I had the lovely opportunity to be invited onto the Fitness Pain Free Show hosted by my man Dan Pope recently. Dan and I have known each other for several years (the facility he works out of, Champion Physical Therapy & Performance, is located about 20 minutes away from my training studio in Boston) and he and I have conversed over shared clients/athletes during that time.
I’ve long championed that personal trainers and coaches need to be proactive and go out of their way to develop and curate relationships and networks with local physical therapists.
it not only enhances the results for the (injured) client, but it never hurts to have two sets of biceps eyes on the same problem.
Training While Injured: A Thoughtful Convo With One of My Man Crushes
In this episode Dan and I break down how we connected and how we’ve continued to hone our professional relationship in order to get our clients the best outcomes possible.
We also discuss the idea behind the TRAINABLE MENU and how it came to fruition during my own achilles rupture rehab. What’s more, Dan and I also discuss why it’s important for fitness professionals to respect scope of practice and why it’s important to NOT treat injured clients like a patient.
I think you’ll really dig this episode.
You can listen to it on Spotify (HERE) or iTunes (HERE).
My good friend, colleague, and currently ranked in my Top FIVE of man-crushes, Dan Pope, just released his latest resource: Fitness Pain Free Certification.
NOTE: Dan’s a physical therapist and coach here in Boston who’s one of my “go to” sources when I need to refer some of my more banged up clients to someone with a keener eye than myself. Plus he’s just someone I have learned a ton from throughout the years and his new course is fucking OUTSTANDING.
Dan provided me with a special discount code to my readers to save $200 off the price of course for a limited time.
Use code [TONYGFPF] to save through the month of January.
There’s more about the course at the bottom, but in the meantime Dan was kind enough to answer a few questions I had for him about the resource and his approach to training.
TG:Can you take a few moments to inform my readership how awesome you are?
DP: Sure Tony, I’m not 100% I’d use the word “awesome” to describe myself but I’ll give you a little background on me.
My name is Dan Pope.
I’m a physical therapist and strength coach.
I’ve got a pretty big background in sports, particularly strength and fitness. I was a polevaulter in college at Rutgers. After that I got really involved in Strongman and won a state and national title in 2009. After that I got involved in CrossFit and have competed at the CrossFit Regionals competition twice. Now I’m a bit washed up but still enjoy lifting heavy things in the gym.
I’ve also always been very involved in the fitness and strength world from a professional background. I’ve been a personal trainer and strength coach for about 15 years and did that full time before becoming a physical therapist.
I got into the pain and injury game as a strength coach and personal trainer because I was working with people on a very regular basis that had pain and injury. Every time I was working with these folks I’d refer them to a physical therapist. The physical therapists I was working with kept on telling me, “Of course your athlete got hurt, you were performing deadlifts.” or “Of course your athlete got hurt you were performing kettle bell swings.” Basically every exercise in the gym was responsible for injury.
Being a meathead at heart myself, I knew this had to be wrong. I wanted to learn how to help these people. So I went on a journey to do exactly that.
Fast forward over a decade of schooling and experience and I’ve found that this old advice was anything but true.
Training is definitely good for you, for getting out of pain and ALSO preventing future injury (duh).
However, there is definitely an art to it.
You can’t go willy nilly with your clients in the gym and expect to never get them injured. You also can’t go blindly into working with some one who is injured or coming out of an injury. If you make the wrong decisions you can keep them painful or even make them worse.
Do the right things and you can continue working towards their goals safely and can help them get out of pain as well. So I’ve basically devoted my life towards helping athletes in pain and also teaching other fitness and rehab. professionals how to safely and effectively work with these folks.
I also love gratuitous amounts of grilled cheese once per week and have a pet snapping turtle named Champ.
TG:For the record, I wouldn’t have had enough eye rolls to give if I had to endure a bunch of narrow-minded physical therapists – who likely never lifted a weight in their life – tell me that deadlifts were the bane of everyone’s injuries.
Anyway, with the particulars out of the way, who is the Fitness Pain Free Certification designed for and what do you feel separates itself from the masses?
DP: I actually created this certification because I feel it fulfills a very specific niche.
