Recently, I received an inquiry from a follower who asked why it's so hard to "feel" serratus anterior targeted exercises. There's a fair amount to unpack in this regard, so I recorded a video on the topic:
Today’s guest post comes from Cressey Sports Performance – Florida coach and internship coordinator, Andrew Lysy.
Bear Position to Thoracic Bridge is one of the newer mobility exercises we’ve been using lately to enhance thoracic spine, shoulder and hip mobility.
Unlike many other thoracic mobility exercises, Bear Position to Thoracic Bridge actively stretches out your biceps and pecs in a closed-chain manner.
In addition to creating length in the biceps and pecs, the athlete will also be working on anterior expansion, manubrium expansion and shoulder extension, which can help you regain shoulder internal rotation.
A few important cues for properly executing Bear Position to Thoracic Bridge:
1. Actively push away from the ground with your legs and arm/hand. While pushing away from the ground, create a cork-screw feeling with your hand so that your shoulder doesn’t tip/dip forward!
2. While extending your hips, maintain a straight line from your shoulders to your knees. This will help resist excess extension from your lower back and put all of the pressure on your hips!
3. Your feet and thighs should be parallel to each other.
This exercise is commonly used as a warm-up, mobility exercise or filler. We’ve used it for 2-3 sets for 5-8 reps. We’ve also held the Thoracic Bridge position for breaths.
Note from EC: If you're looking to learn more about how I evaluate, program, and coach at the shoulder joint, be sure to check out my popular resource, Sturdy Shoulder Solutions. It's on sale for $40 off through this Sunday at midnight; just enter the coupon code APRIL22 at www.SturdyShoulders.com.
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Thursday is Major League Baseball Opening Day, an event that's always circled on the calendars of just about anyone in the baseball world. We're excited to see all our pro players back on the field in games that count!
To celebrate, I've put my resource, Sturdy Shoulder Solutions, on sale for $40 off through this upcoming Sunday (4/10) at midnight.
This has been one of my most popular resources of all time, and it's particularly useful if you work with baseball players. Don't miss out on this great chance to pick it up at an excellent discount. Just head to www.SturdyShoulders.com and enter the coupon code APRIL22 at checkout to get the discount.
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With 2021 winding down, I'm using this last week of the year to direct you to some of the most popular content of the past 12 months at EricCressey.com, as this "series" has been quite popular over the past few years. Today, we start with the most popular articles of the year; these are the pieces that received the most traffic, according to my hosting statistics.
1. An Overlooked Function of Serratus Anterior- If you've followed my work for just about any length of time, you've probably quickly learned that I pay a lot of attention to serratus anterior for its profound impact on upper extremity function. And, this article was no exception.
3. 5 Lessons from a First-Round Draft Pick- In the 2021 Major League Baseball Draft, Cressey Sports Performance had 15 athletes selected – including three of the top 30 picks. Here are some important lessons you can learn from one of them.
5. Thinking Beyond Diagnostic Imaging - In the past, I've written about the need for both "Medical" and "Movement" diagnoses. In reality, there might be a middle ground that helps to unify the two - and I discuss it in this article.
I'll be back soon with another "Best of 2021" feature. Up next, the top videos of the year!
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If you're involved in any sport that requires a lot of precise control of the extreme external rotation position (as in throwing), here's an advanced progression that you could benefit from trying. Many rotator cuff exercises focus on building strength/motor control/timing in positions that aren't specific to the throwing motion, but this one forces athletes to be proficient in positions that really matter.
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.
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3. Even less love as a posterior tilter of the scapula
4. Just about zero love for its impact on rib internal/external rotation.
Most importantly, you'll see that the upper fibers of the serratus anterior attach on the first rib - the very bone that's removed during thoracic outlet surgery.
Images by Anatomography - en:Anatomography (setting page of this image), CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=27010000
When the serratus fires, it depresses the first rib and clears space under the clavicle for important nerve and vascular structures to pass.
If you take a second to think about it while looking at the anatomy charts below, you'll appreciate that this attachment effectively makes serratus anterior an antagonist to the scalenes and subclavius, which both elevate the first rib.
This is one reason why a lot of the thoracic outlet syndrome cases you'll encounter aren't your classic kyphotic (hunchback) posture, but actually a lot of flat thoracic spine, heavy scapular downward rotation/depression, and horizontal clavicle presentations.
Getting serratus anterior going favorably impacts scapular upward rotation (which brings the clavicle up), first rib positioning, and the ideal convex-concave relationship between the rib cage and scapula.
Fun fact: serratus anterior also indirectly impacts contralateral thoracic rotation, but that's a post for another day!
If you're looking to learn more about how I assess, coach, and program for the upper extremity, be sure to check out Sturdy Shoulder Solutions.
