Home Posts tagged "Sturdy Shoulder Solutions"

Subscapularis 101

The subscapularis is the largest of the four rotator cuff muscles, but it might also be the most misunderstood. With that in mind, I thought I'd use today's video as a chance to bring you up to speed on it:

This video is an excerpt from my popular Sturdy Shoulder Solutions resource. For more information, head to www.SturdyShoulders.com.

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Random Thoughts on Sports Performance Training – Installment 33

It's time for this month's installment of my random thoughts on sports performance training. In light of my ongoing 30% off sale (ending Sunday at midnight) on my Sturdy Shoulder Solutions resource (enter coupon code BASEBALL at checkout for the discount), I thought I'd focus this edition on the shoulder.

1. If you want a healthy shoulder, getting tobacco products out of your life is a good place to start.

The research is pretty clear: smoking is a bad idea (and an independent risk factor) if you're looking to stay healthy from a musculoskeletal standpoint, or have a good outcome in rehabilitation (whether conservative or post-surgical) . Here's an excerpt from a recent study with an excellent review of the literature:

"Cigarette smoking adversely affects a variety of musculoskeletal conditions and procedures, including spinal fusion, fracture healing, surgical wound healing, tendon injury and knee ligament reconstruction. More recently, smoking has been suggested to negatively impact rotator cuff tear pathogenesis and healing. Tobacco smoke contains nicotine, a potent vasoconstrictor that can reduce the blood supply to the already relatively avascular rotator cuff insertion. Furthermore, carbon monoxide in smoke reduces the oxygen tension levels available for cellular metabolism. The combination of these toxins may lead to the development of attritional rotator cuff tears with a decreased capacity for healing."

Many times, we're looking for the best exercise, rehabilitation protocol, soft tissue treatment, or volume amounts - but we really ought to be looking at lifestyle factors.

With a large baseball readership on this site, the logical next question: are these harmful effects also noted with smokeless tobacco (i.e., dip/chew)? The research is somewhat sparse, as it's harder to study a younger, active population than a bunch of middle-aged post-operative rotator cuff patients. However, it's hard to believe that the aforementioned carbon monoxide implications would cause 100% of the issues and that the nicotine would serve as just an innocent bystander. So if you're looking to check every box in your quest to stay healthy, it's not a bad idea to lay off the dip.

And, if healthy tendons aren't enough to convince you, do yourself a favor and read this article by Curt Schilling.

2. The 1-arm, 1-leg landmine press isn't a mainstay in your training programs, but can be a perfect fit in a few circumstances.

This looks like kind of a wussy exercise, but I actually really like it in two circumstances.

a. It's awesome in a post-surgery period when you can't load like crazy, but still want folks to be challenged in their upper extremity progressions. The single-leg support creates a more unstable environment, which means that antagonist activity is higher and there is more work going to joint stability than actual movement. In other words, it makes pressing safer.

b. Once we get to the inseason period, it allows us to check two boxes with a single exercise: single-leg balance and upper body strength (plus serratus activation/scapular upward rotation).

3. Posterior pelvic tilt increases lower trap activation.

I've written about it a lot in the past: core positioning has an incredibly important impact on shoulder function. Check out this study on how reducing anterior pelvic tilt increases lower trapezius activation during arm elevation and the return from the overhead position.

In my experience working with extension-rotation athletes (particularly baseball players), one of the biggest risk factors for shoulder injury is when the lower trapezius can't keep up with the latissimus dorsi. Just consider the attachment points of the lat in the picture below; as you can imagine, if you posteriorly tilt the pelvis, the lat is inhibited, making it easier for lower trap to get to work.

The lower trapezius is very important for providing posterior tilt (slight tipping back) of the scapula and assisting in upward rotation. These two functions are key for a pitcher to get the scapula in the correct position during the lay-back phase of throwing.

By contrast, the lat has more of a "gross" depression effect on the scapula; it pulls it down, but doesn't contribute to posterior tilting or upward rotation. This might help with an adult rotator cuff pain patient who has an aggressive scapular elevation (shrug) substitution pattern, but it's actually problematic for a thrower who is trying to get his scapula up and around the rib cage to make sure that the ball-on-socket congruency is "flush" when it really matters: the maximal external rotation position.

