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3 Keys to Restoring Shoulder Function

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Y ExerciseEach day I treat many shoulder and elbow injuries in all types of athletes. Whether it’s a Crossfit athlete, a professional baseball pitcher, or just someone looking to improve their overall shoulder function, I often see many overlapping similarities.

No matter the situation, the key is to restore their functional range of motion and strength through a well-designed program targeting the implicated tissues.

Each case presents a new challenge for me but there are definitely many overlapping issues that I see on a regular basis. Typically, if we can address these and introduce an evidence-based exercise program, then the athlete can quickly return to their sport at the same, if not higher level.

Common Issues We See

I wrote about Restoring Shoulder Soft Tissue Mobility In Baseball Pitchers on some of the ways I use manual therapy to help restore shoulder soft tissue mobility. Mike and I also published a study on Changes in shoulder and elbow passive range of motion after pitching in professional baseball players  showing the acute effects of throwing on shoulder motion. We know these acute changes need to be addressed to restore normal movements and allow the athlete to perform as needed.

Knowing this, I always insist on empowering the client to do most of their exercises at home with the goal of having complete control.

3 Keys to Restoring Shoulder Function

If I had to target 3 key areas to improve a client’s overhead function, it would definitely be:

  1. Thoracic spine mobility
  2. Shoulder soft tissue mobility
  3. Rotator cuff and scapula strength

 

Thoracic Mobility

Foam RollMost people lack adequate thoracic mobility and have to compensate with lumbar spine extension or push their shoulder into a position that may be symptomatic.

By improving thoracic mobility, we can potentially take stress off of the lumbar spine and shoulder joint. This can also help to restore improved scapula position, as the scapular is highly influenced by the thoracic spine.

Someone with a more flexed thoracic spine will have excessive scapular protraction and anterior tilt. This often leads to a decrease in the joint space where the rotator cuff tendon sits and can potentially lead to issues of pain or dysfunction if not addressed.

Shoulder Soft Tissue Mobility

Lax Ball Post CuffWe briefly talked about the importance of maintaining good shoulder motion and the issues we often see in our athletes. There are specific movements, that we use daily, to help the client regain or maintain their motion.

The soft tissue restrictions, if not treated on a regular basis, can lead to adaptive changes that may put the shoulder in a disadvantageous position. Often times, we can address these issues with some simple drills which can help restore or improve the athlete’s range of motion.

Cuff and Scapula Strength Exercises

Shoulder ROMAnd finally, we definitely would be remiss if we didn’t address any strengthening activities for our clients. It’s easy to work on shoulder and thoracic mobility but all may be lost if we don’t attempt to lock in these gains with a good rotator cuff and scapula stabilization program.

We often see that our clients have been working on the bigger, sexier muscle groups but ignoring the smaller, stabilizing muscles. Remember, you’re only as strong as your base of support so we’ll maintain that your rotator cuff and scapular stabilizers are as important.

Download Our Home Exercise Program

Combining the 3 key factors above can often unlock lost potential and allow the athlete to return to their sport at a higher level. Careful consideration to improve thoracic spine mobility, shoulder soft tissue mobility and rotator cuff/scapula strength will lead to improved shoulder function.

Click below to download an example of a home program we often use for people with these needs:

 

 

Pad the Shoulder

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I was talking with one of our athlete’s fathers the other day discussing his son’s health and performance. We were talking about the usual weight gain for adolescent athletes and then began talking about shoulder health. In talking we stumbled onto a term or phrase that I have heard before and admit to using when I was younger. Tying into our weight gain conversation, “padding the shoulder” came up. Paraphrasing “we want to pad his shoulder in order to avoid injury.” Like I mentioned, I remember using that term in high school and its still out there today.

 

What does “pad the shoulder” mean?

The definition that you would hear from most people would be along the lines of: to add weight or muscle around your shoulder so that it’s able to withstand more stress placed upon it during play. Or adding muscle around the shoulder so it can act like a cushion in helping take the beating from pitching and throwing.

My translation of that definition would be to increase the size of your deltoid muscle and muscles in close proximity in an effort to almost encase the shoulder joint to keep it safe.

