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.

Wow, it has been a while since I posted.  After battling what may have been H1N1 for nearly 2 weeks I am back at it.  I just returned from the Sports Physical Therapy Section Meeting in Las Vegas held last weekend.  All the brightest minds in the industry were there covering the latest research with an emphasis on knees and shoulders this year.

I must say I came away most impressed with Dr. Scott Dye.  He is an orthopedic surgeon at the University of San Francisco, CA.  He spoke on several topics but continued to highlight this concept of respecting the “envelope of function” in regard to activity and healing.  It really resonated with me as it sounded a lot like my concept of threshold training.

He believes we have a set envelope of function, if you will, that predetermines how much stress our body will absorb before breaking down.  There is the natural envelope and then an area he termed “supra physiologic load.”  Once we break this barrier of supra physiologic load, then mechanical tissue failure ensues.

He preached using bone scans as a diagnostic tool for measuring whether your body was really at tissue homeostasis as opposed to still being inflamed.  His assertion is that often we push people back to full activity too soon based upon subjective reports of no pain and clinical tests as opposed to measuring the joint itself with a scan to see if it is still reactive.

He raised a few eyebrows when he suggested that he does not let athletes return to play after ACL reconstruction until somewhere near 18 months.  While that may seem crazy, he had some interesting research he has done to show how his post-op patients do not get early arthritis at follow-up as far out as 15 years after surgery. 

In essence, he explained that we as practitioners must progress rehab and training in a very sequential and client specific way based upon this envelope of function theory.  While I am not sure I bought  his rehab time lines lock, stock and barrel, I do believe he is right on track with this envelope of function idea.

I have been saying for years that pain is not a good sign during training or rehab.  My critics have often said you can push through some pain with frozen shoulder, rotator cuff pain and the likes with training in order to move forward.  I have always countered that your body has a threshold to activity.  The only surefire way to progress without re-injury is to adequately gage and understand the threshold level, while adding stress to the system only as able while staying within the threshold.

How do I measure the threshold?  I have included my basic definition below:

With a proper training threshold, the athlete or client learns how to grade and evaluate the stress on his/her body during every practice/training session, while gaining an understanding of the exact threshold itself.  The threshold (activity tolerance level) should increase or progress with subsequent training, and the use of pain or soreness in response ot said stress should be the guiding factor in adding more load or volume.

Key parameters to track include:

• Pain at rest or before activity
• Pain during activity
• Pain after activity
• Length of time for pain (if present) to resolve or return to baseline

Teaching athletes and clients to track and understand this concept is critical to long term health.  First, you must get them to honestly report their symptoms.  Then, you must earn their trust by reassuring them your goal is to return them to full activity as soon as possible but as safely as possible.  Finally, you must implement the system and relate it to the exercises for them to understand how to measure their body’s response.

As I work with elite level athletes and everyday folks struggling with SLAP tears, rotator cuff impingement and knee arthritis to name a few, I become more convinced that accurately gaging their threshold or envelope of function is the key component when it comes to successful exercise program design and progression.

Well, with Turkey Day nearly upon us, I am gearing up for a 4 miler on Thursday morning.  I have run 5Ks, 10Ks and half marathons, but this will be my first 4 miler.  They give you a bottle of wine at the end of this one so it is pretty popular in my neck of the woods. 

As I expand my own running and train more and more runners, I often find that many lack good single leg stability and hip strength.  If you are a runner and not doing any strength training or simply focusing on traditional machine-based exercise, you need to shift gears and incorporate single leg exercises to maximize performance and prevent injuries.

