My fiancée Anna and I just got back last night from a wedding weekend (not ours) in Halifax. We had a great time drinking Molson celebrating our friends' big day.
Anna was a bridesmaid, so I was largely left to be an American tourist flying solo, which left a bit of time for people watching. There weren't any Canadian celebrities - Nelly Furtado, Gordy Howe, Michael J. Fox, or even Keanu Reeves (who was stripped of his "celebrity" status thanks to years of anti-Reeve propaganda at tonygentilcore.com) - on hand, so my attention focused on a remarkably obese woman in the hotel lobby who had a couple of yappy little dogs with her.
While I'm a big-time dog lover, frankly, at that moment, I wanted to punt these little balls of worthlessness into the nearby harbor just to quiet them down. However, rather than doing so and getting myself deported back to the U.S., I turned my attention to these pups' "Big Mama."
This woman had two dogs that were obviously frantic to go outside, enjoy the sunshine, and essentially give her the perfect reason to exercise (take them for a walk). It wasn't happening, though.
It was like giving a young hockey player a stick and some skates - but having him refuse to use them while playing. Or, like offering employees a corporate fitness deal, only to have them ignore it.
Undiagnosed ADD guy that I am, this really got me to thinking about how so many people out there don't even realize that they have key resources right at-hand who could really help out on their fitness journeys.
Maybe it's a spouse who would love to exercise with you or help you to clean up your diet?
Perhaps your gym has new equipment that you haven't touched yet when what you really need is some variety?
Could there be a training partner at your gym right now on the same schedule at you who would be willing to give you hands-off/spots so that you can push yourself that little bit more in your weight training program to get strong?
Or, do you think it could be that you just need a new strength training program to get you out of a funk so that you're accountable to something?
You never know unless you stop to consider this, and evaluate what's going on around you. Chances are that there are people, places, and things out there that'll help get you closer to where you want to be.
Now, shouldn't you be finding a dog to walk?
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Here's this week's list of recommended reading from the EricCressey.com archives:
The Proactive Patient - This is still, in my eyes, one of the best articles I've ever written.
The 315 Deadlift Fiasco - This article, on the other hand, pissed a few people off. There were good lessons to be learned, though.
Why I Don't Like the 5x5 Workout - While the classic 5x5 set and rep scheme certainly has its place in some strength training programs, it definitely has its limitations.
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A buddy of mine - we'll call him Bobby Ballsofsteel - has been really working at it lately in a dedicated push to pack on a little muscle mass with his strength training program. He's somewhat of a classic "hardgainer" who needs to really forcefeed himself to gain every ounce. Nonetheless, Bobby's busted his butt in the gym (I train with him, so I know) and the kitchen over the past few months and has gone from 200 to 210 pounds. This is a huge deal, as we aren't talking about "newbie" gains; we're talking about a guy who had already gone from 160 to 200 over the previous two years.
Bobby was super-intimidated about starting a strength and conditioning program back in 2007 because, although he was a great athlete, it was unfamiliar territory for him because he immediately become the little dog at the pound.
It took a lot of guts to start things up - something we see with a lot of people from different walks of life who begin exercise programs with motivation and a desire to change, but a long way to go and a fair amount of intimidation and embarrassment in their minds about where they stand with respect to the challenge ahead. Whether you're an elite athlete who has never trained in an organized setting, an untrained 14-year old baseball player, or a 55-year-old female who is just getting into exercising to drop body fat, the first step is the toughest - and it's our job as fitness professionals to make this first step more manageable and less daunting. The problem is that we have outside influences with which to compete.
With many people embarking on a strength training program, there are other people in their lives - maybe it's relatives, spouses, employers, best friends, or others - who for whatever reason go out of their way to find fault with people for making the decision to start exercising or eating healthy. In many cases, these "disablers" sabotage people's efforts at the exact time when they need the most support from those close to them.
