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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: shoulder exercises

Do you suffer with shoulder instability, shoulder weakness, poor trunk control or chronic shoulder/back pain? One of the biggest issues overhead athletes have is poor proximal stability, often leading to scapular dyskinesia. In turn, undue strain and force can cause stress on the rotator cuff and/or labrum.

In addition, nagging back pain can also occur as a result of repetitive micro-trauma. Improving pillar stability can reduce stress with hyperextension and rotation that creates stress and injuries in the lumbar spine.

This exercise is a unique and challenging way to improve shoulder and torso stability. In some instances, the stress on the wrist can be difficult, and in these cases I suggest using a closed fist on the stationary arm or moving to the knees. It is particularly effective exercise for swimmers, gymnasts, overhead athletes, and anyone with a history of shoulder instability.

Click here to read the entire column.

In the case of shoulder pain and dysfunction, the lower trapezius and serrates anterior are often implicated as part of the problem. Research has shown that these two muscles often fatigue and don’t contribute equally to the force couple between them and the upper trapezius that facilitates upward rotation of the scapula.

Building scapular stabilization and dynamic stability is a must for those doing repetitive overhead activities such as throwing, swimming, serving, or work-related tasks.  It is a given that asymmetries will exist, so optimizing the strength of the rotator cuff and scapular stabilizers is paramount to prevent injury and recover from overuse syndromes.

To strengthen the lower trapezius, one of my ‘go to’ exercises is the lower trap raise. It can be done with just the weight of your arms or using light dumbbells.  The link below includes the full description for the exercise, and I also embedded the video below.

http://fit-pro.com/article-4137-Lower-trap-raise.html

In the next column, I will include a serratus anterior exercise using a kettle bell as a follow-up to this post.

Many of my clients need to improve shoulder and pillar stability.  Combating poor glenohumeral and scapular stability and insufficient trunk stability is a must to reduce injury risk, resolve shoulder and back pain and eliminate compensatory motion with exercise, sport and life.

The following two exercises are “go to” ones I utilize to do just this.

Plank Push-ups

Stir the Pot

The links above are for two recent exercise columns I authored for PFP Magazine.  These exercises include load bearing using the client’s bodyweight and include progressions and regressions.

The shoulder mobility screen in the FMS often reveals side-to-side asymmetries.  It is more common to see hypermobility in female clientele, while their male counterparts exhibit more hypomobility.  Overhead athletes tend to demonstrate excessive horizontal external rotation and a relative loss of internal rotation on the dominant side.  This hypomobility can be detrimental to overhead athletes and increase risk for overuse injuries if it becomes excessive.

The following exercise is an effective way to improve shoulder mobility and optimize function.  One important point is to focus on form and move very deliberately through the motion.

Execution: Begin lying on the floor face up.  Bend the left knee up to 90 degrees and cross the right leg over top of the left interlocking them.  Roll to the left side and pin a folded towel or pad between the right knee and the floor.  Place the arms in 90 degrees of shoulder flexion with the right on top of the left in an outstretched position. Next, slowly sweep the right arm up overhead and around the body as you attempt to place the torso/back on the floor.  The finish position for the right arm will be reaching the right hand and arm up behind the back.

Exhale as you perform the sweeping motion and hold the end position for 2 seconds.  Reverse direction and return to the start position.  Perform 5-10 repetitions on each side.

Application: Limited shoulder mobility is a common finding, especially among male clientele with tightness in the pecs, lats and posterior shoulder.  Asymmetry with respect to mobility is common with greater difficulty found trying to reach the dominant arm up behind the back on the FMS shoulder mobility screen.  This exercise will help improve thoracic spine motion and shoulder mobility.  The focus should be on strict form and proper stabilization to avoid unwanted motion.  Pinning the pad (or towel roll) to the floor will help ensure better stabilization.

If hypomibility is an issue and clients score a 1, foam rolling the pec minor/major, latissimus dorsi and the posterior rotator cuff musculature prior to performing the exercise will be helpful.  Stability training can be added in later once the soft tissue mobility restrictions and movement pattern is improving.

It is no secret that proper scapula alignment and muscle activation makes for a healthy shoulder.  There are many forms of dysfunction that may be present.

f1large

Generally speaking problems revolve around muscular tightness/weakness and faulty movement patterns.  The term “SICK” scapula is often used and refers to Scapula Inferior Coracoid Dyskinesis.  Common examples of a “sick”  scapula include:

  • Type I – Inferior border prominence.  This is typically related to tightness in the pec minor and weakness in the lower trapezius.  Keep in mind the upper trapezius will naturally dominate the lower trap in the force couple with the serratus anterior for upward rotation.  You may also see increased thoracic kyphosis which will inhibit the normal resting position of the scapula.
  • Type II – Medial border prominence.  In this case the scapula is internally rotated or protracted and there is liekly weakness present in the rhomboids and middle trapezius.  The serratus anterior may also likely be weak with evidence of scapular winging.  This position places the humerus in relative internal rotation and increases risk of impingement with arm elevation.
  • Type III – Superior border presence.  Here the scapula appears elevated in the face of an overactive upper trap and/or levator scapulae.  With active arm elevation, you may notice excessive shrugging or superior humeral head migration in light of the imbalance.  Again, the lower trapezius is probably weak and being overpowered.

Click here for a great graphic display from the Journal of the American Academy of Orthopaedic Surgeons of how the scapular muscles work collectively as a force couple to promote optimal movement in the shoulder.

In many of the throwers and overhead athletes I see in the clinic, they often exhibit either medial border prominence of inferior border prominence.   Additionally, I frequently observe GIRD (glenohumeral internal rotation deficit) values of 20 degrees or higher in those patients who come in with symptomatic shoulders (rotator cuff and/or labral issues).  What does this mean?

Well, in a nutshell, it means addressing posterior capsule tightness in the throwing shoulder is important for avoiding internal impingement and SLAP tears.  Tightness (or too much GIRD) can increase the load/tension in the late cocking phase of throwing thereby contributing to friction between the cuff and labrum, as well as excessive torsion on the proximal biceps tendon.  Any excessive humeral head migration with repetitive throwing is a recipe for injury over time.


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