But First…(Speaking Engagements, Stuff I’ve Written, & Other Tidbits Curated To Showcase How Important I Am)
1) Happy Birthday Julian
I was terrified a year ago today.
I remember standing in a coffeeshop across the street from the hospital getting a little teary eyed thinking to myself “holy shit, Lisa and I are parents and in a few hours they’re sending us home. No more cafeteria, no room service, and no more team of nurses on standby to help.
We’ll be alone, with this crying, pooping, and please, for the love god stop crying thing.”
SPOILER ALERT: It’s a year later. Lisa and I survived; as does every other sleep-deprived parent.
Lisa and I are so thankful for Julian and for our family and friends who have helped to fill Julian’s love tank along the way.
I’ve had the honor of presenting at two previous iterations of the Motivate & Movement LAB (the brainchild of MFF’s Harold Gibbons) and it’s unequivocally one of the most unique events in the fitness industry.
Think: TED Talk, but with deadlifts and lots of f-bombs.
Anyways, the next LAB is this coming February, and will feature myself, Dan John, Pete Dupuis, my wife (Dr. Lisa Lewis), and several of the MFF coaching staff including Brian Patrick Murphy and Amanda Wheeler.
I had to take a break from The Fitness Summit last year for two reasons:
1. Eating way too many cookies.
2. But mostly because I succeeded in making a baby and my wife would have tossed me so much shade if I was all like “Hey Babe, going to KC for three days. Toodles.”
Well this year I’m back and excited to take part in a Fitness Summit first. Dean Somerset and I will be putting on a Pre-Conference day where we’ll spend a few hours test driving some new material as a follow-up to our Complete Shoulder & Hip Blueprint.
Tentatively titled The More Completer Hip & Shoulder Blueprint.
We’ll be taking deep dive into squat and deadlift technique: discussing ankle, foot, hip and upper extremity considerations in conjunction with regressions/progressions and programming. Whether you’re a coach or just someone who likes to lift heavy things you’ll undoubtedly learn something. And if not, cool, you still get to hang out with us for a few hours.
Registration is now open for returning and new attendees. Come experience one of the best fitness events of the year.
Always like David’s perspective on things and this no different.
Social Media Shenanigans
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I get asked a lot about progressive overload. No need to make it more complicated than it needs to be. 1. Write your shit down. Track it. 2. The following week look at what you did, then do more.
Save the fancy algorithms for breaking the space-time continuum.
Bicep Tendonitis? When In Doubt Check These 5 Muscles Out
Knowledge and wisdom are not one in the same. A profound statement for an article that is going to discuss pain at the plain old bicep tendon. The reason I bring this up is because an endless amount of information is available to you through the internet.
When you search bicep tendon pain you will likely run into 100,000 articles that talk about pain local to the bicep tendon. I could make an argument that less than 1% will discuss techniques that you can implement to independently resolve your pain.
That is our plan for today.
Before we start drawing up a six week rehabilitation plan for your shoulder or sending you to the nearest orthopedic surgeon, lets attempt some quick fixes. Please, do not mistake a quick fix with a half-hearted attempt.
Refrain from replacing the whole roof when a few shingles will do.
Step one is making sure you are an appropriate candidate for this article. Let’s rule out a bicep tendon rupture!
Schedule an appointment immediately with an Orthopedic Physician if:
1. You heard a sudden “ pop” at the shoulder, along with swelling and bruising around the bicep.
This typically occurs when you are trying to “man up” and carry something that is a tad bit too heavy for you. Often a result of your best friend refusing to pay for a moving company.
2. You have a nice “Popeye” deformity at the bicep.
This doesn’t imply that you have impressive biceps. It means you tore the bicep tendon.
Other Reasons For Concern:
Weakness and pain local to the bicep when flexing the bicep or rotating your palm up to the sky with the elbow partially bent. This does not indicate a rupture, but a partial tear is still possible.
I don’t think I tore my bicep tendon. What else could cause irritation to the bicep tendon?
It is common for the bicep tendon to be a pain generator because of its location. The bicep tendon is often impinged between the humerus and surrounding structures in the shoulder (usually the acromion and the coracoid process).
Keep in mind that impingement is normal.
We have nice “cushions” named bursae that are built to tolerate this compression. It is when this compression becomes too frequent or too intense that we see injury occur at the bicep tendon. We tend to see this in people who perform a lot of overhead activities in athletics or with work requirements.
It hurts when I rub my fingers across the bicep tendon. Doesn’t this mean it is a bicep tendon problem?
Simply rubbing your finger across the bicep tendon is not an accurate way to diagnose a bicep tendon injury. This is the most common mistake I see by medical providers and those with a certification in WebMD browsing. This is not a specific or sensitive test for diagnosing a bicep tendon injury. (Gill, HS)
What is the best way to determine if the bicep tendon sustained an injury?
The gold standard would be an ultrasoundfrom a physician (Skendzel, JG). Isolating the bicep is the next best method. Resistance to the bicep, or lowering yourself in a reverse grip pull up is also useful information.
It is possible that you have developed some inflammation local to the bicep tendon. Most of the special tests specific to the bicep do not have great statistics. We can make a more accurate diagnosis by considering how you sustained your injury and the movements that provoke your pain.
Could pain at the front of my shoulder be related to something else besides the bicep tendon?
Absolutely. Muscles throughout the shoulder and neck can refer pain to the front of the shoulder. The same way that organs can refer pain to different regions of the body.
Let’s check out 5 muscles that commonly refer pain to the front of the shoulder.
Note From TG: A lacrosse or tennis ball work well for all the drills demonstrated in the video, but my preferred “tool” is the ACUMobility Ball by ACUMobility.com.