Usually, the ones doing the "disabling" are simply insecure about themselves. Maybe they are just comfortable eating poorly and not exercising, and they perceive it as a threat when someone close to them starts changing these habits, as it may have a spillover effect to them. Or, perhaps they're deconditioned and just don't want to be alone - so it's easier to try to bring someone else down a peg than elevate themselves. Maybe it's just that the world wouldn't be safe with only one overweight superhero as opposed to two. Batman wouldn't just leave Robin out to dry like that.
And that's how we come back to my buddy, Mr. Ballsofsteel, and his great progress of late. Bobby came to the gym royally pissed off the other morning, and proceeded to tell me the story of how he had met up with some of his best (long-time) friends the previous night. While it had been good to see all of them, one of these friends - we'll call him "Tommy the Tool" - went out of his way to remark (in front of the entire group) that Bobby had "gotten awfully big suspiciously quickly." Effectively, he was implying that Bobby was using steroids (which is clearly not the case if you ask anyone who has seen him regularly throughout this time period). The accuser (or shall we say "disabler?") practically tried to turn it into a group intervention.
You can imagine what an awkward position this created for Bobby. On one hand, if he had gotten defensive in light of all the hard work he'd put in to do things the right way, they'd have thought he had something about which he should be defensive. On the other hand, if he had just shrugged it off, they'd have thought that the accusation is true and that Bobby just wanted to change the subject. Awkward situation, indeed.
Awkward situation aside, there is a "not-so-coincidental coincidence" that emerged in my eyes as Bobby told me the story. Apparently, Tommy the Tool presented to this gathering about 15 pounds of "not-so-good weight" heavier himself because he'd been on the road for work, eating poorly and not exercising.
It's funny how our disabler chose to call someone out and attempt to delegitimize someone else's progress at the exact same time when he was feeling the worst about himself. Actually, it's not really "funny." It's more "predictable" and "pathetic." You try to take someone down a peg to make your unfit, unhealthy status quo feel more acceptable; it's easier to take when everyone is miserable. Or, maybe it simply takes the attention off you, Tommy the Tool.
This happens in fitness, athletics, business, academics, and countless other components of our everyday lives. I always tell our athletes that the higher up you go, the more hot air you are going to encounter. Get negative people out of your life and surround yourself with those who are not only supportive of your goals and your progress, but can actually help to set you up for more success.
In Switch: How to Change Things When Change is Hard, one message from authors Chip and Dan Heath is that you will almost never effect quick change a person, but you can always work to change the situation that governs how a person acts - and do so relatively transiently.
As an example, we've had numerous high school athletes who have completely changed their family's nutrition for the better by applying the principles they've learned in nutrition consultations at Cressey Performance. It isn't that their parents didn't want to be healthy prior to that point; it was just that the situation in which they cooked and ate was different. Once a young athlete came home excited about nutrition armed with knowledge and recipes, though, their supportive parental instincts enabled him to adopt these new habits, and his enthusiasm and newfound education and resources enabled them to adopt new practices for the family. They were still the same people; they just happened to have new situations.
It's why I think our semi-private training model at Cressey Performance works so well. Sure, it makes training more affordable, and the strength and conditioning programs are obviously very individualized. However, I think that most important thing we've done is creates an unconditionally positive training environment where people can support each other - even if they may have different fitness/athletic goals. Success is both visible and encouraged.
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At the last Winter Olympics, Dutch speedskater Sven Kramer missed out on a gold medal because his coach, Gerard Kemkers, directed him into the wrong lane part way through the race. Kramer finished the race with an Olympic record time - four seconds ahead of his nearest competitor - but was immediately disqualified because of an incorrect lane change with eight laps remaining on his long-time coach's cue.
In the aftermath of the disqualification, Kemkers obviously came under a ton of scrutiny. After all, he committed a pretty big coaching mistake - and it'll probably become a huge part of his legacy, as unfortunate as it is.
