Home Posts tagged "Shoulder Health"

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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Building Mobility Efficiently: Modified Pigeon with 1-arm Child’s Pose

Here's another Sturdy Shoulder Solutions sale inspired post. The Modified Pigeon with 1-arm Child's Pose is another new drill we've busted out in our warm-ups to get a little more bang for our buck. It's particularly useful for pitchers, who need to get into their lead hip (adduction) while getting lat length, scapular upward rotation, and apical expansion on the throwing shoulder.

A few big coaching points:

1. You should feel a stretch in the outside of the front hip, but nothing in the knee (particularly the inner part). If you're feeling it in your knee, you've probably set up incorrectly.

2. Think of a stretch along the entire outside of the torso and arm: quadratus lumborum, lats, and long head of triceps, especially. If you pinch at the front/top of the shoulder, ease off it a bit.

3. Breath in through the nose and exhale fully through the mouth as if you're blowing out birthday candles (and hold for a count of three before inhaling again). You should feel your abs turn on as the shoulder stretch increases. Do five breaths.

You can learn more about how I assess, program, and coach at the shoulder girdle - and save $50 through Sunday at midnight - at www.SturdyShoulders.com.

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Video: When Should You Train Shoulder Internal Rotation?

With this week's $50 off sale on Sturdy Shoulder Solutions, I did a Q&A on my Instagram page the other day, and one of the questions was whether it was ever useful to train shoulder internal rotation. With the lats and pecs (both internal rotators) always getting blasted in a typical strength training program, is any specific work for internal rotation ever recommended? My response warranted a three-part video, which I've compiled into one here:

To learn more about how I assess, program, and coach at the shoulder girdle, check out Sturdy Shoulder Solutions. It's on sale for $50 off through Sunday at midnight.

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Exercise of the Week: Wall Slides with Upward Rotation and Lift-off to Swimmer Hover

With this week’s $50 off sale on Sturdy Shoulder Solutions, I wanted to introduce a new drill I’ve started using. The wall slide with upward rotation and lift-off to swimmers hover effectively blends two schools of thought: Shirley Sahrmann’s work and that of Functional Range Conditioning.

1. With the wall slide portion, we drive scapular upward rotation.

2. With the lift off portion, we get scapular posterior tilt and thoracic extension (as opposed to excessive arm-only motion).

3. With the swimmer hover, we lengthen the long head of the triceps and even drive a little bit more serratus anterior recruitment as the scapula rotated around the rib cage.

Get exposure to multiple philosophies and have an appreciation for functional anatomy, and the exercise selection possibilities are endless. Learn more at www.SturdyShoulders.com.

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Why Rhomboids Probably Aren’t Your Best Friend

Today, I've got an excerpt from my new course, Sturdy Shoulder Solutions. I discuss the functional anatomy of the rhomboids, a commonly misunderstood muscle group with big implications.

For a lot more functional anatomy insights like these - as well as a comprehensive look at shoulder assessment, programming, and coaching - be sure to check out Sturdy Shoulder Solutions.

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

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Mobility Exercise of the Week: Supine Banded Shoulder Flexion on Roller

The supine banded shoulder flexion on roller is a new shoulder mobility drill I came up with that is really growing on me quickly. Effectively, it's an alternative to a back to wall shoulder flexion for those who may struggle to "compete against" gravity as they take the arms overhead in the standing position.

In this drill:

1. The foam roller provides feedback for posterior pelvic tilt, thoracic extension, and a more neutral cervical spine posture.

2. Gravity assists the individual into overhead motion to overcome stiffness through the lats, teres major, long head of triceps, inferior capsule, pec minor, etc.

3. The fact that the roller doesn't impede scapular motion (like the wall or floor would) makes it easier to achieve some scapular posterior tilt as the arms go overhead.

4. The supinated grip drives some shoulder external rotation, placing the lats on stretch in the transverse plane so that folks can't "cheat" the movement by letting their hands drift toward the midline.

5. The band creates some posterior rotator cuff recruitment,

I'll take this over a few sets of ugly band pullaparts any day. What's not to like?

Looking for more cutting-edge shoulder strategies like these? Check out my new resource, Sturdy Shoulder Solutions at www.SturdyShoulders.com.

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Stop Thinking About “Normal” Thoracic Spine Mobility

Two years ago, I published a post, Tinkering vs. Overhauling - and the Problems with Average, where I discussed the pitfalls of focusing on population averages, especially in the world of health and human performance. I'd encourage you to give it a read, but the gist is that you have to be careful about overhauling a program because you see someone as being outside a "norm" that might have been established for an entire population when they are unique in so many ways.

