Brian Schiff’s Blog

So, I have made part of my living the past several years helping people overcome shoulder pain.  I often laugh when I hear people say “how hard can putting together an exercise program really be?  It’s not rocket science or anything.”  Well, maybe not, but getting it just right may mean the difference between a healthy shoulder and really hurting.

There is a new study soon to be released saying weight training injuries are on the rise (especially in males).  In fact, injuries are up 50% from the period between 1990 and 2007.  The majority of these injuries involved free weights.  Many of the upper body injuries I see almost always involve the rotator cuff and/or labrum.  Why?  There are some primary reasons such as:

1. Improper form
2. Poor or absent spotting
3. Exceedingly high loads in what I term the “high risk” soft tissue zones
4. Too much volume/frequency
5. Lack of posterior chain strength due to pressing dominance
6. Too little recovery
7. Pushing through pain

What most people fail to understand is that the high repetition associated with weightlifting coupled with unfavorable biomechanical stress through long lever arms leads to eventual mechanical breakdowns/failure.  The basic translation = fraying, degeneration, tendinitis, tendinosis and tears.

This pattern equates to lost time in the gym and in some cases surgery.  The ironic part is the damage is often done in the early lifting years but not seen or felt for a decade or two later.  This is why the young twenty somethings like to debate me on the modifications I suggest for bench presses and such.  Yet, read what one former power lifter recently emailed me below: 

Yes you can count me as another one of your satisfied customers.  I followed your 6 week injured series religiously and have recently moved on the your healthy shoulder series.

My main concern at this point is to avoid injuring the shoulder again and I will follow your advice on the 7 bonus exercises listed.  My background fits the profile mentioned in your manual – 46 years old, former power lifter, injured dominant shoulder doing barbell presses about 6 months ago.  I have been doing presses for over 30 years and unfortunately never read about the scapular plane.

The take home message is that modifying the load and adjusting the arc of movement with certain lifting exercises will indeed prevent common shoulder injuries and keep you in the gym for many years to come without the fear of a lifting injury.

While the hard core lifters and competitors may scoff at my application of the science and my suggestions now, they may also suddenly come to realize the potential consequences of their ways when a debilitating shoulder injury hits.  Am I saying full range of motion and heavy loads are absolutely forbidden?  No, but I do think you should ask yourself how often and for what purpose am I doing certain lifts in certain ranges of motion.

Additionally, I am saying that insufficient muscular balance coupled with repetitive load to near failure will over time result in acquired laxity, accelerated tendon degeneration and potential mechanical failure.  Gravity and friction are two forces that will tear a shoulder down over time with exercises such as pressing, flies, dips, upright rows, side raises and push-ups to name a few. 

So, the next time you feel a “twinge” in the shoulder with lifting, it may be time to consider backing off and making some changes in your routine as time and experience has taught me the rotator cuff and A-C joint will eventually say "enough is enough."  If you want more information on my exercise modifications, check out my shoulder book at www.rotatorcufftraining.com.

Well, I just finished day two of the 2nd IYCA Youth Summit.  I attended last year as well.  Each year I took away some new info, reinforcement about what I am currently doing along with motivation to become a better coach.  Yet, the best part of attending these live events is building relationships. 

I have met so many incredible coaches and people.  Whether having breakfast with the likes of Kwame Brown and Carlo Alvarez or chatting with Dave Jack and Chris Mohr, I am reminded that greatness is not about ego or self seeking.  Rather, greatness comes from giving, humility and most importantly “doing the right things” for our clients.

What does this look like in my fitness and sports performance business?  Well, it involves the following:

• Putting 100% of my passion into products, training and consulting
• Assessing the needs, abilities and goals of my clients
• Constantly re-assessing to “tweak” programming and exercise prescription
• Being willing to admit when you are wrong or change the way you do or see things when it is in the best interests of the client
• Continually learning and striving to get better each day
• Delivering results through sound evidenced based training (knowing “why” I do what I do)
• Being honest and dedicated to improving the lives of my clients

So, you may be asking why I am telling you all this.  I have a simple answer.  I want you to trust me and look to me as a credible expert when it comes to corrective exercise, rehab and sports performance.  I also want to assure you it really is the proper application of knowledge that defines success with exercise.  It is an exact science.