Here is a guy who has likely helped thousands of speed skaters over the years, presumably devoting countless hours to research, coaching, and becoming the best he could be - both as a coach and an athlete (he won a bronze medal at the 1988 Olympics). And, as Kramer noted, it is hard to argue with the success Kemkers helped him achieve: "Three times world champion, four times European champion, so many World Cups and Olympic gold in the 5,000 meters." In the process, Kemkers had to have omitted little to nothing; otherwise, he wouldn't have been coaching at such a high level.
Had Kemkers never endeavored to get to a high level - or taken shortcuts to get there - there would have been countless omissions along the way: gaps in his knowledge, an inability to befriend athletes, and a fundamental misappreciation for what it takes to compete at a high level. He would have been mediocre at best.
Kemkers' mistake was an act of commission, not omission.
Meanwhile, millions of "armchair" quarterbacks around the world will criticize him for being an idiot, when in reality, the opportunity to make this mistake might never have come along if he hadn't spent so much time preparing to not be an idiot.
Speedskating isn't really our thing here in the United States, so let's apply this to something that better fits our existing schema: ACL injuries in female athletes. We know ACL tears are extremely common in female athletes, particularly those participating in basketball, gymnastics, and soccer. I actually recall reading that the average NCAA women's soccer team has one ACL tear every year, and that typically, 1 in 50 female NCAA basketball players will blow out an ACL in a given season. These numbers may be a bit dated now, but you get the point: if you don't train to prevent these injuries, you're omitting an insanely valuable initiative that protects your athletes...and mascots.
Now, we need to see another "ACL Injury Prevention Protocol" on Pubmed like I need to experience another Tony Gentilcore Techno Hour. In other words, there are plenty of them out there, and we know what kind of strength and conditioning programs work; it is just about execution.
So, let's take your typical strength and conditioning coach who puts his female athletes through everything he should to protect them from ACL injuries - but one girl drops a weight on her foot and breaks a toe to miss the rest of the season.
Had he omitted external loading from his strength training program, this never would have happened - but he probably would have had four times as many ACL tears as broken toes and his athletes wouldn't have performed as well. Here, an act of omission would have been far worse than an act of commission - just like we saw with Kemkers. This isn't always the case, but it's important to realize that two kinds of mistakes occur, and sometimes you're better being proactive and making a mistake than you are ignoring a responsibility and just keeping your fingers crossed.
It's been said before that strength and conditioning programs are both a science and an art - and the art is interpreting what to leave out and what to include in light of risk-reward for each unique athlete. For instance, a front squat is a fantastic exercise from a scientific standpoint, but on the art side of things, it may not be appropriate for an athlete whose spine doesn't like axial loading. Or, it may be a problem if an athlete hasn't been front squatting, and introducing it right before competition would cause soreness that might be counterproductive to performance.
Think about how this applies to the next strength and conditioning program you write, and the next client/athlete you coach.
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In my strength and conditioning writing, I throw the term "efficient" around quite a bit; in fact, it's even in the title of our Building the Efficient Athlete DVD set. I'm sure that some people have taken this to mean that we're always looking for efficiency in our movement. And, certainly, when it comes to getting from point A to point B in the context of sporting challenges, the most efficient way is generally the best.
And, just think about strength training programs where lifters simply squat, bench press, and deadlift to improve powerlifting performance. The goal is to get as efficient in those three movements as possible.
And, you can look at NFL combine preparation programs as another example. Guys will spend months practicing picture-perfect technique for the 40-yard dash. They might not even get faster in the context of applicable game speed, but they get super efficient at the test.
However, the most "efficient" way is not always the right way.
In everyday life, efficiency for someone with poor posture means picking up a heavy box with a rounded back, as it's the pattern to which they're accustomed, and therefore less "energy expensive." This would simply prove to be an efficient way to get injured! I'd rather lift things safely and inefficiently.
And, take those who run long distances in hopes of losing fat as another example. The research has actually shown that runners burn fewer calories for the same given distance after years of running improves their efficiency. While this improvement is relatively small, it absolutely stands to reason that folks would be smart to get as inefficient as possible in their training to achieve faster fat loss. In other words, change modalities, intensities, durations, and other acute programming variables.