Use the coupon code GENTILCORE at checkout for an additional 10% off your purchase.
Deltoid
People often forget that the muscle fibers of the deltoid run over the bicep tendon. When you feel pain while pressing around the bicep tendon it may actually be an irritated deltoid.
Biceps
Another no brainer if you are having pain around the bicep tendon. Overuse of the biceps or a quick force applied to the biceps (eccentric force) can cause trigger points to develop in this muscle. If you notice increased discomfort around the bicep some soft tissue work and a few days off from the “gun show” should help.
Pectorals/Subclavius
The real problem here could be too many chest days and not enough leg days!
Poor resting posture during the day and poor technique with exercise are often the true culprits. Falling into a slumped position on a regular basis can put the pectorals in a shortened position.
This faulty posture can lead to excessive impingement, as well as increased tone and trigger points in the pectoral muscles.
The subclavius runs deep to the pecs. It attaches between the clavicle and the first rib, often referring pain to the front of the shoulder. You can usually address this spot while working on the upper fibers of the pecs.
Scalenes
These muscles run on the front, side and back portion of your neck.
The scalenes are one of the many muscles responsible for moving your neck. If you tend to adopt a forward head posture or a slight tilt of the head to the left or right these muscles may be engaged more often than necessary.
Having a forward head posture means that you are passively hanging on these muscles for support during the day. This can lead to increased tone and trigger points. We also tend to see issues in the scalenes show up following a whiplash injury.
The scalenes are also involved in breathing. If you tend to be an upper chest breather these muscles may be taking a beating. Keep in mind, adopting this breathing style can lead to increased tension in the neck and thorax, as well as feelings of anxiety. After you do some soft tissue work, be sure to be more aware of posture and work on accessing your diaphragm.
Infraspinatus
The infraspinatus in one of the four infamous rotator cuff muscles.
It runs right on top of your shoulder blade.
Dysfunction in this muscle tends to show up regularly with shoulder pain. Trigger points in the infraspinatus are a problem because they alter timing and strength of this muscle (or any muscle). This alters normal mechanics at the shoulder with overhead activities. Often leading to an unstable shoulder with excessive impingement taking place.
We wrote another article in the past that discussed how referred infraspinatus pain also resembles carpal tunnel syndrome. This is not the easiest muscle to treat on your own, but don’t skim over it.
Final Consideration:
In some instances, performing soft tissue work around the shoulder will do the job just fine. This does not mean we can overlook the pieces that may have contributed to this injury in the first place. Your goal is to control what you have the ability to control.
What can you control?
1. You can normalize the tissues surrounding the shoulder.
Treat local trigger points, normalize muscle flexibility and reduce stiffness. The goal is to restore normal shoulder mechanics to the best of your ability. Treating muscle stiffness and trigger points helps optimize the timing and strength of the muscles around the shoulder to enhance stability.
2. You can also modify your activity for the time being.
If a certain activity worsens your pain, back off. It is possible that your shoulder is inflamed and needs some time to recover. This is not a fast pass to weeks off from the gym with your best friend Netflix. This means more attention on soft tissue work and flexibility. You also want to gradually return to exercise. Experiencing some discomfort during exercise is ok.
“Poke the bear, but don’t take it to dinner.”(in reference to pain)
– Adriaan Louw
Interested in a FREE Mobility Program to treat pain at the front of the shoulder? Click here
About the Author
Dr. Michael Infantino is a physical therapist. He works with active military members in the DMV region. You can find more articles by Michael at RehabRenegade.com.
References
Gill HS, El Rassi G, Bahk MS, et al. Physical examination for partial tears of the biceps tendon. Am J Sports Med 2007; 35:1334.
Skendzel JG, Jacobson JA, Carpenter JE, Miller BS. Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol 2011; 197:942.
Stephen M Simons, MD, FACSM, J Bryan Dixon, MD Section, Biceps tendinopathy and tendon rupture
Uptodate.com
Taylor SA, O’Brien SJ. Clinically Relevant Anatomy and Biomechanics of the Proximal Biceps. Clin Sports Med 2016; 35:1.
I’ve had the honor of presenting at two previous iterations of the Motivate & Movement LAB (the brainchild of MFF’s Harold Gibbons) and it’s unequivocally one of the most unique events in the fitness industry.
Think: TED Talk, but with deadlifts and lots of f-bombs.
Anyways, the next LAB is this coming February, and will feature myself, Dan John, Pete Dupuis, my wife (Dr. Lisa Lewis), and several of the MFF coaching staff including Brian Patrick Murphy and Amanda Wheeler.
I had to take a break from The Fitness Summit last year for two reasons:
1. Eating way too many cookies.
2. But mostly because I succeeded in making a baby and my wife would have tossed me so much shade if I was all like “Hey Babe, going to KC for three days. Toodles.”
Well this year I’m back and excited to take part in a Fitness Summit first. Dean Somerset and I will be putting on a Pre-Conference day where we’ll spend a few hours test driving some new material as a follow-up to our Complete Shoulder & Hip Blueprint.
Tentatively titled The More Completer Hip & Shoulder Blueprint.
We’ll be taking deep dive into squat and deadlift technique: discussing ankle, foot, hip and upper extremity considerations in conjunction with regressions/progressions and programming. Whether you’re a coach or just someone who likes to lift heavy things you’ll undoubtedly learn something. And if not, cool, you still get to hang out with us for a few hours.
Registration is now open for returning and new attendees. Come experience one of the best fitness events of the year.
I’ll go a head and say it: I feel this is one of the single most important courses I have ever taken.
If you train women it behooves you to understand the intricacies surrounding this topic: pelvic floor dysfunction, prolapse, incontinence, etc.