I still really feel there are no certifications out there right now that do a good job of preparing fitness professionals to work with individuals with pain and injury.
It used to drive me crazy as a personal trainer back in the day.
I’d be working with people in pain every day of the week and was supposed to know how to deal with all of these people with complex pain problems. The solution for pain was always, “Just avoid doing anything that hurts and refer out to a doctor or other healthcare provide.” Meanwhile as I said previously the healthcare providers were no help and were even more useless than I was.
The truth of the matter is that the good trainers out there would figure out how to work with painful folks over time, but this made no sense to me. If you want to be a plumber, there’s education for that. If you want to be a physician there is school for that. For trainers there was school and certifications but everyone stayed away from pain and injury. Pain remained this nebulous problem only reserved for healthcare providers and physicians, yet half of my clients had some sort of nagging injury they were dealing with that affected their ability to train on a regular basis.
Meanwhile, the healthcare providers don’t have the knowledge to work with athletes in the gym. They’re making exercise the villain when we know this anything but the truth. For this reason there isn’t any good certification out there that shows these folks how to work effectively with powerlifters, olympic weightlifters, CrossFit athletes and really anyone who just likes to train hard in the gym.
With that being said, I made this certification with these two folks in mind.
For the fitness professionals I completely demystify pain and injury and show you exactly how to safely and effectively work with people in pain.
For the healthcare providers I show them how to effectively get these folks out of pain, back to high level performance and how to keep them pain free for the long haul.
TG: What I respect about you most is that you’re not only an amazing therapist/clinician, but you also practice what you preach. I.e., you actually lift weights. I know you’ve touched in this already, but just how integral do you feel the whole “you gotta lift shit to fix shit” manta plays with helping people get out of pain?
DP: Hahaha, I think it all comes down to the person’s goals and what they’re trying to get back to.
I think there is a trend right now in the physical therapy and strength world that heavy strength training fixes everything.
I’ve got to be honest, I’d love to shout that from the roof tops if that was completely true.
In reality a lot of treatments can be effective for pain.
Back pain is a great example.
We have research to show thats squats and deadlifts are helpful for getting people out of pain. However, we also have research to show that walking, aerobic exercise, core stability and pilates can help decrease low back pain. We also have some research to show that sometimes deadlifting is not the best plan of action to get out of pain.
I think the best treatment option does two things.
For one, it’s got to be something that the person will actually do. So it definitely helps if the person enjoys some sort of active exercise.
Secondly, the rehab has to be specific to what the athlete wants to get back to.
If you take a 600lb deadlifter with low back pain and rehab them with pilates for three months, great. They’re out of pain. But if you ask them to pick up a 600lb barbell after three months of nothing but pilates you’ve probably got another injury on your hands. So if you want to get back to weight training then yes, you’ve got to pick some heavy shit up.
The body is very adaptable if we show it the stress it needs to adapt to. Show it that it needs to be able to lift heavy shit and it will learn and grow.
TG: Since we’re on the topic of addressing and training around injury: Which inane term makes you want to throw your face into a wall more when you hear it: Shoulder impingement or anterior knee pain? I know you’re on the same page as me that those two terms really don’t mean anything (but we have to use nevertheless).
DP: Man, I have a bunch.
I think the term that I’m disliking recently is “balance”.
I.e., The reason why your shoulder got hurt is because you have a poor “balance” of training all of the muscles around the shoulder.
What I will say is that having a comprehensive program for the shoulder is important, so balance is important from that perspective.
However, in other sports we very clearly define “mechanisms of injury” or basically how people get hurt playing their sport. For ACL injuries in the knee for example it’s usually when an athlete is pivoting and their knee goes in under too much load.
Boom, torn ACL.
So how do we go about preventing future injury? We work on pivoting and landing without having knee in. It makes total sense. However, we don’t always approach injury prevention in the gym the same way.
Let’s say I hurt my shoulder bench pressing. Now, I can chalk this up to “having a poor balance” of shoulder training in the gym.
But this doesn’t really make sense to me.
The shoulder breaks down because it doesn’t have the strength and integrity to handle the forces of training. These injuries are typically “overuse” in nature.
