Categoriescoaching Corrective Exercise Strength Training

5 Strategies for Healthy Shoulders

Unlike Dan John, I lack the ability to seemingly rattle off an array of quotable quotes with the frequency of a Donald Trump soundbite.

That said, every now and then luck strikes and I chime in with gem like this:

“Lifting weights isn’t supposed to tickle.”

Muscles are going to get sore, and joints are going ache. And, in keeping things real, the risk of sharting yourself increases exponentially.

Sorry, it comes with the territory.

Being “sore and achy,” however, while nothing new to anyone who lifts weights on a regular basis, shouldn’t be a regular occurrence…or badge of honor.

Likewise, while the saying “pain is just weakness leaving the body” is a popular one amongst fitness enthusiasts (most often, CrossFit participants and marathoners1)…it’s really, really, really stupid.

Pain is not weakness leaving the body. It’s your body telling you to “quit the shit” and that what you’re doing has surpassed its ability to recover.

Of course, there are different levels of pain. I can have someone perform a set of 20-rep squats or Prowler drags – on their hands, blindfolded, uphill, for AMRAP – and there’s going to be a degree of “pain” involved.

But if pain is present – to the point where, you know, stuff fucking hurts – then that’s something entirely different and something that needs to be addressed…sans the machismo.

The shoulders are a problem area for many lifters and often take a beating. Below are some brief, overarching talking points on how to address shoulder pain/discomfort.

Note: it’s a broad topic, and one teeny tiny blog post won’t be the answer to everything. However, chances are, addressing one – if not several – of the talking point below may be exactly what’s needed to get the ball rolling in the right direction.

1) Stop Doing What Hurts

I had a client approach me recently about his shoulder. The conversation went something like this:

Client: “My shoulder hurts when I do this.”

[Proceeds to do this weird behind the head, shoulder dislocation thingamajiggy]

Me: “stop doing that.”

Client and Me: “LOL LOL LOL LOL LOL.”

Me: “seriously, stop doing that.”

It seems like an obvious thing to do, but if something hurts – whether it be the weird Cirque du Soleil contortionist move my client was doing, bench pressing, or whatever – stop doing it.

At least for now.

I know it’s a hard blow for a lot of guys to be told to stop bench pressing for any length of time, and in fairness, much of the time it’s a matter of addressing a handful of common technique flaws:

  • Better upper back stiffness (learning to pull shoulder blades together and down for improved stability).
  • Learning to engage the lats (to make a “shelf” and to “row” the bar down towards the chest).
  • Maybe tweaking wrist and elbow position (so one isn’t so flared out).
  • Addressing leg drive.

BAM – shoulder doesn’t hurt anymore.

All that said, it’s usually a better play to take out the incendiary movement altogether – maybe for a few days, or even weeks – and take the time to allow tissues to calm down and address any profound weaknesses and dysfunctions present.

2) Earn the Right to Overhead Press

The ability to raise one’s arms overhead – I.e., shoulder flexion – is something that’s not quite as easily accomplished in today’s society.

The left: what most people look like (forward head posture, excessive lumbar extension). The Right: dead sexy. Kinda.

We just don’t spend that much time there. Yet, walk into any commercial gym or CrossFit box and you’ll witness any number of trainees happily pushing, hoisting, and/or kipping overhead.

Often with deleterious ramifications.

Several factors come into fruition when discussing the ability to elevate the arms overhead2:

  • Shoulder: if one lacks abduction/upward rotation on any given side, you could see any number of compensations like lack of elbow flexion.
  • Scapulae: we need upward rotation, protraction, and posterior tilt to get overhead. Most people are lacking in one or all three.
  • T-Spine: does it extend? It should.
  • Lumbar Spine: does it extend? It sure as shit shouldn’t.

This is where assessment and individualized programming comes into play. Some people require a different “corrective” approach compared to others. However, if that’s not your wheelhouse, refer out!

