CategoriesAssessment coaching Program Design

How to Fix Scapular Winging

Scapular winging. It’s a thing.

I guess.

Copyright: olegdudko / 123RF Stock Photo

 

Forgive the aloof and standoffish tone. I recognize the term “scapular winging” is a thing and that it can be an actual, real-live, medical diagnosis with dastardly consequences.[footnote]Can I get some grammar bonus points for use the word ‘dastardly’ in a sentence?[/footnote]

But more on that in a minute.

It’s just that, in some ways, I find a lot of fitness pros – personal trainers, strength coaches, and even physical therapists – can often be a little too liberal with use of the term. They toss it around with little understanding of what it actually means and with little “feel” on how it’s interpreted by their clients and athletes.

I’ve long championed the sentiment that most (not all) fitness pros use the initial assessment as an opportunity to showcase how much people suck at doing things and how broken they are, and that, for the mere cost of a 215 pack of training sessions (the equivalent of a really, really nice Audi), they’ll fix you.

Pffffft, who wants an Audi anyways?

Here’s how a typical conversation goes:

Client: “Hey, I’m thinking about hiring someone to train me.”

Douchy Trainer: “Great, I’d be glad to help. We need to start with an assessment so I have ample opportunity to showcase how much of walking ball of fail you are and how I alone can fix you.”

Client: “Uh, okay. When do we start?

Douchy Trainer: “Right now, take off your shirt.”

Client: “Not going to buy me dinner first, huh? Kidding, okay, BAM.”

[takes off shirt]

Douchy Trainer: “Oh……….MY………..GOD.”

Client: “What? What’s wrong?”

Douchy Trainer: “I’m sorry to have to tell you this, but, you may want to sit down for this.”

Client: “Okay. What is it?

Douchy Trainer: “I’m sorry to have to tell you, but, but…..you have scapular winging.”

Client: “Is….that bad?”

Douchy Trainer: “I honestly have no idea how you’re able to walk, let alone speak complete sentences. We need to fix this ASAP.”

And this is where the trainer turns into that a-hole nun from Game of Thrones walking the client, Cersei style, down to the training floor to take them through a bevy of corrective exercise drills.

via GIPHY

 

Lets pump the brakes, mmmkay?

Scapular Winging: What It Is

It’s this:

Now, admittedly, the key words used to find this picture were “most fucked up, dumpster fire of a case of scapular winging on the internet,” so don’t get too alarmed.

This is a legit, medically diagnosed case, and not at all normal.

 

Pretty cool, right? That’s some Gandalf shit right there.

Quadruped Rockback w/ Floor Press

 

Typically the Quadruped Rockback is a a screen used to gauge active hip flexion ROM and to ascertain someone’s appropriate squat depth based of his or her’s anatomy. However, after listening to Mike Reinold speak on the topic it’s also a great drill to cue people into more protraction and upward rotation

Floor Press w/ Upward Rotation

 

Taking the floor press a step further, we can take away a base of support (and force the stabilizing arm to work that much harder in order to maintain position) and then incorporate some upward rotation.

Wrap Up

The umbrella theme here is not to dismiss scapular winging as an actual diagnosis. It is a diagnosis. It’s just not as common as people think, and I wish more fitness pros would stop jumping to conclusions so fast.

Oftentimes the fix is just to coach people up, introduce some load, and get them into better positions.

Last Chance to Save $100 off Complete Shoulder & Hip Blueprint

TODAY (7/6) is, for real this time, the last day you can purchase Complete Shoulder & Hip Blueprint at 50% off the regular price.

Because of the 4th and everyone’s travel plans, Dean Somerset and I extended our sale by one day so more people could take advantage.

That’s $100 you’re saving. Take that money you’ll save and go to a nice steak dinner instead.

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CategoriesUncategorized

5 Reasons Your Shoulder Is Jacked-Up and Not Jacked – Part II

Welcome back!

For those who missed it, yesterday I posted PART ONE (Newsflash: you’re reading part II) of some of the reasons why your shoulder is most likely jacked-up and not jacked.

If you’re too lazy to click the link above, here’s the dealsky:

1.  Your technique on just about everything is, for lack of a better terms, is god-awful.

2.  The program you’re following, while written with good intentions and attention to detail, may in fact be feeding into your issues and causing more harm than good.