Now lets clarify and debunk this statement. Injuries that occur at the shoulder, rotator cuff injuries, impingement, or labral tears, happen within the glenohumeral joint (shoulder) or result from dysfunction at the joint. That means that we could lock our shoulders in a bulletproof safe, yet that does nothing for keeping your shoulder joint healthy. The term padding the shoulder with muscle and weight around the joint doesn’t do anything for us when referring to the muscles you can see – the deltoid. Sure adding strength and muscle can be good, but it carries no merit without addressing mechanics at the glenohumeral joint.

Think of it as if you put layers of steal and concrete around your car so that you could drive as fast as you wanted and if you hit anything you will be fine. Sure the car will be fine, but if you aren’t strapped in, as soon as you hit something, your body is going through the windshield or going flying in any other direction inside that car. The “padding” is the steal and concrete. The person driving the car represents your humeral head and the interior of the car represents the glenoid (shoulder socket) and surrounding tissue structures.

How Your Shoulder Joint Functions

One of the main functions of the rotator cuff that is often overlooked is its ability to keep the humeral head centered inside of the glenoid. When muscles are unbalanced, the humeral head at rest can be out of alignment. Which is going to lead to some issues.

All over our body at different joints we present with what are called force couples. A force couple is the relationship between 2 or more muscles acting on the same joint. Your muscles each have actions and lines of pull. A muscles line of pull refers to the direction of its fibers and how it exerts force on its attachment site. A muscle action is the movement, function or how it stabilizes a surrounding joint.

Sticking with the shoulder joint, surrounding muscles have jobs to pull in one direction while other muscles at the same joint are meant to pull in an opposite direction. When certain force couples are unbalanced, where one muscle isn’t contributing the right amount of pull, we again start to have issues. The shoulder becomes so complicated because the scapula has 17 different muscles that attach there. All 17 have their jobs to pull on the scapula in different directions.

Pad the Shoulder

Lets look at one force couple, the rotator cuff and deltoid. Remember, the deltoid is our “pad” in our example phrase. One of the actions of the deltoid is to flex the humerus, or lift your arm over your head. We can say that the deltoid works to elevate the humerus. One of the actions of the 4 rotator cuff muscles works to depress the humerus. The deltoid is a much bigger and stronger muscle than the rotator cuff muscles. With a weak rotator cuff, the deltoid can easily win this force battle and begin to elevate the humeral head too far.

When we have humeral head elevation, we are now talking about an impingement syndrome. You now run the risk of that humeral head rubbing up against your supraspinatus tendon, superior labrum, bursa, and the long head of the biceps tendon. There are quite a few soft tissue, tendons, and bursa that all share space above where you humerus sits to make up your shoulder joint. Having a misaligned humeral head can also play a role in the function of the glenohumeral ligaments, which work to create anterior stability in the joint.

Baseball players and specifically pitchers need a tremendous amount of anterior shoulder stability. Due to the extreme forces present in throwing a baseball, the anterior portion of the shoulder joint is tested. If we put all this “padding” on our shoulder, we would be continuing to feed into this problem of impingement no matter how strong our rotator cuffs are.

The moral of the story is that its not about just adding bulk around your shoulder. It’s about having proper rotator cuff strength and function as well as proper mechanics in sport.  Rotator cuff strength is the key.

If we want to pad something to protect the shoulder, do it in the lower body. The lower body is responsible for generating strength and power to your arm. We want our much larger and stronger muscles in our lower body to take the load off of the shoulder. With a weak lower half and core, we put the arm and shoulder on overtime to create all the force needed to throw or hit a baseball. But that’s a whole other topic.

Am I saying not to do any deltoid work? Yes and no.

We do posterior deltoid work with our baseball players at Champion. That’s used in conjuncture with direct rotator cuff work or in an effort to pull certain athletes out a rounded shoulder position. With upper body pressing exercises, the anterior deltoid is firing as well. Dumbbell Y’s and T’s are options but notice how there is no overhead pressing or any other meaty deltoid exercises. We aren’t talking bodybuilding, this is baseball.

This of course is just one example and a look at one aspect of obtaining optimal shoulder health, and working to clarify a misconception that’s still out there.

Keep those cuffs strong and if you are going to “pad” up anything, make it your legs.

 

 

3 Ways to Improve Your Overhead Position

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improve your overhead positionIn our practice at Champion, one of our areas of expertise is helping people get the most out of their bodies and improve their performance.  One of the more common areas of performance we work on with people is improving their overhead position.