The types of exercise, reps, sets and such really do matter.  See what one client recently said about my shoulder rehab program:

I began using your exercises immediately.  In just 6 days I have seen significant change.  I have been able to use my hamd/arm again to wash my hair, close my car door, reach for items and just stop holding it up and against my body.  Today I had a weekly massage (she was formerly a PT) and she was amazed at my progress.  I feel there is hope again.  I know the book cost a fee, but I still want to say thank you for creating an exercise plan that does not include torture.

Wow, torture is never good, right?  Exercise should never be painful – just effective.  If you have not seen significant positive change within 30 days, this should raise a red flag.  So, beware of ultra hype and too good to be true claims, yet understand that you should see some measurable results in a reasonable time frame.  I will always stand behind my programs and products. 

With that said, I will be revealing a series of specific exercises I use with my clients over the next month.  In these posts, I will show you the exercise, explain the applications and reveal the training tools I use to make them work.  The posts will give you real exercises you can use to fix muscular imbalances, improve strength and maximize physical health and performance.  Most importantly, you can rest assured I remain 100% committed to doing things the “right way.” 

Whether you are lay person, trainer or therapist reading this blog, I try to keep you up to date on science, training and my interpretation/application of exercise based upon the research and practical application in my practice.

Today, I want to touch on an article just published in the Journal of American Sports Medicine.  It was based on a  study conducted by Tim Tyler et al in New York.  They set out to determine what effect decreasing GIRD (aka glenohumeral internal rotation deficit) and posterior shoulder tightness had on reducing symptoms associated with internal shoulder impingement.

For those unfamiliar with GIRD, it basically looks at total shoulder motion side to side but focuses on deficits in internal rotation.  Throwers often lack internal rotation on their dominant arms and exhibit excessive external range of motion for cocking and ball velocity.  We tend to call this acquired laxity.  Pitchers tend to have higher GIRD as well.  Keep in mind total shoulder motion is critical as well.  So, you cannot assume one will have problems just becasue there is decreased internal rotation.

You may see similar GIRD and psterior shoulder tightness patterns in other overhead athletes (swimmers, tennis players, volleyball players, etc.)  This particular study looked at the effect on 11 men and 11 women who received manual mobilization by a PT combined with ER ROM, posterior shoulder stretches and scapular strengthening.

They studied all 22 subjects (range of symptoms from 1 to 24 months) and then compared data on the patients with and without symptom resolution.  In effect the study revealed that posterior shoulder tightness was significantly improved in 12 of the subjects that had complete resolution of symptoms (more so than in the 10 who did not).  In addition, changes in GIRD did not seek to impact the results.

What is the take away from this study?  In a nutshell, if you have symptoms related to internal impingement, you should be doing posterior shoulder stretches.  So, what are the best ones to do?  There was a recent article in the NSCA Strength and Conditioning Journal (December 2009) that laid out some effective stretches (two of which I will show you in the video).  Also, you should note that this pattern of tightness is common in weight lifters.

I have included a short video clip with 3 effective stretches that easily can be done at home.  The stretches are as follows:

1. Standing cross chest shoulder pull (across the chest) – this is a basic stretch I start most clients with who are experiencing pain.  The drawback is that the scapula is not stabilized (or fixed) so you do not isolate the posterior shoulder effectively.  However, it tends to be more comfortable for many early on and you will still get some benefit.  When you are ready, it can be done against a wall to fix the scapula.
2. Side lying cross chest shoulder pull – this would be equivalent to doing stretch number 1 against a wall.  The floor acts to stabilize the scapula and then you pull the arm up and hold.
3. The sleeper stretch – go easy with this one as pushing too hard may actually increase inflammation in my experience.  You may also vary the angle of the upper arm to hit different portions of the joint capsule.  For example, you may elect to stretch at 90, 70 and 45 degrees.

I advocate holding each stretch for 20-30 seconds and repeating 2-3 times daily.  If you are in therapy, the stretching should be done following the joint mobilization by your therapist.   Click the video below to see the stretches.

If you have ever experienced shoulder pain (whether sudden or chronic) you have probably heard people or docs throw out the terms tendinitis, bursitis, or partial and full thickness tears.  In this post, I will attempt to summarize these and delineate as best I can between the symptoms you may experience.