Dr. Sarah Duvall covers everything from assessment/screening to corrective exercise (tons of attention to proper breathing mechanics) to training considerations immediately postpartum (1-4 weeks) onward to a year plus.
What’s more, what I truly dig about Sarah’s approach is that she advocates women to eventually “lift shit to fix shit” (my words, not hers). Sooooo, there’s that.
FYI: TODAY (1/26) is the last day to register for this go-round. However you can use the coupon code TONYG at checkout for an additional $50 off your purchase. You know, cause I’m awesome.
Is it supposed to happen? Does it get better? What can you do to lessen the amplitude?
Lance chimes in with some simple advice.
Social Media Shenanigans
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DB presses hurt your shoulders? Maybe try a neutral grip. Squatting hurts your lower back? Maybe brace more or don’t squat so low (to a box). There I just fixed the issue without giving you 147 different “corrective exercises” to try.
If you missed Part I of Dr. Licameli’s guest post, you can check it out HERE. Now, you could read today’s post and get the gist of what was said yesterday, but you run the risk of missing out on some nitty-gritty details.
Kinda like watching Blade Runner 2049.
You could watch it without watching the original, but you’re missing out on some important context.
*** This is the part where’d you know what points 1-4 were all about.
5) Don’t Push Through Pain…Not All The Time, Anyway
There is good pizza and there is bad pizza. There is good pain and there is bad pain. Differentiating the difference is of utmost importance when training the shoulders.
We’re not talking about delayed onset muscle soreness (DOMS), which is felt 1-2 days after training.
We’re talking about pain during training.
What follows are some guidelines to help you navigate your way through pain.
KEEP IN MIND, THESE ARE GENERAL GUIDELINES. IF YOU HAVE PAIN, BE SURE TO SEE A QUALIFIED HEALTHCARE PRACTITIONER!
I stress finding a qualified healthcare practitioner. A qualified healthcare practitioner will explain all of this, in addition to providing several options to keep you training while recovering from injury.
Let’s face it…not all physical therapists have spent much time under a bar. Some have spent time at the bar or even at barre class, but many have no experience or expertise in weight lifting or bodybuilding. You deserve your goals to be taken seriously. You deserve more than things like, “stop squatting for 4 weeks” and standing internal and external rotation with a band to “strengthen” the rotator cuff…or is it rotator cup…no, it’s rotary cuff…rotary club!
That’s it.
Characteristics of good pain:
-How Does It Feel?: Muscle burn; usually symmetrical right to left.
-Onset: Gradually increases as the set progresses.
-When Does It Stop?: At the completion of a set.
Characteristics of bad pain:
-How Does It Feel?: Sharp, numb, tingling; intensity may be asymmetrical right to left.
-Onset: Quickly; may be felt after only the first few reps
-When Does It Stop?: Days, weeks, months…; stays well after the set is completed, however may also end at the completion of a set.
If you find yourself experiencing bad pain, it may not be the end of the world. Bruce Lee also said, “Be like water.”
Water has the flexibility to take the shape of whatever container it is placed in, while still maintaining its identity…water.
In a similar way, our training can be modified without losing its identity or effectiveness. Try to modify your training. Sharp pain when pressing overhead with a barbell? Try a landmine press. Unable to perform a reverse flye? Try a face pull. Keeping the same exercises and modifying training volume may also do the trick.
6) Don’t Overdo It With The Classic “Rehabilitation” And “Injury Prevention” Exercises. There Are Hidden Benefits In Some Classic Movements.
It is no one’s fault but our own that, as a profession, physical therapy has a certain reputation when it comes to injury and injury prevention. The misconception is that in order to reduce pain or prevent injury, a hefty dose of classic “rehabilitation” exercises need to be added into an already packed training regimen.
For me, and many out there like me, gone are the days of separating “therapeutic exercise” from “regular training.” Say goodbye to blocking off a half hour pre and post workout to foam roll and perform straight leg raises and clamshells. If you look closely, you can find what you need for healthy shoulders right there in your existing training routine. Here are some examples:
Face Pull: Trains scapular retraction and external rotation. Great for scapular stability, rotator cuff strengthening, and balancing out internal vs. external rotation.
Farmer Carry/Overhead Carry: Excellent way to train postural, scapular, and global rotator cuff stability, not to mention full body/core strength.
Plank on Ball with Protraction and/or the Ab Wheel: Great way to dynamically train serratus anterior, core stability, and scapular stability.
Plank with Band Around Wrists with Protraction: Great way to train external rotation as well as dynamically train serratus anterior, core stability, and scapular stability
Landmine Press: With proper scapular movement (more on this to come), this is an excellent exercise to dynamically strengthen serratus anterior and improve scapular neuromuscular control.
Pull-up/Pull-down: With proper scapular depression at the initiation of the pull, this is a fantastic exercise to target the lower traps, which play a key role in scapulohumeral mechanics. Full range of motion and a long eccentric will also help lengthen the lats, which can limit shoulder mobility.
Squats/Deadlifts: Train “shoulder packing” position. A proper warm-up prior to these lifts will also include thoracic mobility work.
Seek out experts like Tony Gentilcore (obviously), Andrew Millett, John Rusin, Jeff Cavaliere, Quinn Henoc, Mike Reinold, Mike Robertson, Eric Cressey, Dean Somerset, Zach Long, Joel Seedman, Ryan DeBell, Teddy Willsey, and many more.
But if you have pain, GO SEE A QUALIFIED HEALTHCARE PRACTITIONER FIRST!
7) Symmetry…Don’t Forget External Rotation and Thoracic Mobility
As previously mentioned, weightlifters tend to be very “internal rotation dominant,” and for good reason.
