Home Posts tagged "shoulder mobility drills"

Should You Chase Shoulder External Rotation – And If So, How?

Each time I run an Instagram Q&A, I get a few high school baseball players who ask how they can increase shoulder external rotation for throwing. The answer really depends on a few things, so here's a video to walk you through them.

Also, as a friendly reminder, Sturdy Shoulder Solutions is on sale for $40 off through this Sunday at midnight. Just enter coupon code OFFSEASON19 to receive the discount at checkout at www.SturdyShoulders.com.

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4 Yoga Push-up Progression Strategies

We use yoga push-ups a lot in our training programs, but one challenge with incorporating them over the long-term with more advanced athletes is that they're hard to load up. You can't use bands or chains as external resistance because they slide over the course of the set. And, weight vests really can't provide enough external resistance without getting too bulky and cumbersome. Luckily, there are a few other ways to progress the drill:

1. Slideboard Yoga Push-ups

2. 1-leg Feet-Elevated Yoga Push-ups

3. Feet-Elevated Spiderman Yoga Push-ups

4. Yoga Push-up with Opposite Arm Reach

5. Controlled Tempo

Last, but not least, you can simply slow down the tempo at which the yoga push-up variations are performed. I like adding a full exhale at the top position, too.

Speaking of upper extremity progressions, if you're looking for some more information on how we assess, coach, and program for the shoulder girdle, be sure to check out my resource, Sturdy Shoulder Solutions.

 

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Assessments You Might Be Overlooking: Installment 6

It's been quite some time since I published an update to this series, but some recent professional baseball initial offseason evaluations have had me thinking more and more about how important it is to take a look at lateral flexion.

In the picture above, I'd say that the athlete is limited in lateral flexion bilaterally, but moreso to the left than right. You'll also notice how much more the right hip shifts out (adducts) as he side bends to the left; he's substituting hip fallout for true lateral flexion from the spine. The most likely culprit in this situation is quadratus lumborum on the opposite side (right QL limits left lateral flexion).

As you can see from the picture below, the triangle shaped QL connects the base of the rib cage to the top of the pelvis and spine.

Stretching out the QL isn't particularly challenging; I like the lean away lateral line stretch (held for five full exhales). This is a stretch that can be biased to target the lat, QL, or hip abductors.

That said, the bigger issue is understanding why a QL gets tight in the first place. As Shirley Sahrmann has written, whenever you see an overactive muscle, look for an underactive synergist. In this case, the right glutes (all of them) are likely culprits. If the gluteus maximus isn't helping with extending the hip, the QL will kick on to help substitute lumbar extension. And, if the gluteus medius and minimus aren't doing their job as abductors of the hip, the QL will kick in to "help out" in the frontal plane. This double whammy has been termed a Left AIC pattern by the good folks at the Postural Restoration Institute, and they've outlined many drills to not only address the apical expansion (which creates length through the QL), but also bring the pelvis back to neutral.

Taking this a step further, typically, those with very overactive QLs will also present with limited thoracic rotation (in light of the QL attachment on the inferior aspect of the ribs), so you'd be wise to follow up this stretch with some thoracic mobility work. The athlete in the example at the top of this article had the most limited thoracic rotation (both active and passive) that I've seen in any pitcher this offseason.

That said, here's a good rule of thumb:

If you have a flat thoracic spine athlete with limited thoracic rotation, look at pectoralis major, latissimus dorsi, and quadratus lumborum. If horizontal abduction (pec) and shoulder flexion (lat) both check out well, go right for QL tissue extensibility (as measured by lateral flexion). It will be absolute game changer - particularly in rotational sport athletes.

If you're looking to learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out my new resource, Sturdy Shoulder Solutions.

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Making Movement Better: Duct Tape or WD-40?

It's often been said that anything can be fixed with duct tape and WD-40. And, as a guy with extremely limited handyman skills, I really like this flowchart.


