Brian Schiff’s Blog

It is that time of year where baseball pre-season throwing is ramping up. I am starting to see throwers coming in to my clinic with shoulder and elbow issues. In many cases, injury can be avoided with proper stretching and strengthening as well as effective loading programs.

Pectoralis major/minor and latissimus muscle tightness along with poor scapular control often leads to postural dysfunction and shoulder problems. Improving shoulder mobility and scapular control can reduce injury risk and shoulder strain.

The video below from one of my Functional Fit columns will demonstrate an excellent exercise that can be programmed for every thrower to aid in optimizing shoulder mobility and promoting shoulder health.

I often use this exercise following soft tissue release techniques and in conjunction with thoracic spine extension mobilization on the roller. It is an excellent warm-up and activation exercise.

Click here to read the entire Functionally Fit column.

It has been a month since my last blog post. Things continue to improve. I would say I have recovered about 85% of my ROM to date. There is still some stiffness reaching behind my back, and I lack about 10-15 degrees of horizontal external rotation and elevation. Overall, my strength continues to improve, and I no longer have a shrug sign when I lift the arm up.

Pain

I am pain free the majority of the time. However, I have learned that overdoing it (trimming my bushes or pushing the weight with rows or simple horizontal presses in the gym) will remind me I am still not 100%. The shoulder will get sore if seated with pressure on the elbow for extended periods of time. However, the best part is sleeping pain free – the whole reason I had the surgery to begin with.

Work

I am having no issues working with my patients. I have realized that lifting my arm up against gravity with any resistance (e.g. stretching a client’s left hamstring) can be challenging if I have to hold the arm up for any extended period of time.

Exercise 

I continue to do my pulley and ROM exercises daily. Meanwhile, a colleague stretches me 1-2x/week. I am doing scapular and rotator cuff exercises 3x/week, while I try to hit the gym at least 2x/week. I am sticking to exercises with my arms by my side for the most part. I have done some light pull downs and very gentle horizontal pressing. Admittedly, I am also being very cautious given the partial tearing on the right side.

What’s Next?

I have my final MD follow-up on 10/22. I am confident that my repair is healing as expected, yet also acutely aware I still have a long way to go before I am back to “normal.” I fully expect it to take a year before the shoulder no longer feels as if it is stiff, sore or weak at any given time.

As for the right shoulder, I plan to modify my lifting regimen and avoid risky exercises and activities. At some point in the next 2-3 years, I will explore having a subacromial decompression to remove the bone spur in the right shoulder and hopefully avoid a full repair.

Closing Thoughts

For those reading and hoping to avoid shoulder surgery, practice good posture, perform routine rotator cuff strengthening and be willing to adjust your exercises as you age to reduce strain on the cuff. This type of injury is more common in men, but overuse and repetitive motion can impact us all.

If you are experiencing ongoing pain at night and.or pain along the outer arm, I would advise you to seek further evaluation from a therapist or MD. If you have a bone spur like me, the situation is likely to worsen over time. If you treat it early, you may be able to avoid surgery altogether or just have the body decompression done, which leads to a faster and less painful recovery.

This exercise is intended for advanced users who want or need to increase shoulder, core and hip stability, while also seeking to improve hip disassociation. The core must function in an anti-extension and anti-rotation fashion throughout which is a safe and effective way to target those muscles while also providing a demanding strengthening exercise for the upper body and hips.

With that said, sufficient upper body strength is a must for this exercise.  Clients with wrist pain/weakness or elbow and shoulder pathology should only perform this exercise provided they have are symptom free and have moved through the following progressions. In many cases, it is best to start with tall planking and leg lift progressions on the floor before trying this exercise.

The video below will review the exercise in one of my latest columns for PFP Magazine.

Many athletes and clients I work with lack adequate pillar and shoulder stability. Whether this is related to acquired laxity, inherent instability or simply a lack of proper muscular control, I think it is important to assess baseline stability in anyone performing overhead lifts, ballistic upper body training and in overhead athletes.

In my clinic, I work with lots of baseball players, swimmers and volleyball players. Most females tend to struggle with hyper mobility (loose shoulder joints) whereas many of my males tend to have soft tissue tightness and in some cases limited internal rotation (GIRD). Both males and females tend to have a need to improve dynamic shoulder and pillar (core) stability to reduce injury risk and optimize mechanics.

The following exercise is one I use to both assess anti-rotational control/stability as well as train the body to resist torsional forces. In the video below, you can see how to assess your baseline strength and stability.

This exercise is very effective in working improving glenohumeral and scapular stability as well as enhancing shoulder, torso and hip stability. In my opinion, athletes with poor stability in this assessment should not perform unilateral Olympic lifting or ballistic overhead training as they may lack the necessary neuromuscular control to execute the proper movement pattern.

This is a follow-up to my previous post with respect to scapular strengthening for optimal shoulder function. Serratus anterior weakness is a common issue with overhead athletes, especially throwers. It may present clinically as scapular winging, however, it often fatigues quickly with repetitive throwing and contributes to scapular dyskinesia and shoulder dysfunction. Since throwing is an asymmetrical activity, I like to include some unstable and progressive strengthening exercises for the dominant arm.

In the video below (as part of my ‘Functionally Fit’ column for PFP Magazine) I will demonstrate how to use a bottom up kettle bell approach to strengthen the serratus anterior muscle.

To see the full article with progressions and regressions check out the link below:

http://fit-pro.com/article-4136-Unilateral-bottom-up-serratus-punch.html