And that’s all I’m gonna say on that front. If you want to dive in and a get a litte more detail you’re just going to have to click on the link and read part one.

Hint: You should read part one.

Moving things along, lets go a head and get the most obvious one out of the way first.  And while it’s the most obvious, I’d argue that it’s still something that many people disregard altogether and shove into some back room like a red-headed stepchild.

Not Addressing Tissue Quality

Much like taking your car in to get its oil changed, or going to dentist every six months for a cleaning, or clipping your nose hairs before a big date, addressing tissue quality should be considered preventative maintenance.  Or, at the very least – especially with regards to the latter – set you up for long-term success.  Maybe even second base if you play your cards right!

Either way, it still dumbfounds me that people (especially those in pain) refuse to put two and two together and aren’t more proactive on this front.

It’s not a sexy topic, which is probably why so many people turn their backs on it.  But watering things waaaaay down:  when you palpate tissue, it shouldn’t hurt.  Conversely, if you palpate your pec (and if you’re really talented, your pec minor) and it makes you jump off your chair, then that should tell you something.

Almost always, the pec (and by association, the pec minor) is going to enter the equation when the discussion of shoulder pain comes up.  Think about what I mentioned yesterday and how most programs are aligned:  there’s a heavy emphasis towards pushing movements compared to pulling.  As such, it’s not uncommon to observe many people with rounded, abducted shoulders – kind of like this poor guy here who I found on Google images:

Putting my Captain Obvious hat on for a second, it stands to reason that this said random guy should become BFFs with a foam roller, and spend a lot of time rolling his upper/mid back, as well as his lats (which is an area that many people neglect).

But that’s just half the equation. Anteriorly speaking, what do you think is pulling is scapulae into a more abducted position?

His pecs!

Taking the time to perform some dedicated self myofascial release on the pecs, and as a result working to get into a more optimal alignment, can pay huge dividends when you’re dealing with a cranky shoulder.

Doing your part to help release built up scar tissue, adhesions, and trigger points is a step in the right direction, but you also need to understand that it’s just as important to lengthen that tissue after the fact and then “cement” that new length with proper strength training.

Stealing a popular phrase from physical therapist, Charlie Weingroff, we need to “get long, and get strong.”

You can’t make the mistake of JUST foam rolling or whatever and then just going about your business.  You also need to lengthen that tissue and strengthen it within that new length.

It’s actually a profound litmus test if you’re someone who’s going to a physical therapist or manual therapist.  Are they just treating the symptoms with whatever modality they prefer (Graston, ART, dry needling, deer antler spray, Unicorn tears) and kicking you out the door, or are they following treatment with appropriate stretching and strength training?

If the former, I’d be reticent to continue with said therapist.

Doing Too Much Band Work

I’ve mentioned this in the past, but it bears repeating.

If I were to ask you what is the function of the rotator cuff, what would you say? If I were a betting man, I’d garner that the vast majority of people reading would say one of three things:

  • External/Internal rotation of the arm (glenohumeral joint).
  • Elevates the arm in the scapular plane.
  • Where the hell’s the rotator cuff? Isn’t this the part of the post where you post a picture of a scantily clad hot chic

If you mentioned either of the two former options- congratulations you’ve obviously read an anatomy book within the past 25 years. And, while you’re technically not wrong, you’re not entirely correct either.

With regards to the latter option, I’d would post a picture of the rotator cuff to help clear the air but THIS is actually the point where I post a picture of a scantily clad hot chick.

For the record, her rotator cuff would be approximately 2 o’clock from her cleavage. How that’s for functional anatomy….;o)

Okay back on track: While the rotator cuff does invariably play a significant role in external/internal rotation, as well as elevation of the arm, you’d be remiss not to recognize that it’s main function is to simply center the humeral head within the glenoid fossa.

Unfortunately, if you were to take a peek into what most people’s shoulder “rehab” programs look like it would most likely resemble a hodge-podge collection of rotator cuff band exercises done ad nauseam.

Now I’m NOT suggesting that band exercises are a waste of time or that dedicated RC exercises like the side lying external rotation shouldn’t be performed.

Far from it.  In fact, side lying external rotations (with the arm abducted slightly) have been shown to have the greatest EMG activation of the rotator cuff – when done correctly.