Source: http://laughingateverydaylife.com/2016/07/duct-tape-vs-wd40/

While this might seem like a dramatic oversimplification with respect the human body, I think there are actually some noteworthy parallels. To prove this, let's take a look at a study my buddy, Mike Reinold, co-authored back in 2008. While they looked at range of motion changes in professional pitchers after an outing, the findings of the study that I always keep coming back to have more to do with the absolute range of motion numbers in the data set (moreso than the changes). Take a look:

Looking at the mean shoulder total motion pre-throwing, MLB pitchers averaged about 191 degrees. However, when you look at the standard deviation of 14.6 degrees, you'll see that there were guys down around 175 degrees (very hypomobile or "tight"), and others up around 206 degrees (very hypermobile or "loose").

Speaking very generally, the tight guys need more WD-40 (range of motion work), and the loose guys need more duct tape (stability training). Now, here's what you make your mark as a coach: identify the exceptions to this rule.

For example, when you have an otherwise "tight" guy who comes back from a long season in with a significant range of motion increase at a joint, it could mean that he's developed instability (e.g., blown out a ligament). Or, maybe you see an otherwise "loose" guy who has lost a considerable amount of range of motion, it could mean that he's really hanging out in a bad pattern, developing musculotendinous shortness/stiffness that "overpowers" his ligamentous laxity. Or, he might be really out of alignment, or have developed a bony block.

Identifying outliers - exceptions to the rules - is a crucial part of evaluation success and subsequent programming. As I've often said, don't just focus on average.

Speaking of lessons to be learned in managing overhead throwing athletes, this will actually be a topic I expand upon at the upcoming fall seminar at Cressey Sports Performance - Massachusetts. We've got a great lineup, and the early bird registration deadline is this Fridya, September 21. You can learn more HERE.

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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: 12/4/17

Happy Monday! It's been two weeks since my last recommended reading compilation, as I took a little blog hiatus last week in light of some travel and the chaos that is the professional baseball offseason. The good news is that it gave me time to stockpile some good content for you. Here goes...

Tinkering vs. Overhauling - and the Problem with Average - One of our interns asked me about my thoughts on the "average" range of motion at a particular joint, and it got me to thinking about this article I wrote last year. There are big problems with using averages in the world of health and human performances, so I'd encourage you to give it a read to learn more.

Core Control, Hamstrings Patterning, and Pitching Success - This was a whopper of an Instagram post from CSP-MA pitching coordinator, Christian Wonders. Be sure to check out all four parts.

Brett Bartholomew on the Art of Conscious Coaching - This was an excellent podcast from Mike Robertson, as Brett is a skilled coach and charismatic personality. It's definitely worth a listen.

Top Tweet of the Week

Top Instagram Post of the Week 

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10 Tips for Making Mobility Work with Your Schedule

I received the following inquiry via email the other day, and thought it might make for a good Q&A post:

I've come to the unfortunate realization that 15 years of sitting at a desk - combined with the simple fact that I'm almost 40 - have left me severely lacking in mobility. And, it's something I now want (and need) to really address. However, I'm also a realist and know that with a busy work and family schedule, getting to the gym is hard enough - but adding a lot of mobility work on top of that could be really challenging. So, I'm wondering what the best way to efficiently tackle this problem is? Should I do a little bit each day? Is it better to go to a yoga class 1-2 times per week? Or something else? I'd like to make some positive changes, but ideally without completely overhauling my weekly schedule. Thanks for any direction you can provide.

The short answer to this question would be a blunt one:

[bctt tweet="If it's really important, make time instead of finding time."]

That wouldn't make for much of an educational blog, though, so let's explore this in more detail. Here are ten things I'd consider if you'd like to really dedicate yourself to improving your overall mobility as efficiently as possible.

1. Frequency is everything.

Remember that - simply stated - mobility is your ability to reach a certain position or posture. It's different than flexibility in that mobility necessitates stability within a range of motion, not just the range of motion of a joint (or series of joints). In other words, you need motor control to have motor control.

Think back to when you were learning to ride a bike. Did you go out and try for 5-6 hours every Saturday morning, or did you put in several runs every day for a few weeks? If you're like most people, it was definitely the latter option.

[bctt tweet="Frequent exposure is key for motor learning, and you can't improve mobility without motor control."]