Let’s look at the muscles that internally rotate the shoulder.
Just to name a few: pec major, lats, subscapularis, teres major, front deltoid.
Let’s take a look at the muscles that externally rotate the shoulder: infraspinatus, rear deltoid, teres minor.
The muscles that internally rotate the shoulder are of greater number and greater size (the pecs and lats are two of the strongest muscles of the upper body). The external rotators are less in number and much smaller. Give those external rotators a fighting chance to create some balance! Don’t neglect them!
It’s important to note that just performing an equal amount of presses and rows/pull-downs will not improve shoulder rotation symmetry because, as previously mentioned, both the pecs and the lats internally rotate the shoulder. So even though pull-downs and rows are “back” exercises, they still train the lats and therefore still train internal rotation.
Some of my favorite exercises to train external rotation are face pulls, W raises/pulls, reverse flyes with external rotation bias, wall slides with a band, and planks with a band around the wrists.
Adequate thoracic mobility is crucial to optimal shoulder function. If the scapulae are the foundation of the shoulder, the thoracic spine is the ground on which the foundation is built.
Thoracic mobility should be included in almost every warm-up, regardless of the body part being trained. One of my favorite thoracic mobility exercises is a kneeling protraction sit-back into a lat stretch with deep breathing. Be sure to check out this video of a sample lower body warm-up routine that includes this exercise.
8) Don’t Pin Down The Scapulae
It happens all the time.
An idea comes out and soon gets morphed into an extreme.
“Dynamic stretching may be better than static stretching pre-workout” turns into, “Don’t ever do static stretching because it’s a waste of time.”
“Foam rolling may help improve short-term soft tissue restriction and range of motion” turns into “I have to foam roll for 30 min when I wake up as well as pre workout, post workout, and before bed in order to break up adhesions and prevent injury.”
The idea of “shoulders down and back” seems to have experienced a similar course. Yes, keeping the shoulders in a retracted and depressed position with a properly extended thoracic spine will place the muscles, nerves, and joints in a structurally advantageous position as well as open up the subacromial space by about 30%. It also allows for unrestricted overhead shoulder range of motion.
However, the scapulae must move, and they must move correctly. The scapula is the base and foundation of the shoulder and dysfunction can most certainly lead to injury.
Note From TG: Check out THIS article I wrote a while back touching on the same topic; in this case how it relates to performing a DB Row correctly.
Generally, the scapula remains relatively stationary during the first 30 degrees of shoulder abduction (lifting the arm out to the side as in a lateral raise), with the movement coming primarily from the glenohumeral joint. As abduction continues past 30 degrees, the scapula begins to move and the glenohumeral joint and scapulothoracic joints move in about a 2:1 ratio.
This means that at 120 degrees of abduction, the glenohumeral joint has contributed about 80 degrees and the scapula has contributed about 40 degrees. If the scapula remains pinned “down and back,” range of motion will be restricted and the glenohumeral joint will be forced to overcompensate. This dysfunction will likely limit performance and increase risk of injury.
In addition to upward rotation, the scapula also needs to protract (glide forward) during both overhead and pulling movements. Serratus anterior is one of the main muscles responsible for protraction as well as for adhering the concave surface of the scapula to the convex surface of the ribcage. Pinning the scapulae down and back is not what we need…we need controlled, scapular motion.
I’m Done
If at least one person benefits from these tips, I have done my job. My hope is that you will keep these tips in mind and reap the benefits of strong, healthy shoulders. You’re putting the work in, now let’s capitalize on it.
About the Author
Nicholas M. Licameli
Doctor of Physical Therapy / Pro Natural Bodybuilder
Every single thing he does, Nick believes in giving himself to others in an attempt to make the world a happier, healthier, and more loving place. He wants to give people the power to change their lives. Bodybuilding and physical therapy serve as ways to carry out that cause. Nick graduated summa cum laude from Ramapo College of New Jersey with his bachelor’s degree in biology, furthered his education by completing his doctoral degree in physical therapy from Rutgers School of Biomedical and Health Sciences (previously the University of Medicine and Dentistry of New Jersey) at the age of 24, and has earned professional status in natural bodybuilding. His knowledge of sport and exercise biomechanics, movement quality, and the practical application of research combined with personal experience in bodybuilding and nutrition allows him to help people in truly unique ways. Love. Passion. Respect. Humility. Never an expert. Always a student. Love your journey.
The shoulders (delts) are an area that many trainees wish were bigger. They’re also an area that’s often injured. In today’s guest post by Dr. Nicholas Licameli he discusses and breaks down some of his top training tips for shoulder health and hypertrophy.
In order to build a quality and symmetrical physique, all muscle groups must be trained and developed equally. An overdeveloped muscle group can never compensate for an underdeveloped one. That being said, a well-developed set of shoulders, along with a narrow waist, can really enhance a physique and create a nice V-taper.
While the shoulders are one of the most sought after muscles to develop, they also tend to be one of the most stubborn and most commonly injured. Here are my top shoulder training tips to help you on the journey to strong, healthy shoulders.
1) Listen To Your Body
Early in my training career, I remember feeling as if there were some aspects of my training that could not be changed. Compound lifts had to be performed using a barbell only and with heavy, lower rep sets. Dumbbells and lighter/higher rep training were for isolation movements.
For years, I trained in the 6-10 rep range for barbell overhead presses and in the 12-20 rep range for lateral raises, rear deltoid work, and other isolation movements. I never really felt “satisfied” or that “good” fatigue after completing heavy sets of overhead presses.
I eventually took the leap out of my comfort zone and started using dumbbells and a landmine set up for overhead pressing.
What a difference!
