Brian Schiff’s Blog

By far the most comments on my blog and emails that flood my inbox these days have to do with SLAP tears.  I must admit that outside of ACL tears and rotator cuff issues, I find myself increasingly drawn to studying and researching this issue.  It definitely is a source of great pain for many and an issue that medical professionals are challenged by today.

In my personal clinical experience, I see good, bad and in between outcomes.  Through email and my blog I tend to read more on the not so good side from people who are seeking my expertise in how to resolve their issues.  When I speak to surgeons, I find they are often hesitant to commit to a set algorithm of treatment, and they are not 100% sure what the right answer is in addressing these injuries as a whole.

If you read the literature, the success in terms of patient satisfaction and return to premorbid activity levels is not going to make you rush down to the operating room and opt for an arthroscopic repair if you are an overhead athlete (especially baseball players).  However, other studies have presented more favorable data ranging from 63%-75% good-excellent satisfaction in other overhead athletes who have had the procedure done.

If you are unfamiliar with SLAP tears, I suggest reading my original post on them (click here).  In today’s post, I wanted to present a quick recap on Type II SLAP tears and some new published research on the results of revision procedures where the primary repair failed.

Below are two images of a type II tear (MRI and operative view from the scope)

Keep in mind a type II tear means the biceps anchor/superior labrum has pulled away from the glenoid with resulting instability of the complex.  This is the most common type of tear seen among injured people.  In a study from the Kerlan-Jobe Orthopaedic Clinic in LA in the latest American Journal of Sports Medicine (June 2011 – click here for the abstract), they discussed a chart review of from 2003-2009 looking at patients who had undergone revision type II SLAP repairs.

Continue reading…

In most gyms and training circles, people are performing bench press or push-up exercises.  There is no doubt in my mind that repetitive heavy full range bench press causes many of the labral and cuff injuries among males I have seen over the years These injuries are often the attritional type – developing over many months and years.

What about push-ups?  Is the force development pattern the same?  Are they safer?  Honestly, I believe in keeping the elbow at a point at which it does not drop below the plane of the body (bench press) or move above the body (push-up).  Essentially that means keeping to a 90 degree angle or less.  Why?  Well, regardless of load, I feel the real risk is not so much in the motion itself but the very repetitive manner in which it occurs with external loads, often lending itself to acquired anterior shoulder laxity, strain on the proximal biceps anchor (think SLAP lesions) and secondary shoulder impingement.  The picture below hurts my shoulders just looking at it, and over time this technique will hurt your shoulders too.

But, I say all that to set up today’s post.  In a recent article in the February edition of the Journal of Strength & Conditioning Research, David Suprak et al. looked at the effect of position on the % of body mass supported during traditional and modified push-ups.

The study looked at 4 static positions in 28 males (about 34 years old) who were highly trained and members of the special forces or SWAT team (the up and down position for regular and modified push-ups) to determine the change in body mass (BM) supported by the upper body in different ranges of motion.  The down positions studied were at approximately 90 degrees (the lowest depth I safely recommend) and all holds were performed for 6 seconds.

Continue reading…

I probably get more emails about shoulder problems than anything else.  Most of the emails center on rotator cuff and SLAP tears, as well as whether or not to have surgery.

Let me be clear – I am not going to tell you TO or NOT TO have surgery in this post.  That is for you and your MD to decide.  However, I will give you my thoughts on key considerations with respect to this major decision.

Below are some major considerations to take into account if you are facing this dilemma.

Indications for having surgery:

• Unremitting pain (especially at night)
• Loss of daily function (dressing, bathing, self care activities)
• Marked loss of strength
• Bony impingement with failed rehab
• Moderate to massive tears with active jobs, healthy and < 50 y/0
• Isolated partial and full thickness tears with high probability of operative success after failed rehab

Now, some contraindications for surgery:

• Weakened tissue (including too much tissue retraction or shortening)
• Multiple tears in older population
• Failed previous rotator cuff repair
• High risk patients (includes those with cardiovascular and other medical issues)
• No rehab trial to date
• Partial or full thickness tears with good range of motion, negligible pain and sufficient strength to do most activities of daily living

These thoughts are mostly relative to rotator cuff pathology.  SLAP tears are a much different animal in that they often do not do well conservatively with rehab, particularly in active patients.  I approach SLAP tears in rehab much like I do a cuff problem, but the varying degrees of SLAP tears and associated involvement of biceps tendon pathology and/or rotator cuff damage make the treatment algorithm more challenging.