Training exclusively for efficiency on a few lifts might make you better at those lifts, but it's also going to markedly increase your risk of overuse injuries. I can say without wavering that we'd see a lot fewer knee and lower back injuries in powerlifters if more of them would just mix in some inefficient single-leg training into their strength training programs. And, shoulders would get a lot healthier if these specialists would include more inefficient rowing variations and rotator cuff strength exercises.
In the world of training for athletic performance, it's important to remember that many (but not all) athletes perform in unpredictable environments - so simply training them to be efficient on a few lifts fails to fully prepare them for what they're actually face in competition. A strength and conditioning program complete with exercise variety and different ranges-of-motion, speeds of motion, and magnitudes of loading provides athletes with a richer proprioceptive environment.
In other words, inefficiency in strength and conditioning programs can actually facilitate better performance and a reduced risk of injury.
Taken all together, it's safe to say that we want inefficiency in our training, but efficiency in our performance - provided that this efficiency doesn't involve potentially injurous movement patterns.
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Q: I've read a lot from you, Robertson, and Hartman about including push-up variations in strength training programs is really important for shoulder health. Unfortunately, whenever I do them, I have pain in my bum shoulder. Any ideas what to do?
A: Well, obviously, there are two things we need to rule out:
1. You may simply have a really irritated shoulder, which (in most cases) means that any sort of approximation or protraction movement could get it angrier, even if it is a closed-chain movement like the push-up that is normally pretty shoulder-friendly. Likewise, if you have a significant acromioclavicular joint injury, the extension range-of-motion at the bottom of a push-up could exacerbate your symptoms. So, obviously, the first step is to rule out if something is structurally wrong with your shoulder, and if so, if the push-up even belongs in your strength training program.
2. Your technique might just be atrocious. If the elbows are flared out, hips are sagging, and/or you're in a forward head posture, simply changing your technique may very well alleviate those symptoms. In a good push-up, the elbows should be tucked to a 45-degree angle to the body, with the hips, torso, neck, and head in a straight line. The muscles of the upper back should essentially "pull" you down into the bottom position:
Once you've ruled out those two issues and still have some annoying issues, there is one more thing you can try: simply elevate the feet. Looking to the research, Lear and Gross found that performing push-ups with the feet elevated significantly increased activation of the serratus anterior (SA).
If we can get more SA recruitment and less pectoralis minor contribution, it keeps us out of a position of scapular anterior tilt, which mechanically decreases the subacromial space through which the rotator cuff tendons pass. In the picture below, think of the area just below the word "acromion" being smaller, and then picture what would happen to the tendons that pass through that region; they get impinged. Serratus anterior (along with lower trapezius) can help prevent that.
That said, I've seen quite a few folks with persistent shoulder pain with bench pressing variations (barbell and DBs) and regular push-ups who were able to do the feet-elevated versions completely pain free in their strength training programs. Obviously, begin with just body weight and see how it goes, but over time, you can start to add resistance and use the single-leg version.
Day in and day out, I see loads of athletes and regular fitness enthusiasts who have hit plateaus in their quest to get stronger, bigger, and leaner - or run into injury issues. Each situation is unique, but one thing that I am always especially attentive to is learning whether someone has recently altogether overhauled their approach to training.
As is the case in so many things in life, "Slow and steady wins the race," "Rome wasn't built in a day," and "Don't run sideways on treadmills while wearing jeans." Actually, that last one wasn't all that applicable to what I'm getting at, but it's probably still good advice to heed for some of our easily distracted teenage readers.
I come across a lot of "program hoppers" in what I do. These are individuals who might do four weeks of Sheiko, four weeks of 5x5 workouts, four weeks of Crossfit, four weeks of German Volume Training, and then four weeks of Tae-Bo DVDs in spandex. At the end of this five month journey, they are somehow more fit - but literally have no idea what training principles were key in them achieving that end. Everything was too muddled; they overhauled the entire strength and conditioning program rather than keeping the valuable stuff.