I felt a connection to my deltoids like never before. The overhead press soon went from one of my least favorite movements to one of my favorites.
I also started to realize that my lighter warm up sets seemed to feel better (even when not taken anywhere near failure) than my heavier working sets. I took another leap and started training the overhead press in the 12-20 rep range and again, I was blown away at how my body responded. Does this mean I completely removed heavy overhead pressing from my training?
Of course not, but I am definitely not afraid of lighter training.
The take home message here is listen to your body.
If heavy barbell training doesn’t quite “click” for your shoulders, don’t be afraid to change it up.
We now know that if hypertrophy is your goal, overall volume (volume = weight lifted x sets x reps) and progressive overload at an appropriate intensity is what matters.
Note From TG: Technically speaking, for muscular hypertrophy three factors take precedence: Mechanical Tension, Metabolic Stress, and Muscle Damage.
Hypertrophy can be seen by training with heavy weight and low reps as well as light weight and higher reps. Keep in mind that if your goal is strictly to increase strength on the barbell overhead press, you’re going to have to train the barbell overhead press with heavy loads, as specificity is much more important when it comes to strength.
2) Obey Your Anatomy: The Upright Row and Lateral Raise
The upright row seems to have more controversy surrounding it than Donald Trump administering a flu vaccine to a gluten-free, ketogenic, vegan, transgender circus elephant in captivity while drinking creatine sweetened with aspartame.
Is the traditional “muscle magazine” upright row the safest or most effective exercise to build big, strong, and healthy shoulders?
Probably not.
Can it be modified?
Absolutely.
By nature of the movement, the barbell upright row places the shoulder in resisted internal rotation with elevation. This is a less than optimal and, dare I say, vulnerable position because it narrows the subacromial space, which can increase risk of injury.
Does that mean our shoulders will break on the first rep?
No.
Our bodies are resilient and can handle less than optimal positions, but why risk it if we can find a better way? Need a refresher on what the sub-acromial space is and how narrowing it can lead to injury? Check out Tony’s awesome article right here.
Great alternatives to the barbell upright row are the dumbbell upright row and the face pull.
Face Pull
As mentioned above, the barbell upright row puts us into internal rotation, which narrows the sub-acromial space.
External rotation, however, can be a shoulder’s best friend.
The dumbbell upright row frees up our joints and allows us to externally rotate throughout the movement. The face pull reduces the amount of internal rotation at the bottom of the movement and increases the amount of external rotation at the end of the movement.
Many training routines tend to be abundant in internal rotator strengthening (pecs, lats, etc.) while lacking strengthening for the external rotators (posterior rotator cuff, rear deltoids, etc). Both the dumbbell upright row and face pull involve resisted external rotation, which means they can help balance out a traditional training routine (more on this to come).
Note From TG: Speaking of Face Pulls I am reminded of THIS classic T-Nation.com article by Mike Robertson and Bill Hartman on the topic.
The lateral raise is a staple in most shoulder training routines, however if done incorrectly, can be very similar to the barbell upright row.
By internally rotating at the top of a lateral raise, as if pouring a pitcher of water, the shoulder gets placed into resisted internal rotation with elevation, which we now know is not that great of a position.
Why is that a common cue (even Arnold recommends it!)? Because in order to maximally target the middle deltoid, it needs to be directly in line with the force of gravity and the “pouring-the-pitcher” position accomplishes this.
Middle deltoid is directly in line with the force of gravity (good!), however the shoulder is in internal rotation and elevation (bad!)
Anterior deltoid is directly in line with the force of gravity
Bending forward or lying face down in a bench targets the posterior deltoid because it is directly in line with the force of gravity.
Posterior deltoid is directly in line with the force of gravity
So how do we reduce our risk of injury while still maximizing the force through the middle deltoid?
Simple.
Hinge at our hips and lean forward, just a bit.
The line of gravity has now changed. We’re now able to externally rotate (reversing the pitcher pouring motion) while still placing the middle deltoid in perfect alignment with gravity.
Middle deltoid is directly in line with the force of gravity (good!) AND the shoulder is in external rotation (good!)
For a video demonstration and explanation of this, go HERE.
3) Don’t Overdo It…Pay Attention to Volume
When looking at weekly shoulder volume, don’t forget to account for all of the exercises that involve the shoulders as secondary movers.
Shoulder presses, lateral raises, and reverse flyes are not the only exercises that add to weekly shoulder volume.
The shoulders get worked during exercises like bench presses, rows, dips, and even pull-ups and pull-downs. If you have a volume goal you are trying to hit, be sure to keep this in mind to avoid overtraining and overuse injuries. Remember, more is not better…better is better.
4) Don’t Try To Get Too Creative Just For The Sake Of Novelty
Bruce Lee said,
“I fear not the man who practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.”
Too much variety for the sake of novelty can limit your ability to progress, especially when it comes to shoulder training.
In general, the basic variations of shoulder movements are presses, lateral raises, extension-based movements (face pulls, reverse flyes, etc.), and global stability movements (farmer carries, planks, bird dogs, etc.).
My suggestion would be to find your preferred variations of those movements and perfect, fine tune, overload, and progress them. Yes, change it up every once in a while, but don’t swap out a solid landmine press for a banded, blood flow restricted, single-arm kettlebell press while standing on a BOSU over a pool of sharks with laser beams attached to their heads.
Stay tuned for Part II tomorrow where I offer four more of my top shoulder training tips.