In today’s post, I am going to give you an excellent progression of single leg hip drives or lifts to improve stance leg stability, gluteus medius strength and swing leg hip flexor strength.  In addition, this exercise will improve knee stability and ankle proprioception thereby reducing excess tibial rotation/pronation along the way.  That matters if you have experienced IT Band issues or shin splints along the way.  The exercise sequence is as follows:

1. Single leg hip drive holds (3-5 seconds)
2. Supported single leg hip drive
3. Unsupported single leg hip drive
4. Unsupported single leg hip drive with resistance
5. Unsupported single leg hip drive (unstable surface)

You should progress through this sequence of training to ensure best results.  I suggest 1-3 sets of 10-15 reps of each sequence.  The unstable or most advanced version is suitable for cross country runners, runners with poor ankle stability (chronic sprains or hypermobile) or those with poor closed chain mechanics from the ground up.  I have included a few sample reps of these in the video below:

I hope you can put these exercises to good use.  They are great for increasing stance leg strength and stability, while simultaneously improving swing leg strength and mobility. Happy running and have a great Thanksgiving everyone!

I am often asked when is it safe to go back to play after an injury.  In most cases, I am dealing with lower body or back injuries with my athletes, so for the purposes of this post, I will address a lower body functional return to play paradigm.

The tricky part about this question is that no two injuries are created equal.  Sure, I will be the first to acknowledge that I have general approaches to certain injuries and have a sense of how long it should take most of the time.  But, over the past 13 years I have seen enough irregularity and differences to say that everyone heals and recovers differently.

For example, I have had athletes with a simple grade 1 ankle sprain not go back to sport for 6 weeks, whereas those with much more severe grade 2 or even grade 3 sprains go back in much less time.  Why?  There may be several reasons including compliance, body structure, previous medical history, fitness, pain tolerance, and the quality of the rehab to name a few.

In the end, rehab professionals and strength coaches must have sound knowledge of pathophysiology, tissue healing, and program design that ensures maximal progression with optimal tissue loading.  Messing up the stress gradient (too little or too much) will slow the return to play process.  Below are some major milestones my athletes must clear in order before we even get to what I term “functional rehab” or preparatory movement prior to controlled practice:

1. Full active range of motion
2. Normal strength on muscle testing
3. Normal walking gait
4. Symmetrical squat and lunge patterns
5. Single leg squat (back, hip or knee injury) and/or calf raise (ankle injury) within normal limits compared to uninvolved side
6. Single leg hops in place x 10 equal to uninvolved side with no pain or instability
7. Normal running gait on treadmill x 5′ without pain or instability
8. Lateral gait cycle within normal limits (shuffle, carioca and cross stepping)
9. Planned and predictive controlled agility without pain or instability
10. Low level plyometrics in 3 planes without pain or instability

After moving through this fundamental progression (may take days or weeks), the athlete may then begin to perform more demanding neuromuscular work.  This would involve more rotational work, full intensity sprints an cutting, and gradually the transition to reactive agility and speed drills.  Once the athlete completes this process, he or she is ready for controlled practice.

This is an area where I see student athletes get in trouble. They get “cleared” so to speak by the MD and go back to practice.  Cleared to a coach means full go, right?  The athlete should ease back into practice even after a carefully prescribed rehab plan like the one I just laid out.  However, too often, I see athletes rushed back to full practice too soon.  In the case of soft tissue and stress reaction injuries, this often sends them back to the training room or sideline much sooner than the coach or athlete would like.

What is the answer?  Controlled practice progressions with the idea of first increasing volume (total minutes) prior to restoring maximal intensity.  Athletes know what is hard and what hurts.  We just need to communicate with them.  Allow them to do the easier drills and fill up time with those prior to ramping up the intensity for the entire practice.

Let’s take soccer as an example.  Dribbling, passing and light shooting are lower level drills.  In contrast, set pieces and small sided games are much more demanding.  Athletes and coaches must use discretion when returning form play to avoid re-aggravating an injury.  Measuring pain before, during and for 24 hours afterward is crucial in determining how the body is absorbing the force and responding to the training stress. 

If soreness is lingering for more than 24 hours, this is a red flag that the volume and/or intensity is too much.  I educate all my parents, coaches and athletes to follow this simple 24 hour rule.  I have found if you do, you end up with predictable results in terms of recovery and return to play.  So, if you have suffered an injury, be sure to consider moving through a set functional progression and be sure to used a controlled return to play approach to ensure you make a full recovery.  Have questions?  Leave a comment or shoot me an email.