About 8,000 strength coaches before me have used the line, "The best program is the one you aren't on." Well, I would agree with that - unless, of course, it means that this new strength and conditioning program leaves out all the important stuff that you learned from previous training experiences.
I mean, honestly, I've heard of guys going to strength training programs where they only squat, bench, and deadlift. They don't even do warm-ups; nothing else stays! Then, after six weeks of this program, they email me to ask why their shoulders, back, and knees hurt. Uh, maybe become the only thing they kept from your old program was specificity? With no single-leg work, no horizontal pulling, and no mobility work, it's a surprise that they have only been diagnosed with a musculoskeletal injuries - because they probably should have been institutionalized for being so dumb that they're a harm to those around him.
For instance, rather than tell this individual to stop squatting (he actually kept a pretty good neutral spine on the way down), I'd encourage him to a) get a squat rack, b) get a training partner/spotter, and c) put on some clothes.
Major kudos for rocking "The Final Countdown," though; seriously.
Where am I going with this, and how does it apply to you? Well, the message is very simple: never overhaul. Instead, tinker, fine-tune, adjust, or whatever else your thesaurus recommends as a synonym. Good strength and conditioning programs all share certain things in common, and anything that deviates from those qualities isn't worth it. It's something that I really tried to take into account when I wrote Show and Go: High Performance Training to Look, Feel, and Move Better.
To take it a step further, I encourage you to be leery of those who encourage you to adapt an entire discipline and change everything that you're doing. I find that even in the most injured and hopelessly weak folks that come to me for help, I can always find several things that they're doing correctly that deserve to stay. This is something I've seen in some of the best physical therapists and strength and conditioning coaches with whom I've worked in the past, too. A good professional should work with athletes and clients to meet halfway on what works, not simply pass judgment on a strength training program and overhaul it altogether.
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Q: I know that you're a bid advocate of including barefoot weight training in your strength and conditioning programs. What in general is your "shoeless" policy with your athletes, if any?
A: Yes, we use a lot of barefoot weight training around Cressey Performance in our strength training programs. In addition to strengthening the smaller muscles of the feet, barefoot training "accidentally" improves ankle mobility in athletes who have been stuck in restrictive shoes their entire lives.
Here are the exercises we're open to doing barefoot:
All deadlift variations (rack pulls and DB variations included), box squats (hip dominant), and all any body weight mobility drills.
We don't go barefoot for any loaded single-leg movements (aside from 1-leg RDLs and 1-leg squats/pistols) or more quad-dominant squatting variations.
All that said, we are careful about integrating barefoot drills in very overweight or very weak clients. These individuals do not go barefoot for any of our dynamic flexibility warm-ups aside from in-place ankle mobilizations, as lunging variations can be a bit too much stress on them at first.
We do, however, encourage clients (in most cases) to go with a good minimalist shoe. My personal favorite is the New Balance Minimus.
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In Part I, I went into some detail on why I really didn’t like the catch-all term “shoulder impingement.” This week, I’m going to talk about the different kinds of shoulder impingement: external and internal.
External impingement, also known as outlet impingement, is the one we hear about the most. Here, we’re dealing with compression of the rotator cuff – usually the supraspinatus, and over time, the infraspinatus (and biceps tendon) – by the undersurface of the acromion. This impingement can lead to bursal-sided rotator cuff tears - and happens a lot more with ordinary weekend warriors and very common in lifters (not to mention much more prevalent in older populations.
External impingement can be further subdivided into primary and secondary classifications. In primary impingement, the cause is related to the acromion – either due to bone spurring or congenital shape. As you can see in the photo below, hook (II) and beak (III) are worst than flat (I), as there are marked difference in “clearance” under the acromion.
Secondary impingement, on the other hand, is usually related to poor scapular stability (related to both tightness and weakness, as described in last week’s newsletter), which alters the position of the scapula. In both cases, pain is at the front and/or side of the shoulder and is irritated with overhead activity, scapular protraction, and several other activities (depending on the severity of the tissue problems). You’ll also generally see a lack of external rotation range-of-motion, as these are folks who do too much bench pressing and computer work (both of which shorten the internal rotators).
