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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'shoulder'

Many people struggle with faulty posture (forward head and rounded shoulders).  Tightness in the pec major or pec minor can negatively affect the body.  Often, the throwers I see suffer from tightness in this region.  Any overhead athlete can be affected as well as the person who sits and types all day long in the office.

The video below reveals how to use a trigger point ball and block to work on soft tissue tightness.  I like the TP ball and baller block from Trigger Point for this exercise sequence.

For more information on this technique and its application, click here to read my online column for PFP magazine. Note: the final “W” motion in the video is not described in the column article, but it is another option that can be included.

Unstable Upper Body Step-ups

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!!

Working with athletes of many disciplines affords me an opportunity to look at many shoulders week to week. Increasingly, I am seeing more Crossfit athletes for various shoulder problems.  In many cases, they have rotator cuff tendonitis, impingement, AC joint pain, labral pathology or a combination of the aforementioned issues.  The other big group of athletes I see is throwers.

These two groups share many of the same dysfunctions including posterior shoulder tightness and decreased mobility. Tightness in the pecs and lats is commonplace.  I feel latissimus tightness often goes unnoticed or perhaps is not an area of emphasis in prehab/rehab plans.  Tight lats will restrict elevation and contribute to postural dysfunction.

With restricted elevation, athletes may turn to excessive spinal extension and/or rotation to achieve elevation necessary (e.g. overhead squats, snatches, throwing) and this can contribute to poor movement patterns.  I have also seen this impact volleyball players asymmetrically with serving and hitting.

Lat tightness can easily be assessed by placing the athlete supine and simply asking them to bring the arms completely overhead.  While most people do not have 180 degrees of flexion, I feel working to achieve elevation greater than or equal to 160 is completely reasonable.  The body often uses abduction and external rotation to make things work (and this is natural for throwers), but the more pure elevation capacity we have the the better.

Crossfit involves lots of pull-ups and throwing heavily utilizes the pecs and lats for acceleration.  It only follows that muscular tightness in this region may need to be addressed.  Step one often involves soft tissue mobilization/compression techniques.  I prefer to use a Trigger Point ball or Grid to work on the soft tissue mobilizing it on the wall (TP ball) or floor (Grid) in an elevated position.

Next, I like to employ active mobility work.  I recently featured a simple exercise using the BOSU Ballast Ball in my PFP column. The pictures below reveal a rolling double arm version, as well as a single arm method/progression.  These active movements can also be complimented by sustained holds as desired.

For a more detailed description and application of this exercise, click here to read my “Functionally Fit” column.  I had one Crossfit enthusiast see me for limited shoulder mobility as it was hindering his overhead lifts and causing back pain.  He had about 130 degrees of shoulder flexion.  Daily STM using the foam roller, mobility work and some stretching increased his elevation by 10 degrees in 2-3 short weeks.

So, the take home message is that overhead athletes should assess and address this limitation if it is present as it may cause kinetic chain issues and energy leaks.  Improving mobility will better enable utilization of proper muscle activation and optimal movement patterns.

Sliding Exercises

Below are two videos demonstrating some sliding exercises I like to use in training and rehab.  The first video reveals one of my tougher hamstring exercises I prescribe, while the second video displays some shoulder/core stability variations using sliding discs.  I have included links to the PFP columns that better explain the set-up, execution and application for each exercise.

Click here for the Functionally Fit Column on sliding hamstring curls.

Click here for the Functionally Fit column on sliding shoulder raises.