Home Posts tagged "Shoulder Health"

Simplified Shoulder Solutions

I've devoted a lot of my articles to shoulder assessment, training, and programming over the years. Some have been lengthy articles (like my lat strain feature), others have been quick hit posts (like this bear crawl vs. crab walk one), and some have been video technique tutorials and common mistakes, like this:

When you've been at something a long time, the natural tendency is to chase increasing complexity. The more complexity you chase, the more novelty you encounter - and that novelty is what keeps folks engaged when they "specialize" in the same joint over an entire career. One thing I've done well in this regard is to chase complexity in my own education, but kept our application of these principles simple in the way we evaluate and coach athletes. Because, at the end of the day, this is what it comes down to:

[bctt tweet="Shoulder health is about keeping the ball on the socket. Period."]

Keep in mind that we're speaking specifically to the glenohumeral (ball and socket) joint, when in reality the entire shoulder girdle is comprised of many different articulations). As I mentioned, though, the point of this blog is to simplify this discussion.

There are a lot of factors that impact how well one is able to do that. It could be cuff strength, scapular control, ligamentous laxity, previous injury, bony changes, faulty thoracic positioning, tissue density, core control, and a host of other issues. These things all - in one way or another - impact how the ball and socket interact.

As strength and conditioning and rehabilitation specialists, you still need to understand the most common injuries incurred at the shoulder. You must appreciate population specific norms. And, you need to understand the assessments that determine whether static posture and movement quality are where they need to be. However, you should never get away from always bringing these concepts back to the fact that they all have to do with ball-and-socket interaction.

As Einstein once said, "If you can't explain it simply, you don't understand it well enough." That's both the goal of this particular blog, and also my upcoming Shoulder Assessment, Corrective Exercise, and Programming seminar in New York City on August 20. Today is the deadline for getting the early bird registration rate, and I hope to see you there!

Also, I'll be delivering the same course near Washington, DC on September 17, if that's of interest. You can learn more HERE.

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How Bench Press Technique Impacts Shoulder Health

We often hear that an elbows-tucked bench press technique is more shoulder friendly than an elbows-flared approach. Nobody really ever seems to discuss why this is the case, though - so I thought I'd devote today's video blog to it:

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Rhythmic Stabilizations: Where Should You “Feel” Them?

Earlier this week, I received the following question, and thought it would make for some good video content:

Q: I've been training a couple college guys this month before they go back to school and I had a few questions regarding rhythmic stabilizations. I started implementing them with my pitchers recently and they say they don't feel anything. Should they be? Is there any extra coaching points I'm missing here? Thanks for your time.

A: This video!

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The Best of 2015: Strength and Conditioning Videos

With my last post, I kicked off the "Best of 2015" series with my top articles of the year. Today, we'll highlight the top five videos of the year. These videos only include instructional videos, not quick exercise demonstrations.

1. Avoid this Common Wall Slide Mistake - I'm a huge fan of wall slides for teaching good scapular upward rotation. Check out this video to see if you're making a common mistake on this front:

2. Steer Clear of this "Shoulder Health" Exercise - Continuing with the shoulder theme, here's a drill I don't particularly like. The good news is that I propose a suitable alternative. 

3. Serratus Anterior Activation: Reach, Round, and Rotate - This video covers some of our common coaching cues for a different variation of wall slides than featured in video #1.

4. 3 Back to Wall Shoulder Flexion Cues - This drill is both a great training exercise and an assessment. With the right cueing, you can clean the pattern up pretty quickly, in most cases.

5. Exercise of the Week: Split-Stance Anti-Rotation Medicine Ball Scoop Toss - This is one of my favorite medicine ball exercises for early on in training progressions. 

I'll be back soon with the top guest posts of 2015!

