CategoriesAssessment Corrective Exercise Exercise Technique

Common Mistakes With Shoulder Assessment

Assessment in the health and fitness setting can be tricky, and rife with numerous (common) mistakes some fitness professionals make.

This is especially true when we start talking shoulders.

Mistake #1: the shoulder isn’t just the shoulder. 

As in: it’s not just one “thing.” We’re actually referring to a shoulder “complex” that’s, well, complex.

The “shoulder” is comprised of four separate articulations (glenohumeral joint, sternoclavicular joint, acromioclavicular joint, as well as the scapulothoracic joint), all playing nicey-nice together in order to perform a wide array of movement(s).

All deserve their time under the assessment microscope.

Mistake #2: However, while all areas are important, I do find that assessing and addressing scapular function/positioning is often the key to unlocking answers. Unfortunately, it’s often the area that’s least looked at with regards to shoulder pain/dysfunction.

Mistake #3: shoulder assessment can – and should be – attacked from a few different perspectives.

Far too often, I find, fitness professionals take a static view of what’s going on and that’s it. They’ll have an individual stand there in the middle of a room, utter a few “mmm’s and ahhh’s,” write a few fancy schmancy words like “internally rotated,” “kyphotic,” or “I have my work cut out for me,” and that’s that.

Assessment complete.

Lets go squat!

When in fact, shoulder assessment should be broken down into a few disparate – but not altogether separate – components: Static Assessment, Integrative Assessment, and Dynamic Assessment.

Not to mention one’s ability to fill in a smedium t-shirt. Very important.

All three provide pertinent information that will help better ascertain the appropriate plan of attack when it comes to movement dysfunction, pain, and/or improved performance within the shoulder complex.

I Got 99 (Shoulder) Problems and….

…..My scapulae are the reason for all of them.

Sorry, I’m no Jay-Z. And I know I just butchered one of his classic hits.

But it was the only way I could think of to best articulate my point.

The scapulae (shoulder blades) are kind of a big deal when we begin to discuss shoulder health. It’s an arbitrary number I’m throwing out there with no research to back it up – so please, don’t quote me1  – but 90-95% of the “shoulder” issues I’ve helped address in the past when I was a coach at Cressey Sports Performance as well as the present (now that I am on my own), can be correlated back to scapular positioning and function.

Static Assessment

  • The scapulae should be in slight upward rotation. As you can see in the picture above, this individual is in slight downward rotation statically (both inferior medial borders (the two bottom x’s) of the scapulae are inside the superior medial borders.
  • Both scapulae should rest between T2-T7. The top middle “x” is T2 and you can see this person is below that point and in slight shoulder depression.
  • The medial borders themselves should rest between 1-3 inches from the spine.

If we only used static assessment it would be easy to assume this person is f****d. Many fitness pros would see this, hyperventilate into a brown paper bag, and immediately go into corrective mode.

But as Mike Reinold has poignantly noted time and time again:

“Statically, everyone’s shoulder blades start in a different position (elevated vs. depressed, internally rotated vs. externally rotated, abducted vs. adducted, anteriorly titled vs. posteriorly tilted, Autobots vs. Decepticons), and it’s moot to take static posture at face value.”

Besides, the above picture is of me, and when this was filmed/taken I presented with zero shoulder pain. This isn’t to imply I don’t have anything to work on, but it does showcase that static posture alone isn’t going to tell you all you need to know.

Integrative Assessment

Once we start adding movement – looking at scapulohumeral rhythm (the interplay between humerus and shoulder blade) or one’s ability to elevate arms above their head – sometimes, people self-correct really well.

What presents as “bad, “faulty,” or “shitty (<— depending on your rating system) statically, may very well be passable or very good once you add movement.

When looking at shoulder elevation/flexion, for example, does the scapula posteriorly tilt, upwardly rotate sufficiently (generally looking at 55-60 degrees of upward rotation), and does the inferior angle wrap around the thorax to the midline of the body?

This is something that can’t be determined if you’re only looking at static posture.