But as a strength and conditioning professional you could still set people up for success by having them perform more “shoulder friendly” overhead pressing.

1-Arm Landmine Press

 

Serratus Upward Jab

3) Improve Upward Rotation

Many people are “stuck” in a downwardly rotated position – especially those who participate in an overhead sport (baseball for example) or are a lifetime meathead.

Due to lack of anterior core control, tight/stiff lats, soft tissue restrictions, poor programming balance, or a combination of several factors, many tend to live in a state of “gross” extension.

To that end: anything we can do to target the muscles that help upwardly rotate the scapulae – low/upper traps, serratus – would bode in our favor.

Band Wall Walks

 

1-Arm Prone Trap Raise

 

1-Arm Band Overhead Shrug

 

TRX Hinge Row

Moreover, a little TLC to foam rolling the lats would work wonders, as well as addressing anterior core control/strength with exercises like deadbugs.

Too, proper coaching/cueing by not allowing clients to crank though their TL junction or lumbar spine during movement would be stellar. Thanks, appreciate it.

4) Obligatory Commentary On How Breathing Will Cure Everything

I’m a believer in PRI (Postural Restoration Institute) principles and have used it to great success with clients in the past and present.

Helping to “reset” posture with focused breathing drills can be a game changer – especially for those living with shoulder pain.

First, lets address a common fallacy…beautifully articulated by NYC-based physical therapist, Connor Ryan:

Taking the conversation on “gross extension” a little further, we can attempt to apply Connor’s analogy with some focused breathing drills like this:

 

Doing so:

  • Helps stimulate parasympathetic activity (excessive extension = “impingement” of Posterior Mediastinum leading to constant sympathetic – flight or flight – activity).
  • Allows a window for the thorax/rib-cage to move, which, in turn, allows the scapulae to move.
  • I only perform 1-3 different drills here, lasting, maybe, 2-4 minutes. And then it’s time to go lift heavy shit.

5) Let Your Shoulder Blades Move

A common mistake I see many trainees make is “glueing” their shoulder blades in place during exercises like a 1-arm dumbbell row or even push-ups.

This is not wise.

Scapular retraction (adduction) is important, but so it allowing the shoulder blades to protract (abduct).

In short: the shoulder blades should have the ability to move around the rib cage.

If their always pinned in place, this will often manifest into glenohumeral issues – namely, anterior humeral translation and instability.

Translated into non-geek speak, your shoulder is basically saying:

Simple Shoulder Solution

Strength coach Max Shank just released a handy manual called the Simple Shoulder Solution.

Anyone familiar with Max’s work knows he’s a guy that likes to think outside the box and help get people more athletic.

Much of what I discussed above mirrors much of what Max covers in this manual (with more detail).

In order to best address the function of the shoulder you need to follow the order of operations and handle the surrounding structures first. These are:

1) Breathing and Core Activation
2) Thoracic and Neck Mobility
3) Scapular Mobility and Stability
4) Glenohumeral Mobility and Stability

The main idea here is that if you do not address 1-3 FIRST, you are likely to create more compensation, hypermobility and potential for injury at the Glenohumeral joint.

I can dig it.

Give it a look for yourself HERE.

CategoriesStuff to Read While You're Pretending to Work

Stuff To Read While You’re Pretending To Work: 2/5/16

Going to keep this quick today because I am the master of procrastination and have a boatload3 of catching up to do on programs, writing, probably watching Netflix (who am I kidding?).

But as my good friend, Ben Bruno, always states:

“If you wait till the last minute, it only takes a minute.”

I swear, I should just write programs that go like this:

A1. Squat.
A2. For an hour.
A3. You’re welcome.

That’ll save me so much time.

Oh, before I get into this week’s list, two things:

1) Be sure to check my upcoming speaking/workshop schedule HERE. Things start to ramp up in a few weeks highlighted by the Mark Fisher Fitness Motivation & Movement Lab in NYC at the end of the month and then Dean Somerset and I begin the 2016 tour of our Complete Shoulder & Hip Workshop in Toronto in March, Seattle in April, and two stops in Europe in May.