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With my current sale on Sturdy Shoulder Solutions, it seemed like a good time to update this series on program design strategies. Many fitness professionals and strength and conditioning enthusiasts have looked to this resource as a model upon which to base some of their program design efforts, so I thought I'd dig in a bit deeper on a few useful principles you'll find in it that should be consistent across all programs.
1. Use your "pre-work" to address the most pressing issues.
In Cressey Sports Performance programs, you'll see five distinct "components" to each day in most programs:
a. Warm-ups
b. Pre-Work
c. Strength Training
d. Metabolic Conditioning
e. Cooldown
Of course, there's always some variation included. For instance, not every day will feature metabolic conditioning, and there may be training sessions that don't include strength training. All that said, when folks come to observe at CSP and take a glance at a program, they're often most intrigued about our "pre-work."
This section of the training session comes at the end of the warm-up and before the strength training for the day. Typically, it's power training that'll include some medicine ball work and sprint/agility/plyometric work. However, we'll often take it a step further and include some single-leg balance work, or even mix in some technique practice on something like a Turkish get-up. Basically, it's a bridge from the warm-up to the heavier lifting; we want this period to be all about athletes actually being athletic: moving fast, and being challenged in a rich proprioceptive environment.
Typically, in this time period, there are some rest periods that athletes have a tendency to rush through. Since they don't feel very fatigued from a set of 6/side rotational medicine ball shotputs, they tend to rush from one set to the next. To get the most of these drills, though, we need to slow them down - and if we're going to have them rest, we might as well make it productive rest. To that end, we use the pre-work period as a great time to mix in some fillers. Here's an example we might use for an athletes with a flat thoracic spine and poor end-range external rotation control:
The secret is to pick the 2-3 highest priority movement struggles for each athlete and attack those in the 2-3 fillers you have each day in the pre-work. Over the course of a week, this could be an additional 15-20 sets to help get things moving in the right direction.
2. Proximal-to-distal almost always works great...almost.
Anyone who's followed my work knows that working proximal-to-distal is a strategy I like to employ when addressing movement challenges. The principle is simple: work on something toward the center of the body (e.g., neck positioning) and it'll often yield downstream benefits (e.g., shoulder range-of-motion) as we work our way to the extremities. One time you might backtrack this strategy, however, is when there is a known pathology more distally. I'll use myself as an example. I had a left knee meniscus repair (the first orthopedic surgery of my life) just over six weeks ago, and it has actually been a great learning experience for me.
As part of the surgery, my medical-collateral ligament had to be loosened (the equivalent of a Grade 2 sprain). There are some very specific post-op contraindications: I can't flex the knee beyond 90 degrees in weight-bearing right now, and any of the classic drills that take my hip into external rotation (like a cradle walk) and abduction (split-stance adductor mobs, or lateral lunge) can easily irritate the medial (inside) aspect of my knee. Additionally, when you're a bit limited in how much you can flex the knee during the gait cycle while in the brace, you tend to "cut off" hip extension on each stride. What does all this mean? The hip on my surgery side feels tighter than normal.
Sure, I can get creative with my hip mobility drills and even do some soft tissue work to settle down some muscles that can't be lengthened, but the best solution is actually a distal to proximal one: get my knee right! Sure enough, getting the swelling out of the joint early on and hitting all my ROM targets immediately improved the hip symptoms because my weight-bearing strategies improved.
The take-home message here is that before you look to integrate a proximal-to-distal approach, be sure your assessment picks up on any unusually "sticky" joints. And, where appropriate, refer those cases out to someone who can get them "unstuck."
3. Make your warm-ups more efficient so that you don't have to "sell" them as much.
Let's face it: people don't typically enjoy the warm-up period. It's without a doubt the "most likely to be skipped" part of any training session. We probably aren't going to change people's perspectives on this, but we can change the situation in which they operate. In other words, we can adjust our programming to make it logistically easier to complete for our clients/athletes. One way to accomplish this is to just structure the program in a more convenient context. To that end, here's how I like to structure a warm-up:
a. Ground-based (e.g., positional breathing drills, supine/quadruped mobility drills)
b. Standing, stationary (e.g., wall slides, bowler squats)
c. Standing, moving (e.g., classic dynamic warm-up drills like lateral lunges, spidermans etc.)
This approach saves the time of having athletes get up and get down over and over again; it's a more efficient flow.
Once you've incorporated this strategy, you can make them even more efficient by considering the location of any equipment - bands, benches, TRX straps, etc. - that they may need to complete the drills. In an individualized warm-up, putting these implements in convenient spots helps athletes keep their body temperature up while they're moving from one spot to the next.
Finally, you can always use "combination" exercises to attack multiple qualities in the same drill. As an example, an adductor stretch with extension-rotation gets you both hip and thoracic mobility.