Dynamic Assessment

This is basically the part of the assessment where I ask the person to do stuff. Rather than boring someone to tears poking and prodding for an hour and making him or her feel like a patient, I prefer to get them moving and have them demonstrate certain exercises.

The push-up tells me a lot. Not only does it give me insight on their ability to move their scapulae (many times they’re “stuck” in adduction), but it also provides details on their lumbo-pelvic-hip control.

Because, something like this makes my corneas want to jump into a pool of acid:

 

Note: I understand the point of the video above was to purposely showcase a bad push-up. Mission accomplished.

More importantly, if someone comes to me with pain present, having them demonstrate how they perform certain exercises provides unparalleled understanding of what needs to be fixed.

A common theme I see amongst many trainees is allowing their shoulders to roll forward during execution of given exercises.

A Brief Review: when we elevate our arms above our heads the shoulder blades posteriorly tilt (hug the rib cage) and upwardly rotate. Reversing the action calls for scapular anterior tilt and downward rotation.

Many people “feed” into excessive downward rotation/anterior tilt by allowing the shoulders roll forward during common exercises like rows, push-ups, curls, and tricep press downs.

Stop It

https://www.youtube.com/watch?v=A9ytqrIf-dc

 

I Said, Stop It!

https://www.youtube.com/watch?v=47xXBhD7SuI

 

The “fix” here is easy:

Me to Client: “Okay, show me how you’d perform a standing cable row and tricep press down.”

Client: “Um, okay.”

[Then proceeds to emulate technique from the videos above.]

“Yeah, that hurts.”

Me to Client: “Stop doing them that way.”

[Puts client in a better position…shoulders rolled back with posterior tilt.]

Client to Me: “Wow, that feels so much better. You’re so smart and attractive.”

That’s Not All

What’s described above is in no way an exhaustive approach to shoulder assessment, but I hope it at least opened your eyes to the notion that it’s more multi-faceted than many give it credit for.

And on that note, I’d be remiss not to point people in the direction of guys like Eric Cressey, Mike Reinold, and Dr. Evan Osar.

Functional Stability Training – Upper Body is an excellent resource for more insight on shoulder assessment and corrective exercise.

Likewise, Dr. Osar’s Integrative Corrective Exercise Approach is an excellent resource.

And, pimping myself up a little bit, I cover the above and many other shoulder related topics in mine and Dean Somerset’s Complete Hip & Shoulder Workshop coming to the Toronto area in a few weeks (1 week left to take advantage of the Early Bird Special), Seattle, and two stops in Europe in May.

Go HERE for dates and to register.

CategoriesMotivational rant

The Law of Repeated Exposures and How It Can Help You Master Any Topic

As most who read this site know I spent this past weekend in St. Louis with Dean Somerset teaching our Complete Shoulder & Hip Workshop2 to a group of 25 personal trainers, coaches, and PTs at Blue Ocean Fitness located just outside of the city itself, in Chesterfield (if you’re in the area, give John Farkas a call. Great coach and amazing staff). In addition, I spent the last few days eating a fair amount of dead animal flesh.

For as much as Kansas City gets all the BBQ hype (and with good reason, it’s delicious), I have to say…St. Louis ranks right up there too.

Pulled pork aside, the entire weekend was a success – no one left early or asked for their money back. And from what I could tell everyone who attended walked away with a number of ah-HA moments.

A few “big rock” examples:

1. Shoulder assessment is much more in depth than only paying attention to anterior-posterior imbalances (rounded back). It’s crucial to pay close attention to superior-inferior imbalances as well; the ability to upwardly rotate the scapulae and control, eccentrically, downward rotation.

2. If someone lacks the ability to achieve ample shoulder flexion, they probably shouldn’t be performing overhead pressing, snatches for AMRAP, or kipping pull-ups. Ever.

3. The term “shoulder stability” is kind of a misnomer. Stability suggests broad bony structures and ligamentous attachments. This has nothing to do with the scapulae. Instead, a better term – I stole from Sue Falsone – is controlled scapular mobility.