This means to me that the shoulder was either:
1) Under too much stress (excessive volume / intensity)
2) Not strong (or prepared) enough to handle the forces of training
3) Not recovering well enough
So if we understand that this is why the shoulder breaks down we can very easily come up with a strategy to prevent future injury.
For the bench presser’s shoulder that may mean:
1) Decreasing pressing volume slightly
2) Strengthening the pressing muscles with accessory exercises to improve the shoulder’s ability to tolerate training
3) Improve sleep, nutrition and stress management
Now, maybe a “balanced” shoulder training program does all of these things but I feel like we’re just beating around the bush. If we want to prevent injury we need to figure out why injuries are happening in the first place and come up with a comprehensive plan to prevent future injury based on these factors.
TG: I’m constantly asked what are the major differences between writing programs for athletes and that of general population clients.
Do you have any thoughts?
DP: I’m a big fan of writing training plans with end goals in mind.
For athletes this is generally optimized performance.
For the general population this is usually health, function and looking good naked.
For athlete’s we’ll always be pushing the boundary between doing as much as possible to optimize performance and doing too much and getting injured.
This means there is a lot more wiggle room for general population folks.
For athlete’s we’re constantly pushing the envelope.
TG: With regards to working with athletes, load management is a term that’s grown in popularity of late. Training around injury is something I know you’re fanatical about – in a good way (I refer to it as Trainable Menu) – can you offer some general tidbits for other fitness professionals to consider when working with athletes/clients who are injured?
DP: For sure.
Exercise is an amazing medicine that heals injured structures in our bodies. What’s important to understand is that this medicine must be dosed appropriately after an injury to have positive effects. Think of the difference between taking two aspirin and taking the whole bottle.
One is the perfect amount and the other kills you.
The magic is in the dosage.
After an injury we need to find that right dosage to create a positive effect.
I think step 1 is learning how to dose stress to muscles and joints. For example, if someone has knee pain, what factors increase and decrease stress on the knee in the gym? Well, technique, speed of execution and load are three easy variables we can use to dose stress. If we understand these principles we can figure out the right dosage of exercise and then slowly progress this dosage as our clients heal over time.
The other important concept to understand is that a lot of injuries don’t tend to get better unless we stress it enough. So you get these folks where rest doesn’t help them and they’ve got a bum knee for the rest of their lives because no one ever taught them to load appropriately and they thought loading it was bad. If you learn these principles you can be the person who finally ends your client’s pain problem.
TG: Let’s end with a bit of fun.
I’ve always kinda bashed on the kipping pull-up. Okay, there’s no “kinda” about it. I know you cover the exercise in your course and I want to learn: Can you “defend” it here?
Why is it a thing? Who does it benefit? What are the training advantages?
DP: You’re right, kipping is terrible for you…
Just kidding!
My views on kipping have been shaped largely by two things.
1) I work with a bunch of olympic level gymnasts that coach CrossFit athletes how to move well. Kipping is a very common and remedial movement for those guys. There are certainly good and bad ways to kip and when done well can be a safe and effective exercise.
2) Second, I really don’t see too many injuries strictly from kipping. Ya, they certainly do happen but I’d say I see more back issues with deadlifting and shoulder issues with pressing then kipping injuries.
If you have absolutely no desire to compete in a competition that allows kipping during pull-ups then I wouldn’t train it. You can probably build as much muscle and strength (and probably better) with our good old friend the strict pull-up.
However, if you want to perform kipping pull-ups then you probably want to learn how to perform them with solid technique and also how to program them into your training properly.
What I will say is that learning some of the more advanced dynamic gymnastics movements like ring muscle-ups and front uprises is a lot of fun and can be a really cool addition to your normal training. You should probably learn how to do this properly before going about it though.
Remember above when I said how this course is fucking outstanding?
That’s an understatement.
You get 20+ hours of lecture and videos of Dan covering a plethora of topics. If you’re a personal trainer/coach in any capacity this is an investment in yourself that will be well worth the price.