About the Author
Nicholas M. Licameli
Doctor of Physical Therapy / Pro Natural Bodybuilder
Every single thing he does, Nick believes in giving himself to others in an attempt to make the world a happier, healthier, and more loving place. He wants to give people the power to change their lives. Bodybuilding and physical therapy serve as ways to carry out that cause. Nick graduated summa cum laude from Ramapo College of New Jersey with his bachelor’s degree in biology, furthered his education by completing his doctoral degree in physical therapy from Rutgers School of Biomedical and Health Sciences (previously the University of Medicine and Dentistry of New Jersey) at the age of 24, and has earned professional status in natural bodybuilding. His knowledge of sport and exercise biomechanics, movement quality, and the practical application of research combined with personal experience in bodybuilding and nutrition allows him to help people in truly unique ways. Love. Passion. Respect. Humility. Never an expert. Always a student. Love your journey.
I’ve had the honor of presenting at two previous iterations of the Motivate & Movement LAB (the brainchild of MFF’s Harold Gibbons) and it’s unequivocally one of the most unique events in the fitness industry.
Think: TED Talk, but with deadlifts and lots of f-bombs.
Anyways, the next LAB is this coming February, and will feature myself, Dan John, Pete Dupuis, my wife (Dr. Lisa Lewis), and several of the MFF coaching staff including Brian Patrick Murphy and Amanda Wheeler.
2) Appearance on the All About Fitness Podcast
Host Pete McCall does a superb job with this podcast and keeps things light and entertaining.
In this episode I discuss my journey towards my 600 lb deadlift.
You can go HERE (Episode 85) or HERE (Episode 85) via iTunes.
I’ll go a head and say it: I feel this is one of the single most important courses I have ever taken.
If you train women it behooves you to understand the intricacies surrounding this topic: pelvic floor dysfunction, prolapse, incontinence, etc.
Dr. Sarah Duvall covers everything from assessment/screening to corrective exercise (tons of attention to proper breathing mechanics) to training considerations immediately postpartum (1-4 weeks) onward to a year plus.
What’s more, what I truly dig about Sarah’s approach is that she advocates women to eventually “lift shit to fix shit” (my words, not hers). Sooooo, there’s that.
FYI: Use the coupon code TONYG at checkout for an additional $50 off your purchase.2
Per the usual Mike takes a rather complicated topic and dumbs it down for us peons. I REALLY liked his breakdown on the differences in adaptations between aerobic training and anaerobic, and how it’s the former (aerobic) that will likely help with better progress in the weight-room.
The deep squat screen can tell you a lot about a person. It can tell you his or her’s ability to achieve adequate ankle dorsiflexion, as well as much hip mobility, thoracic extension, and shoulder flexion they have.
About the only thing is doesn’t tell you is their favorite installment in the Fast & Furious franchise.
But what does the deep squat really tell us? Travis sheds some light.
Very comprehensive article that covers a litany of popular recovery strategies:
– Those that work well
– Those about which science is uncertain
– Those that don’t seem to work as planned or much at all.
Social Media Shenanigans
Twitter
Be sure to “finish” your push-ups. Scaps shouldn’t be retracted, touching, or making out at the top. Think about pushing away so they move around rib cage (protract) on each rep.
A lot of articles and information directed towards postpartum women cover the initial weeks and months after giving birth. That’s awesome. But what about one year after? Five years?
PCES is an outstanding course, and one I’m currently going through now. It’s only being offered for another week, with a special offer for TG.com readers below.
Are there any special considerations for training a woman that is over a year postpartum?
For this question we need to ask ourselves, “does the postpartum period end at an arbitrary time?”
In some cases, yes.
Time does have a positive impact and in other cases, no. So, let’s take a look at when time matters and when it doesn’t.
In the early stages postpartum women are still dealing with excessive ligament laxity that was needed to help get the baby out. Most women notice a decrease in the laxity by 4-6 months postpartum but for those that continue to breastfeed, the laxity can continue well over a year.
This matters because laxity creates instability and increases vulnerability to injury, especially in the pelvic floor.
So, being further along postpartum is a real win for not having to worry about the extra ligament laxity.
Most of the stories I hear from patients about post-delivery prolapse development happen in this one-year window. There is still a chance of women getting prolapse outside this time frame, but thankfully, the chances go down with the recovery time.
Why does this matter?
Women should take it slow getting back into impact exercise that could place an unnecessary strain on the pelvic floor while it’s still healing. (This goes for C-Section ladies as well!)
Incontinence or leaking during exercise is another one of those pesky issues that a significant number of women complain about and we often associate with having a baby. A survey taken among women that experience leaking showed that women with no leaking three months after delivery had a 30% chance of experiencing leaking twelve years later.
This is a significant number!
Now we’re talking about a woman who decides to get in shape and head to the gym and all of a sudden she is experiencing this pelvic floor issue she never had before.
Why does this happen?
I think it’s a breakdown of the system. An accumulative effect, if you will.
When proper steps aren’t taken postpartum to ensure complete pelvic floor recovery, our system can form compensations. Sometimes these compensations can take years to show up. Much like many preventable chronic injuries throughout the body.
The same thing can happen with the core. If 100% of women that go into delivery have a diastasis, then checking for it should be a routine part of any initial visit. Pregnancy pushes women into poor movement patterns.
The large amount of weight in the front causes a posterior weight shift and lengthened abdominals.
Because of this weight shift, women will often end up with tight paraspinals and a hinge point at the T12-L1 junction. This can cause back pain and tightness as well as perpetuating a poor breathing system that prevents complete core recovery.
Along with this weight shift, the baby itself pushes up on the diaphragm continuing to shut down deep breathing. Proper breathing is the foundation for core and pelvic floor recovery.
These postural compensations can stay with women for the rest of their lives unless someone gives them the right corrective exercises to break these patterns. Checking for a diastasis and asking key questions about pelvic floor health should be high on the priority list for a woman at any stage postpartum.
