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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'rotator cuff'

I find that many patients and clients lack dynamic shoulder and pillar stability. Assessing this with tall plank arm taps or tall plank Y reaches can tell you a lot about one’s ability to stabilize and resist gravity in single arm support. In light of the insufficiencies I see, I prefer to use exercises that encourage integrated shoulder, torso and hip stability.

Improving shoulder and torso stability is important for overhead athletes, wrestlers, MMA competitors as well as those with any shoulder instability. This exercise is a great way to build dynamic stability and postural stability.

Click here to read my entire online column for PFP Magazine on this exercise including progressions and regressions. I think you will find this movement both challenging and rewarding for you or your clients.

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Visit http://www.brianschiff.com/Products.asp to see my catalog of products and simply enter the code BFIT50 in the coupon box at checkout. The sale will end Monday at midnight.

Blood flow restriction (BFR) therapy/training is one of the newer and more exciting techniques being used in the sports medicine field. I received training with Owens Recovery Science and have been utilizing personalized blood flow restriction (PBFR) therapy in my clinic since November 2017 using the Delfi personalized tourniquet system (PTS).

What exactly is BFR?

It is the application of a specialized tourniquet system to the proximal arm or leg, which is inflated to a personalized and specific pressure to reduce blood flow to an exercising extremity. For the lower extremity, the occlusion pressure is 80%, whereas the upper extremity pressure is usually set at 50%.

The application is brief and intermittent, usually lasting about 6 minutes per exercise. For most clients, a total of 3-4 exercises are used leading to 24-30 minutes based on the specific exercises prescribed. Typically, to increase strength and hypertrophy a person would need to lift a significant amount of weight (greater than or equal to 60% of a 1 repetition maximum). With PBFR you can create significant strength and hypertrophy gains with loads as low as 20% 1RM.

We utilize the Delfi tourniquets as suggested with the Owens training course. You can see the PTS and tourniquets below:

img_e54641

What is the science behind this training tool?

The landmark study by Takarada published in 2000 revealed that significant hypertrophy gains are seen with occlusion and the use of lighter training loads. There is an increase in muscle protein synthesis as well as growth hormone secretion. Below you find some links to abstracts from Takarada’s work:

https://www.ncbi.nlm.nih.gov/pubmed/10846023

https://www.ncbi.nlm.nih.gov/pubmed/10642363

https://www.ncbi.nlm.nih.gov/pubmed/11128848

In addition to hypertrophy, there also appears to be an application for preventing disuse atrophy simply using occlusion. This may prove very beneficial for clients who are non-weightbearing after an injury or surgery, yet not able to perform much resistance training.


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I just returned from the Sports Physical Therapy Section’s annual conference in Las Vegas. There were plenty of great presentations from various industry leaders. I thought I would take a moment and summarize a few key points from the conference that may be helpful to clinicians and consumers alike.

The conference theme was the power of innovation. Hot topics covered were blood flow restriction therapy, cupping, dry needling, eccentric loading for tendiopathy, weighted ball training, and kinesiotaping and laser therapy to name a few. Below are some takeaways worth mentioning:

  • Blood flow restriction (BFR) training can be used to help reduce muscle atrophy after surgery, improve muscle protein synthesis and provide a way to increase strength with loads as low as 20-30% of 1RM for clients unable to tolerate heavy loading
  • BFR is not superior to nor a substitute for high intensity training (need to push weight to see best strength gains), but it can be used as an adjunct to training. It also produces an increase in IGHF1 after exercise.
  • BFR should not be used before higher intensity activities such as HIT, plyometrics, SAQ, etc.
  • Clinicians and strength coaches should consider Olympic lifting derivatives as an alternative to traditional lifts if there is concern with catch phases or biomehcanical/physical concerns. Examples include high pulls/snatch pulls instead of traditional cleans and snatches.
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Shoulder impingement is a common problem for many clients. Specifically, some clients will suffer from internal impingement as a result of a significant loss of internal rotation range of motion, also known as GIRD (glenohumeral internal rotation deficit). This has been widely researched in baseball players, and it is a common issue for overhead athletes. Of note, it can also impact those doing repetitive overhead lifts.

It is common to see asymmetry in internal range of motion for the dominant and non-dominant arms. For those clients who have a total shoulder motion asymmetry greater than 5 degrees, it becomes more important to resolve internal range of motion deficits based on the current literature. In my previous post, I revealed how to improve soft tissue mobility. In this post, I will review the sleeper stretch and cross body stretch to improve posterior shoulder mobility while increasing internal rotation.

The video below from my column ‘Functionally Fit’ for PFP Magazine will demonstrate how to do these stretches.