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Coaching Up the Bottoms-up Kettlebell Carry

I love bottoms-up kettlebell carrying variations for teaching scapular control and getting reflexive rotator cuff recruitment. Sometimes, though, folks won't feel these drills in the right positions. With that said, check out today's video to learn how you can usually quickly and easily shift the stress to the right spots in the shoulder girdle:

If you're looking to learn more about our approaches to assessing and training the shoulder girdle, I'd encourage you to check out out one of our Elite Baseball Mentorships. Our next upper extremity course takes place January 17-19, 2016 at Cressey Sports Performance in Hudson, MA, with December 17 serving as the early-bird registration deadline. For more information, check out www.EliteBaseballMentorships.com 

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Get Up to Get Down: The Impact of Scapular Movement on Pitch Location

Today's guest post comes from physical therapist Eric Schoenberg. Eric is an integral part of the Elite Baseball Mentorships team.

Every baseball player on the planet has heard their coach say “stay on top of the ball”, “get out in front”, and/or “throw downhill”. It is an easy thing to say, but a little more difficult to teach. A common response that I hear from players that I work with is: “I understand what the coach is saying, but I don’t know how to actually get my body to do it”.

There are many mechanical reasons why a pitcher will struggle to create this downhill plane. (e.g. front leg stability, trunk tilt angle). However, on the movement side of things, one of the main culprits that we see is a lack of scapular upward rotation. If you are a frequent visitor to this blog, you know that EC has hit on this topic for years. I wanted to add some thoughts to this critical concept.

If a pitcher lacks the ability to “get up” (insufficient scapular upward rotation and/or elevation), he will not be able to effectively get his hand out in front to maximize velocity. Pitchers will describe this feeling as “cutting the ball off” or “feeling stuck”. The result is a decrease in velocity and difficulty “getting down” in the zone. It is very common for this to occur later in the season once the off-season training effect has been lost and the predictable loss of range of motion (shoulder flexion, upward rotation, hip and thoracic mobility) kicks in.

ScapularDownwardRotation

The most effective pitchers share three things in common: consistent velocity, consistent location, and health. None of these are possible with faulty scapular movement patterns.

The best time to establish proper scapular upward rotation is in the off-season (NOW!). The challenge comes with educating the athlete on how to not lose this motion during the season.

By now, we are aware of the importance of wall slide variations, back to wall shoulder flexion, and trap raises. However, the message of consistency with these exercises EVERY DAY during the season cannot be overstated. This is akin to brushing your teeth. A habit needs to be established and it then needs to be repeated. Every baseball player that I see in my office for elbow or shoulder pain comes in with faulty scapular movement. This is certainly not the only thing that leads to pain in pitchers, but it is certainly a good place for us to be looking early on.

A great exercise that we have been using to emphasize “getting up and out in front” is the One-Arm Band Rotational Row from a Low Setting.

This drill is much more about the deceleration phase than the actual rowing pattern, however all phases of the movement are important. I prefer to use a band instead of a cable due to the increased velocity of the recoil. This is a great drill to use in a training or warm-up program. With that said, I find the best application is to be used in a pre-throwing program (preferably the last drill before a pitcher picks up the ball to begin throwing).

Set-Up: Wide base to emphasize hip mobility. Front foot should mimic where the land foot is in the delivery. Back foot and hips are rotated fully so the athlete is “squared up” in the sagittal plane. Coaching from the Posterior View will give you a good vantage point to see this.

Instruction: Initiate the rowing motion from the hips first, then the thoracic spine, then the scapula, and finally the humerus. Make sure the athlete’s elbow doesn’t end up behind the line of his body. Back foot should rotate to mimic the position on the rubber with the hip hinged and loaded. Cue the athlete to decelerate the band with his body (core, front hip) and not just with his arm. Coaching from a 90 degree angle to the side will show this the best.

A key component for a pitcher to develop/maintain velocity and location is to make sure that their body is in a stable position to deliver their arm (and the baseball). The One Arm Rotational Row accomplishes this by via the following avenues:

1. Single Leg Strength

a. Land Leg: Proper stability and balance to accept weight, stop forward momentum, and translate force from the ground up the chain.

b. Drive leg: Ability to hinge back into drive hip and not translate forward (toward 3rd base for a RHP) or collapse into valgus. Keeping weight through the whole foot and not just on the toe

2. Stable core throughout delivery – especially as trunk and hips start to separate

Leaking into anterior pelvic tilt or lumbar extension will drive scapular downward rotation and depression (resulting in the hand moving under or around the ball, as opposed to staying behind the ball).