Bursitis – inflammation of the subdeltoid bursa (fluid filled sac) beneath the deltoid.  Bursae are in place to cushion the soft tissue and prevent rubbing or friction.  They lie between tendon and bone or between the tendon and skin.  In the shoulder, signs of bursitis include:

• Pain and tenderness along the upper arm with radiating pain down the to the elbow in many cases
• Pain lying on the affected shoulder (esp. at night)
• Pain with repetitive motion (especially overhead and behind the back)
• Warmth and swelling along the middle deltoid

Tendinitis – the tendon itself becomes inflamed and swollen (usually the supraspinatus) and may become trapped or start rubbing beneath the acromion (top of the shoulder blade) and then becomes an impingement problem (known as impingement syndrome).  Pain may also be felt along the biceps tendon as it may undergo undue stress and strain in relation to a cuff issue.  It is also important to note that bursistis often accompanies tendinitis.  Typical symptoms include:

• Point tenderness at or near the top of the shoulder or over the biceps tendon as it meets the shoulder
• Pain and joint soreness along the front of the shoulder
• Pain that worsens with elevating the arm above 90 degrees or moving it away from or behind the body
• Pain with lying on the affected shoulder
• Pain tucking in your shirt, fastening a bra or styling your hair

Tear – defined by a disruption in the quality or integrity of the muscle and or tendon.  Tears are typically quantified by the location (articular or bursal side) size (in centimeters) and degree (partial or full thickness).  Not all tears are created equal – that is a fact.

I have seen small tears (less than 1-2 cm) create equisite pain and dysfunction, while large tears (greater than 3 cm) may produce less pain and limitations in daily activities for folks.  Hallmark symptoms of a tear include:

• Pain at night that interrupts sleep
• Persistent dull ache or even throbbing pain that is not affected by rest or positional changes
• Significant weakness or even muscle atrophy (look at the shoulder blade from behind or int he mirror)
• Loss of elevation and arm rotation overhead and behind the back
• A positive shrug sign (see below as excessive upper trap work that compensates to elevate the arm in light of a torn rotator cuff muscle)

Positive Shrug Sign

Some research suggests up to 90% of tears will worsen over time.  Tears do not spontaneously heal.  With that said, many respond well to conservative rehab with an emphasis on restoration of motion, appropriate strengthening and avoidance of abusive activity.

The prescription for healing bursitis and tendinitis is much the same.  However, catching the “itis” early on and using ice, rest and anti-inflammatory medication as prescribed can often cure it in weeks and prevent further damage.  Pain shouldreally guide all activity and exercise progression.  The other forgotten friend is ice – whether acute or chronic I advise daily icing for pain relief.

Want more answers to rotator cuff issues?  Visit my site at www.rotatorcufftraining.com.

Since publishing my rotator cuff manual over 4 years ago, I have received emails from all over the world with shoulder related lifting questions.  Invariably, I discover that many shoulder injuries are simply caused by repetitive micro-trauma in the weight room.

What does this mean?  In effect, it is like taking sand paper and rubbing it over your rotator cuff day in and day out for weeks, months and years until you either create tendinitis or wear a small hole in it.  Exercises that often get people in trouble are bench press, dips, flies, lateral dumbbell raises, and military press to name a few.  I show modifications for all these in my book.

In my shoulder rehab programs, I have always advocated front lat pull downs.  Why?  Simply because I can strengthen the posterior chain muscles, improve posture and activate scapular stabilizer muscles while encouraging retraction and downward rotation of the shoulder blade.  These are necessary things to balance the shoulder.

Some experts and customers question this technique from time to time because they disagree with taking the arm above shoulder height during periods of inflammation.  I say this  varies from person to person.  I have worked with over 10,000 people and can tell you there is never one certainty among symptoms and response to exercise.  With that said, I do not want people to exercise through pain.

To that end, I offer a modified version of the pat pull down to accomplish a similar movement.  The straight arm lat pull will effectively target the same things when done properly.  I have included  a video below showing the technique with a traditional straight bar on a pulley as well as with resistance tubing.

The key points to remember are these:

1. Begin at or below shoulder height
2. Keep the knees slightly bent at all times
3. Maintain a tight core (contract abdominals throughout)
4. Keep the elbows straight at all times
5. Focus on pulling the shoulder blades closer together on the pulling motion
6. Return to the start position under control to avoid momentum taking over
7. Breathe out on the way down and in on the way up

I have found this to be an excellent alternative for those unable to continue with traditional lat pull downs during the course of a shoulder injury or rehab.  It is 100% safe.  The only precaution would be not going forcefully past the hips with the tubing pulls for those with anterior shoulder instability or a known labral tear.  This is not an issue with the cable pull as the bar stops prior to this point.