Conversely, internal impingement, also known as posterosuperior impingement, really wasn’t proposed until the early 1990s. This form of impingement is more common in younger individuals who are involved in overhead sports, making it more of an “athletic impingement.” Adaptive shortening and scarring of the posterior rotator cuff in these athletes causes a loss of internal rotation and an upward translation of the humeral head during the late cocking phase of throwing (or swimming): external rotation and abduction. These issues are magnified by poor scapular control, insufficient thoracic rotation, and weakness of the rotator cuff.
When the humeral head translates superiorly excessively in this position, it impinges on the posterior labrum and glenoid (socket), irritating the rotator cuff and biceps tendon along the way. So, pain usually starts in the back of the shoulder, as you are seeing irritation of the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus tendons. Gradually, this pain may “shift” toward the front as the biceps tendon, and that implies labral involvement. At least initially, the pain is purely mechanical in nature; it won't bother an athlete unless the "apprehension" position (full external rotation at 90 degrees of abduction) is created.
We often hear about SLAP lesions in the news. This refers to a superior labrum, anterior-posterior injury. In reality, when we are talking about labral injuries in overhead athletes as they relate to internal impingement, it’s mostly just posterior (although serious cases can eventually affect the anterior labrum, too). There are different kinds of SLAP lesions (1-4). Every baseball pitcher you’ll meet has a SLAP 1, which is just fraying. SLAP 2 lesions are far more serious and often require surgical intervention. SLAP 1 issues become SLAP 2 lesions when poor mobility and dynamic stability aren't established.
So, just to bring you up to speed, we’ve got two different kinds of impingement, one of which (external) has two subcategories that mandate different treatment strategies (primary = surgery, secondary = corrective exercise). We also have two separate areas where pain presents (external = front/side, internal = back). That’s just the tip of the iceberg, though, as we have two more considerations…
First, symptomatic internal impingement tends to be "mechanical pain." Unless you’re dealing with a more advanced case, athletes with symptomatic internal impingement only have pain when they get into the late cocking phase (and sometimes follow-through). It usually isn’t present when they’re just sitting around – and for this reason, they can usually be more aggressive in the weight room with upper body training. Keep in mind that I use the term “symptomatic” because I think that internal impingement is a physiological norm, just like I observed last week with external impingement. You're essentially just going to go out of your way to avoid this "apprehension" position in the weight room by omitting exercises like back squats. An apprehension test - illustrated in the most enthusiastic video in internet history - is a quick and easy assessment many doctors and rehabilitation specialists use to check for symptomatic internal impingement, as it reproduces the injury mechanism.
Second, and perhaps more importantly, you are dealing with two rotator cuff tears that are fundamentally different. It’s these differences that make me think doctors need to get rid of the term “impingement.” Here’s the scoop:
Let’s say that we have two guys with partial thickness tears of the supraspinatus – one from external impingement and one from internal impingement.
With external impingement, we’re usually dealing with a bursal-sided tear, as the rubbing comes from the top (acromion). These issues will generally heal more quickly because the bursa actually has a decent blood supply.
With internal impingement, on the other hand, we’ve got an articular-sided tear, meaning that the wear on the tendon comes from underneath (glenoid). The tear is more interstitial in nature. Blood supply isn’t quite as good in this area, so healing is slower (or non-existent).
Traditionally, articular has been an athletic injury, and bursal has been a general population issue. This is not always the case, though.
Factor in the activity demands of overhead throwers, and they have more challenging tears and greater functional demands. Fortunately, they also typically have age and tissue quality on their sides, so things tend to even out.
With all these factors in mind, if a doctor ever tells you that you have "shoulder impingement," ask:
1. Internal or external?
2. If external, is it primary or secondary? (It’ll probably be both)
3. If internal, is there labral involvement? Biceps tendon?
4. If internal, what is the internal rotation deficit? (They should measure it, as this will begin to dictate the rehabilitation plan)
5. Given my age, activity level, and the nature of the tear, do you feel that surgical or conservative treatment is best?