4. The “anti-flexion” movement has given rise to a host of other equally deleterious imbalances to shoulder (and spinal) health; namely those “stuck” in gross extension, and subsequently depressed/low shoulder girdles and downwardly rotated scapulae.

This is important because how you go about “treating” and programming for these individuals will often be in stark contrast to the likes of computer guy (and zombies), who are stuck in flexion. For instance, for those in a more extended posture it’s not uncommon to hammer upper trap activation to help improve scapular upward rotation.

Something most “computer guys” won’t need. They may need to improve upward rotation, but NOT by means of MORE upper trap activation.

5. Not everyone is meant – or designed (we need to appreciate and respect people’s anatomy and bony limitations) – to squat ass-to-grass. The internet disagrees and it can go fuck itself.

6. Perceived mobility restrictions could very well be lack of motor control and/or instability. Don’t assume limited ROM in any movement means you need to stretch for endless hours or “smash” a muscle with a foam roller, lacrosse ball, barbell, or for the more hardcore SMR types, a live grenade.

Aggressive soft tissue work has a time and place, but I do feel many take it too far.

7. Along those same lines, improving proximal stability with things like plank variations and rolling patterns – to help aid core firing and stability – will result in improved distal mobility.

Dean and I didn’t film our lecture(s), but I encourage you to watch the video below of Dr. Perry Nickelston discussing the soft roll.

 

Also here’s an older video of Dean going all Gandalf on people, showcasing the power of planks at improving hip range of motion.

 

And here’s a video of me stabbing a SWISS ball. Because, corrective exercise.

 

And now it’s all over.

As the case is every time I complete a workshop, I did what any self-proclaimed introvert would do: collapsed on my hotel bed, vegged out, and binge watched HGTV.

What can I say: Nothing says I live life dangerously more than House Hunters and Property Brothers.

It was an early wake-up call this morning, and as I type these words on my keyboard I’m sitting here in the airport waiting for my flight to Cincinnati where I’ll connect back to Boston.

I didn’t have anything concrete to write about today, but then I remembered a question one of the attendees of the workshop this past weekend asked me prior to starting on Saturday:

“How did you get so good with shoulder stuff? Where did you learn it from?”

It was a huge compliment. It made me feel good. But it also caught me a little off guard, because I don’t consider myself anything special with regards to shoulder knowledge.

If we’re discussing the ability to quote the movie GoodFellas, regurgitate random Mark McGwire baseball statistics, and list, alphabetically, the name of each character to die in Game of Thrones…then I’m the shit.

But shoulders? I guess I’m okay. I’m also my own worst critic. I know I know a thing or two.

However, I think anyone would feel inferior in this department if one of their best friends was Eric Cressey.

Then again, that’s part of the reason I’m comfortable with the topic.

That and what I wanted to briefly discuss today:

The Law of Repeated Exposure(s)

Mind you, I don’t believe this is a real thing, much less a law. Not like The Law of Thermodynamics or The Law of Gravity or The Law of Paula Patton’s hotness.

This “law” is more or less something I made up, but nonetheless pertinent to the conversation.

Simply stated: the more you immerse or “expose” yourself to any given topic or thing (<- how’s that for science), the more likely you are to have some degree of mastery in it.

As an example Dean and I were discussing the Strong First certification this past weekend with the attendees, and he mentioned to everyone that when he took the course last year he performed roughly 3000 kettlebell swings in two days.

He got really good at swings.

Likewise, how does someone get better at deadlifting, squatting, or chin-ups?

They do them. A lot.

I work with a lot of women, and one of the common themes I notice is their apprehension or reluctance at their ability to perform a strict, full-ROM chin-up.

Whether it’s via negative self-talk (“I’ll never be able to do that!”) or the fact much of the mainstream media channels them into believing they’re these delicate flowers that can’t (or worse, shouldn’t) train with appreciable weight or intensity…many (not all) have waived the white flag before having tried.