2) I’m excited to announce I’ve partnered with the company that makes my favorite supplement in the whole wide world (seriously, I can’t live without it), Athletic Greens. Click on THIS link to receive 50% off and an all-expenses paid trip to a hug, from me

You’re Not a “Hardgainer.” You Just Don’t Like To Listen – Lee Boyce

Lee hits the nail on the head with this one.

Listen, “hardgainers” do exist. Like unicorns. But more often than not it comes down to taking a little bit of accountability and admitting 1) you’re (probably) not training/eating enough and/or 2) no, really, you’re (probably) not training/eating enough.

NOTE: the hardgainer-unicorn comment was a joke, Relax.

Exercise Spotlight: Kettlebell Windmill – Karen Smith

I see this exercise being butchered ALL. THE. TIME….interpreted – falsely – as something where you just “bend over and reach towards the floor. Weeeeeeeeeeeee.”

When I see the kettlebell windmill performed in this manner – especially by personal trainers or coaches –  it makes me want to take the kettlebell they’re holding in their hand and punch them in the face with it.

Excellent, excellent article from Karen Smith on the topic.

3 Ways to Get Out of Shoulder Pain – Andrew Millett

Andrew has been a long-time client at Cressey Sports Performance, and he’s also a well-respected physical therapist within the Boston area.

It’s amazing to see that he’s now doing more writing and putting out some awesome content.

CategoriesCorrective Exercise Exercise Technique

The Difference Between External and Internal Impingement of the Shoulder

Shoulder impingement.

Not to play the hoity toity Jonny Raincloud card, but the words themselves – shoulder impingement – is a garbage term.

It doesn’t really mean anything.

To one degree or another your shoulder is always being “impinged.” So when you or your trainer or someone with more letters next to their name (or the Easter Bunny) says “you have shoulder impingement” when your shoulder hurts, they’re not really saying anything significant and just playing the Captain Obvious card.

Thank you, that will be $149.99. Cash or credit?

Facetiousness aside, I should backtrack a bit and note that shoulder impingement isn’t a completely useless term – I mean, plenty of people still say anterior knee pain to diagnose, well, anterior knee pain – it’s just, you know, mis-managed.

The thing about shoulder impingement is that it’s very much a real thing. Like I said, everyone lives with it. While it’s a watered down description, when people refer to impingement they’re typically referring to compression of the rotator cuff – usually the supraspinatus, and over time, the infraspinatus and biceps tendon – by the undersurface of the acromion.

[Except for when it’s not and we’re talking about INTERNAL impingement. More on this below.]

This happens all the time – even in quote-on-quote healthy shoulders. It’s inevitable. It’s anatomy.

But the degree of impingement is what we’re really alluding to here.

In other words: the rotator cuff (RC) gets “impinged” by the acromion due to a narrowing of the space between the two.

In (other) other words: you have an ouchie. Or, for the non-PG people in the crowd “your motherfuckin shoulder hurts!”

98% of the time this type of impingement results in bursal-sided rotator cuff tears, and as Eric (Cressey) has noted on numerous occasions “happens more with ordinary weekend warriors and very common in lifters (not to mention much more prevalent in older populations).”

The thing that irritates me is that telling someone they have a shoulder impingement – assuming there’s pain present – doesn’t speak to the root cause of why their shoulder is flaring up in the first place.

Is it structural?

Tissue quality?

Lack of mobility somewhere? Relative stiffness elsewhere?

A programming flaw?

They wore green on a Thursday?

Moreover there are different kinds of impingement (external and internal; and the former has different categories: primary and secondary) which manifest in different ways, in different populations, and will require different approaches.