As such, you can say that the lat and lower trap "compete" for control of the scapula - and the lat has a big advantage because of its cross-sectional area and multiple attachment points. It's also much easier to train and strengthen - even if it's by accident. Upper body work in faulty core positioning (in this case, too much anterior pelvic tilt and the accompanying lumbar extension) shifts the balance to the lats.

We'll often hear throwers cued "down and back" during arm care drills. The intention - improving posterior tilt via lower trap activation - is admirable, but the outcome usually isn't what's desired. Unless athletes are actually put in a position of posterior tilt where they can actually feel the lower traps working, they don't get it. Instead, they pull further down into scapular depression, which feeds the lat-dominant strategy. This is why we teach almost all our throwers to differentiate between depression and posterior tilt early on in their training at Cressey Sports Performance.

If you're looking to learn more about how I assess, program, and coach at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions. It's on sale for 30% off through Sunday at midnight; just enter the coupon code BASEBALL at checkout to get the discount. Learn more at www.SturdyShoulders.com.

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The Best of 2018: Product Reviews

To wrap up my “Best of 2018″ series, I’ll highlight the top product reviews I did at this site in the last year. Here they are:

1. Complete Youth Training - This was Mike Boyle's great new resource for those who work with young athletes. He touched on everything from the problems with early specialization to age-specific training stages. It's a good investment for parents and coaches alike. I loved how his perspective as a parent coalesced with his commentary as a strength and conditioning coach and business owner.  Since it was the most popular product I reviewed this year, I reached out to Mike to see if he'd be up for running a quick promo sale for my readers, and he kindly agreed. From now through January 4, you can get $50 off on the resource. No coupon code is needed; just head HERE.

It inspired this blog I wrote: Strength in the Teenage Years: An Overlooked Long-Term Athletic Development Competitive Advantage.

2. The Culture Code - This new book from Dan Coyle was one of my favorite reads of the year. Dan's become a friend over the years, so I was able to get him to do an interview here at EricCressey.com when the book was released: Coyle on Culture.

3. Bought In - Brett Bartholomew is an outstanding strength and conditioning coach who has taken a huge interest in the art of "getting through" to athletes. In this course, he outlines a lot of great strategies for building rapport with athletes. Brett authored a guest post for this site as well: 5 Quick Tips to Enhance Coach-Athlete Communication.

Also in 2018, I released a product of my own that was a long time in the making: Sturdy Shoulder Solutions. This resource includes close to seven hours of webinars and lab sections on everything upper extremity. 

We're back to the regular EricCressey.com content this week. Thanks for all your support in 2018! We've got some great stuff planned for 2019.

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The Best of 2018: Strength and Conditioning Videos

With my last post, I kicked off the "Best of 2018" series with my top articles of the year. Today, we'll highlight the top five videos of the year.

1. Supine Banded Shoulder Flexion on Roller - I love this exercise for building thoracic spine mobility, shoulder flexion, and scapular posterior tilt.

2. Split-Stance Hip Abduction End-Range Lift-off - CSP coach Frank Duffy contributed this awesome hip mobility challenge as part of a guest post this year.

3. Landmine Lateral Lunges - This is an exercise I thought up on the fly while working with three-time Cy Young Award winner Max Scherzer, and we liked it so much that it's become a mainstay in his offseason programming.


4. Rhomboids Functional Anatomy - this webinar is an excerpt from my popular new resource, Sturdy Shoulder Solutions.

5. Knee-to-Knee Rollover Medicine Ball Stomp - this new medicine ball drill was a power training exercise thought up by my CSP-FL business partner, Shane Rye. The knee-to-knee approach encourages the athlete to stay in the back hip longer.

I'll be back soon with the top guest posts of 2018!

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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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Exercise of the Week: Quadruped 1-arm Trap Raise to Swimmer Hover

I recently started implementing the quadruped 1-arm trap raise to swimmer hover with some of our baseball guys, and it’s quickly become one of my favorites.

This drill addresses several important needs in a throwing population:

1. scapular posterior tilt

2. scapular upward rotation

3. tissue extensibility of the long head of the triceps and lat

4. the quadruped (all fours) position really reaffirms the good convex-concave relationship between the scapula and rib cage

You should not feel this at all in the front or top of the shoulder. Rather, the movement should be felt in the lower traps (mid back) and serratus anterior (add a full exhale at the top of each rep to intensify that activation). Some individuals will feel a good stretch through the triceps.