What does that mean in the context of mobility work? You need to do something every day - and possibly even multiple times per day.

For most folks, a quality pre-training warm-up is an important first step. If you look at my High Performance Handbook as an example, each pre-training warm-up consists of about five minutes of foam rolling and ten mobility drills that should take about ten minutes total.

HPH-main

2. Find new planes and ranges of motion in your strength work.

Most training programs are very sagittal plane (front-to-back) dominant. In other words, a lot of exercisers do very little in the rotational (transverse) and side-to-side (frontal). While you do have to do work in these planes during single-leg work, that doesn't mean much for actually taking them close to their end-range of mobility. Simply adding in some lateral lunges to your warm-ups and strength work can go a long way.

Eric-Cressey-Plate-Slide-576

If you're looking for more examples, check out this detailed article of mine: 7 Ways to Get Strong Outside the Sagittal Plane.

3. Sign up for classes if you really need the accountability or the instructor is absolutely fantastic.

Yoga and Pilates can be absolutely fantastic tools for helping you to improve your mobility if:

a) They improve your accountability so that you're more likely to actually make this a priority.

b) You have an outstanding instructor that both motivates you and teaches you about how your body works.

These options can also be terrible approaches if you have unqualified instructors or attending them absolutely destroys your schedule - and therefore becomes a burden more than a blessing.

4. Mix in a little work at night before bed.  

This piggybacks on the aforementioned "frequent exposures" theme. I know of a lot of people who'll do a bit of foam rolling and stretching at night while watching TV or getting ready for bed. Anecdotally, it does seem to help some people unwind - possibly by kicking the parasympathetic nervous system on (especially if combined with a good focus on breathing during this work). If getting in some stretching and rolling before bed doesn't exactly thrill you, just pick 1-2 high priority drills and do them. Or just stretch out your calves while you're brushing your teeth! 

5. Break up prolonged periods of immobility.

Each spring, I drive from Florida to Massachusetts. Then, in the fall, I drive back to Florida. It's a lovely 23 hours in the car over two days.

The first time I did it, I tried to be a cowboy and just plow through it with as few stops as possible. My hips hated me for about three days after the trip was done.

Since then, I make sure to stop every 2-3 hours. In fact, on my ride back this spring, I even stopped twice to train along this journey. I felt dramatically better in the days that followed.

I think you can extend this logic to how we break up our days, too. If you have to be at a computer for the majority of the 9am-5pm work day, try to get up and move around every 20-30 minutes. Walk to get some water, or do a doorway pec stretch.

1-armDoorwayPec

It's a lot easier to do a little to maintain your mobility than it is to lose it and try to get it back.

6. Incorporate a bit more unilateral work.

When you take a lifter who's never done much single-leg work and start incorporating these unilateral movements, good things always seem to happen. I suspect that it has to do with the fact that a lot of these individuals are actually extending their hips past neutral for the first time in years, but I doubt that's the only mechanism.

To be clear, this doesn't mean that the hardcore squat/deadlift enthusiasts need to drop (or even tone down) these movements. It just means that it'd be a good idea to work in some more single-leg drills to the warm-up period, and to do some as an assistance exercise. They don't need to be loaded like crazy, either, particularly early-on. It's not uncommon to see groin strains (or very pronounced soreness) when someone incorporates single-leg work to a previously 100% bilateral program, so incorporate them gradually in terms of loading and volume. 

7. Be patient and don't skip steps.

Getting transient (quick) improvements to range of motion isn't particularly difficult. You can get that from manual therapy, increased body temperature, or "tricks" to the nervous system. After these initiatives, we need to incorporate some stability training to make these changes "stick."

They won't magically improve dramatically from one session to the next, though. In fact, you may only hold 5% of that change from one session to the next - and that's why you need to stay patient and persistent with these drills over an extended period of time to see pronounced results.

With that said, it's important not to skip steps in this process. Just because your squat pattern improved a little doesn't mean you're ready to sink a 500-pound front squat to the "butt-to-heels" position the right way. And, just because you experienced subtle improvements to your active straight leg raise doesn't mean that you're ready to run a sub-10-second 100m dash. Own the changes before you try to challenge them in more chaotic environments.