Thoracic spine mobility is an excellent example. What would be considered acceptable for an 80-year-old man would be markedly different than what we'd want from a 17-year-old teenage athlete in a rotational sport. This athlete, for instance, had some marked negative postural adaptations that contributed to two shoulder surgeries during his time as a baseball pitcher. If he was far older with different physical demands, though, he might have never run into problems.

Lumbar locked rotation is a great thoracic spine rotation screen I learned from Dr. Greg Rose at the Titleist Performance Institute. Briefly, you put the lumbar spine in flexion (which makes lumbar rotation hard to come by) and the hand behind the back (to minimize scapular movement). This allows you to better evaluate thoracic rotation without compensatory motion elsewhere. Check out the high variability among three athletes who are all roughly the same age:

On the left, we have a professional baseball pitcher. In the middle, we have an aspiring professional golfer. And, on the right, we have a powerlifter who's moved well over 600 pounds on both the squat and deadlift. Adaptation to imposed demand is an incredibly important part of this discussion of "normal." The hypertrophy (muscle bulk) that benefits the powerlifter could possibly make the baseball pitcher and golfer worse, but at the same time, I wouldn't necessarily say that the powerlifter is "lacking" in thoracic rotation because you don't need a whole lot of movement in this area for a successful, sustainable powerlifting career.

I should also note that these are all active measures. If we checked all three of these guys passively, we'd likely see there's even more thoracic rotation present than you can see here. And, that can open up another can of worms, as having a big difference between active and passive range of motion can be problematic, too.

The take-home message is that if you're going to call someone's movement quality "abnormal," you better have a clear designation of what "normal" is for their age and sport, as well as what's required for their athletic demands.

For more information on how we assess and train thoracic mobility, I'd encourage you to check out my new resource, Sturdy Shoulder Solutions.

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Strength and Conditioning Stuff You Should Read: 6/9/18

Happy Saturday! This edition of "stuff to read"is a few days late in light of the Major League Baseball Draft and release of my new resource, Sturdy Shoulders Solutions. As a quick reminder, it's on sale for $50 off through the end of the day tomorrow (Sunday). You can learn more at www.SturdyShoulders.com.

With it being a shoulder product, I figured I'd use this week to "reincarnate" some upper extremity content from my archives:

Are You Packing the Shoulder Correctly? - Most people don't appreciate the relevant anatomy involved in packing the shoulder, so that may actually utilize the wrong muscles to get the job done. This webinar delves into the topic in detail.

3 Tips for Improving Your Back to Wall Shoulder Flexion - This video demonstrates a few quick and easy cues to improve your capacity for overhead reaching.

Exercise of the Week: Standing External Rotation Holds to Wall - This exercise is a great fit for everyday lifters and baseball players alike, as it builds rotator cuff strength without any equipment.

Top Tweet of the Week

Top Instagram Post of the Week

Have a great weekend!

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Are You Getting Shoulder Motion in the Right Places?

With this week's release of my new project, Sturdy Shoulder Solutions, I thought I'd give you a little sampling of what's included. In this TRX serratus anterior exercise video excerpt, I talk about the importance of getting good scapulothoracic (shoulder blade on rib cage) movement so that you don't have to find extra glenohumeral (ball on socket) motion.  Check it out:

This is a key shoulder health principle I cover in great detail in my new resource - and it's on sale for $50 off through Sunday at midnight. You can learn more at www.SturdyShoulders.com.

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Shoulder Health: Where Small Hinges Swing Big Doors

The shoulder girdle is a complex series of joints unified by subtle movements in perfect timing. If you need proof, just check out this slide from my new release, Sturdy Shoulder Solutions.

This study looked at the difference between the empty can and full can in terms of both muscular recruitment and actual movement in folks with symptomatic impingement vs. healthy controls. Not surprisingly, the empty can exercise hurt more. Just looking at this picture hurts my shoulder (and my shirt is wildly fitting).

To me, though, that's not the most significant takeaway from these study results. Rather, take a look at some of the numbers included in their findings: 1-3 degrees (joint movement) and 1-4% (muscular activation). These are subtle, subtle quantifiable differences between those in pain and those who are pain free - and most of them really can't be perceived "on the fly."

What does this mean for how you assess, program, and coach?

First, from an evaluation standpoint, we have to truly understand what quality movement should look and feel like. If you can't truly define "normal," then how can you ever truly appreciate "abnormal?"

Second, not all exercises are created equal (as we learned from the empty vs. full can discussion). 

Third, in coaching, we have to constantly solicit feedback from our athletes on where they feel exercises.

These are all key principles on which I focus in my new resource, Sturdy Shoulder Solutions - and it's on sale for $50 off through Sunday at midnight. You can learn more at www.SturdyShoulders.com.

 

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