Brian Schiff’s Blog

For those familiar with my blog, you know I like to post research updates and exercises that prevent injury and maximize performance.  In my setting, I get to work with a very active population ranging in ages from 10-50 in most cases, including elite and professional athletes.  I am pointing this out simply because I have an opportunity to test and measure unique and challenging exercises every day with fit, athletic clients.

As part of my world, I am often faced with restoring shoulder, core and hip stability.  As clients progress through rehab and conditioning, I am always seeking advanced training options that are feasible and functional.  One training tool I like to employ, especially in upper body, core and hip training is the BOSU Balance Trainer.

Emphasizing co-contraction and scapulothoracic and glenohumeral stability is essential for optimal shoulder function.  But more importantly, addressing kinetic chain function in the shoulder, torso and hips is a must if we are to soundly address energy leaks and reduce injury risk.  To that end, I like to incorporate unstable closed kinetic chain training when my athletes are ready.  The video below demonstrates two upper body step-up progressions (forward and side-to-side) on the BOSU Balance Trainer that I utilize for higher level clientele.

Upper Body Step-ups

Regression - in place stepping (this can be used to prepare clients for the step-ups)

This regression can also be a very effective training tool especially if the client lacks sufficient strength, endurance and form to execute the full step-up patterns.  Pain and form should always guide exercise selection and progression.

Below are two links to my Functionally Fit columns describing the execution and application of these exercises:

Unstable Upper Body Step-ups (forward)

Unstable Upper Body Step-ups (lateral)

I am big fan of lat pull downs and pull-ups.  I think when done properly, this is a fantastic way to improve postural strength and safeguard the shoulder against injury.  In April 2012, I wrote a column on lat pull downs addressing shoulder pain (click here to read that post).

I decided to add to that previous post and discuss a recent article published in the February NSCA Strength and Conditioning Journal.  In the article, the authors present some research regarding how altering hand orientation and grip width affects muscle activity during the exercise.

Grip Width Summary

Lehman J Strength Cond Res 2005

• No significant difference between narrow supinated grip and wide pronated grip with biceps and latissimus dorsi
• Highest level of latissimus dorsi activity occurs with seated row with retracted shoulders

Lusk et al. J Strength Cond Res 2010

• No difference in biceps, latissimus or middle trapezius activity (note - wide grip only slightly larger than narrow grip)

Sperandei et al. J Strength Cond Res 2009

• In front of the head pull downs with standardized width and hand orientation revealed higher activation for posterior deltoid and latissimus compared to behind the neck
• This study did NOT compare different grip widths

Hand Orientation Summary

Youdas et al.J Strength Cond Res 2010

• Pronated grip during pull-ups (56 +/- 21% MVIC) was most effective for activating the lower trapezius compared with the supinated grip
• Pronated grip also resulted in greater infraspinatus activation (45 +/- 22% MVIC) compared with the perfect pull-up
• Perfect pull-up showed higher latissimus activity (130 +/- 53% MVIC) than the supinated grip of a chin up
• Supinated grip of the chin-up revealed an increase in pec major (57 +/- 36% MVIC) and biceps brachii (96 +/- 34% MVIC) versus 44 +/- 27% (pec major) and 78 +/- 32% (biceps brachii) for the pronated version
• Posterior deltoid showed no difference in all hand orientations

Lusk et al. J Strength Cond Res 2005

• Pronated grip during lat pull-downs elicited a 9% greater muscle activation of latissimus dorsi compared to supinated grip
• No difference between middle trapezius and biceps brachii in pronated or supinated grip

My Takeaways

1. If your goal is maximizing latissimus activity and improving scapular stabilizer and rotator cuff function opt for the pronated grip
2. Supinated grip elicits greater activation in the pectoralis major and biceps - no surprise here based on physics and kinesiology -> easier for clients to do and also not going to stress the shoulder as much in the presence of any inflammation or pathology
3. Range of motion, scapular dyskinesia, pain, soft tissue restrictions and imbalances play a vital role for each client so they may need some preparatory work to make the most of this exercise
4. Small tweaks (in my opinion) can make a big difference in comfort level and performance of the exercise (refer to number 3 for why) so do not be afraid to experiment between wide and narrow in a pronated grip
5. The authors mention that if individuals elect to do the behind the neck version they should have adequate range of motion to do it safely.  Let me be clear - there is NO reward big enough to justify the risk involved in doing behind the neck pull-downs.  Save your neck and shoulders by eliminating this option altogether as I would bet most of us do not have perfect bony anatomy, mobility and optimal muscle firing throughout the motion to ensure that potential repetitive micro trauma will not occur over time.

For my CrossFit friends - optimal shoulder mobility, scapular stability and adequate thoracic spine extension and rotation is a must to minimize risk with kipping and less than perfect pulling form.  I much prefer unweighting or assisting the body through pull downs, bands or partner assists to build pre-requesite strength initially until the client is better able to manage the movement under full body weight.

Quality movement ABSOLUTELY matters over hundreds and thousands of reps.

As far as research goes, I think we still need further studies on grip width and specifically how it may directly impact not only muscle activation but force on the glenohumeral joint itself.  For me, I opt for pronated pull-ups and or pull-downs once per week with a moderate grip width in my own routine.  I hope this information serves you well.  Happy lat training!!