It’s great to see so many people wanting to work overhead again, however, this is a more challenging position to achieve than most realize.  I’m not going to lie, I’m worried that we’re pushing people during their workouts and causing more harm than good for many.  I’ve seen a bunch of people in for physical therapy recently with shoulder pain and an angry rotator cuff because they’re working beyond fatigue while trying to maintain a quality overhead position.

Before we get into a few ways to improve your ability to work overhead, let’s briefly discuss some of the reasons this position can be compromised.

 

Why The Overhead Position is Challenging

The overhead position, although commonly utilized in workouts, can be more of a challenge than most think.  Not only does the bony anatomy offer an inherent obstacle on some, but efficient dynamic stability of the shoulder joint and endurance of the muscles are often compromised. This can lead to subtle positional changes that often go undetected by the athlete or the strength coach.

The bony anatomy of the glenohumeral joint affords only a small amount of space for the rotator cuff tendons, bursal tissue and biceps tendon.  If the humeral head (the ball) rides up in the glenoid (the socket) because of fatigue, poor control or even encroached upon by a small bone spur, then pain and poor function may result.

Working through these deficits will not help improve the overhead position.  This isn’t one of those areas you can just force through and hope it gets better.  Over time, this can lead to tissue wear, impingement (tendonitis) or even a rotator cuff tear over time..

Let’s look at the anatomy and what is involved.  As you can see, there’s only a small amount of space in the shoulder, about 1 cm in a normal joint.  This space isn’t empty, it’s filled with your rotator cuff tendons and a bursa.  We have little room for error, especially in an athlete doing repetitive overhead activities like throwing a baseball, pressing or even a snatch.

In the photo below, I’ve highlighted the subacromial space in red (photo credit).  This is where the rotator cuff and bursa are located:

subacromial space - overhead position

 

As a result, you may present with shoulder pain along the outside aspect that is almost felt midway down the arm (where the deltoid muscle attaches).

This is typically referred pain from the rotator cuff or bursal tissue (bursitis).  If this is the case, the athlete needs to stop the overhead position and be assessed by a physical therapist to determine the extent of the injury and potentially make changes to their workout routines.  I’ve seen this a bunch recently and there’s a common theme with most of them:.

  1. They have subtle laxity in their shoulders, meaning the joint capsule is just slightly looser than the ‘normal’ shoulder. They can’t do anything about this as this is most likely a genetic predisposition.  This is probably a good thing in the long run and common in athletic people.
  2. They also have poor dynamic stability and weakness of the shoulder and scapula musculature but have never really had a rehab program to address the ‘little’ muscles and get a good base of control.  Combine this with #1 above and we are starting to see the problem…
  3. Finally, their overhead position has been compromised by a lack of mobility.   These mobility restrictions are usually tightness in their soft tissue, particularly their lats, and poor thoracic mobility.  These mobility issues usually come from a society that is biased toward sitting at a desk for many hours or being on a smartphone and having our neck and spine in a forward flexed position.  This can be made worse in athletes as a result of overhead workouts that are focused on creating a powerful acceleration forces (ie throwing a baseball or swimming).

 

3 Ways to Improve Your Overhead Position

Based on these three common findings, here are some techniques I often use to improve overhead position.  These 3 exercises can help address the above mentioned issues and help return the athlete to their workouts.

 

Latissimus Foam Rolling

Recent studies have the shown the efficacy of foam rolling on muscles to aid in performance recovery and soreness.  I don’t think we completely understand the exact mechanism behind this but I definitely see client’s recover faster if they foam roll between workouts or after a big athletic event. I’ll take it!!

The foam roll is used on the area of tightness, which is usually the latissimus, or lat, muscle.  We instruct people to roll over the area of tightness for ~30 seconds and to hold on tender spots for an additional 10 seconds.  This often results in relaxation of the muscle and improved mobility.

Latissimus foam rolling

 

Thoracic Spine Extension on Foam Roller

Another pre-workout activity I like to add into a shoulder program is a thoracic spine extension over a foam roller.   This will improve thoracic extension and result in more greater overhead shoulder mobility.

