February 26th, 2010

Robertson Training Systems Newsletter 6.06

Shoulder Solutions, Part I

In Part I of our Shoulder Solutions newsletter, we’re going to discuss some of my general thoughts on training clients with dodgy or beat-up shoulders.

It may be helpful to re-visit my previous newsletter on Low Back Pain as well as many of the same principles apply here as well.

#1 – Do No Harm!

I shouldn’t have to say this, but I’ll do it anyway.

If someone is injured and comes to you for training, the last thing you should be doing as a trainer or coach is making it worse.

When a client comes in who is beyond your scope of practice, feel free to refer out to a health care professional.  When your place a premium on the health and well-being of your clients, they’ll be yours for a life time.

Here are a few things that I will do initially to “play it safe.”

Decrease pressing volume.

I know, I know – everyone wants a bigger bench press.  But if your goal is to keep your clients healthy, reducing pressing volume is a great way to get them back on the road to health.

The exception to this rule is push-up variations.  Push-ups are a closed chain exercise, which makes them very effective and strengthening the stabilizing musculature surrouding the shoulder.

Along those same lines, they strengthen the serratus anterior, a key muscle which not only improves scapular stability, but scapular upward rotation as well.

(For more info on this topic, be sure to check out Bill and I’s article Push-Ups, Face Pulls and Shrugs.)

Increase pulling volume.

If reducing pressing volume is step one, increase pulling volume is step two.

I can’t tell you how many clients come to me with horrible posture, much of which is training related.  They’ve bench pressed every Monday, Wednesday and Friday for years, without anywhere near that volume being devoted to their upper back strength.

In this case, a lot of my shoulder focused clients’ training programs will look like a bodybuilders “back day.”  We’re going to put a heavy premium on developing strength in their upper back, and therefore restoring structural balance to the surrounding muscles and joints.

In this case, we’ll incorporate horizontall pulling, vertical pulling, as well as “cominbation” exercises (i.e. face pulls) into the equation.  It’s imperative that we focus on the actual motion that should be occuring at the scapulae as well.

In horizontal pulling variations, we should think about pulling BACK, or retracting the scapulae.

In vertical pulling variations, we should think about squeezing the scapulae DOWN, or depressing the scapulae.

Too often, we get focused on the weight versus the movement quality.  There’s a time and a place for heavy weights, but if your goal is to get your body healthy, now isn’t it!

Train the stabilizers!

It’s not sexy, but all those little exercises like I’s, T’s, and Y’s, internal/external rotations, etc. can go a long way to improving shoulder health and function.

When we assess clients at IFAST, we take them through a thorough assessment of all these muscle groups.  What we tend to find are people with great “show” muscle strength (pecs, lats, etc.) but horrible stability when it comes to the little guys.

If your goal is to make the big guys as strong as possible, you have to keep the little guys up to the task at hand.

#2 – Individualize the program

When dealing with any injured (or previously injured) client, you have to understand where the dysfunction lies.  This is where I could ramble on incessantly about how important your initial assessment is, but I figure that’s preaching to the choir here.

When evaluating your client, ask yourself the following:

  • Do they need more mobility?
  • More stability?
  • Or a combination of the two?

Often, we’ll find that our clients need more mobility at the thoracic spine and gleno-humeral joint.

Your thoracic spine is the starting point for your upper extremity kinetic chain.  If you have horrible t-spine alignment (such as a large kyphosis or slumped shoulders), your scapulae will never be in the appropriate position.

Commit this to memory:  Optimizing thoracic spine position is critical if your goal is long-term shoulder, elbow and wrist health.

Without addressing the thoracic spine, we’re fighting a losing battle with all the other stuff we talk about.  Will it help to some degree?  Sure.  But we’ll never optimize things without first optimizing t-spine alignment.

We’ll also see issues with regards to gleno-humeral joint range of motion as well.  Most clients should exhibit 180 degrees of total rotation – you’ll typically see more external rotation on the dominant limb (especially if you learned how to throw a football, baseball or softball growing up), and more internal rotation on the non-dominant limb.

Shoulder rotation is both client- and athlete-specific, however.  If you work with overhead athletes, chances are they’ll have more external rotation than normal, while having less internal rotation than normal.  The goal is to keep them close to that 180 degree mark, and always keep tabs on their shoulder internal rotation (especially post game/practice).

(Note: If you’re an overhead athlete and want more information on this topic, be sure to check out the work of Eric Cressey, Bill Hartman, and Mike Reinold.  They are all fantastic in this regard).

We can’t forget about the scapulae, though.  The scapulae are interesting – we know that if we lack scapular stability, we’re much more likely to have rotator cuff and gleno-humeral joint issues.

But, the scapulae also requires a certain degree of mobility as well.  We need upward rotation mobility to get our arms overhead, so for most of us, we want to keep that up to snuff!

All this was considered when Bill and I created Inside-Out, and later when Bill, Eric and I created Assess and Correct.  The Inside-Out approach is a foundational piece of our philosophy- don’t just look at site of pain, look up the kinetic chain for dysfunction

Often, you’ll find that a shoulder, wrist, or elbow injury is often the result of issues at the scapulae or thoracic spine.  Without optimizing function up the kinetic chain, we’re fighting a losing battle.

That’s it for Part I.  In Part II, we’ll discuss some specific training strategies I use to regain and improve lost function at the shoulder.

Stay strong



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