And even if they do try, it’s less a real, valiant attempt than it is a whimper. Training the chin-up once – maybe twice – per week isn’t going to cut it.

I often defer to my good friend, Artemis Scantalides, who, is not only an outstanding coach, a Strong First instructor, one of only a handful of women to complete the Iron Maiden Challenge, and a black belt in Kung-Fu, but also champions the idea of training the chin-up in some way or fashion – varying set/rep schemes, accessory movements, etc – 4-6x per week.

That’s how you get better and more proficient with it.

Taking the “law” outside of the realm of health and fitness, it’s still every bit as efficacious.

What do writers do to get better at writing? They write.

It’s every bit as much of a learned skill as acting, throwing a baseball, learning to play guitar, or finally beating Mike Tyson in Mike Tyson’s Punch Out.

I’ve written well over 1,800 blog posts on this site, and cringe at some of my early work. I still cringe and struggle with the bulk of my writing today (I have yet to meet anyone who does a fair bit of writing and believes he or she is a “good” writer). But I know I’m better than I was 2006.

Chefs get better the more they cook. Dancers get better the more they dance. Nerds get better at not getting laid the more Star Trek conventions they go to.3

It all falls under the same umbrella.

The more you do something and the more you expose yourself to the material, the more confident you are in your abilities to master it.

Coming back full circle to shoulders: I still don’t consider myself an expert. But there’s a lot to be said from all the assessments I’ve done in the past eight years, the sheer number of overhead athletes I’ve worked with, programs I’ve written, the countless articles and books I’ve read, DVDs I’ve watched, and seminars/workshops I’ve attended.

Too, I understand that having access to someone like Eric Cressey and the amazing group of coaches I’m surrounded by on a daily basis puts me at a slight advantage.

But that’s also because I’ve worked hard to put myself if in that situation. Doing so has allowed me opportunities I otherwise couldn’t have fathomed ever happening.

Like teaching at this past weekend’s workshop.

Here’s the Lesson

Regardless of what you want to get better at: Shoulder anatomy, assessment, biceps, Scrabble, posting cute cat pictures on the internet, whatever. There is no one correct way or answer. The onus is on YOU.

Ask questions and be inquisitive. That goes without saying. But also do whatever it takes to get as many repeat exposures to the material as possible.

And then don’t stop.

CategoriesExercises You Should Be Doing

Exercises You Should Be Doing: Wall Windshield Wipers & Wall Walks

You could say we know shoulders at Cressey Sports Performance.

Because we work with a ton of overhead athletes (and a lot of meatheads who have the uncanny ability to extend “bench day” to 4x per week), we’ve taken it upon ourselves to learn everything there is to know about the shoulder. Give or take.

Everything from assessment and corrective exercise strategies to program design and effective ways to soften the blow when you tell someone with limited shoulder flexion that performing barbell snatches probably isn’t a good fit for them (“Dude, you can’t lift your arms above your head!”)…it’s all in a days work at CSP.

Take the picture above for example.

To the untrained eye that looks like a normal, beefy back.4 Those “x’s” you see aren’t some weird, hipster, tribal tattoo whateverthef***. Nor do they reflect some kind of pentagon fetish.

They’re actually marks used to highlight “landmarks” of the scapulae. The outer x’s mark both the superior and inferior border of the medial border of the scapulae.

A few things to note:

1. Scissor hand didn’t chop off this person’s head.

2. The right shoulder is lower (which plays into some of the “predictive” patterns you’ll find under the Postural Restoration Institute philosophy).

3. On BOTH sides you’ll note the inferior border is INSIDE the superior border, speaking to more of a downwardly rotated scapulae.

4. You’ll also note more of a “depressed” presentation of the entire shoulder girdle/complex (notice the sloped shoulders?). An easy way to ascertain this information is to compare where the AC joint lies in relation to the SC (sternoclavicular) joint.

In a “normal” presentation, the AC joint is (typically) 1-1.5 inches above the SC joint. In this example it’s even (see pic below).