Course Curriculum
7 Reasons Why Athletes Get Hurt in the Gym and What To Do About It
What is Pain and Why Modification is Essential
How to Create Injury Prevention Plans
How to Write Rehabilitation Programs
Breaking Down the Power Lifts
Breaking Down the Olympic Lifts
Pull-ups, Muscle-ups and Kipping
Handstands and Handstand Push-ups
Overhead Press, Push-ups and Dips
Shoulder, Low Back, Knee and Hip Pain
All of this on top of endless templates, progressions/regressions, videos on exercise technique, how to develop injury prevention and rehabilitation programs, as well as assessment breakdowns.
It’s not uncommon for people to seek out a coach or trainer because an exercise doesn’t feel right or because something – a shoulder, a knee, lower back, their soul perhaps – routinely hurts and they can’t seem to get out of their own way.
That’s where I come in to save the day.
Most of the time.
To fix someone’s squat technique and to maybe (probably) give him or her a reality check.
This is a term I stole from a friend of mine, Dan Pope of Champion Physical Therapy & Performance, and to a larger degree has its roots from a presentation I watched him do centered around the conversation of understanding shoulder pain.1
“Boom or Bust” refers to the person who handles their business as follows:
Train/Overload –> Do a lot –> To the point where it becomes painful –> Get pissed off, becomes upset, is inconsolable, and inevitably increase their volume of ice cream and Julia Roberts’ movies –> Feels better –> Repeat –> What an asshole.
I’m sure many of you reading – whether the above sequence of events describes you or some of your clients – can commiserate.
It can all be summarized using the following graph:
Again, props to Dan Pope. I essentially drew his graph, but added a little Tony LOLs.
What this depicts is a scenario and approach that keeps the alarm system sensitive as well as pain levels up. They train hard on Monday and hit their bench pretty aggressively, of course.
A day or two passes, the shoulder feels okay, and they decide to test the waters again and perform a bunch of high-rep push jerks. Another day or two passes, the shoulder starts to feel, normal again, and since they have zero fucks to give, decide it would be a swell idea to perform kipping pull-ups paired with handstand push-ups for AMRAP on broken glass.
All they do is perpetually plow through their pain threshold and the cycle continues over and over and over again like an episode of Russian Doll.
This, of course, is absurd, and makes zero sense.
Conversely, what also makes zero sense is the opposite approach…
…UNDER-loading, over corrective exercising people to death, or worse, doing nothing at all.
I’m not dissing the corrective component. Depending on how sensitive someone’s pain threshold is, we may very well have to resort to a myriad of side lying external rotations, arm-bars, and band work.
The key to improving pain, though, particularly with the long game in mind, is to elicit a smidge (key word: SMIDGE) of it during training. You want to tease it, buy it a drink, make out with it a little bit.
If you want to elicit change, you need to move. When we move, we induce something called mechanotransduction, which is just nerd speak for “tissue begins to heal.”
Pain, when DOSED ACCORDINGLY, can be beneficial during exercise. When we push into a little pain there’s generally better short-term results than if not. Think of it like this:
There’s a line in the graph above labeled “pain threshold.” On a scale of 1-10 (1 = no biggie, I got this and a 10 = holy shit, a panther just latched onto my carotid), exercise should hover in the 2-3 realm.
In this case, the person can tolerate things like push-up, landmine, and row variations.
When (s)he perform those exercises, the pain level never exceeds a “3.”
When (s)he’s done exercising, along with the hours after, the pain level never exceeds a “3.”
The following day, the pain never exceeds a “3,” and in an ideal situation is back down to baseline, which is a “1.”
That’s the sweet spot and what we’re after from a managing pain standpoint. We’re doing juuuust enough to elicit a training effect, playing footsie with the pain threshold, but avoiding any boom or bust scenario where we place commonsense ahead of our ego.
And then, over time, the graph looks like this:
I’m an idiot. That arrow pointing up should be labeled “Improvement in Pain.”
The pain threshold slowly creeps higher and higher, and before long, push-jerks, bench pressing, and fighting Jason Bourne ain’t no thang.
Training (with weights), when matched with someone’s current ability level, and when dosed effectively, can be corrective.
I had to take a break from The Fitness Summit last year for two reasons:
1. Eating way too many cookies.
2. But mostly because I succeeded in making a baby and my wife would have tossed me so much shade if I was all like “Hey Babe, going to KC for three days. Toodles.”
