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How to Coach and Perform Shoulder Program Exercises

The latest Inner Circle webinar recording on How to Coach and Perform Shoulder Program Exercises is now available.

How to Coach and Perform Shoulder Program Exercises

How to Coach and Perform Shoulder Program ExercisesThis month’s Inner Circle webinar is on How to Coach and Perform Shoulder Program Exercises.  While this seems like a simple topic, the concepts discussed here are key to enhancing shoulder and scapula function.  There are many little tweaks you can perform for shoulder exercises to make them more effective.  If you perform rotator cuff or scapula exercises poorly, you can be facilitating compensatory patterns.  In this webinar, we discuss:

  • How to correctly perform rotator cuff and scapula exercises
  • Coaching cues that you can use to assure proper technique
  • How to enhance exercises by paying attention to technique
  • How to avoid compensation patterns and assure shoulder program exercises are as effective as possible

To access this webinar:

 

 

 

How to Perform and Advance Rhythmic Stabilization Drills

The latest Inner Circle webinar recording on How to Perform and Advance Rhythmic Stabilization Drills is now available.

 

How to Perform and Advance Rhythmic Stabilization Drills

How to Perform and Advance Rhythmic Stabilization Drills Mike ReinoldThis month’s Inner Circle webinar is on How to Perform and Advance Rhythmic Stabilization Drills.  Rhythmic stabilization drills have become very popular since I discussed in my DVD Optimal Shoulder Performance several years ago.  These are easy and excellent drills to start working on dynamic stabilization.  However, I must say over the years I feel like people are getting pretty sloppy with these drills, which essentially makes them much less effective.  Just because an exercise is simple, doesn’t mean that we should be sloppy with how we perform.  In this inservice presentation, I discuss how to perform rhythmic stabilization drills and all the ways we advance them from simple to advanced.

In this webinar, we discuss:

  • Why rhythmic stabilization drills are a great way to start enhancing dynamic stability
  • How to perform basic rhythmic stabilizations
  • How to advance rhythmic stabilization drills by changing technique variables
  • How to know when to advance someone or scale back to get the most out of the drills

To access this webinar:

 

 

5 Tweaks to Make Shoulder Exercises More Effective

The latest Inner Circle webinar recording on 5 Tweaks to Make Shoulder Exercises More Effective is now available.

 

5 Tweaks to Make Shoulder Exercises More Effective

5 Tweaks to Make Shoulder Exercises More EffectiveThis month’s Inner Circle webinar is on 5 Tweaks to Make Shoulder Exercises More Effective.  Over the years, you tend to pick up on the little things that can make a big difference.  I’m always reading the latest research to find simple little tweaks that I can make to an exercise to change the desired result.  Maybe I’m trying to optimize the mechanics of the scapula, or trying to enhance EMG activity of a certain muscle, or even change the ratio of activity between two muscles.

In this webinar, we discuss:

  • Why little tweaks can make a big difference
  • Why integrating the kinetic chain into a shoulder exercise may be effective
  • How altering hip and trunk movement during exercises change the muscle activity
  • How you can put this all together and make your own functional exercises specific to each person

To access this webinar:

 

 

 

A Better Way to Perform Shoulder Exercises?

It’s pretty obvious that the shoulder is linked to the scapula, which is linked to the trunk.  So why do we so often perform isolated arm movement exercises without incorporating the trunk?  It’s a good question.  The body works as a kinetic chain that requires a precise interaction of joints and muscles throughout the body.

 

The Effect of Trunk Rotation During Shoulder Exercises

A recent study was published in the Journal of Shoulder and Elbow Surgery that examined the impact of adding trunk rotational movements to common shoulder exercises.

The authors chose overhead elevation, external rotation by the side, external rotation in the 90/90 position similar to throwing, and 3 positions of scapular retraction while lying prone (45 degrees, 90 degrees, and 145 degrees) that were similar to prone T’s and Y’s.  The essentially had subjects perform the exercise with and without rotating their trunk towards the moving arm.

A Better Way to Perform Shoulder Exercises?

EMG of the the upper trapezius, middle trapezius, lower trapezius, and serratus anterior were recorded, as well as 3D scapular biomechanics.

There were a few really interesting results.

  • Adding trunk rotation to arm elevation, external rotation at 0 degrees, and external rotation at 90 degrees significantly increased scapular external rotation and posterior tilt, and all 3 exercises increased LT activation
  • During overhead elevation, posterior tilt was 23% increased and lower trap EMG improve 67%, which in turn reduced the upper trap/lower trap ratio.
  • Adding rotation to the prone exercises reduced upper trapezius activity, and therefore enhanced the upper trap/lower trap ratio as well.

 

What Does This All Mean?

I would say these results are interesting.  While the EMG activity was fairly low throughout the study, the biggest implication is that involving the trunk during arm movements does have a significant impact on both muscle activity and scapular mechanics.  Past studies have shown that including hip movement with shoulder exercises also change muscle activity.

This makes sense.  If you think about it, traditional exercises like elevation and external rotation involve moving the shoulder on the trunk.  By adding trunk movement during the exercises you are also involving moving the trunk on the shoulder.