8. Manage your breathing.

We'll keep this one really simple and watered-down:

Inhale = tension = stress

Exhale = relaxation = destress

If you're holding your breath while doing your mobility drills, stop! You're just stretching your lats, not attempting a 700-pound deadlift. Control your breathing, and think about fully exhaling at the lengthened position to give your system a chance to perceive it as a "new normal." The yoga folks have been preaching this for thousands of years, but us meathead strength and conditioning coaches have only started to figure it out in the past decade or so.

One drill I love for teaching this is the TRX deep squat breathing with lat stretch. Just sink down into this bottom position and exhale fully on each breath. Give it a "two-one-thousand" count before inhaling again. I usually program five breaths per set.

TRXDeepSquatBreathingWithLatStretch

9. Choose comprehensive mobility drills.

If you only have 10 minutes per day to devote to improving your mobility, you are best of focusing on drills that provide plenty of bang for your buck. In other words, you want drills that challenge multiple joints and planes of motion at the same time. Here are a few good options as examples:

10. Balanced programming and optimal technique help to improve mobility.

Sometimes, the best thing you can do is "audit" your programs and training technique to see if they're pushing you further into your mobility deficit. Maybe you're benching too much and rowing too little? Or, perhaps it's been a lot of squatting and not enough deadlifting? Could it possibly be that you've been board pressing a ton and omitting full range-of-motion benching that could actually be really helpful for your shoulder? There are countless programming pitfalls into which one can fall, but you'll never identify them until you take a step back to review what you've been doing.

Moreover, crappy technique under load reinforces bad patterns and loss of mobility. Additionally, it can turn soft tissue and neuromuscular control restrictions into joint restrictions (laying down bone that shouldn't be there). You can't just fix reactive changes to the joint with stretching, either. Train hard, but train smart and with solid technique.

Wrap-up

These are only ten thoughts off the top of my head, and there are surely many more. At the end of the day, though, most of the mobility improving strategies come back to common sense. Your body desperately wants to move, and you need to make time for that movement - and approach it with a plan as you would any other priority in your life.

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6 Saturday Shoulder Strategies

In light of the recent announcement of my upcoming shoulder course in Colorado, I thought I'd use today's post to throw out some thoughts on training the shoulders.

1. In the upper extremity, the assessments are often the solutions, too.

Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.

Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...

...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.

This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?

My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct. 

Zone-of-Apposition-300x220

These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.

Just thinking out loud here, though. Fun stuff.

2. Anterior shoulder pain usually isn't "biceps tendinitis."

First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.

shoulder

Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.

3. Thoracic outlet surgery really isn't a shoulder surgery.

Over the past few years, each time a professional pitcher gets thoracic outlet surgery, you see many news outlets call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."

With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.

Gray112thoracicoutlet

Additionally, surgeons usually opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.

Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.

pecminor

This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.

All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.

4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.

Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...

...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.

5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.

To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter. 

With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:

Eric-Cressey-Shoulder_OS___0-300x156

Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.

6. Pre-operative physical therapy for the shoulder is likely really underutilized.

It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).

I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.

For more information on my June 24 seminar in Colorado, please click here.

Have a great weekend!

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3 Principles for Understanding and Improving Mobility

Today's guest post comes from Dean Somerset, the creator of the excellent resource, Ruthless Mobility, which is on sale for 60% off through the end of the day on Monday, July 4. Dean is a tremendous innovator and one of the brighter minds in the fitness industry today, and this article is a perfect example of his abilities. Enjoy! - EC

ecover-167-DVDcase-267x300

Mobility can be described in a number of different ways, depending on who is writing the story: yoga, flexibility, stretching, movement training, dynamic warm-ups, bendy stuff, and in some cases “how the heck do you even do that?” Regardless of what it’s called or who’s doing it, there are some basic rules and physiologic elements to be aware of when it comes to understanding mobility and how to use it in training programs. Today I wanted to outline the "three big rocks" of developing, using, and maximizing mobility in a safe and progressive manner. 

