Brian Schiff’s Blog

Ever feel the tightness or ache deep in the shoulder during or after a series of bench press sets?  I must admit I LOVED doing bench press all through college and in my early twenties.  Guys love the chest pump and of course nothing impresses a girl more than broad shoulders, a big chest and beefy arms, right?

Then as I began gaining years of experience as a therapist and started my personal training career, I began to realize a common scenario in men lifting weights regularly.  They had horrible posture, weak posterior chain strength and sore shoulders.  The common thread was this:

• Bench press and loads of chest exercises 2-3x/week and maybe some occasional back exercises thrown in once per week. 

This repetitive bench pressing, dips and flies created a HUGE imbalance.  Keep in mind for every chest exercise you do, you should balance it with a back exercise.  Some believe the ratio of back to chest exercises should be 3:2, while others suggest 2:1.  Suffice it to say I just believe we need less pressing and flies and more back exercises in general.

The poor weak rotator cuff stands up tall in the teens, twenties and early thirties, but it eventually starts to break down over time.  Aside from modifying range of motion, load and changing arm angles (all things I preach), you must work hard to reverse the effects of gravity by doing more upper/lower back training to prevent the caveman syndrome.

Your long term shoulder health depends on it.  I have rehabbed hundreds of shoulders going through rotator cuff and labral repair that are no doubt in some way related to lifting abuse.  Take my word for it when I tell you backing off the load, volume and frequency of bench pressing will add years of life to your shoulders and prevent you from living on anti-inflammatory medication to make it through the day.  I am not anti-bench per se, but I do believe once per week is more than enough for most of us.

Today, I have included a link to a recent column I wrote for PFP Magazine on one such posterior chain exercise to work the upper back and cuff.  Click here to read the column.

In addition, I added a video of the exercise below.  This is easy to do and will immediately improve shoulder health.  Consider adding it to your gym routine at least 2x/week on upper body days.

In closing today, I want to wish all of my friends, family, subscribers and followers a Happy Holiday Season!

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.

Okay, today I am going to rant just a bit about two fundamental problems in modern America with repsect to medicine.  Before I get started, let me first say this blog post is not a universal generalization or assessment of all people or all physicians.  With that said, here is the email I received from a customer today that has spurred this post:

“I’ve started on the rotator cuff muscle exercises and my right shoulder is already feeling better. The left shoulder, which has been torn for the longest, is not yet showing a noticeable improvement. Considering my doctor told me I’d have to ‘put up and shut up’ I am feeling very pleased.“

So here are the 2 problems:

1. MD’s are typically trained to prescribe pills and operate as opposed to encouraging and trusting the human mind and body to heal itself with the proper intervention
2. Too many people just blindly accept the physician’s treatment approach without considering other qualified opinions or asking “why” the MD feels that way

In the case of my client above, the MD obviously told the patient if she chose not to undergo an operation that she would continue to suffer and needed to shut up and quit complaining.  While one shoulder has yet to improve, in less than one week on my program she is already seeing positive improvement.  Hmmm.  Surgery or exercise to relieve shoulder pain.  What would you choose out of the gate?  This is a no brainer in my mind.

Now, this client has a backbone and chose to look at other options.  Thankfully, she believes there is another way.  She did not just say okay and get in line for surgery.  She is optimistic that she can use conservative means to achieve pain resolution and restore function.  Trust me when I tell you the human body is remarkably resilient.  It will generally heal on its own if we simply get out of its way.  Too often, we ignore what it tells us and just do more damage until there is no choice aside from cortisone, pain pills or surgery to allow us to return to what we need to do as soon as possible.  Perhaps we simply need to practice patience over instant gratification.

 So, I want to encourage you to critically analyze what people tell you to do when it comes to your body.  Ask this magic one word question: “Why?”  Always know the “why” behind what you do when it comes to exercise, medication, surgery, etc.  I always have a “why” for every exercise I prescribe and implement in a client’s program.  There is no room for mindless prescription in exercise or medicine.  We need to treat every person differently based on their specific injury, needs, goals, work and life demands, and past medical history. 

My intention in sharing this post is not to bash physicians.  There are lots of excellent docs who practice case by case decision making and serve as true patient advocates.  However, there are also many who need to take a step back and recognize that pills and surgery are not always the answer despite what statistics and tendencies tell us.  If you or someone you know is suffering, be sure to ask their health care professionals “why.”

Yesterday, I revealed a simple yet effective way to strengthen the posterior cuff muscles for overhead athletes.  Today, I want to give you a slightly more difficult version while positioned prone on the ball.  It still targets the posterior cuff, but allows you to focus on both shoulders and stabilization too.

Again, move through a pain free range of motion and use a deliberately slow cadence on this exercise.  I typically like a 1/1/1 or a 2/1/2 pace to get full activation of the muscles throughout the range.  Deceleration of a throwing, stroking or hitting arm is one of the key roles the posterior cuff plays, so emphasizing eccentric strength is necessary to prevent and rehabilitate a shoulder injury. 

Perform 2 sets of 10-15 repetitions with a lighter weight, while maintaing strict form.  If you sense the upper torso is lifting off the ball, consider using less weight or moving to a position where the knees are on the floor to increase stability.

I have literally helped over 10,000 people rid themselves of shoulder problems in just the past 3 years with my Ultimate Rotator Cuff Training Guide. What has been the secret of my success? To be honest, it comes down to understanding how to systematically couple and progress specific exercises at definitive time intervals to deliver a positive rehab outcome.

Sounds easy enough, right? Well, I have found it is not. In the next few blog posts, I will share some critical shoulder exercises to incorporate into your program if you have weakness or pain related to poor rotator cuff and scapular muscle strength.

The first exercise today is seated dumbbell horizontal external rotation. It is imperative to keep the arm slightly forward of the plane fo the body (scapular plane is ideal) and move at a predictable pace through a pain free range of motion. Do not push back through pain as this only perpetuates inflammation.

This particular exercise is effective for increasing strength in the posterior cuff muscles and also for athletes participating in overhead sports such as volleyball, baseball, swimming, and golf to name a few. Do 2 sets fo 10-15 repetitions with a light weight. Tomorrow, I will reveal a more advanced progression of this exercise.