Well this year I’m back and excited to take part in a Fitness Summit first. Dean Somerset and I will be putting on a Pre-Conference day where we’ll spend a few hours test driving some new material as a follow-up to our Complete Shoulder & Hip Blueprint.
Tentatively titled The More Completer Hip & Shoulder Blueprint.
We’ll be taking deep dive into squat and deadlift technique: discussing ankle, foot, hip and upper extremity considerations in conjunction with regressions/progressions and programming. Whether you’re a coach or just someone who likes to lift heavy things you’ll undoubtedly learn something. And if not, cool, you still get to hang out with us for a few hours.
Registration is now open for returning and new attendees. Come experience one of the best fitness events of the year.
I’m excited to announce that both myself and my wife, Dr. Lisa Lewis, will be presenting at the inaugural Spurling Spring Seminar at Spurling Fitness in Kennebunk, ME in a few months.
If you live in New England and you’re a fitness professional you won’t want to miss it. Early bird special is currently in effect.2
This FREE multi-day course by John Berardi will help give coaches the knowledge and resources necessary to help their clients decide what the best diet is for them…
…whether Paleo, ketogenic, low-carb, high-carb, intermittent fasting, or the all cold cereal diet (<—not a thing, but it should be)
And even if you’re not a coach it’ll help make the waters less murky on the topic of diet and nutrition and what may be the best fit for YOU and YOUR goals.
All you have to do is offer your email and you’ll get instant access. Don’t worry, John won’t spam you. Because, he’s not a dick.
Here’s an effective drill to help improve t-spine extension. A common mistake many people make is getting too much motion from lumbar spine. This helps eliminate that: pic.twitter.com/xltqoNRdeM
I’ve had the honor of presenting at two previous iterations of the Motivate & Movement LAB (the brainchild of MFF’s Harold Gibbons) and it’s unequivocally one of the most unique events in the fitness industry.
Think: TED Talk, but with deadlifts and lots of f-bombs.
Anyways, the next LAB is this coming February, and will feature myself, Dan John, Pete Dupuis, my wife (Dr. Lisa Lewis), and several of the MFF coaching staff including Brian Patrick Murphy and Amanda Wheeler.
I had to take a break from The Fitness Summit last year for two reasons:
1. Eating way too many cookies.
2. But mostly because I succeeded in making a baby and my wife would have tossed me so much shade if I was all like “Hey Babe, going to KC for three days. Toodles.”
Well this year I’m back and excited to take part in a Fitness Summit first. Dean Somerset and I will be putting on a Pre-Conference day where we’ll spend a few hours test driving some new material as a follow-up to our Complete Shoulder & Hip Blueprint.
Tentatively titled The More Completer Hip & Shoulder Blueprint.
We’ll be taking deep dive into squat and deadlift technique: discussing ankle, foot, hip and upper extremity considerations in conjunction with regressions/progressions and programming. Whether you’re a coach or just someone who likes to lift heavy things you’ll undoubtedly learn something. And if not, cool, you still get to hang out with us for a few hours.
Registration is now open for returning and new attendees. Come experience one of the best fitness events of the year.
I’ll go a head and say it: I feel this is one of the single most important courses I have ever taken.
If you train women it behooves you to understand the intricacies surrounding this topic: pelvic floor dysfunction, prolapse, incontinence, etc.
Dr. Sarah Duvall covers everything from assessment/screening to corrective exercise (tons of attention to proper breathing mechanics) to training considerations immediately postpartum (1-4 weeks) onward to a year plus.
What’s more, what I truly dig about Sarah’s approach is that she advocates women to eventually “lift shit to fix shit” (my words, not hers). Sooooo, there’s that.
FYI: TODAY (1/26) is the last day to register for this go-round. However you can use the coupon code TONYG at checkout for an additional $50 off your purchase. You know, cause I’m awesome.
Is it supposed to happen? Does it get better? What can you do to lessen the amplitude?
Lance chimes in with some simple advice.
Social Media Shenanigans
Twitter
DB presses hurt your shoulders? Maybe try a neutral grip. Squatting hurts your lower back? Maybe brace more or don’t squat so low (to a box). There I just fixed the issue without giving you 147 different “corrective exercises” to try.