[Note: I put “normal” in quotations because even if someone presents as “normal,” that doesn’t mean they’re in the clear or that they’re not symptomatic with pain. The person above had no pain. But it’s clear, statically, that they present with less than ideal alignment. What a loser!]

Don’t worry: that loser is me.

Abs.

Anyways, the example above was just to prove a point:

1. I can spell scapulae correctly.

2. Shoulder assessment sometimes takes a keener eye for detail.

3. It served as a nice segue to today’s Exercises You Should Be Doing.

When working with overhead athletes (and pretty much everyone for that matter) there’s a group of criteria we’re generally (not always) trying to address:

Lack of scapular upward rotation (and subsequently poor eccentric control of downward rotation), poor external rotation strength, lat dominance, poor shoulder flexion, classic Upper Cross Syndrome (shortened muscles anteriorly, lengthened/weak muscles posteriorly), poor tissue quality, alignment issues, and gluten intolerance…because, why not?

Gluten is blamed for everything else nowadays.

The two exercises below are two that I “stole” from physical therapist Sue Falsone, and are ones that provide a lot of bang-for-our-corrective-training-buck with regards to improving shoulder function, performance, and health.

Wall Windshield Wipers

 

What Does It Do: Helps strengthen/activate posterior cuff, helps with driving more scapular posterior tilt, strengthens glenohumeral external rotation, and provides a nice stretch to the anterior musculature (pecs, namely) which are often short/stiff.

Key Coaching Cues: It’s important to OWN RIB POSITION <– something I discuss HERE). What you don’t want to happen is to drive through lumbar hyperextension and allow the ribcage to flair out too a large degree. This creates a poor zone of apposition, which then starts a cascade effect where we start talking about the Posterior Mediastinum and how over-extension will “inhibit” our nervous system and affect diaphragmatic function.

It’s a deep, dark, rabbit hole that I don’t want to get into here. Just don’t do it…mmmm kay?

Chin stays tucked. Wrist must stay neutral throughout. Pretend like you’re making the number “11” with your arms.

Also, be sure to protract away from the wall which will help activate the serratus anterior.

You want to drive movement through the elbows. If you drive through the wrists they won’t stay neutral, and you fail at life.

There won’t be a ton of ROM here, so don’t judge this exercise by how much distance you achieve. The bread and butter of this exercise (to me at least) is protracting away from the wall, attaining the posterior tilt of the scapulae, and then CONTROLLING the return back.

Band Wall Walks

 

What Does It Do: I consider this a progression from the Windshield Wiper, albeit in this context we’re trying to drive more scapular upward rotation and learning to control, eccentrically, downward rotation.

Key Coaching Cues: Much the same as above. Watch for lumber hyperextension and owning rib position. Start with your arms emulating the number “11,” protract away from the wall, provide a bit of external rotation to the band, and then “walk” your arms up gradually.

Don’t go too high!

I like to tell people to stop when their elbows reach eye-level. From there work your way back to the starting position by CONTROLLING the movement; don’t just allow your arms to fall back down into position.

With both exercises I’m more inclined to do these as part of an extended warm-up, as their own corrective approach, or as a “filler” in between sets of squats or deadlifts.

Windshield Wipers: sets of 8-10 reps

Wall Walks: sets of 3-5 “walks” (up and down).

Give them a try today and let me know what you think.

CategoriesAssessment

Do Assessments “Need” to Be New and Exciting?

I’ve been doing a lot more traveling this past year.  Some for pleasure, mostly for work, but sometimes I’m fortunate and get to combine the two which is always cool.

In the past two months alone I’ve been to Cortland, NY (which doesn’t really count since that’s basically my home town), Fargo, North Dakota, and Kansas City, Missouri….all of which were for speaking engagements

Next week I’m heading to Cancun, Mexico to spend 4th of July with Lisa and some of her family. In addition I’ll also take part in a 1-day “coaching the coaches” workshop at Warrior Fitness where I’ll have the opportunity to talk shop with a dozen or so local trainers and coaches, and possibly discuss my secret fascination with Lucha libre; or Mexico’s version of “free wrestling.”