3. Optimal Thoracic Positioning

This drill drives thoracic flexion moment to allow for a congruent platform for the scapula to ride up and create the desired extension at ball release.

Give this drill a try with your athletes (make sure to train both sides) and emphasize consistency with their scapular upward rotation exercises in order to develop a more durable arm with improved velocity and location.
If you are interested in learning more about our approach to managing baseball athletes, we'd love to see you at one of our Elite Baseball Mentorships. The next three-day course is January 17-19, with December 18 serving as the early-bird registration deadline. 

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Steer Clear of this “Shoulder Health” Exercise

Call me a traditionalist, but I still love using prone (on the stomach) drills to teach good scapular (shoulder blade) control. However, we never teach these drills face-down on the floor. Check out today's video to learn why:

If you're looking for a detailed tutorial on how to perform this exercise off a table, give this a watch:

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Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 12

It's time to bring back this coaching cues series to the forefront, as it's always been a popular one here at EricCressey.com. Here are three more cues I find myself using on a daily basis at Cressey Sports Performance:

1. "Chest before chin."

One of the biggest issues we see in folks with a lack of anterior core control and/or upper body strength is that they'll shoot into forward head posture as they descend to the bottom position of a push-up. Effectively, they're substituting head/neck movement for true scapular protraction and retraction. One cue that seems to clean the issue up quite well is the "chest before chin" recommendation - which means that the chest should arrive at the floor before the chin does. 

You do, however, need to make sure that the individual doesn't confuse this with simply puffing the chest out, which would put them in more extended (arched back) posture at the lumbar spine.

2. "Get your scaps to your armpits."

A huge goal of upper body corrective exercise program is to teach individuals how to differentiate between scapulothoracic movement and glenohumeral movement. In layman's terms, this means understanding that it's important to know when the shoulder blade is moving on the rib cage, as opposed to the upper arm (ball) moving on the shoulder blade (socket). Especially during overhead reaching, what we typically see in athletes is insufficient scapulothoracic movement and excessive glenohumeral movement - particularly in those athletes with noteworthy joint hyper mobility. This is one reason why we incorporate a lot of wall slide variations in our warm-ups.

Since we are really looking to teach good upward rotation (as opposed to just elevation), I always try to cue a rotational component to the scapular movement as the arms go overhead. I've found that "get your scaps to your armpits" can really get the message across, especially when this verbal cue is combined with the kinesthetic cue of me guiding the shoulder blades around the rib cage. These modifications can really help to kick up serratus anterior recruitment, as this video shows:

3. "Start in your jump rope position."

When you're working with young athletes on jumping variations - whether they're broad jumps, box jumps, or some other variations - many of them will start with an excessively wide stance. Then, they'll "dip" to create eccentric preloading (stretch) and the knees almost always cave in. As I've said before, if the feet are too wide, the knees have no place to go but in. My feeling is that many young athletes "default" to this pattern because a wider base of support generally supports a more stable position for a weaker athlete. Unfortunately, this position doesn't put them in a great posture for producing force.

The best coaching cues are the ones that build upon those movements an individual already knows, and most kids have jumped rope in the past. If you use a wide stance when you jump rope, you trip over the rope. Instead, you have to stay with the feet in around hip-width, which is right where we want our jump variations to occur.

1079349493_1443093190001_vs-1443043410001-2

If you're looking for more coaching tutorials and exercise demonstrations, be sure to check out Elite Training Mentorship, which is updated each month with new content from Cressey Sports Performance staff members.

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Exercise of the Week: 1-arm Serratus Wall Slides with Med Ball

It's been a while since I posted a new "Exercise of the Week" feature, but to atone for the wait, I've got a great one for you. I actually came up with this one myself while brainstorming a bit during my own warm-up a few weeks ago.