1. Structure Determines Function.

It’s easy to say that genetics are a separating feature for those who can gain a lot of muscle and those who have trouble adding a pound. The same can be said of those who are congenitally lax (via something like a higher Beighton hypermobility score or a diagnosis of Ehlers Danlos syndrome), compared to people who move like the tin man. Some of this could be connective tissue related difference in collagen to elastin ratio, but much of it could also be considered by the shape and orientation of the joints themselves.

In terms of the acetabular angle, D’Lima et al (2011) found in a computerized prediction model for prosthesis implantation that:

a. those with more acetabular anteversion (forward placement on the pelvis) had greater flexion range of motion and less extension
b. lateral placement of 45-55 degrees gave the best overall mobility
c. a lateral angle of less than 45 degrees gave more flexion range of motion and more than 45 degrees gave less rotation capability
d. if the femoral neck was thicken by 2 mm in diameter, it significantly reduced the range of motion in all directions, irrespective of placement.

Higgins et al (2014) even showed there was a large difference in anteversion angles bilaterally in the same individual (potentially lending some validity to PRI concepts of inherent asymmetry), with as much as a 25 degree difference in anteversion angle between left and right hip. This could translate to a difference in flexion range of motion of 25 degrees between your two hips, without any other feature affecting the outcomes. Zalawadia et al (2010) showed there’s a big variance in the femoral anteversion angle (whether the head of the femur pointed more forward or possibly backward) as the femoral neck attaches to the acetabulum, with the majority being between 10-20 degrees.

Additionally, some acetabulums have too large of a center edge angle, where the socket faces more inferiorly than laterally, which makes impingement during abduction more likely compared to a smaller center edge angle.

Screen Shot 2016-06-29 at 9.32.28 PM

These structural differences are primarily set and unchanging after puberty when bones don’t deform as easily to external forces as with young kids. Baseball pitchers can undergo deformational changes at the proximal humerus (upper arm) to allow a much greater external rotation range on their throwing arm compared to adults who pick up the sport later in life. Eric showed that with his comparison of presidential first pitches HERE.

With advancing age, joint range of motions tend to reduce further with degenerative changes to the structures involved, either with an increase in concentration of cortical bone at contact areas, a reduction of cartilage thickness, or decreased fluid content of the joint space itself. The end result is a tighter joint that doesn’t move as easily.

Most of these types of changes, barring injury or disease, tend to not be limiting factors in mobility until many decades have passed, so if you’re in your 20s and concerned about your lack of mobility, it’s pretty safe to say that it’s likely not related to degenerative changes just yet. If you’re 50 or 60, it’s much more of a likely scenario.

This Canadian study showed that men lost an average of 5 degrees of shoulder abduction and 6 degrees of hip flexion per decade between 55 and 86 years old, while women lost an average of 6 degrees of shoulder abduction and 7 degrees of hip flexion in the same age range, and that this loss sped up after 70 years old and was actually not linked to self-reported activity levels. Being more active is better for everything as you age, but based on this study, not necessarily for keeping your mobility into your golden years.

What this means is that everyone will be different in terms of how much mobility they have and in which directions or movements. One person may be able to press overhead because they have joints that easily allow it, while another may never get there due to specific limitations, and a third may just not be ready to press yet. They may have the specific ability to do the motion, but don’t have the control or strength at the moment to do it effectively, which is where part 2 comes in.

So how do you determine a structural limitation? The best mechanisms are simply to see what the range of motion looks like in a couple of scenarios:

a. passive – have someone move you through the range while you’re relaxed)

b. supported - pull the joint through a range without using the muscles involved in the action. (Think a hamstring stretch with a towel wrapped around the foot and pulling on it with your arms)

c. in a different position or direction – in looking at hip flexion, compare a squat to a rock-back or Thomas test to look at the same range of motion.

If you consistently get the same joint angles in different motions or positions, it’s reasonable to believe that could be the true limit of your flexibility based on structural aptitudes. There’s always a potential that the limitation could be something else, and if you involve some of the training practices and options used later and notice an improvement, it’s a happy bonus. Short of developing X-ray vision, these are some of the best options for determining structure that everyone has available to them, whether we’re talking about the clinician, trainer or average meathead looking to get all bendy and stuff.