In short, I have every intention of going all Nacho Libre on their asses!

But seriously, the game plan is to break down how to coach the squat, deadlift, bench press, Turkish get-up, and, oh who am I kidding…….the piledriver, too!

Later this summer I may be doing some staff in-services for SportsClub LA, which takes us into the fall where my schedule kicks into overdrive.

Dean Somerset and I will be in London (Sept) and Washington, DC (Oct) for our Excellent Workshop High Five, and we’re also looking at adding a date in  Los Angeles in November.

And, serving as a bit of a teaser, all signs point to me (and Lisa) heading to Australia in March 2015 for two separate, 2-day workshops in both Sydney and Ballina respectively. Nothing is set in stone yet, but the prospect of being able to put some of my Crocodile Dundee quotes to good use is making me pee my pants.

After all that, what’s left is trying to set-up dates in Hoth, Minas Tirith, and Cybertron. Fingers crossed.

My point to all of this is something that came up a week or so ago. Now that I’m “in demand” and traveling more for work, it’s always interesting some of the feedback I receive from my presentations.

As an example, my use of colorful language has come up. Whereas on the east coast, and Boston in particular, talking like a sailor and peppering a few f-bombs here in there is the norm, in the mid-West it may come across as bit more juvenile and un-professional. And that makes a lot of sense.

This is something I’ve had to learn and adapt to the more and more I’ve travelled to different places. But, in general, a good rule of thumb is to not be too gratuitous with language and make references to explosive diarrhea with a bunch of doctors in the audience.

Oops. My bad.

However, on a more relevant level I’ve noticed another “theme” that’s been present the more I’ve spoken. It’s nothing glaring and it’s more the minority mindset, but it’s been brought up a handful of times.

And it’s the notion that I don’t offer anything “new or exciting.”

To be more specific, I had someone comment that I offered “nothing new or exciting” with regards to shoulder assessment as part of a presenter evaluation for a recent speaking engagement.

I’m all for constructive criticism and I appreciated the feedback, but since when did assessment or screens need to be exciting or revolutionary?

Sometimes it comes down to doing the “boring stuff” correctly, no?

I’ll be the first to admit that I’m NOT a researcher, and the likelihood I’ll ever offer anything “revolutionary” is on par with Justin Bieber not coming across somewhat douchy.

This is also the same mentality I take with program design. Boring is generally what works best for most people in most situations. Focusing on the principles – whether it be assessment or program design or “insert whatever you want here” – is what many people overlook, and why most tend to miss the forest for the trees.

How am I supposed to make shoulder assessment more glamorous?  Do I need to add some pyrotechnics?  Have them juggle a pair of chainsaws? Please, tell me!

Walk into an assessment or screen at Cressey Performance and you’re bound to see things like:

1.  Looking at standing/static posture. Posteriorly, what’s the medial border of the scapulae tell you?  Is the inferior border closer to the spine than then superior border, as shown in the pic below (which is of me by the way, taken from Eric Cressey and Mike Reinold’s Functional Stability Training of the Upper Body).

If so, the scapulae are downwardly rotated and could be the root cause of someone’s shoulder pain.

How about anteriorly?  What about clavicular angle? Drawing a line from the medial border of the sternum along the clavicle, does one present with a more horizontal angle?

NOTE:  Abs alert!!

If so, that’s not ideal.  We’d like to see a 10-15 degree upslope of the clavicle.  Again, this translates to a “depressed” shoulder girdle  and downward rotation emphasis.

2.  If someone presents with a wonky static posture (<=== how’s that for a scientific term?), you can almost guarantee they’re going to present with aberrant movement patterns with regards to standing shoulder flexion or when testing scapulohumeral rhythm.

Then again, they could “fix” things once you start adding dynamic movement, but you’re never going to know unless you screen/assess for it.

Admittedly, these tests aren’t sexy or revolutionary….but they sure as hell get the job done. And, when done right, consistently, offer more than enough feedback and information to come up with an appropriate corrective strategy and training program.