The company I am privileged to work for has officially entered into a partnership with Athletes’ Performance. We are joining forces with them to take our performance training to an even higher level.  So, the Athletic Performance Center is now:

I am pumped as we will be able to offer the same elite level training and nutrition services that are offered at other locations in AZ, FL, TX, CA and MA.  I will continue in my role as supervisor and sports physical therapist and look forward to all the great things to come.  If you are not familiar with AP, check them out at www.athletesperformance.com.

Click here for a detailed press release from Raleigh Orthopaedic Clinic.  I am confident this new venture will help me sharpen my saw and become an even better clinician and performance training expert.

As a therapist and fitness enthusiast, I always want to know the “why” and implications for exercises.  I have posted on modified push-ups in the past, but I felt compelled to share some information that was published in the October 2012 Strength and Conditioning Journal.  Bret Contreras et al. discuss the biomechanics of the push-up and provide an excellent overview of the different types of push-ups and what research has to say about them.

I was most interested by the parts on unstable push-ups as I tend to use the BOSU Balance Trainer and BOSU Ballast Ball in many of my programs.  Here are some key points that the authors point out that are worth mentioning:

• BOSU push-ups have been shown to increase activity of some of the scapular stabilizers namely upper, middle and lower trapezius fibers compared to standard push-ups, while serratus anterior activity is diminished (Tucker et al. Arch Phys Med Rehabil 2010)
• Lehman et al. (Man Ther 2008) reported that elevating the feet above the hands had a greater stimulus on scapulothoracic stabilizing musculature than placing the hands on an unstable surface
• Lehman et al. (Dyn Med 2006) found that push-ups w/hands on a stability ball significantly increased the triceps brachii activation as well as invoking increased activation of pec major, rectus abdominus and external obliques compared with push-ups on a bench from the same angle.  However, note that feet on the stability ball did not affect muscle activity compared to push-ups with feet on a bench at the same angle
• According to Marshall and Murphy (Apply Physiol Nutr Metab 2006) triceps brachii and abdominal EMG activity was much greater when performing push-ups off a stability ball compared to stable surfaces from flat and elevated positions

Takeaways:

1. Using unstable surfaces for push-ups when the primary base of support is the stability ball, BOSU, or BOSU Ballast Ball is more effective in increasing muscle activation of aforementioned muscles
2. Placing the feet on an unstable surface does not add much benefit in terms of increasing muscle activation
3. Maintaining a stable torso and spine angle is key and should not be compromised with an unstable surface

Other thoughts of mine:

Mastering form, alignment and strength with stable push-ups is common sense, right?  So, do not advance to unstable push-ups without pre-requisite strength and satisfactory technique in a stable environment.  Wrist mobility, shoulder stability, and core strength are just a few other key factors that should weigh in your decision to implement unstable push-ups.

Considering some isometric work with slightly bent elbows or even some small pulses can be effective in progressing toward these more advanced unstable push-ups.  Clients need to understand the point of no return and I prefer to spot closely particularly when using a stability ball or BOSU Ballast Ball.  Working with the BOSU (dome side down) is generally safer and allows for easier modification with the knees on the ground for those with less upper body strength or diminished control.

I also like to add a plus (scapular protraction at the top) to help counter the loss of serratus activity seen with BOSU push-ups. In the end, I really like using the unstable surface as the point of balance and have for some time.  There are many ways to do push-ups, but considering some unstable work has a good return for those clients whoa ready for it.

Below is a picture of the BOSU Ballast Ball - I prefer it over the stability ball as it is less likely to slip out from underneath the client.  It provides excellent shoulder and core stability work - my primary goals when electing to use it.  Reps, sets, progression and recovery will be dictated by fatigue and form at all times.

I work with lots of patients and clients who consistently demonstrate inadequate hip and core stability.  I see this show up routinely as asymmetrical 1’s for the trunk stability push-up, in-line lunge, hurdle step and rotary stability movements on the FMS. Unfortunately, this has been a recurring them in many of my females recovering from ACL reconstruction as well as runners with persistent pain/dysfunction in one lower extremity.

I am always looking for better ways to train the body in whole movement patterns as well as functional positions.  One of my preferred positions is to test and challenge my clients in a split squat position.  I begin with an isometric split squat cueing proper alignment and muscle activation.  As clients master isometric postural control, I will allow them to add an isotonic movement by squatting in the position.

As they progress, I will add in perturbations to stimulate changes or challenges to their center of gravity.  Often, you will see them struggle much more on the involved side.  But to be honest, I find most people have an incredibly hard time maintaining proper alignment for long without cheating or falling forward or to the side.  Allowing clients to lose form is okay provided they are cued to fix their alignment or they naturally self correct.

An additional wrinkle I throw in for this training is using the BOSU Balance Trainer.  Below is a video that shows how I use this progressing from shin down to just the toes as a support on the trail leg.  The second version will burn up your clients’ thighs and quickly become one of their least favorite exercises.  The great thing is that you do not have to offer much resistance to create a significant perturbation.

For more detail on this exercise and application, click here to read my PFP column featuring it this week.