Check out this video for a couple key posture tips that help promote diastasis healing.
Bottom line, once a woman is postpartum she is always postpartum.
Being pregnant increases her risk of pelvic floor issues, diastasis and postural changes.
These risks are not limited to the first year or even the first five years postpartum. These are issues that affect many women for the rest of their lives. The good thing is that with a little knowledge we can do something about it. These women can have hope for healing at any stage in life.
I’m not going to beat around the bush, if you’re a fitness professional you should considering taking this course.
It will undoubtedly make you a better coach and better prepare you for the delicate nature of working with women postpartum (which, as Sarah noted, never really ends).
I’ve trained several women through their pregnancies and have obviously trained hundreds after the fact. I thought I knew what I was doing, and I’ve done okay.
I guess.
This course has helped me immensely and has really shed a spotlight on some coaching/information gaps on my end. I can’t recommend it enough.
Sarah only offers it a handful of times per year and she’s been kind enough to extend it for another week so my readers can take advantage. What’s more, if you use the coupon code TONYG at checkout you’ll get an additional $50 off your order.3
A wife, mom and adventure sports athlete, Sarah is a women’s fitness specialist that takes functional training to a whole new level. In her unique approach to treating patients, she believes in teaching. Fully understanding every aspect of the body is a necessity to complete healing. She integrates functional movement with cutting-edge exercises to bring you results-driven programs for postpartum recovery, with an emphasis on the pelvic floor and abdominals. When she is not hanging off the side of a mountain, Sarah enjoys writing and presenting athttp://www.CoreExerciseSolutions.comand figuring out how her patients can continue to pursue their dreams and lead a strong, adventurous life.
References
Viktrup L, Rortveit G. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol. 2006 Aug;108(2):248-54.
I’ll be the first to admit my brain is a little lackluster. It doesn’t work in the same fashion as other coaches like, say, Ben Bruno, BJ Gaddour, or Meghan Callaway.
I’m often dumbfounded by all the practical (and inventive) ways they’re able to put their own spin on certain exercises and/or methodologies. I’ll watch a video or read an article and immediately think to myself “Well, I guess I’m an idiot for never thinking of that.”
Now, granted, giving credit where it’s due, when it comes to movie quotes or 90’s hip-hop trivia I’d be able to hang with the best of them:
What was director Paul Thomas Anderson’s second feature film and is generally considered Mark Wahlburg’s breakthrough role?4
What two albums were released on November 9, 1993 and are both considered hip-hop classics? ADDENDUM: These same albums were also the one’s I listened to most as a teenager in my bedroom, alone, not hanging out with chicks, ever. 5
But since we’re currently not hanging out in a bar playing Stump Trivia or on the set of what would arguably be the greatest game show of all-time, lets just chalk things up to me being an exercise comer-upper buffoon.
In today’s iteration of Exercises You Should Be Doing I want to share a row variation I’ve been using a lot with my clients of late and one I think you’ll enjoy as well.
In reality I think what ended up happening was Jessica was like “hey, I’ve been using these lately and really like them. What do you think?”
So, here’s what I think:
1. They’re a superb upper back/lat exercise. I’ve always liked “deadstart” or “deadstop” variations because:
They help to “standardize” the exercise: Everyone has to start and stop at a given point.
I like the subtle “reach” involved with the bottom portion of the lift. This helps aide better scapular mechanics/movement (shoulder blades moving around the rib cage and not stuck in place glued together the entire time).
The fact one KB stays “anchored” on the floor at all times helps to keep people a little more honest and prevent too much body-english from coming into play.
2. The set-up very much mimics the deadlift. To that end I think this is a great accessory movement for anyone A) has a weak upper back and B) has trouble with too much rounding of the upper back during their deadlift.
Key Coaching Cues: I like to tell people to “find their hamstrings” upon the initial setup. As they bend over to grab the kettlebells on the floor, they should be situated in way where they feel a lot of tension in their hamstrings.
From there they’ll “row” the kettlebell up making sure their elbow doesn’t go past the midline of their body (avoid excessive glenohumeral extension) in addition to trying to maintain a 45(ish) degree torso angle throughout the duration of the set.
In short: try to limit torso rotation or creeping up as the set progresses.
I’ve had the honor of presenting at two previous iterations of the Motivate & Movement LAB (the brainchild of MFF’s Harold Gibbons) and it’s unequivocally one of the most unique events in the fitness industry.
Think: TED Talk, but with deadlifts and lots of f-bombs.
Anyways, the next LAB is this coming February, and will feature myself, Dan John, Pete Dupuis, my wife (Dr. Lisa Lewis), and several of the MFF coaching staff including Brian Patrick Murphy and Amanda Wheeler.
Things like hypermobility (which tends to be more prevalent in females) and high-heels come into play when discussing the mobility needs of women.
Some awesome stuff in here from Trish.
Today’s Edge: Strengthen Your Adductors Part I and II – Tim DiFrancesco
I appreciate Tim’s insights and contributions to the strength & conditioning community. My brain does not work like his. He’s always thinking outside the box and coming up with stellar content.
If you’re not already, you should be checking out his website and social media accounts. He’s routinely providing short, bite-sized gems.
HERE’s Part I of Strengthen Your Adductors; and HERE’s Part II
Social Media Shenanigans
Twitter
I’ve got an influx of clients extolling the virtues of detoxes and cleanses. Alas, it’s that time of year. I just tell them their money is better spent tossing it into a live volcano.
I’m a member of a local neighborhood bank here in Boston. I joined a year ago when I finally grew tired of all the shady hidden fees my previous bank was hammering me with – maintenance fees, minimal balance fees, checking fees, etc.