I'll be back soon with another "Programming Principles" installment, but in the meantime, be sure to check out my popular resource, Sturdy Shoulder Solutions if you're interested in digging in deeper on upper extremity assessment, programming, and coaching.
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Today is the first day of games in Major League Baseball Spring Training, a day that's always circled on the calendars of just about anyone in the baseball world. We're excited to see all our pro players back on the field!
To celebrate, I've put my resource, Sturdy Shoulder Solutions, on sale for $40 off through this upcoming Sunday (3/7) at midnight.
This has been one of my most popular resources of all time, and it's particularly useful if you work with baseball players. Don't miss out on this great chance to pick it up at an excellent discount. Just head to www.SturdyShoulders.com and enter the coupon code ST2021 at checkout to get the discount.
Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
Often, I'll get inquiries that go something like this:
What do you think of yoga?
How do you feel about Pilates?
I have a friend who liked MAT. Do you think it's legit?
These are always challenging questions to answer because there are actually a number of variables you have to consider. To illustrate my point, let's try for some parallels in different industries. What do you think of real estate attorneys? Accountants? Veterinarians? Plumbers? General contractors?
As you can probably infer, there's going to be a high amount of variability in the delivery of each method, so you have to ask the following questions:
1. Is the method actually legit?
Sometimes, entire methodologies are based on bad science or bad people manipulating science for their own financial gain. A good example of this would be the thousands of different kinds of "cleanses" marketed in the nutrition/supplement industry.
2. Is the practitioner actually educated (and, where appropriate, licensed) in the method?
This is something that is near and dear to me. Each week, we get emails from young baseball players and their parents who say they train with a "Cressey guy" or someone "Eric has mentored." Then, they tell me that coach's name and I've never heard of him, and he's never even purchased one of my products or attended our actual baseball mentorship. Instead, he saw me give a one-hour talk in 2009. In describing himself, however, he positions himself on par with one of our interns who spent 3-5 months side-by-side with me six days per week. That's a markedly different level of education in our method.
As a good rule of thumb, think of the telephone game. The further away from the founder of a method, the more watered down the product becomes. As an example, Ron Hruska created the Postural Restoration Institute, and it's mostly disseminated through courses he's designed and by instructors he's trained himself. If an attendee then returns and teaches his/her staff the principles, then they teach their clients, and then the clients share their favorite positional breathing drill with a friend after a few adult beverages at a cocktail party, is it really representative of how impactful PRI can really be?
3. Does the practitioner actually have attention to detail?
Having just built a brand new Cressey Sports Performance facility, this is fresh on my mind. Not all contractors are created equal. Two can look at the exact same finished product and one person says it's beautiful, and the other says it's terrible work. No matter how great the method might be, if someone is lazy, it won't be positioned in a great light.
4. Does the practitioner understand how to "pivot" within a philosophy?
The back-to-wall shoulder flexion exercise is a central piece of our philosophy at Cressey Sports Performance. We think it's imperative to get the arms overhead without compensation at adjacent joints. Give this a video a watch to learn how we'd coach it under the three most common challenges one will typically encounter:
As you can see, these modifications rely on being able to do some basic, quick evaluations on the fly. If you don't have the ability to perform them, the client will likely just wind up banging on the front of the shoulder.
This is where a lot of group exercise methodologies can fall short. They don't understand how to pivot when someone can't perform a drill, so they wind up plowing through a bony block or exacerbating an existing movement fault.
5. Has the practitioner evolved with the methodology?
I tweeted this several years ago, but it still holds true:
If you look at your programs from 5 years ago and don't do a facepalm, you probably need to reconsider your continuing education approach.
If you look at CSP years ago versus now, it's easy to see how much we've evolved. What you would have learned in a single day of observation at the facility in 2010 is a lot different than what you'd learn on a 2020 visit. This might refer to the methodologies represented, coaching approaches, or equipment utilized.
6. Does the practitioner utilize one methodology exclusively?
As the hackneyed expression goes, "If you're a carpenter who only has a hammer, everything looks like a nail." For example, I'm very leery of chiropractors who only do adjustments when there are undoubtedly many other associated therapeutic interventions that could further help their patients. I'll always refer to multi-dimensional providers over one-trick ponies.
Pulling It All Together
As you can see, five of my six qualifications had nothing to do with the method, but rather the practitioner carrying out that method. That, my friends, is why I always refer to PEOPLE and not just methods. And, it's why you should always try to find good people - regardless of the methodologies they utilize - to help you get to your goals.
It's also why continuing education is so important: we need to understand the principles that govern how successful people can be within various methodologies. If you're looking to learn more about some of those principles and how I apply them to evaluation, programming, and coaching at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions.
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In this installment of Random Thoughts on Sports Performance Training, I want to hone in on shoulder stuff because, well, that's what I talk about a lot!