2. Can you actually get there?

Now, let's consider shoulder mobility; imagine that we look at an individual in supine and there’s no limitation standing in the way of going through full shoulder flexion.

SupineShoulderFlexionAssessment1

However, when this same individual is asked to bring their arms overhead in an upright position, they do some wonky shoulder shrug, low back arch, and their upper lip curls for some reason. In short, they aren’t able to access that flexion movement very well, even though they have the theoretical aptitude to get there on their own.

We’re looking for the image on the right, but wind up getting the image on the left:

shoulderflexion

Now the great thing about the body is it will usually find a way to get the job done, even if it means making illegal substitutions for range of motion from different joints. In this case, the lack of shoulder motion is made up with motion from the scapula into elevation instead of rotation, and lumbar extension in place of the glenohumeral motion.

This by itself isn’t a problem, but rather a solution. It’s not bad to have something like this happen by itself, but it does alter the specific benefits of an exercise when the segments you’re looking to have do the work aren’t actually contributing, and you’re getting the work from somewhere else. There’s also the risk of injury from poor mechanical loading and improper positioning that increases the relative strain on some areas that aren’t meant to be prime movers for the specific exercises.

Now, the big question is whether someone is willing to not do an exercise because they’re demonstrating that they’re not ready for at the moment. If a client wants to squat in a powerlifting competition, but his hip range of motion makes it very difficult to get below parallel to earn white lights without losing lumbar positioning or grinding the hip joints to pieces, how willing would he be to adjust his training or eliminate that possibility to save a lot of hassles? Some people identify themselves by their sport, so telling them not to do what they love isn’t an option. I’ve worked with a lot of runners, and saying “don’t run” tends to go in one ear and out the other.

Back to the overhead example, maybe going right overhead isn’t possible at the moment, but a high incline press can be done easily. This is working in what Mike Reinold calls on Functional Stability Training: Optimizing Movement “Green Zone vs Red Zone training.” Overhead at the moment is a red zone movement as they can’t get there easily and on their own. Green zone would be a landmine press, where they’re still working on flexion, but not moving into a range they can’t easily access.

One manner that could help an individual access this range of motion if they have shown an ability to get there passively is through what Dr. Andreo Spina calls eccentric neural grooving of the motion. Use either a support or pulley to get into the terminal range of motion, release the support or pulley and try to maintain the terminal position while slowly moving out of the end range as controlled as possible. Here’s Dr. Spina doing ENG work on the ankle and anterior shin for some dorsiflexion work.

Here’s another version with yours truly working on a similar variation via controlled hip abduction:

You could do this for the shoulder easily enough as well by grabbing a rope, pulling the shoulder into flexion, releasing the rope, and trying to maintain the position before slowly lowering the arm out of terminal flexion. Just make sure you’re not letting your low back arch or shrug up your shoulder blades in to your neck.

3. Can you use it with force when needed?

So now you’ve shown you have the joints to do stuff, you can get there on your own without assistance, and you want to train the heck out of it to look like your favorite Instagram bendy people.

One thing to consider when exploring these ranges of motion is that force production tends to be greatest in mid-range positions, likely due to the greatest torque development required to overcome natural leverage elements and also due to spending less time in the end ranges. There’s also the reduction of cross bridge linkages in these positions, limiting sarcomeric action when you’re gunning your biceps in peak flex.

Controlling these end ranges (even if the goal may not be to develop maximal force in them for moving the biggest weight from point A to B) can help expand the usable range of motion where peak torque development occurs, as well as provide the potential for expanding sub-maximal torque percentage ranges of motion. These movements aren’t easy and tend to take a lot of mental energy coupled with physical effort, but if getting awesome was easy, everyone would already be there.

Summary

To round things out, understanding and developing mobility comes down to:

a) having the structure to produce the range of motion
b) being able to get into position to effectively use that range of motion
c) building strength and conditioning within that range of motion to keep the ability to use those ranges for a long time, and through as many positions and directions of movement as possible.