It’s been a lovely experience and I appreciate the more personalized approach my current bank provides. In particular I appreciate Nelson, the gentleman responsible for helping to set up all my business accounts.
Every time I walk in he greets me by name, asks how business is going, and it’s not uncommon for us to detour into some movie small talk.6
Also, since he’s the one who manages my business accounts, Nelson also knows what I do for a living and he’ll often ask me for some fitness advice…like he did today when he asked my opinion on what’s better for weight loss: cardio or lifting weights?
Now, normally when I’m out in public and stranger or even casual acquaintance asks me that question one of two things happens:
I immediately fall to the ground and feign an epileptic seizure.
The theme music from Jaws reverberates in my inner dialogue.
It’s such a murky and convoluted question with so many variables to consider that there’s no one definitive way to answer. What’s more, if I were to be honest, my answer is usually not what most people want to hear and all I get in return are a bunch of “mmm’hmms” and “uh-huhs” peppered with a few “so, that’s great and all , but what I read on the internet was…….”
I’d rather swallow live bees.
However, in Nelson’s case it’s the least I can do. He’s helped me out a ton in the last year, and, I’m not a dick.
So, of course I’m going to answer to the best of my ability and hopefully point him (and you, dear reader) in the right direction.
Losing Weight 101
At the most basic level, losing weight comes down to one umbrella theme: eliciting a caloric deficit via taking in less calories than you burn7. I often tell clients of mine that this can be as simple as not inhaling that bowl of Fruity Pebbles on a nightly basis…….
……one’s nutrition and being dialed-in with calories in vs. calories out always has been and always will be the main obstacle to consider/tackle with regards to weight loss.
But too, eliciting a caloric deficit can also be achieved via consistent exercise whether it’s by taking a spin class or by lifting heavy things.
Which is more effective or optimal, however?
Well, that depends.
BOTH work and I often reiterate to people that the answer is not to perform one in lieu of the other. In fact, I encourage everyone to implement both strategies if they have the time and means to do so.
I understand why the bulk of people tend to gravitate towards the cardio end of the spectrum.
Hopping on a spin bike or lacing up a pair of sneakers for a jog tends to be more “user friendly.”8
Cardiovascular’centric endeavors tend not to require a gym membership.
They can also be performed anywhere.
What’s more, one main reason why I feel a lot of people shun lifting weights – outside of not knowing really where to start – is that they see a picture like this…..
Or this…..
And proceed to destroy the back of their pants.
They see pictures of advanced, highly-trained individuals performing seemingly unfathomable feats of strength and think to themselves “that’s a whole lotta nope right there.”
[I’m not going to get into the “will lifting weights make me bulky” argument right now. For starters, “no, it won’t.” But mostly doing so will just make me want to throw my face into a brick wall repeatedly.
The other, more germane reason (I think) why many shun weight-training is, hate to break it to you, sheer ignorance.
I’m Biased – But Here’s Why I Think Weight Training Works Well And Should Often Take Priority
I try to limit the number of blank stares I receive when trying to explain why weight training is important for weight (fat) loss.
Here’s my go-to elevator pitch:
NOTE: Yes, I understand there are many nuances to consider when breaking down the topic. This is a blog post, not a dissertation.
“Comparing minute-to-minute…accounting for intensity, cardio will almost always burn more calories compared to lifting weights – I’d say somewhere in the range of 2-3x more. However, it’s what your body is doing afterwards, when you’re sitting at home binging Stranger Things on Netflix or playing Magic the Gathering (<— can we hang out?), that’s the difference maker. When you hop off the elliptical machine you’re pretty much done burning calories. However, when you lift weights, in the hours after9, you’re not done. It goes by several names – Thermal Effect of Exercise, Afterburn Effect, being a brick fucking shit-house – but when you lift weights, you’re burning calories looooong after you’re done.”
You can also think of it this way:
Again accounting for intensity, lifting weights, for all intents and purposes, breaks down muscle to a (much) larger degree compared to cardio. It takes energy to build that muscle back up. This requires more energy from the body. This is what’s often used to best explain the AfterBurn Effect mentioned above.
Muscle is more metabolically “active” tissue compared to fat. The more muscle you have, the more calories you burn at rest.
Cardio doesn’t build (that much) muscle. You lose weight, but then you just end up looking like a smaller, weaker version of your original self. Sad face.
At the end of the day, though, it does come down to personal preference and what people are actually going to do.
If someone really hates lifting weights or just really likes doing cardio…I’m going to encourage them to stick with whatever modality allows them to remain the most consistent.
But Here’s My Final Say
#1. Don’t eat like an asshole
After that….do both (cardio & lifting weights).
I’ll tell people they should prioritize 2-4x per week of weight training and use their cardio to either compliment those days or serve as ancillary “bonus” days to get some exercise in.
I just feel the benefits of adding strength and muscle to the mix far out-weighs any misconceptions that may exist (and will only help to expedite the process).
As far as how to lift weights or where to start? A great option would be to read The New Rules of Lifting by Lou Schuler and Alwyn Cosgrove (HERE’s the version for men, and HERE’s the version for women) or maybe check out my CORE Online service.
Dr. Michael Infantino is a physical therapist. He works with active military members in the DMV region. You can find more articles by Michael at 
Nicholas M. Licameli
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A wife, mom and adventure sports athlete, Sarah is a women’s fitness specialist that takes functional training to a whole new level. In her unique approach to treating patients, she believes in teaching. Fully understanding every aspect of the body is a necessity to complete healing. She integrates functional movement with cutting-edge exercises to bring you results-driven programs for postpartum recovery, with an emphasis on the pelvic floor and abdominals. When she is not hanging off the side of a mountain, Sarah enjoys writing and presenting at
