Brian Schiff’s Blog

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!

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 &quot;enough is enough.&quot;  If you want more information on my exercise modifications, check out my shoulder book at www.rotatorcufftraining.com.

One of my favorite tools I use in the gym with my clients is the BOSU.  Admittedly, it is really easy to get carried away with various tools and equipment when training clients or ourselves.  But, the BOSU is awesome if you are into building strong stable shoulders and safeguarding them against injury.

Many people focus on open chain (the hand is free in space) shoulder training, but in overhead athletes such as swimmers, volleyball players and throwers, it is essential to build a solid level of scapular strength to absorb force and enable the shoulder to move freely and effectively generate power.

I routinely include BOSU stability work in the following ways:

1. Dynamic warm-up
2. Core training
3. Upper body work & scapular strengthening

One of my favorite exercises is what I term the “BOSU clock.”  I wrote a column on this exact exercise for PFP Magazine a few months back.

Click here to read more and learn how to use this exercise to improve shoulder stability and reduce pain and/or injury risk related to shoulder instability, rotator cuff pathology and muscular imbalances.

This is just one great way to use the BOSU in your training.  If you are interested in getting your very own BOSU, head on over to my OpenSky Shop and check it out – http://brianschiff.theopenskyproject.com/