Some specific movements or positions may not be possible due to your own unique structure and abilities, but work hard at using everything you do have, build strength throughout the entire range of motion, and enjoy the process as much as the outcomes.

Note from EC: If you're looking for more mobility tips and tricks - and the rationale for their inclusion in a program - I'd encourage you to check out Dean's fantastic resource, Ruthless Mobility. Your purchase includes lifetime updates and continuing education credits. Perhaps best of all, it's on sale for 60% off through this Monday (7/4) at midnight.

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Exercise of the Week: Resisted Scapular Wall Slides

Today's "Exercise of the Week" guest post comes from Lee Boyce. Enjoy! -EC

One of the basic exercises that people are taught to practice for improved shoulder rotation, upper back activation, scapular mobility and anterior muscle release as a by-product is the standard scapular wall slide. To do them, a lifter would simply stand with the heels, butt, upper back, shoulders and full arms and hands against the wall, reduce the lower back arch, and slide the hands up and down, mimicking a full shoulder press movement pattern.

Regressing this movement is as simple as taking the feet a few inches away from the wall and assuming position otherwise. Progressing this movement, however, is another story.

The problem is that people adapt quickly to an unloaded mobility drill, and because of this, the wall slide can become another non-transferrable “skill” that doesn’t carry over to generally improved posture or performance. Moreover, depending on whether the humerus is properly nested in the glenoid fossa to begin with, the wall slides themselves may always pose a problem from a biomechanical perspective. To help this cause, adding some mild resistance can “remind” the muscles of the rotator cuff to center the humeral head in the socket and create a much more effective external rotation position. Plus, using a neutral grip via ropes (as compared to a palms-forward grip) creates a much more ideal (and shoulder friendly) environment for external rotation that can act to counter anterior shoulder glide.

For resisted scapular slides, I like using a cable pulley, and performing the lift from a seated position. It’s a bit easier for a lifter to focus on avoiding back hyperextension, which is a common compensation pattern when lifters have insufficient shoulder mobility.

This movement creates a force angle that works against the standard slide pattern, so keeping the hands and arms moving along the same plane becomes a much more challenging task for the scapular muscles. It’s easy to “let up” and allow the hands and arms to drift forward. To view the movement in action, watch the video below.

Coaching Cues

1. Have the athlete sit squarely on a box or bench. The closer parallel the box puts him in, the better.

2. Set up the cable pulley and ropes in a position just above head level. This way, at the top position, the force angle won’t be strictly downward, and there will be ample tension throughout.

3. If the lifter is still novice or intermediate level as far as shoulder mobility and control goes, a neutral grip is recommended for reasons mentioned above. If the lifter is more advanced, he can feel free to pinch-grip between the thumb and first finger, and face the palms forward.

4. During the movement, avoid slipping into lower back hyperextension; maintain thoracic region extension; and be sure to maintain neutral head posture. Also, avoid letting the elbows fall out of line with the hands in the vertical plane.

5. Your target areas are the rotator cuff muscles, rear deltoids, and lower traps (as you raise the weight further overhead). When you start feeling this in other areas like the biceps and upper traps, readjust positioning and continue.

6. The exercise is very specific, so it shouldn’t take much weight for it to be effective. 15-20lbs of resistance on most machines is usually plenty.

7. The movement won’t work if it’s done in a rush. Think of a 2121 tempo as a solid guideline.

8. Use higher reps to build up the muscular endurance of these muscle groups.

9. Your range of motion should replicate your typical dumbbell shoulder press – meaning the rep begins very close to the shoulder level, and ends at a full arm extension overhead.

10. Through the movement, remember to keep the hand separated (pull the rope handles apart) as much as possible. Doing so keeps the upper back engaged, avoids internal rotation, and keeps the hands stacked over the shoulder, where they belong.

About the Author

Lee Boyce (@CoachLeeBoyce) is a strength coach, writer, and former collegiate level sprinter and long jumper, based in Toronto, Canada. In 2013, he was named to the training and treatment staff for team Jamaica at the Penn Relays . He’s regularly featured in the largest fitness publications as a writer. Visit his website at www.LeeBoyceTraining.com or check him out on Facebook.

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