Home Posts tagged "Shoulder Pain"

Injuries vs. Niggles

My business partner, Shane Rye, once dropped an amazing one liner with respect to injuries that has stuck with me for years now:

[bctt tweet="You have to listen when it whispers instead of waiting for it to yell."]

The concept is simple: if you ignore minor aches and pains, they rarely just magically go away. Rather, they usually get magnified by volume and intensity and eventually reach a painful threshold where are more extensive intervention is required. The research actually supports this concept - but only if you know how to dig a bit deeper.

As an example, consider this Scandinavian study of patellar tendinopathy in junior basketball players. Researchers looked at 134 teenagers (268 total patellar tendons) and found that only 19 tendons presented clinically with symptoms. However, under ultrasound examination, 22% of the remainder of the group (who'd said they've never had patellar tendon pain) could be diagnosed with tendinopathy. In other words, "ultrasonographic tendon abnormality is 3 times as common as clinical symptoms."

Now, keep in mind that this study looked at teenagers, who are markedly less likely to have tendinopathy than older individuals. Just imagine if they'd done this study on a cohort of middle-aged men playing hoops at the local YMCA. The point is that whether you have symptoms or not, you likely have some changes in your tissues.

To be clear, this isn't particularly shocking to anyone who's looked at MRIs of asymptomatic individuals. We see loads of asymptomatic rotator cuff tears, spondylolysis (stress fractures), and torn labrums. And, I don't think we should just treat MRI findings when they aren't aligned with clinical symptoms. However, they do provide a reminder that we often have several issues that might just be waiting to reach a painful threshold if we aren't cognizant of our training volume and intensity - and our movement quality.

I call these potential problems "niggles." Maybe it's that Achilles tendon that's cranky first thing in the morning, but feels good after you warm it up. Or, it's that stiff neck you get after a few hours of working at the computer, but feels better after your spouse massages your upper trap. It could be the shoulder that bugs you only when you barbell bench press, but feels pretty good when you use dumbbells instead. These niggles are all premonitions of an imminent training disaster - so listen to them.

Maybe it's seeking out some extra manual therapy in a specific area. The solution could be looking at a more individualized warm-up to address these issues. It might even be that you strategically drop particular exercises from your program at various points during the year.

Above all else, though, it's about understanding that good training teaches your body how to spread stress over multiple joints. Instead of that cranky patellar tendon taking on 90% of the load on each landing, we work on hip and ankle mobility and strength so that it might only have to be 30%. Spreading out the stress ensures that one area won't ever hit the point of pain.

Understanding how to distribute stress mandates that you understand what quality movement actually looks like, though - and that's unfortunately where a lot of fitness professionals fall short. With that in mind, many of my products focus on the topics of assessment and corrective exercise, so they're good options for bringing these knowledge gaps up to speed. In particular, I'd recommend the following ones, which happen to be 25% off through Cyber Monday:

Sturdy Shoulder Solutions - this is my most up-to-date upper extremity resource, and it delves into everything from the neck, to thoracic spine, to scapular control. I discuss functional anatomy and key competencies you need for upper extremity health and high performance.

Functional Stability Training - this four-part series is a collaborative effort with physical therapist Mike Reinold, and we cover core, upper body, lower body, and optimizing movement. The components can be purchased individually or as the entire package (at a big discount).

The discounts for all these items are automatically applied at checkout after you've added them to your cart. For more information on all my Black Friday/Cyber Monday sales, head HERE.

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Exercise of the Week: Bent-over T-Spine Rotation with Hip Hinge

I wanted to introduce you to a new exercise we've been playing around with lately. I created the bent-over thoracic spine rotation with hip hinge because I was looking for a way for athletes to avoid compensatory movements as we worked on thoracic spine mobility in the standing position. Essentially, you'll often see folks with limited thoracic spine mobility move East-West with the hips or laterally flex through the spine as they try to find motion in spite of their limitations. By pushing the butt back to the wall, we effectively block off compensatory hip motion (and work on a better hip hinge pattern at the same time).

Key coaching points:

1. By having the eyes follow the hand, you get some cervical rotation to help things along.

2. Make sure the upper back is moving and you aren't just "hanging out" on the front of the shoulder. This is especially true in a throwing population who may have acquired anterior shoulder laxity.

3. We'll usually do eight reps per side. This can be included as a single set during a warm-up, or for multiple sets as fillers during a training session (we'll often plug it in between medicine ball sets).

4. This is a better option for those who have active range-of-motion limitations to thoracic spine rotation, as opposed to passive limitations. In the case of the passive limitations, athletes are better off with things like side-lying windmills, where they have assistance from gravity (instead of having to compete against it).

To learn more about how we assess, program, and coach around the thoracic spine (and entire shoulder girdle), be sure to check out Sturdy Shoulder Solutions.

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Is It Really Biceps “Tendonitis?”

One of my biggest pet peeves is when all anterior shoulder pain is given a "blanket diagnosis" of biceps tendonitis. With that in mind, today, I've got a webinar excerpt from my Sturdy Shoulder Solutions resource that delves into the topic in greater detail. Check it out:

For more information, check out www.SturdyShoulders.com.

Also, if you're looking for an in-person shoulder course that discusses these topics in greater detail, be sure to look into my November 11 course in Indianapolis. You can learn more HERE.

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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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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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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.

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Have a great weekend!

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