Sans fireworks or anything “new and exciting.”

CategoriesAssessment Corrective Exercise Program Design Rehab/Prehab

So Your Shoulders Are Depressed (So Sad)

Depressed man with hand on forehead over gray

So Your Shoulders Are Depressed (S0 Sad)

Despite the cheekiness nature of the title, you can relax: I’m not suggesting that your shoulders are “depressed” in the literal sense of the word.

I mean, it’s not as if they just got word they contracted ebola or that their heart just got ripped out by some uppity bitch who left them for some toolbag named Cliff who goes to Harvard and rows Crew.  Or worse, they’re a Celtics fan (<—- they’re really bad this year).

Nope, we can hold off on the Zoloft, Haagen Dazs and Bridget Jone’s Diary marathon for now.  That’s NOT the depression I’m referring to.

When it comes to shoulders and the numerous dysfunctions and pathologies that can manifest in that region, generally speaking we tend to give much more credence to anterior/posterior imbalances like a gummed up pec (major or minor) or weak scapular retractors.

Rarely, if ever, do we point the spotlight on superior/inferior imbalances.

Translated into English, yes the rotator cuff is important, but we also have to be cognizant of the interplay between upward and downward rotation. More and more (especially with our baseball guys, but even in the general population as well) we’re seeing guys walk in with overly depressed shoulders.

For the more visual learners in the crowd here’s a picture that will help:

It should be readily apparent that 1) that’s a sick t-shirt and 2) there’s a downward slope of the shoulders, yes?

Hint:  yes.

This can spell trouble for those whose livelihood revolve around the ability to get their arms over their head (baseball players) as the downward rotators of the scapulae (levator, rhomboids, and especially the lats) are kicking into overdrive and really messing with the congruency and synergy between the scapulae, humeral head, glenoid fossa, and acromion process.

And this doesn’t just pertain to overhead athletes either.

We’re seeing this quite a bit in the general population as well, particularly with meatheads (those who like to lift heavy stuff), as we’ve (i.e: fitness professionals) done a great job of shoving down people’s throats ”shoulder blades down and together” for years now, emphasizing what I like to call reverse posturing.

Likewise, much of what many meatheads do (deadlifts, shrugs, farmer carries, pull-ups, rows, fist pumps, etc) promote more of what renowned physical therapist, Shirley Sahrmann, has deemed downward rotation syndrome.

Putting our geek hats on for a brief minute, statically, it’s easy to spot this with someone’s posture.  For starters, you’ll see more of a downward slope of the shoulder girdle (see pic above).  Additionally, you can look at the medial (and inferior) border of the scapulae and observe its relationship with the spine and ascertain whether someone is more adducted (retracted) or abducted (protracted).

Many trainees, unless engaged in regular exercise or sporting activity, have a slightly protracted scapulae (kyphotic posture) due to the unfortunate nature of modern society where many are forced to stare at a computer screen for hours on end.

If someone’s rhomboids and lats are overactive, however  – which is fairly common with meatheads – they’re going to superimpose a stronger retraction and downward pull of the shoulder blade, which in turn will result in a more adducted position.  In short:  the shoulder blade(s) will “crowd” the spine.

All of this to say: things are effed up, and are going to wreck havoc on shoulder kinematics and affect one’s ability to upwardly rotate the scapulae.

So, hopefully you can see how this would be problematic for those who A) need to throw a baseball for a living or B) would like to do anything with their arms above their head.

With special attention to the latter, if someone is aggressively downwardly rotated, the congruency of the joint is such that the humeral head is going to superiorly migrate, which will then compromise the subacromial space (making it even narrower) leading to any number of shoulder ouchies.

Throwing more fuel into the fire, because the lats are stiff/short, shoulder flexion is going to be limited and compensation patterns will then manifest itself in other areas as well – particularly forward head posture and lumbar hyperextension.

Which, of course, makes doing the Dougie a little tricker.