I think my main beef – especially when it comes to band work – is that people are under the assumption that more is better.

The above couldn’t be further from the truth. Training the rotator cuff to fatigue increases superior humeral head migration, and makes about as much sense as making another Sex in the City movie.

Put another way, when the rotator cuff is fatigued, the humeral head will shift superiorly towards the acromion process, effectively increasing the likelihood of shoulder impingement.

So, contrary to popular belief, all of those 50-100 rep sets of band or side lying DB external rotations you’re doing to keep your shoulder “healthy” isn’t doing your shoulder any favors.

I’m not saying it’s wrong to do them.  I just think it’s wrong to do them until you’re blue in the face.

Your Shoulder Probably Isn’t Even the Issue!

Let me clarify before I proceed, because I know I’m getting some people scratching their heads at that last comment.

Looking directly at the shoulder does make sense – especially if 80-90% of your clientele make their living throwing a baseball.

As an example if we get a pitcher walking through our doors who complains of shoulder pain, it only makes sense to look at the shoulder and check out things like total ROM (glenohumeral internal + external rotation), upward/downward rotation, so on and so forth.

But when working with the general population, it’s often advantageous to dig a little deeper.

This isn’t to say that the shoulder ISN’T the problem, it very well could be.  But it’s been my experience that it’s usually not.

I just find it comical whenever I read a random article or blog where someone starts throwing out things like “check for big toe dorsiflexion” or “can they recite the alphabet backwards in less than 17 seconds?” as if any of that really matters.

Sure, I guess we could make a valid (albiet far reaching) case that limited big toe dorsiflexion can effect things up the kinetic chain, but more often than not I just feel people start throwing out that kind of verbiage as a way to make themselves sound smarter than they really are.

Nevertheless, there are a multitude of factors that we have to take into consideration as to why someone’s shoulder is flipping them the bird that may or may not have anything to do with the shoulder.

At CP we take the following into consideration that may have nothing to do with the shoulder:

– Overuse

– Scapular instability

– Poor glenohumeral ROM

– Rotator cuff weakness

– Soft tissue restrictions

– Poor thoracic spine mobility

– Acromion type

– Poor exercise technique (seriously, read yesterday’s post)

– Poor cervical spine function

– Poor programming balance

– Faulty breathing patterns

– And yes, opposite hip/ankle restriction

A handful or maybe all factors above may need some attention and have their share of the limelight, but the real take home message is that you need to think outside the box.  Just because your shoulder hurts doesn’t necessarily mean it’s a shoulder issue.

And that’s that!  Hopefully I was able to shed some light on an often murky and confusing topic.  If you liked this, please do me a favor and “Like” it, as well as share on as many social media outlets as possible.  I’ll give you a hug if you do.

CategoriesCorrective Exercise Program Design Rehab/Prehab Strength Training

5 Reasons Your Shoulder Is Jacked Up and Not Jacked Part I

We work with a lot of overhead athletes at Cressey Performance – in particular baseball players – and it’s no coincidence that we deal with, address, work around, and (hopefully) fix a lot of shoulder issues ranging from the acute like AC joint issues and external/internal impingement to the more “oh shit factor” scenarios like shoulder separations and post surgery situations.

And using the word “acute” in this instance isn’t to downplay things like impingement (as anyone who’s had to deal with a chronic case will think otherwise), but rather it’s just to put things into perspective that some shoulder pathologies take a little more attention to detail and TLC compared to others.

As an example I can’t tell you how many times someone’s walked into the facility complaining of consistent shoulder pain preparing for the worst, only to demonstrate to them that their push-up technique is god-awful.

I didn’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 show them how to perform a push-up correctly and to not piss their shoulder off further.

Unfortunately, it’s not always so cut and dry.  For many people out there – average Joe’s and meat heads in particular – living their day to day life with shoulder pain or discomfort is sometimes second nature.  Analogous to riding a bike, putting your left sock on before the right, or reaching for that second cup of coffee. Or fifth, don’t worry I won’t judge.

What’s more, some view it as a proverbial right of passage or badge of honor, as if living with daily pain comes with the territory for those who spend their free time lifting heavy things.

While true, there is some semblance of “risk” involved, and many will undoubtedly have a few bumps and bruises along the way (we’re lifting weights here not doing origami), just “dealing” with pain  and sucking it up isn’t an option in my book.