Serratus anterior is an incredibly important muscle for shoulder health, as it is really the big player in making sure there is a "rotation" component to scapular upward rotation (watch this video first if you need more information on that). Long story short, as you can tell from the picture below that depicts its positioning and line of pull, serratus anterior is hugely important for healthy shoulder function. This is particularly true in movement patterns involving reaching, whether it's out in front or overhead.

serratus

Loss of serratus anterior function is incredibly common in those with shoulder pathology, but we also see it really commonly in those who are pain-free but don't move well. To that end, we like to include specific serratus anterior targeted drills in our warm-ups and as low-key "fillers" between heavier compound lifts during our training sessions.

The research has demonstrated that serratus anterior recruitment is highest when you have more than 90 degrees of shoulder flexion, and this assertion really recognizes that this muscle does far more than just protract the shoulder blade; it is a key upward rotator. As such, we train it to assist that function:

Coaching Cues

1. Make sure the athlete is not in a heavily extended (arched lower back) posture, and don't allow forward head posture.

2. If range of motion allows, reach behind the back with the opposite hand to monitor the position of the inferomedial (inside/bottom) border of the scapula. It should stay "snug" to the rib cage, not wing off.

3. Think of "wrapping" the scapula to the armpit as the arm goes up. I'll usually manually guide the shoulder blade with my hands as I'm first instructing this. You can usually see if the movement is sufficient through an athlete's shirt.

4. Actively push the medicine ball into the wall the entire time. In addition to training the protraction function of serratus anterior, you'll also likely get some reflexive rotator cuff recruitment. This is a 4-pound med ball, but you can really work anywhere from one pound to six pounds.  

5. The athlete should only feel this along the scapula near arm pit (reference the anatomy picture above for a frame of reference). There should be no anterior shoulder discomfort. If there is, it's a sign of one of two things:

a. Pectoralis minor taking over to protract with anterior scapular tilt
b. Excessive movement of the humerus (upper arm) without sufficient scapular movement

5. Don't force upward range of motion. The arm really shouldn't get above 140-150 degrees, and most people don't even need to go this far. Note that the medicine ball doesn't say in the hand the entire time; it rolls to the elbow. This is a great ROM "check" that tells you how far up you should go.

6. Control things down slowly; don't yank to the bottom.

7. For added benefit, you can add a full exhale at the top of each rep to help solidify the pattern.

I'll generally program this for sets of 6-8 reps on each side. 

If you're looking for some more serratus anterior programming options and detailed coaching cues, check out this video:

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10 Important Notes on Assessments

I'm a big believer in the importance of the "Assess, Don't Assume" mentality. However, it's crucial that assessments be approached the right way in order to deliver optimal results in strength and conditioning programs. Here are ten thoughts on the subject:

1. Assessments are an easy way to differentiate yourself.

With this era of semi-private training and bootcamps, there are still a lot of coaches and facilities out there that pay no attention whatsoever to pre-participation screenings. On one hand, it's a sad commentary on our industry, as one could argue that omitting assessments sets clients up for injuries. On the other hand, it creates an excellent opportunity for skilled coaches and trainers to differentiate themselves in a low-barrier-to-entry industry. If you're not assessing, you're just guessing! Make it a priority to start learning more about your clients/athletes.

2. Thorough assessments include both specific and general components.

In my eyes, every assessment can be categorized as either specific or general. Specific assessments may be anything from single-joint range-of-motion (ROM) assessments to the provocative tests physicians and rehabilitation specialists may use. They identify specific things like elbow extension ROM or whether a particular test elicits pain.

Conversely, general assessments look at global movements and evaluate multiple joints at the same time. Examples include overhead squats and push-ups.

The problem is that both kinds of assessments can fall short. As examples, you may see unstable young athletes who pass all ROM assessments (specific) with flying colors, but fold up like lawn chairs when they do an overhead lunge walk (general).

You may also see athletes with perfect overhead squats, but significantly limited knee flexion ROM that would make you concerned that they'd pull a quad (rectus femoris) while sprinting. These are just two examples, though; there are countless more we could cite.

3. You must always be willing to refer out.

You're better off being a great trainer/coach than you are trying to be an incredibly subpar physical therapist or physician. Even if you had a tremendous knowledge of provocative tests and rehabilitation techniques, as a trainer/coach, you don't have the same resources (e.g., diagnostic imaging equipment) these professionals have. Furthermore, diagnosing is outside your scope of practice, anyway.