Let's get to the new content:
1. The neck is the easiest place to start with cleaning up shoulder movement.
I've written a lot in the past about how our arm care programs work proximal to distal, meaning that we focus on the center of the body before the extremities. Usually, the right proximal changes yield immediate distal improvements both via reducing protective tension and reducing stiffness in the muscles we're trying to "overpower" to create good movement. Usually, though, when it comes to proximal changes, folks look at the thoracic spine and rib cage only. In reality, the cervical spine ought to take precedence over both of them - particularly because all the nerve of the upper extremity originate from the brachial plexus, which ranges from C5 to T1.
Fortunately, while it might be anatomically correct, coaching optimal positioning in the neck is actually very simple in the context of weight training and arm care drills: get it to neutral and keep it there. In 99% of cases, that means getting people out of upper cervical extension, which fires up the levator scapulae (which competes against all the scapular upward rotation we want). Here's a video that walks you through what you need to know:
The thoracic spine and rib cage are sexy right now, but the cervical spine is an older, reliable option for cleaning up movement quickly in just about everyone.
2. Whenever possible, get core control integrated in your arm care drills.
I often come across arm care protocols that literally have athletes laying on a table for 30 minutes worth of "exercise." This not only leads to a disengaged athlete, but also overlooks the fact that the entire kinetic chain needs to be synced up to keep a shoulder healthy. We'll often use predominantly table-based exercises in month 1 to make sure athletes are picking up the technique in a controlled environment, but in almost all scenarios, these table drills are actually "fillers" between sets of strength training exercises that have the athletes up and around in the gym.
More importantly, after that first month, I try to make sure that at least half of our arm care exercises are done separate from the table. Maybe we do our horizontal abductions in a side bridge position, or integrate more bottoms-up carries or bear crawls for serratus activation. Perhaps the prone trap raises take place on a stability ball, or we shift to a TRX Y instead. Or, we could move the athlete to half-kneeling, split-stance, or in a rear-foot elevated position for their 90/90 external rotation holds.
Regardless of what we choose, the buy-in from athletes is definitely better - and just as importantly, the resulting training effect has a more specific carryover to sporting success.
3. Yet another study reminds us that GIRD is a measurement and not an actual pathology.
Glenohumeral internal rotation deficit (GIRD) was all the rage in the baseball sports medicine community for decades. Unfortunately, what many practitioners fail to appreciate is that GIRD can be a completely normal finding as long as an individual's total motion is symmetrical between throwing and non-throwing shoulders. We expect to see less internal rotation and more external rotation in a throwing shoulder because of retroverion in the throwing shoulder; the arc is just shifted. Here's a glimpse at what it looks like:
Anyway, we are now at a point in time where more and more research on GIRD is out there, and it's pretty resounding: it doesn't predict injury as well as we once thought. And, more importantly, the opposite seems to be true: a loss of external rotation (usually from a combination of less retroversion and soft tissue limitations) equates to a greater injury risk. We need to get more of the "GIRD? So What?" literature into the hands of doctors who aren't familiar with the latest research, as many are still making "GIRD" diagnoses when they really are just range-of-motion measurements. I delve into this in great detail in the Sturdy Shoulder Solutions product, but figured another study reiterating the point can't hurt. This one - Relationship Between Glenohumeral Internal Rotation Deficit and Medial Elbow Torque in High School Baseball Pitchers - just found that GIRD wasn't associated with medial elbow torque in high school pitchers.
It's time to move on from GIRD!
4. If you're about to have shoulder surgery (or any surgery), get your Vitamin D checked.
For years, we've known that having an adequate Vitamin D status was important for a myriad of biologic functions. Perhaps the most well known among observations on this front was a 2015 study of NFL players that demonstrated that players with inadequate preseason Vitamin D levels were more likely to have suffered a lower extremity or core muscle injury. In fact, the likelihood of a hamstrings injury was 3.61 higher in those with inadequate vitamin D levels! As such, it's become a big area of focus in the nutrition and supplementation world for athletes.
However, I've honesty never heard of an orthopedic surgeon looking at it for those who either have chronic pain or are about to undergo a surgical intervention to treat a structural defect. We need to change that, though. A recently published study, Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair, should help in that goal, though. Patients with pre-operative Vitamin D deficiency were 1.54 times more likely to require a revision surgery and 1.16 times more likely to require manipulation under anesthesia to overcome post-op stiffness.
Clearly, Vitamin D has a huge link to soft tissue health, so don't overlook it!
Wrap-up
I'm a shoulder nerd and could ramble on all day on this stuff, but instead, I'll direct you to check out Sturdy Shoulder Solutions if you'd like to dig in deeper. You can learn more at www.SturdyShoulders.com.
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