really, it comes down to appreciating what their starting scapular positioning is. If someone is really anteriorly tilted, we'll guide the scapula into posterior tilt. If they have more of a "scaps back" (adducted) military posture, we'll help the shoulder blades to get out and around the rib cage. If someone starts in a more depressed (low shoulder) position as in the video below, we might cue them to incorporate a shrug to facilitate better upward rotation.

When you teach the drill, though, you want to make sure that the motion is coming from not just movement of the humerus (upper arm) on the scapula (glenohumeral movement), but moreso from movement of the scapula on the rib cage (scapulothoracic). I love the "scaps to the sky" cue for this reason. Usually, I'll manually help the shoulder blades up a bit, too.

3. "One inch per second."

I blatantly stole this one from Shane Rye, one of my business partners at Cressey Sports Performance - Florida. When athletes foam roll, they always seem to have a tendency to race through each "pass." It's far better to slow down, recognize areas that need more attention, and gradually work your way along. The "one inch per second" cue always seems to get athletes to pace themselves better.

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