It’s beyond the scope of a blog post to peel back the onion on everything related to shoulder impingement – for that you may want to check out Eric Cressey and Mike Reinold’s Functional Stability Training series. But I did want to take some time to provide some information and help any trainers or coaches or anyone in the general population reading be able to differentiate between the different types of impingement and the mechanisms behind them.

External Impingement (AKA: Meatheaditis)

This is the one that’s relevant to most people reading, and the one we’re discussing when referring to anything related to the rotator cuff being impinged by the acromion via bursal-sided impingement.

Here someone can usually point to pain on the front of the shoulder and things like overhead pressing, bench pressing, and approximation hurt.

In addition to pain during those activities, another way we can distinguish if it’s (most likely) external impingement – is by implementing two simple screens.

FMS Impingement Clearing Screen

This is the exact screen the FMS uses to “clear” someone for impingement. Place palm of one hand on opposite shoulder and, without allowing your palm to come off the shoulder, lift your elbow.

Empty Can Provocative Screen

Place one arm in scapular plane thumb facing down and gently press down with other hand.

Pain with either of the two?

I’d seek out a reputable health professional to do a little more digging.

Read (NOTE TO PERSONAL TRAINERS AND STRENGTH COACHES): you’re not diagnosing anything. These are screens. Nothing more, nothing less. It’s information.

Also, on more of a side note: the empty can screen should NOT be used as an actual exercise. It’s a provocative test (placing people into impingement), used to ascertain if pain is present. Why anyone would use this as an actual exercise is beyond me.

That’s like saying, “Oh, banging your head against a wall hurts? Lets do more of it!” 

Anyhoo, like I said those are two very easy screens you can add into your arsenal to help gather information.

But this still doesn’t speak to WHY someone may have external impingement. And here’s where things get even more interesting.

Primary External Impingement

This can be considered more of a morphological/structural issue (and as it happens, what we have less control over).

Ever watch some old-timers train and they’re able to perform endless sets of overhead presses, upright rows, and bench pressing without their shoulder(s) ever hurting?

Most likely it’s because they have a Type I acromion.

Then there’s you, who just thinks about upright rows, and your shoulder flips you the middle finger. You may have a Type II acromion (more narrow space).

Outside of an x-ray (and surgery) this is something you’re never really going diagnose and solve. But it can speak to how you’d alter your programming to better fit your anatomy.

Secondary External Impingement

This is where the rest of us live and plays into more lifestyle factors. This is more or less things we have control over.

Things like poor scapular positioning (too depressed, too elevated, too abducted, too adducted, all of which affect upward/downward rotation), poor T-spine mobility, poor tissue quality, poor exercise technique, rotator cuff weakness, unbalanced programming, lack of lumbo-pelvic hip control, stiff/shorts lats, inefficient breathing patterns, and host of other factors can come into play here.

Here’s where it’s the trainer’s or coach’s job to figure out which of these is the culprit (often it’s a number of them).

Internal Impingement

Unless you’re involved in overhead athletics, chances are you don’t have this.

With internal impingement someone with describe it as “inside” the joint and will generally point towards the back of the shoulder. Too, it will typically only hurt when they’re in excessive external rotation (think: cocked back/lay-back position for a pitcher).

As Mike Reinold notes: “as you move into humeral external rotation, the more aggressive it is, the more likelihood one will feel a pinching sensation towards the posterior-superior aspect of the glenoid.”

This basically alludes to the “inside” feeling described above.

Internal impingement deals with more of the ARTICULAR side of the rotator cuff, and specifically refers to the contact between the articular side of the supra/infraspinatus and the posterosuperior rim of the glenoid.

The more external rotation (lay back) one goes into, the more internal impingement will arise

And, as Reinold notes, “we don’t get internal impingement from sitting at our desks. It happens when people use their arms in an extreme abducted & externally rotated position.”

So, in short: unless you’re throwing a baseball during your lunch hour (or fighting centaurs4, you don’t have internal impingement.