I refer out every single week. It creates great opportunities for collaboration that will benefit our clients/athletes, and for our staff to learn from related professionals. If you see something on an assessment that raises a red flag, it's better to be safe than sorry.

4. Don't assess just for the sake of assessing; make it to the point.

My biggest assessment pet peeve is when the process takes too long. You can do an incredibly thorough evaluation in about 30 minutes, and most shouldn't even take that long. The only ones that would require more time would be those with extensive injury histories or other unique circumstances.

[bctt tweet="The sooner you're done assessing, the sooner you can get to training."]

5. Assess in the context of both injury history and functional demands.

As a follow-up to point #4, you never want to go into a movement assessment "blind" with respect to the person in front of you. Rather, it's best to first review a health history and have a discussion about training history, goals, athletic demands, and expectations. I find that it's best to perform an evaluation with a better knowledge of an individual's history than it is to look at movement and then work backward from it.

For example, if your pre-assessment discussion reveals that an individual was a baseball player growing up, you can expect to see more external rotation on his dominant shoulder. That might lead you to look more closely at whether he has adequate anterior shoulder stability, and whether his scapula upwardly rotates enough. It also might help to explain a low right shoulder.

RightER

Basically, you need to see the big picture; the "answers" are usually a combination of a bunch of tests, questions, and observations.

6. You have to emotionally separate yourself your personal biases when it comes to assessments.

Baseball players are the largest chunk of my clientele. As a result, I evaluate shoulders and elbows in a ton of detail.

Recently, we started training an NFL punter, though.

I did a thorough assessment with him, but let's just say that we didn't spend a ton of time worrying about verifying that he had perfect elbow ROM. Instead, we spent a lot more time looking at his core and lower extremity; otherwise, the assessment would have taken all day, and we'd acquire a lot of information that wouldn't have a significant impact on his programming.

7. Don't let hypermobile clients/athletes "cheat" assessments.

Just like you need to have both specific and general assessments, you also need to make sure to include both mobility and stability assessments. Hypermobile (loose-jointed) individuals are notorious for cheating assessments that are biased toward ROM. Comprehensive assessments need to also evaluate stability.

elbow10365821_744096285641478_6191697364410130329_n

In this vein, the Functional Movement Screen does a good job of looking at both sides of the equation. The shoulder mobility, overhead squat, and straight leg raise tests are general assessments largely biased toward mobility, but the trunk stability push-up, hurdle step, rotary stability, and in-line lunge screens are all predominately stability challenges.

To learn more about how hypermobile folks can "cheat" assessments, check out my article, 15 Static Stretching Mistakes.

8. Have some feel; don't make new clients (or any clients) uncomfortable.

If a man is overweight and uncomfortable with his body, it's probably not a great idea to have him take his shirt off for a scapular screen. If a woman is seriously deconditioned, it's probably not a good idea to put her through a lunge assessment that she'll fail miserably. And, it's an even worse idea to do these things in front of a crowded gym.

           Remember that the first day is as much about
           building rapport and starting a friendship as it
            is about evaluating how an individual moves.

As has been said in the past, "They have to know how much you care before they care how much you know."

9. Don't forget to highlight what individuals do well, too.

In How to Win Friends and Influence People, Dale Carnegie wrote, “It is always easier to listen to unpleasant things after we have heard some praise of our good points.” This point applies to fitness and movement assessments, too. Think about it: would you like to be criticized non-stop for 30 minutes? Probably not.

By contrast, if someone highlighted what you did well while also covering some important growth areas for you, wouldn't these suggestions be more well received? Absolutely.

Again, your goal is to establish a great relationship, not just analyze movement.

10. Remember that training is a never-ending assessment.

Every exercise is an assessment. Each time your clients and athletes move, they're providing you with information. The more you pay attention, the better you'll be able to individualize their programs and coaching cues moving forward.

If you're looking for more information on the assessment side of things, I'd encourage you to check out our Functional Stability Training series. These resources go into great detail on evaluating the lower body, upper body, and core.

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