Brian Schiff’s Blog

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.

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Today’s blog post is about an observation and fundamental tenet of my practice today as a sports physical therapist and fitness professional. Having been in the business of rehabbing and training the human body for 15 years, I feel qualified to say I know a thing or two about training and exercise.

Perhaps one of the greatest pearls I can pass along as it relates to being a health and fitness professional involves the art of teaching. You see, I have witnessed firsthand the desire people have to attain knowledge when it comes to their bodies. Just look at how quickly and often people take the web in search of answers from the latest ab workout to the source of and remedy to their every ache and pain.

We live in a society of information overload. Unfortunately, the web, YouTube, FB, Twitter and so on give just about anyone a stage to philosophize and sound off as an “expert.” Many people who claim to know how to “train” you for this and that have little to no real world experience doing it, nor do they possess enough pre-requesite knowledge to truly be considered an expert.

I find many people mistakenly look for what they perceive to be the most “in” or “intense” training they can find, as they believe this is the way to finally meet their goals. In reality, what they should be seeking is someone interested in teaching them how to better understand their own body and how to apply the proper training principles to it in order to bring about the desired result they are so desperately seeking.

Training typically involves putting together drills, workouts or routines to challenge clients physically. Teaching, on the other hand, is centered on educating clients how to listen to their bodies and use that feedback to appropriately adjust physical loads and exercise programming to avoid injury and make positive physical adaptations.

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With the new year, millions of people have made a resolution to lose weight.  Along with that, comes the idea they will flatten their midsection.  If you are like me, you share a certain disgust for the infomercials marketing the “next” latest and greatest abdominal machine.

For years, people have sought out how to build the perfect six pack.  Obviously, nutrition is probably the single biggest factor in achieving a sculpted midsection. But, beyond that people often wonder what exercises to do to target the upper and lower abs as well as the obliques.  Is this really possible?

Well, I thought I would share the results of a recent study in the Journal of Strength & Conditioning Research. The authors wanted to look at the use of other training tools versus just a body weight only exercise. In the study, they looked at surface EMG activity for the upper rectus abdominus (URA), lower rectus abdominus (LRA), external obliques (EO), internal obliques (IO), transverse abdominus (TA) and rectus femoris (RF) with the following exercises:

• Abdominal floor crunch
• Supine V-up
• Prone V-up on slide board
• Probe V-up on stability ball
• Probe V-up on TRX
• Prone V-up on power wheel

Crunch

Prone V-up with power wheel

In short the major results are as follows:

1. The most muscle activity overall occurred with the power wheel
2. There was no significant difference for activation of the EO, URA and LRA
3. RF was much less active only during the abdominal crunch

Practical applications include:

• There is no realistic way to isolate portions of the abdominal muscles, but keep in mind one limitation may be that the study looked at MVC (contraction at only one point in the motion)
• The RF is NOT a spinal stabilizer but rather a hip flexor and therefore it can cause an anterior pelvic tilt if overly active which can be viewed as potentially harmful
• Focus on training the core globally as an integrated segment of the kinetic chain to maximize activation and understand how the hips affect completion of the movements

I hope this post stimulates your thinking with respect to abdominal training.  If you do use training tools, simply stop for a moment to consider the desired training outcome, as well as the impact the body position and  muscle firing patterns have on the exercise itself.

So, I am about 4 weeks into my new job at as a supervisor and sports physical therapist at the Athletic Performance Center (www.apcraleigh.com).  So far, I am really enjoying it.

I have seen lots of different athletes ranging from youth to professionals.  The one thing people often seek to eliminate with rehab is pain.  Ironically, what most people fail to realize is that this pain is actually one of the biggest tools they need to rely on in the recovery process.

You see, most injuries I encounter are related to repetitive micro-trauma or overuse.  Such injuries include tendonitis, bursitis, stress fractures, muscle strains, cervical and lumbar disc bulges, and so on.

It is critical that people learn to read their own pain as a marker of how well their body is holding up to the stress they are subjecting it to each day.  If they simply learn to recognize and respect pain and what it tells them, they would be able to rehab and recover much faster.

Pain, while undesirable, is one of the most important tools we can use as therapists, strength coaches, ATC’s and fitness enthusiasts to judge how best to move forward or step back.

No pain, no gain is old school and best left in the past.  To help athletes today and long term, it is best to educate them how best to recognize and react to pain when it occurs.  Too many times they ignore it or fail to report it because they believe they will be held out of participation, or it is not a big deal.

Little do they know that this mentality often costs them more playing time long term or even may jeopardize their health in later years.  So, as I tackle patella tendonitis, lateral epicondylitis, muscle strains and such, I teach my clients how to interpret pain in response to their daily life and sport.

Pain is not the enemy, but rather a warning signal our body sends us when it simply needs a break or is beginning to break down.  Therefore, learn to listen more closely to your body and let pain guide your training, play and rehab process.

I advise people to consider the following:

• Soreness up to 3-4/10 on a 0-10 pain scale (10 being the worst) is acceptable provided it does not escalate with activity
• Any increased soreness after an activity should subside or return to baseline within 24 hours
• Pain that is at 5/10 or greater is a red flag and precursor to mechanical failure

Finally, keep in m ind that once pain subsides, that does not necessarily mean your body is done healing.  Pain is a symptom and there is often a mechanical cause or disruption that leads to it.  So, just remember to pay close attention to soreness and pain with activity as your body was programmed to let you know when tissue is starting to break down.

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.