Anyone see Blade Runner 2049 yet? I heard it’s amazing, which doesn’t surprise me considering the director, Denis Villeneuve, hasn’t made a bad movie yet (Prisoners, Sicario, Arrival).
My movie watching prowess has been slacking of late due to the little nugget, but I think Lisa and I are going to try to make plans to see it this week.
Others on the “to see” list: mother!,Battle of the Sexes, and Brad’s Status. Any other suggestions?
1) Complete Shoulder & Hip Blueprint – Boston (Early Bird Rate Ending)
The Early Bird rate ($100 off) for the Complete Shoulder & Hip Blueprint Workshop in Boston is ending this weekend.
This will likely be mine and Dean’s last hoorah with this workshop. We’ve been doing it for close to three years and it’s time to turn the page and drum up a new topic and curriculum.
Since it’ll likely be our last go we’re not holding back: I hear there will be disco balls, black lights, laser shows, and coffee.
Go HERE for all the deets, and hope to see you there.
I was asked to contribute to this one, which also includes insights for many other heavy hitters in the industry: Paul Carter, Dr. Lonnie Lowery, Mark Dugdale, TC Luoma, Christian Thibaudeau, Amit Sapir, Chris Colucci, Dani Shugart, Akash Vaghela, and Mike T. Nelson.
I’ve been diving into this material and it’s outstanding. Any coach or trainer who’s interested in dialing in their game with regards to shoulder assessment, corrective exercise, and programming strategies would gain a lot of insights from this resource.
Dan and Dave work with a plethora of overhead and CrossFit athletes, in addition to gymnasts at Champion Physical Therapy & Performance just outside Boston so they know shoulders.
If you’re a human being reading this blog post it’s a safe bet you 1) have impeccable taste with regards to the strength coaches you choose to follow 2) have a pair of shoulders and 3) are likely interested in keeping them healthy and thus performing at a high level in the weight room.
NOTE: If you happened to have come across this blog post by Googling the terms “world’s best tickle fighter” or “The Notebook spoilers”….welcome!
I’m a little biased given my years of experience working with overhead athletes and meatheads alike, but I’d garner a guess that nothing is more annoying or derails progress more than a pissed off shoulder…or shoulders.
My friends Dan Pope and Dave Tilley of Champion Physical Therapy & Performance just released a stellar resource, Peak Shoulder Performance, that’s perfect for any coach or personal trainer looking to help their clients/athletes nip their shoulder woes in the bud. AND it’s on sale for this week only at $100 off the regular price.
Guess what most people think is the cause of their shoulder woes?
The rotator cuff.
Guess what’s likely not the cause of their shoulder woes?
The rotator cuff.
It’s lost on a lot of people that the “shoulder” isn’t just the rotator cuff.
I mean, N’Sync back in the wasn’t just Justin Timberlake, right?
JC, Lance, Chris, and Joey (<— didn’t have to look up all their names) deserve our respect and admiration too. They all played key role(s) as individual entertainers to make the group more cohesive, successful, and relevant.
The phrase “the whole is greater than the sum of its parts” has never rang more true than right here and right now, reminiscing on long past their prime 90’s boy bands.
[Except, you know, we all know Justin was/is the only one with talent. He can sing, he can dance, he can act, he’s got comedic timing. He’s a delight.]
The rotator cuff is Justin Timberlake.
It gets all the credit and accolades and attention with regards to shoulder health and function. However, the shoulder consists of four articulations that comprise the entire shoulder girdle:
Glenohumeral Joint (rotator cuff) – Justin
Acromioclavicular Joint – JC
Sternoclavicular Joint – Lance
Scapulothoracic Joint – Joey and Chris
I’d make the case, and this is an arbitrary number I’m tossing out here (so don’t quote me on Twitter), that 80% of the shoulder issues most people encounter can be pin pointed to the Scapulothoracic area (shoulder blades) and what it is or isn’t doing.
The shoulder blades, since you have two of them, are Joey and Chris.
Think about it:
Justin, JC, and Lance were generally considered the heartthrobs of the group and were always taking center stage, in the forefront, and amassing Tiger Beat covers.