That said, not many things can derail one’s progress in the gym like a banged up shoulder.  Okay, a Zombie apocalypse or a raging case of explosive diarrhea rank fairly high on the list for sure.  But a nagging shoulder injury bites the big one, too.

Below, while not an exhaustive list, are some of the more common “reasons” why your shoulder may be hating you.

1.  No, Seriously, Your Technique Is Horrible

I won’t beat a dead horse here, but it stands to reason that half the reason your shoulder hurts all the time is because your exercise technique is less than exemplary.

I know, I know:  you’ve been lifting weights since stone washed jeans were considered a cool fashion trend, and there’s no conceivable way you’re doing something incorrectly.

Well, I’m here to tell you otherwise!

Taking the time to actually learn how to perform a push-up correctly or how to bench press correctly – or at the very least tweak things to make them more “shoulder friendly” – will go long ways in keeping your shoulders healthy.

It’s akin to lightly tapping your thumb with a hammer.  While seemingly not a big deal at first, before long, it’s excruciating.

Constantly performing your exercises with shitty technique day after day, week after week, and month after month will eventually lead to some bad things happening.  Namely a shoulder ouchie.

And this goes for rowing variations, too.  You’d be surprised as to how many people butcher these on a day to day basis.

A perfect example would be something as innocuous as a face pull.

* Video courtesy of the one and only Mike Robertson

I was training at a commercial gym not too long ago and watched a gentleman perform this exercise with the exact opposite form Mike demonstrates above.

For starters, he held the rope with a pronated (overhand grip) which locks you into more internal rotation and thus compromises the acromion space.

Secondly, he’d allow his scapulae to go into posterior tilt with each rep, and worse he’d substitute scapular retraction with an excessive forward head posture.

While I’m sure he had good intentions for including the exercise in his program, the execution was less than to be desired and was probably causing more harm than good.

And this goes for just about every rowing variation out there.  You’d be surprised as to how many people butcher technique and aren’t even close to performing them correctly.

Take the time do things right, and your shoulder will thank you.

 2.  Your Program Kinda Sucks

More to the point: it’s the structure of the program thats sucks. It’s common in the strength and conditioning community to talk about programming imbalances, especially as it pertains to the upper body.

Dissecting most training programs, it’s not uncommon to see significant favoritism or preponderance towards pushing exercises compared to pulling.  It’s no secret:  guys like to bench press.  And as such, many develop muscular imbalances (overactive/stiff pecs and weak/inhibited upper back musculature) which results in a less than happy shoulder.

To counteract this, many fitness professionals will advocate more pulling motions compared to pushing – oftentimes to the tube of a 2:1 or even 3:1 ratio.

In other words: for every pushing exercise prescribed, they’ll “counteract” it with two to three pulling exercises.

This is sound advice, and definitely a step in the right direction for many trainees.  But we’re omitting another less obvious (yet equally as important) component, and it’s something Eric highlighted last year and that we’ve been addressing at Cressey Performance for a while now.

And that is:

While anterior/posterior imbalances are important to address, not many people give any credence to superior/inferior imbalances.

Translated into English, 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 visual reference, cue picture to the right.

Most baller t-shirt, ever ================>

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, as we as fitness professionals have been shoving down their throat  “shoulder blades together and down, shoulder blades together and down” for years now.

In this case, some dedicated upper trap work would be advisable so as to encourage more scapular UPWARD rotation.  And no, relax, I’m NOT referring to barbell shrugs.

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 drills like Forearm Wall Slides with Shrug;

And Back to Wall Shoulder Flexion will work wonders.

Too, it may come down to toning down things like heavy deadlifts, farmer carries, and anything that entails holding onto heavy dumbbells (since all will pull the shoulder girdle down promote significant shoulder depression) in favor of more overhead/waiter carries, Goblet variations (squats, reverse lunges, etc), and barbell related work.

Just some food for thought anyways.

And that’s it for today. Be sure to check back tomorrow for some more insight and conversation on why your shoulder is jacked up and not jacked.

SPOILER ALERT: your shoulder may not be the issue in the first place!

*Smoke bomb, smoke bomb.  Exit stage left*

Also, as an a side (and giving credit where it’s due):  Title inspiration came from THIS article I read a while back on Elitefts.com.