Brian Schiff’s Blog

The longer I train (myself) and my clients, the more and more I gravitate to bodyweight and bodyweight plus training.  Why?  Namely because I find people struggle to control their bodies in space against gravity.  No matter what sport or work task people need to complete, they must be able to move, stabilize, and resist and apply force effectively with respect to their body.

I also find myself looking to integrate systemic, progressive and kinetic chain based core strengthening exercises for maximal efficacy.  The lack of proper core stability and strength will often leave the back and other limbs of the body vulnerable to unwanted force dissipation.  That means increased chance for injury. 

Adding a stability ball (when you are ready) to abdominal exercises will add spice to your routine and surely FIRE UP your core too!  In today’s post, I want to share some pics of core based training related to my most recent column in PFP Magazine.  Before I share one of my favorite ball exercises with you, consider the following pre-requesite steps before attempting this particular exercise:

• Master floor based planks
• Master static stability ball planks
• Master static holds in hand supported plank position (balance/stability)

Pictured below is the stability ball ab circles.  This is great exercise for shoulder stability training and core activation.  Trust me when I say you will feel it after 10 good slow reps.

Ab Circle to the Left

 Click the image below to check out my column on how to execute the stability ball ab circles.

I have used Thera-Band Stability balls for years and love them.  If you are looking to add a stability ball to your training tool box, click on the stabilityball images below to grab your very own today.  The 55 cm ball works great for the ab circles for most people.  Enjoy!

I am sure you or someone you know has suffered with or been affected by a frozen shoulder at some point.  Known in the medical world as adhesive capsulitis, this condition can be downright miserable for folks.

Who gets it?  It is often brought on after injury or a period of immobilization (e.g. arm in a sling after surgery or dislocation).  However, it also comes on insidiously too.  Statistics indicate it more commonly affects women and those with diabetes are at more risk for getting it in both arms.

Some feel it may ultimately be an autoimmune reaction that triggers it.  So, what is it exactly?  Well, in plain terms your shoulder joint has folds of connective tissue we refer to as a joint capsule.  In frozen shoulder cases, the capsule becomes shortened and inflamed making arm movement painful and limited at best. 

There are three distinct phases:

1. Freezing
2. Frozen
3. Thawing

These phases may progress over the course of months or in some cases last as long as 2-3 years to resolve.  In time, the condition will correct itself. 

Symptoms may include:

• Stiffness
• Difficulty sleeping
• Pain along the shoulder or down into the arm
• Certain movements more restricted than others
• Progressive worsening of motion and decreasing pain

No one wants to suffer with this for any prolonged period of time.  So, how do you accelerate the healing process?  You must move the shoulder daily within your available range of motion.  But doing the right exercise is critical.

In addition, I believe having an experienced therapist do joint mobilizations is critical in loosening up the capsule provided it is done within pain tolerance of the patient and followed up by appropriate stretching.  For those without insurance or looking to avoid the grueling stretching some docs and PT’s advocate, I recommend looking at my home therapy guide.

Want more info?  Visit www.frozenshouldertherapy.com for success stories and more details on my proven home remedy.  You can also click on the image below:

In addition, I think you can complement rehab with a tool like the Rotater to help restore mobility.  I have trialed this product myself and I really like the ease of use and control the patient has with the stretching intensity.  For more details, click on the image below:

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.

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.