Conversely, who was in the shadows, taking a back seat, presumably doing all the heavy labor, regional Mall appearances, and B-list talk shows the other guys didn’t want to do?
That’s right…..Joey Fatone and motherfucking Chris Fitzpatrick, son!
Lets Give the Scaps Some Love
All of this isn’t to insinuate the rotator cuff alone is never the culprit or that pain in that area should be shrugged off, ignored, and not addressed directly.
However, when lumping shoulder pain and the rotator cuff into the same sentence we’re often referring to something called “shoulder impingement.”
Shoulder impingement is a thing – loosely defined: it’s compression of the rotator cuff (usually the supraspinatus) by the undersurface of the acromion – and it is a nuisance.
There’s even varying types of shoulder impingement – Internal vs. External Impingement. Moreover, just saying “shoulder impingement” doesn’t say anything as to it’s root cause.
Many factors come into play:
Exercise Technique
Poor Programming
Lack of T-Spine Mobility
Fatigue (rotator cuff fatigue = superior migration of humeral head)
Faulty Breathing Patterns
Wearing White Past Labor Day
And Scapular Dyskinesis…to name a few
Just saying someone has “shoulder impingement” and telling him or her to perform band external rotation drills (oftentimes poorly) till they’re blue in the face doesn’t solve WHY it may be happening in the first place.
Often, the rotator cuff hurts or isn’t functioning optimally because something nefarious is happening elsewhere.
And on that note I’d like to point your attention to the shoulder blades.
Release, Access, Train
I have a lot of people/athletes stop by CORE because their shoulder(s) don’t feel great. Many have gone to several physical therapists prior to seeing me frustrated they’re not seeing progress, and if they are it’s often fleeting.
Full Disclosure: I know my scope and am never diagnosing anyone or anything.
Actually, Things I Can Diagnose = poor deadlift technique, poor movement in general, and epic poops vs. average poops (#dadlife).
Things I Can’t Diagnose = MRIs, musculoskeletal injuries/limitations, gonorrhea.
I find it amazing, though, whenever I do work with someone with shoulder pain, how much of a rare occurrence it is anyone ever took the time to assess scapular function.
If the scapulae are in a bad position to begin with (maybe in excessive anterior tilt or downwardly rotated) and/or are unable to move in all their glory (upward/downward rotation, anterior/posterior tilt, adduction/abduction, elevation/depression), or altogether move poorly…is it any wonder then, why, possibly, maybe, the rotator cuff is pissed off?
Photo Credit: EricCressey.com
While not an exhaustive list or explanation – everyone’s their own unique special snowflake – the following approach covers most people’s bases:
Release
Scapular position is at the mercy of the thorax and T-Spine.
Those in a more kyphotic posture – think: computer guy – will tend to be (not always) more anteriorly tilted and abducted.
Those in a more extended posture – think: athletes/meatheads – will tend to be (not always) more downwardly rotated and adducted.
In both cases the congruency of the shoulder blade(s) and thorax is compromised often resulting in an ouchie.
“Releasing” the area is often beneficial:
Access
Now that the area is released we can then gain “access” to improved scapular movement by nudging the ribcage/thorax to move via some dedicated positional breathing drills.
Think of it this way: if the ribs/thorax are unable to move because they’re glued in place, how the heck are the scapulae going to move?3
A few of my favorites include:
NOTE: Which one you use will depend on an individual’s presentation. A good rule of thumb to follow would be for those in a more extended posture to include breathing drills that place them in flexion and vice versa. There are always exceptions to the rule, but for the sake of brevity it’s a decent rule to follow.
All 4s Belly Breathing
The Bear
Supine 90/90 Belly Breathing
Prone Sphinx
NOTE: I didn’t discuss it in this video but I’d also encourage people to include a full inhale/exhale with each “reach” or repetition on this exercise.
Train (and Go Lift Heavy Things)
Now that we’ve released and gained access to the area, we need to train. Specifically, almost always, we need to improve one’s ability to move their arms overhead (shoulder flexion) without any major compensations.
In order to do so, the scapulae need to do three things:
Posterior tilt
Upward rotation (which, as a whole, describes the end goal)
Protract
All three entail utilizing the force couples of the upper/lower traps and serratus anterior in concert to help move the shoulder blades into the upwardly rotated position we’re after.