To learn more about how we assess, program, and coach at the shoulder girdle, be sure to check out Sturdy Shoulder Solutions.

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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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3 Random Thoughts on Rotator Cuff Readiness

Both Cressey Sports Performance facilities are booming with baseball players coming back to start their offseason training, so it's the time of year when athletes are working hard to get their rotator cuff control back before they start up their offseason throwing programs. With that said, I've been thinking about some big principles on the rotator cuff readiness front.

1. In a broad sense, just above every rotator cuff exercise can be categorized in one of five ways:

a. Strength - this consists of manual resistance work and anything with cables at dumbbells; it needs to be loaded up and challenging.

b. Timing - this consists of drills like 90/90 holds and rhythmic stabilizations.

c. Endurance - this builds on what we see in Option A (some of the same exercises), but the resistance is a bit lower and it's done for higher reps or a longer time. The goal is less about strength and more about training the ability to hold the humeral head on the glenoid fossa for a lengthier period of time. I'd call it more important for a sport like swimming than for baseball or tennis athletes.

d. Irradiation - this can refer to just about any exercise, as your rotator cuff fires reflexively any time your arm moves. That said, certain exercises - bottoms-up kettlebell variations, for instance - are particularly useful for challenging this category of drills.

e. Patterning - these are just drills that take the humerus through its full range-of-motion. Of particular importance is end-range external rotation, which we train with drills like this:

2. I prefer near-daily exposures rather than exhaustive, less frequent programs.

If you look at our training programs, most of our pro guys are doing some kind of targeted training for the rotator cuff 5-6 days per week. Twice per week, we'll push more strength and irradiation work, and twice per week, we'll cover more timing drills. Just about every day, though, there will be some kind of patterning exercise so that we're reminding the cuff of what it's supposed to do.

This approach is a stark contrast to what you usually see in the baseball world, which is notorious for handing out the 2x/week arm care routines that take 45-60 minutes each. They're usually about 15 exercises for multiple sets, and leave an athlete hanging by the end of the session. I think this approach has more to do with the fact that it lines up with what's convenient for 2-3x/week physical therapy sessions than because it's truly optimal. I'm of the belief that you don't need (or want) to exhaust the cuff to get it to where it needs to be.

And, while we're at it, if the cuff is going to get abused on a daily basis with throwing, lifting, and activities of daily living, why not give it some more frequent exposure to build a little tissue resiliency?

3. Posterior deltoid shouldn't be lumped in with infraspinatus and teres minor.

Many times, the reason we have discomfort or the "wrong" feeling with drills is that athletes are paying close attention to the osteokinematics - gross movements of internal/external rotation, flexion/extension, adduction/abduction - of the joint in question, but not paying attention to the arthrokinematics of that same joint. In other words, the rolling, rocking, and gliding taking place needs to be controlled within a tight window to ensure ideal movement.

In shoulder external rotation variations, as we externally rotate the arm, the humeral head (ball) likes to glide forward on the glenoid fossa (socket). The glenohumeral ligaments (anterior shoulder capsule), rotator cuff, and biceps tendon are the only things that can hold it in the socket. In a throwing population, the capsule is usually a bit loose and the cuff is a bit weak, so the biceps tendon often has to pick up the slack - which is why some folks wind up feeling these in the front, thereby strengthening a bad pattern. There are also a bunch of nerves at the front of the shoulder that can get irritated.

Now, here's where things get a bit more complex. The infraspinatus and teres minor are both rotator cuff muscles that have attachments right on the humeral head, so they can control the arthrokinematics (posterior glide) during external rotation work. Conversely, the posterior deltoid (blue, in the image below) runs from the posterior aspect of the spine of the scapula to further down the arm on the deltoid tubercle. In other words, it completely bypasses control of the humeral head.


By Anatomography - en:Anatomography (setting page of this image), CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=22835985

With this in mind, the posterior deltoid actually creates a gliding forward of the humeral head as it externally rotates and horizontally abducts the arm. For this reason, you need to make sure the arm doesn't come back (horizontal abduction) as it externally rotates during your arm care drills. This video should clarify things, if you're a visual learner:

Looking for more insights like these? Be sure to check out my new resource, 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. It's on sale for 30% off through Sunday night; just use the coupon code BASEBALL at checkout to get the discount.

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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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LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
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