Okay, with all of that out of the way what can be done to help alleviate the situation.  Luckily the answer isn’t as complicated as it may seem, and I don’t need to resort to bells, whistles, and smoke machines or take a page out of Professor Dumbledore’s Magic Book of Bedazzling Hexes and Awesome Shoulder Remedies (on sale now through Amazon!) to point you in the right direction.

But make no mistake about it:  you WILL have to pay some attention to detail.

Lets get the contraindicated stuff out of the way first.

Basically it would bode in your favor to OMIT anything which is going to promote MORE scapular depression – at least for the time being (not forever).

Things To Avoid

To that end, things to avoid would be the following:

– Deadlifts

– Pull-Up/Chin-Up Variations (even those these may “feel” good, they’re just going to result in feeding into the dysfunction)

– Suitcase Farmer Carries (again, these are just going to pull you down more).

– Anything where you’re holding DBs to your side (think:  walking lunges, reverse lunges, etc).

– And we may even need to toss in aggressive horizontal row variations if someone presents with an overtly adducted posture.

– Overhead pressing.  Listen, if you can’t get your arms above your head without compensating, you have no business doing push presses, or snatches, or whatever it is you’re thinking about doing.  Stop being stupid.

– Sticking your finger in an electrical socket.  That’s just common sense.

Things To Do Instead

– In lieu of the deadlifts, if you have access to them, utilizing speciality bars like a GCB bar or Safety Squat bar would be awesome.  Learn to make lemonade out of lemons: why not emphasize your squat for the time being?

And because I know I just ruined someone’s world out there by telling them not to deadlift, because you’re going to deadlift anyways, at the very least, limit yourself to ONE day per week.

– You can still hit up a lot of carry variations, just not the suitcase variety.  At Cressey Performance we HAMMER a lot of bottoms-up kettlebell carries because they offer a lot of benefits – especially for those in downward rotation.

Moreover, we can also toss in some GOBLET carries like so:

http:////www.youtube.com/v/90mxsAsOKwQ

– You can still implement a wide variety of single leg work using DBs, but I’d defer again to utilizing GOBLET variations only.

In this way you’re not feeding into the dysfunction by holding the DBs to your side (and pulling you into downward rotation.

With regards to overhead pressing, I’m not a fan for most people.  I’ve said it before, and it bears repeating here:  you need to earn the right to overhead press.

That said I do love LANDMINE presses which tend to offer a more “user friendly” way of “introducing” overhead pressing into the mix.  Check my THIS article on T-Nation I wrote a few months ago, which offers more of a rationale as well as landmine variations to implement.

And the Boring Stuff (<— The Stuff You’re Going to Skip, But I’ll Talk About Anyways)

From a corrective exercise standpoint it’s important that we stress the upper traps to help nudge or encourage us into more upward rotation.

And by “upper traps,” I AM NOT referring to the most meatheaded of meathead exercises – the barbell shrug.

These wouldn’t be useful because there’s no “real” scapular upward rotation involved, and you’re doing nothing but encouraging more depression anyways.

Instead incorporating activation drills like forearm wall slides and back to wall shoulder flexion – both of which encourage upper trap activation, WITH upward rotation – would be ideal:

Forearm Wall Slides w/ OH Shrug

Back to Wall Shoulder Flexion w/ OH Shrug

NOTE:  something to consider would be how you actually go about cuing the shrug portion.  We like to tell people to begin the shrug pattern once your elbows reach shoulder height.  Meaning, it’s not as if you’re going elevate your arms up and THEN shrug.  Rather you want to combine the two.

Another important corrective modality to consider would be something to address the lats.  In this regard my go to exercise would be the bench t-spine mobilization

Bench T-Spine Mobilization

And while I could sit here and pepper you with a deluge of other “correctives,” I think by now you get the point and those three should be more than enough to get the ball rolling in the right direction.

Those combined with the programming modifications suggested above should definitely help to that shoulder frown upside down. <—  HA – see what I just did there?

That’s some wordsmith magic right there.