There are a litany of drills and exercises that can be discussed here, and it’s important to perform a thorough screen/assessment to ascertain which ones need to be prioritized.
It’s been a hectic past few weeks of travel and speaking. Two weeks ago I was in Chicago, last weekend Lisa and I were in Toronto presenting our Strong Body-Strong Mind workshop, and this weekend I’m heading to Saratoga Springs, NY to present my Coaching Competency workshop.
Annnnnd, the next few weekends after that I’m pumped because I get to sit down, relax, take a seat, and be a student myself.
John Rusin and Christian Thibaudeau will be in Boston (10/7-8) presenting their Advanced Performance Coaching & Programming Strategies workshop. Then, on the weekend of 10/15 I’ll head out to Springfield, MA for the Clinical Athlete Workshop with Dr. Quinn Henoch of Juggernaut Systems who will be presenting alongside Matthew Ibrahim and Zak Gabor.
The Complete Shoulder & Hip Blueprint is finally coming to Boston. Not “fake” Boston, either, on the outskirts of the North or South shore, and we end up calling it a Boston workshop.
No, this sumbitch is going to be IN Boston, at AMP Fitness located near Government Center in the heart of the city.
This shindig goes down the weekend of November 11th and will likely be mine and Dean Somerset’s last hoorah presenting this particular workshop.
The early bird rate is currently in effect. Hope to see you there.
I really enjoyed this article by Andy – short, sweet, and to the point. What I also appreciated was that it didn’t make my head hurt with big words and super scientific explanations and mumbo-jumbo.
Not that approach isn’t important (sometimes), but, you know, zzzzzzzzzzzzzzz.
“Scapular winging” can be a bastardized term tossed around by PT’s and personal trainers alike. It is a “thing,” but it’s not as prominent of a “thing” as people think.
I.e., true scapular winging is an actual medial diagnosis (long thoracic nerve, which innervates the Serratus anterior isn’t doing it’s job).
HOWEVER: when scapular winging is a thing (due to muscle weakness, pain, and/or faulty movement), this article explains how you should approach it.
Social Media Shenanigans
Twitter
20 year old me: “dude, I worked out for 2 hours today, it was amazing.”
40 year old me: “dude, 2 hour workouts? Don’t be cray-cray.”
I’ve been before, back in 2014 for a friend’s wedding, and ever since I’ve been wanting to come back to visit.
It’s a lovely place…prime with excellent food, culture, and scenery. I’m here because Dean Somerset and I are teaching our Complete Shoulder & Hip Blueprint this weekend. I came a day early so I had a day to walk around, explore, and marinate in introvert heaven.
As most of you know I have an 8-week old back in Boston, and as anyone who has a child knows, there’s little “me time” in that mix. You’re always on, ready to bust into action – whether it’s to feed or perform an emergency diaper change – at any moment.
Even when things are seemingly quiet you’re on high-alert. Every noise coming through the baby-monitor comes with a degree of jumpiness, unease, and foreboding.
It’s like adult Spidey-sense
Except in this case, instead of an extraordinary ability to sense imminent danger, as a parent to an infant, this version of Spidey-sense gives you a sixth sense for blowout diarrhea and 2 AM whateverthefucks.
So, selfishly, I was very much looking forward to a day of being in my own thoughts, walking around the city, and having a restful night of sleep in my hotel room watching Netflix and eating German chocolate cake.4
It was glorious.
I’m actually sitting in a coffee shop as I write this and then doing a staff in-service at TWIST Conditioning Vancouver this afternoon. Later on I’ll meet up with Dean and we’ll head to Langley, BC for our workshop at All Around Fitnessthis weekend.
Stuff to Check Out Before You Read Stuff
I got nothing, sorry. I want to bounce and go walk around.
As a follow up to THIS post I wrote last week, and Mike Connelly’s guest post that followed suit, The Art of Getting Your Shit Together, this post by Dan Frantz speaks to our constant struggles to incessantly compare ourselves to others and do what they do.
**Maybe check out some of the comments in this one?….particularly by @Realfitnessformums. She had some issues with this video which I felt were kind of shortsighted and woefully out of context.