Regardless in this scenario we’d want to place a premium on addressing scapular position (improve upward rotation), as well as address any shoulder instability. Overhead athletes are notorious for having super lax shoulders, so anything we can do to improve that – rhythmic stabilizations – would be ideal. That, and make sure they perform exercises like push-ups and row variations correctly.

 

And That’s That

Whew, I hope that all made sense. Like I said this wasn’t meant to be an all-encompassing diatribe on everything shoulder impingement, but I hope I was able to get you out of the weeds a bit on the topic.

Oh, And There’s This

This post is just the tip of the iceberg in terms of all the things I cover as part of mine and Dean Somerset’s Complete Shoulder and Hip Blueprint:

 

We discuss and breakdown anything and everything as it relates to shoulders and hips, obviously. Including but not limited to anatomy, assessment, corrective exercise, performance training, programming, etc, in addition to analyzing World of Warcraft strategies. Because, nerds rule.

 

Complete Shoulder & Hip Blueprint HERE.

CategoriesAssessment

Assessing Our Assessments: Shoulder Flexion

Assessment.

It’s a powerful word. A daunting word. A ten letter word. A word that means different things to different people.

But the word itself implies you’re assessing something.

So, what is it?

Well, given this is a fitness website it stands to reason that when I say the word “assessment” I’m not referring to one’s ability to color between the lines, write sick computer codes, or, I don’t know, how to say “excuse me, but can you tell me where the library is?” in Spanish5

No, in this context, when referring to the word assessment…I’m alluding to one’s ability to do “stuff.”

Particularly with their body. Most often in the weight room and/or within the confines of their respective sport(s).

But also their ability to perform every day life tasks – bending over to pick something up off the floor, reaching for something, carrying things, fighting crime, walking down a flight of stairs without snapping their hip in half – pain free.

The other day I said something halfway smart on Twitter:

I approach assessment with every person with a blank slate. While I’d be remiss not to mention we do have a “protocol” we prefer to follow at Cressey Sports Performance – namely because of the unique population we overwhelming work with on a daily basis, overhead athletes – it’s not uncommon for me to go off the beaten track when it’s called for.

Put another way…..

No two assessments are the same.

It’s outside the scope of this article to discuss the entire assessment process. Rest assured I’m asking all the pertinent questions: training history, injury history, goals, favorite Mighty Morphin Power Ranger, you know, the important stuff.

While every assessment is different, there is a go to “algorithm” that exists which helps guide the process and keeps this succinct and organized.

We generally start static to dynamic; proximal to distal; and seated/lying/ground-based to moving.

All that said, under the umbrella of assessment, there are certain protocols or screens I use with just about every client or athlete I work with – no matter what sport he or she plays or what their background is. There are some screens too valuable to omit.

Not only that, we have to be able to look at what the assessment is looking at, whether it’s looking at what we think it’s looking at, and whether or not it’s telling us as much information as we think we’re getting from it.

I don’t even know if that makes any sense, but I’m going with it.

Basically all I’m saying is that, while assessment is cool and all, a lot of fitness professionals really suck at it and have no clue what they’re looking for.

Lets take a look at the standing shoulder flexion screen.

To the casual fitness professional this screen tests one’s ability to get their arms over their head.

It goes like this:

Trainer to Client: “So, like, stand there and lift your arms over your head.”

Client to Trainer: “Like this?” [Cue picture pictured below, the one on the left].

Trainer to Client: “Yes! You did it! Well done. Lets go kip.”

Client to Trainer: “Right on. Weeeeeeeeeeee”

To the untrained eye (again, looking at the picture to the left), and to someone who doesn’t know what to look for, things look a-okay.

Arms + Overhead = Able to train.

But to me it looks like a nightmare. There’s significant forward head posture in conjunction with a massive rib flair and hyperextension through the lumbar spine.

[Not coincidentally, lack of shoulder flexion could easily explain why someone has chronic lower back issues. Look at what happens every time they do anything overhead. They crank through their lumbar spine. Just sayin…..]