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Roughly 10-15 times per week, I get emails from folks who claim that they have "shoulder impingement.” Honestly, I roll my eyes the second I read these emails.
Don’t get me wrong: I’m not making light of their pain. It’s just that it drives me crazy when doctors throw this blanket statement out there. I will be completely and 100% clear with the following statement:
Shoulder impingement is a physiological norm. Everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has it.
Don’t reach up to touch that mouse on your computer; you’ll aggravate your impingement and your supraspinatus will explode!
And, don’t scratch that itch on the back of your neck; your impingement will go crazy and your labrum will disintegrate!
So, the next logical question is: why do some people have pain with impingement while others don’t?
In reality, there are several factors that dictate whether or not someone is in pain, including:
1. Tissue quality – the most “impinged” structures are more likely to break down in older age than they are in earlier years. Younger individuals can regenerate faster even when overall stress on the tissues is held constant, so how you handle a 50-year-old with "impingement" is going to be somewhat different from how you handle a 15-year-old with "impingement."
2. Degree of elevation – the more one abducts or flexes the humerus, the greater the degree of impingement. This is why folks need to start in a more adducted (arm at side) position early on in rehab. Those that impinge early in their arc tend to be dealing with subacromial impingement, whereas those who hit it at the absolute top tend to be more AC joint impingement.
3. Acromion type – flat acromions have significantly less contact area with the rotator cuff tendons than hooked or beaked acromions. These structures may change over time due to…
4. Bone Spurs – bone spurs on the underside of the acromion will increase the amount of impingement.
5. Strength of the rotator cuff – the stronger the cuff, the better its ability to depress the humeral head and minimize this impingement
6. Scapular stability – the more stable the scapula, the more likely it is to posteriorly tilt and upwardly rotate effectively when the humerus is raised into the zones of greater impingement. This scapular stability includes adequate length of the downward rotators (pec minor, levator scapulae, and rhomboids) with adequate strength of the upward rotators (lower traps, serratus anterior, upper traps).
7. Thoracic spine mobility – the posture of the thoracic spine dictates the position of the scapulae, which in turn affects impingement as noted in #6. Assess and Correctis an awesome product for improving thoracic spine mobility - and you can also find some good drills in my recent post, Shoulder Hurts? Start Here.
8. Increased internal rotation – Certain movements that lock the humeral head in internal rotation increase the degree of impingement during dynamic activities. It’s why some people can’t bench press early-on in their rehabilitation programs, yet they can do dumbbell bench presses with a neutral grip pain-free. It’s also the reason why upright rows are a stupid exercise, in my opinion.
9. Breathing patterns – think about what happens when someone has poor diaphragmatic function and becomes a “chest breather:” the shoulders shrug up, and you get extra tightness in the levator scapulae, scalenes, pec minor, and sternocleidomastoid (among other supplemental respiratory muscles). In the process, the degree of impingement can increase.
10. Other issues further down the kinetic chain – I could go on and on about a variety of issues in this regard, but it’s impossible to be exhaustive – so I’ll just give an example. If someone has poor core stability in the sagittal plane that is manifested in an inability to resist the effects of gravity during a push-up, the hips will “sag” to the floor. As this happens, and the upper body remains strong, the scapulae are shifted into an anterior tilt –which increases the amount of impingement on the rotator cuff. So, weakness and/or immobility in other areas can certainly predispose an individual to shoulder problems.
This can also be carried forward to pitchers. We know that shoulder problems are more likely to occur in throwers who have poor lead leg hip internal rotation, as it causes the stride leg to open up early, leaving the arm “trailing behind” where it should be.
Speaking of pitchers, a phrase that has been coined with respect to the “unique” kind of impingement you see in them is “internal impingement.” In next week’s newsletter, I’ll discuss the different kinds of impingement – and why it’s still a cop-out diagnosis for any health care professional to just say you have one or the other rather than tell you explicitly what dysfunctions need to be addressed.
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