In this exercise you use the foam roller as a fulcrum places at the thoracic spine.  Focus is on extended the upper back and keeping the lower back stable.  Perform this for 1-2 sets of 10 reps.

thoracic extension foam roll

Shoulder ER Press

Finally, in order to help maintain these soft tissue and range of motion gains, we need to work on dynamic stability in the newly gained overhead position.  One that I like to use involves simple elastic tubing, in which the athlete pulls into scapula retraction at shoulder height, then presses overhead in a pain free range of motion.

We call this the Shoulder ER Press, as it combines shoulder external rotation and overhead pressing.

The tubing is pulling the shoulder forward so it takes a lot of effort (more than you think) by the back of the shoulder and rotator cuff to maintain a good position.  This requires strength but also works on muscular endurance overhead.

As the athlete progresses, a manual rhythmic stabilization may be incorporated to further challenge the dynamic stabilizers in an overhead position.

 

 

I’ve seen this a bunch recently and have employed these 3 techniques with pretty excellent outcomes in a relatively short period of time.

So, remember to address any soft tissue and mobility issues that may be contributing to the overhead position and work to progressively strengthen the dynamic stabilizers.  Working through these restrictions is only going to maket the situation worse. You should see some improvement in your overhead position in a few visits, once you get the underlying inflammation under control.

 

The Number One Way You Are Killing Your Posture

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The Washington Post published an interesting article last week on how cellphones are changing our posture.  Cell phones, and more importantly, smart phones and texting, are making a significant impact on our posture and overall health.  We spend a large portion of our day starring at a tiny little screen, causing us to strain and position our head forward.

Ready to be amazed?  How about these for statistics:

Cell phone text messaging neck pain

(Photo Source)

 

Cell Phones Are Killing Our Posture

The Washington Post article goes on to discuss that the forward head posture that is caused by looking at a small screen close to your face, such as when texting, places an enormous amount of strain on your neck.

The human head weighs about 12 pounds on average, but the more forward your head in your posture can cause this to increase 5X.  Imagine walking around with a 60 pound weight tied to your head!

cell phone text messaging posture

(Photo Source)

 

This causes the muscles and joints in your neck to be stretched to their end range, which causes muscles tightness, muscle soreness, neck pain, and even headaches.  Overtime, the results are cumulative and cause lose of motion of the vertebra in your spine and stress on your discs and nerves.

It isn’t that simple, however, this is impacting more than just neck pain.

We talk about this a lot at Champion, but the body is really great at compensation and finding the path of least resistance.  So, anytime you have increased flexion of your neck, it’s going to have an impact elsewhere on your body.  In my experience, I see these frequently together:

  • Forward head posture
  • Limited arm elevation
  • Tightness in your thoracic spine
  • Excessive extended posture of your low back
  • Anterior tilting of your pelvic

These can cause problems all over your body, including neck pain, shoulder impingement, rotator cuff injuries, low back pain, tight hip flexors, and tight hamstrings, just to name a few.  What amazes me the most is that young kids these days, including athletes, can’t even touch their toes anymore!  I blame this on this phenomenon and postural adaptations that occur from our cell phone usage.

 

What To Do About It

So, I know you aren’t going to stop text messaging as much, I get it.  Neither am I.  But there are things we can do to minimize the effect of our phones on our posture.  I think there are two really easy tips to implement:

1. Bring your cell phone to your eyes, not your eyes to your phone

Taking a huge step back, cell phones don’t actually cause any of these issues.  You do when you strain to see the screen and move your head (and eyes) closer to the screen.  This causes forward head posture and the ripple effect discussed above.  Instead, try bringing your phone closer to you eyes.

2. Reverse your posture frequently throughout the day

Probably the most important strategy is to reverse your posture frequently throughout the day.  The body adapts to the positions you place it in and needs to reminded to not to lose your normal posture.  For people sitting at a desk all day, we tell them to get up and walk around frequently.  For those texting, you need to reverse your forward head posture.

There is one easy exercise we use all the time, the shoulder W with a chin tuck that I discussed on my website at MikeReinold.com:

This is an easy exercise to work in throughout the day when your neck starts getting tired.  We try to incorporate exercises like this into all of our strength programs at Champion PT and Performance.

Cell phones and text messaging are killing our posture and causing many problems, keep these statistics in mind and try to be proactive with your posture throughout the day.