When corrected – picture to the right – total ROM (shoulder flexion) is reduced because compensation patterns are corrected (no head protraction, rib flair, and pelvis is more posteriorly tilted). And this isn’t even half bad. I’ve seen way worse. Some people I’ve worked with couldn’t get their shoulders past 75 degrees of shoulder flexion when I made sure they weren’t allowed to compensate!

Candidly: if someone can’t pass this simple screen they really have no business doing anything over their head in the weight room, kipping pull-ups included.

So this begs the question: What prevents someone from getting full shoulder flexion in the first place?

It could be any number of things:

1. Shoulder Capsule, osseous changes (which, admittedly, aren’t very common).

2. Soft tissue restrictions – subscapularis, lats, teres minor, traps, etc. (much more common).

3 Lack of scapular upward rotation (instead of upwardly rotating scapulae, they shrug).

4. Thoracic spine mobility.

5. And lastly, and something Mike Reinold speaks to quite often, lack of lumbo-pelvic hip control.

I’m not going to hit on every point above today. I’d encourage you to check out Mike Reinold’s site and/or look into his and Eric Cressey’s Functional Stability Training series (which goes into the geeky stuff in MUCH more detail).

What I will delve into is how, when someone does present with a lack of shoulder flexion, you can differentiate between whether you’re dealing with a lat length/soft tissue restriction or if it’s a anterior core/pelvic control issue.

Easy – test their PASSIVE range of motion.

Like this.

Have them lie on their back (making sure to bend their knees to flatten out the lumbar spine and to account for any excessive rib flair). If their upper arms don’t touch the table….you’re most likely dealing with a soft-tissue restriction (lats, teres minor, traps, rhomboids, etc).

Hammer the lats with some t-spine mobility drills like this one:

 

And you can hit the rhomboids and traps using this drill:

 

And you can get the teres minor using this drill (thank you Mike Reinold).


If you test someone on their back and they pass with flying colors (I.e., their arms touch the table), then it stands to reason you’re probably dealing with a lumbo-pelvic control issue and a weak anterior core.

In that case my go to is coaching someone through deadbug variations.

Standard Deadbug – with emphasis on exhale

 

Note: these can be regressed to include arms only or legs only (or even legs bent so ROM is decreased).

Stability Ball Deadbug

 

Note: placing the stability ball between contralateral elbow and knee forces the trainee to squeeze the ball, thus activating the anterior core to a more effective degree.

Core Activated Deadbug w/ KB

 

People will often roll their eyes at deadbugs – deeming them too easy. That is until they do them correctly.

As well we can’t discount other exercises and drills that challenge the anterior core and pelvic control. Push-ups (and their infinite variations), birddogs, bear crawls, chops, lifts, Farmer carries, Pallof Presses, asymmetrical loaded lifts….all are fair game in my book.

The bigger picture, however, is to pay closer attention to what you’re actually assessing. Does the assessment itself assess what you think it’s assessing? Moreover, are you able to interpret what it’s telling you correctly?

If yes, awesome. You win the internet today.

If no, WTF are you doing???

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.

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.

CategoriesRehab/Prehab

My Shoulder Hurts: The Finest Whine

Happy Sun’s Out/Guns Out Memorial Day everyone!

Given that it IS a holiday – and the unofficial start of summer – I actually had every intention of NOT posting a blog today, and instead, do nothing but get my lift on and then follow that by eating copious amounts of dead animal flesh and high-fiving any serviceman (or woman) that I happen to cross paths with.

While I’m still going to do those things, it just so happens that my latest article on T-Nation went live, so I actually have some content to share today afterall.  Holla!

It’s about shoulders and how to go about taking better care of them. Trust me:  if you’re someone who takes the iron game seriously, and subsequently tends to have shoulders that routinely feel like they’ve been put through a meat grinder, this article is for you.

Pretty Much the Best Article on Shoulder Health Ever Written**

** = Give or take