What I san say with confidence is that shoulder surgery is never quick and easy.  The shoulder is such a complex and pain sensitive joint that whether or not you have arthroscopic or an open repair, the rehab and recovery process is often painful and laborious.  This is not to deter you, but more so to make you aware that once you wake up from surgery your shoulder will not be back to normal, nor is there any guarantee your shoulder will be as good as new again.  You understand that there is no problem surgery cannot make worse (quote from Dr. Jack Hughston).

Finding a skilled and competent shoulder surgeon will certainly lessen the complications and recovery window.  So, when faced with the prospect of surgery, be certain to exhaust conservative measures first, seek multiple MD opinions, get an X-Ray/MRI, and weigh the current functional deficits with the desired functional level to determine the best course of action.

It is no secret that the average male gym goer loves to do plenty of bench press exercises.  I was out at a piano bar last weekend celebrating the 10 year wedding anniversary of some close friends and witnessed the “bar body” syndrome firsthand.

For those not familiar with this lingo, the “bar body” belongs to the guy who overworks the chest and biceps, while typically neglecting the back leg muscles altogether.  They routinely sport tight t-shirts and jeans even in the dead of summer in Ohio.

I spotted the bouncer right away.  He was likely 25 years old and obviously proud of his caveman posture and large stature.  What he does not know is that in 5-15 more years he will likely suffer significant shoulder impingement and AC joint arthritis, not to mention he will have little to no upper body flexibility.

Know anyone that fits this description?  Look around in your local health club and you will surely find them.  So, the takeaway messages are:

1. Perform back to chest strengthening exercises in a ratio of 3:2 or even 2:1 to promote balance and better posture
2. You do not need to bench press all the time (once per week is sufficient and may even be too much for some)
3. You should do routine flexibility exercises for the chest as these muscles are tight in most of the population and they can contribute to increased internal rotation of the shoulders and rotator cuff problems

In light of this, I want to share a few effective exercises from my brand new Training & Sports Medicine Update Newsletter.  To view these exercises, click HERE.

If you enjoyed this information, you can get even more info on exercise, recent research, sports performance training, injury prevention and rehab delivered to your inbox monthly by signing up for a subscription to my newsletter.  You can grab the digital version for just $9.95/month.  By subscribing, you are become eligible for immediate product discounts and promotional pricing on all new items.

Click here to sign up and get the entire first issue today!

In health,

Brian

I have been rehabbing rotator cuff injuries for the better part of 13 plus years now.  I also have the privilege of teaching fitness boot camps, educating other fitness pros on training/rehab and training athletes.  One of the most common issues I encounter in my work is rotator cuff pathology (tendinitis, tears, etc.).

I have sold well over 10,000 copies of my Ultimate Rotator Cuff Training Guide (e-book and print versions) since its release in 2004.  While most of the training methodology is still sound today, I wanted to add some new content and tweak a few progressions.  Like anything, with time you gain more experience and wisdom.

In addition, many people were asking me for the DVD version to better understand how to perform the exercises.  So at last, I have released the DVD version.  Some of the new additions include:

• Soft tissue mobility exercises
• Self assessment screening tools
• Integrating a towel roll with rotation exercises

In addition to the DVD itself, you get a companion CD-ROM with my Self Stretching Guide, personal interview on rotator cuff injuries, my 60 minute rotator cuff explained power point and audio seminar, the entire updated rotator cuff e-book, and 5 second video clips of each the particular exercises in the rehab plan.

I am selling this product for $49.95, but until next Wednesday (June 16) you can get it for only $29.95.

Click here to see a sample clip from the DVD

If you decide to grab a  copy, simply use the code BFITCUFF (all caps) at checkout and be sure to hit apply to get credit for the coupon.  You can order at www.brianschiff.com.

This DVD is ideal for people with acute or chronic nagging shoulder pain related to bursitis, scapular imbalances, rotator cuff tendinitis and rotator cuff tears.  As always, I offer a 60 day money back guarantee on all my products.  If you have any questions, simply post them on the blog.

Here’s to happier and healthier shoulders!