This is how the body works, anyway.  Most people don’t robotically just move their arm during activities, the move their entire body to position the arm in space to accomplish their goal.

It’s also been long speculated that injuries during sports like throwing and baseball pitching may be at least partially responsible for not positioning or stabilizing the scapula optimally.  I think this study supports this theory, showing that trunk movement alters shoulder function.

Isolated exercises like elevation and external rotation are always going to be important, especially when trying to enhance the strength of a weak or injured muscle.  However, adding tweaks like trunk rotation to these exercises as people advance may be advantageous when trying to work on using the body with specific scapular positions or ratio of trapezius muscle activity.

 

5 Tweaks to Make Shoulder Exercises Even More Effective

I’m a big fan of understanding how little tweaks can make a big difference on your exercise selection.  If you are interested in learning more, this month’s Inner Circle webinar will discuss 5 Tweaks to Make Shoulder Exercises Even More Effective.  The webinar will be Tuesday August 25th at 8:00 PM EST, but a recording will be up soon after.

 

 

 

How to Cue the Scapula During Shoulder Exercises

In today’s video, I share my thoughts on the common cue of retracting your scapulae together while performing shoulder exercises.  I’m not sure this is the most advantageous cue, despite it’s popularity.  Instead, I focus on facilitating normal scapulohumeral motion.  I don’t want to restrict the scapula while moving the arm.

Learn more about how to cue the scapula during shoulder exercises in the video below.

 

How to Cue the Scapula During Shoulder Exercises

Learn How I Evaluate and Treat the Shoulder

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The Influence of Pain on Shoulder Biomechanics

The influence of pain on how well the shoulder moves and functions has been researched several times in the past.  It is often though that impaired movement patterns may lead to pain the shoulder.

A recent two part study published in JOSPT analyzed the biomechanics of the shoulder, scapula, and clavicle in people with and without shoulder pain to determine in differences existed between the groups.  Part one assessed the scapula and clavicle.  Part two assess the shoulder.

The subjects with pain were not in acute pain, but rather had chronic issues with their shoulders for an average of 10 years.  Think of it like chronic recurring shoulder impingement.  The authors used electromagnetic sensors that were rigidly fixed to transcortical bone screws and inserted into each of the bones to accurately track motion analysis.

The studies were interesting and worth a full read, but I wanted to discuss some of the highlights.

The Influence of Pain on Shoulder Biomechanics

In regard to the scapula, the authors found:

  • Upward rotation of the scapula less in subjects with pain
  • This decrease in upward rotation was present at lower angles of elevation, not in the overhead position

It is important to assess scapular upward rotation in people with shoulder pain, particularly emphasizing the beginning of motion.  Realize that no differences were observed in upward rotation past 60 degrees of elevation, implying that the symptomatic group’s upward rotation caught up to the asymptomatic group.  This may imply that there is a timing issue, more than a true lack of scapular upward elevation issue.  They are upwardly rotating, but perhaps just too late?

The study also found the following in regard to shoulder motion:

  • Shoulder elevation was greater in subjects with pain
  • This increase in shoulder elevation was present at lower angles of elevation, not in the overhead position

Noticed how I intentionally presented it similar to the scapula findings?  if you put the two finings together, it appears that people with shoulder pain have a higher ratio of shoulder movement in comparison to scapular movement at the beginning of arm elevation.  The shoulder caught up again overhead, so it appears that the timing between shoulder and scapular movement may have an impact.

The Influence of Pain on Shoulder Mechanics

As you can see, it is important to assess both shoulder and scapular movement together, and not in isolation, as movement impairments at one join likely influence the other.  The brain is exceptionally good at getting from point A to point B and finding the path of least resistance to get there.

I should note that in studies like this, it is impossible to tell if the pain caused the movement changes or the movement changes caused the pain.  So keep that in mind.  Regardless of causation, our treatment programs should be designed with these findings in mind.

There are so many other great findings in the study that I encourage everyone to explore these further, but I thought these findings were worth discussing.  Based on these findings, it appears worthwhile to assess the relative contribution of scapular and shoulder movement during the initial phases of shoulder elevation.

Interested in advancing your understanding of the shoulder?  Join my extensive online program teaching you exactly how I evaluate and treat the shoulder at ShoulderSeminar.com.

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Great Exercise to Enhance Posterior Shoulder Strength, Endurance, and Overhead Stability

I wanted to share an exercise I have been incorporating into my programs lately to develop posterior shoulder strength, endurance, and overhead stability.  I call it the ER Press as it combines shoulder external rotation in an abducted position with an overhead press.  When performed with exercise tubing, it provides an anterior force that the posterior musculature must resist during the movement.  The key is to resist the pull of the band while you press overhead.

I use this drill a lot with my baseball players and overhead athletes.  I think it’s a great drill that hits many of the areas that I focus on when training a strong posterior chain of the trunk and arm.

It’s also becoming a favorite of my Crossfit and olympic lifting athletes, who are reporting that they feel more comfortable overhead and have more stability with their snatches and overhead squats.

There are numerous progressions that can be performed by simply changing the position the athlete is in, including tall kneeling, half kneel, and split squat stances.  You can also perform some rhythmic stabilizations at the top range of motion once to increase the challenge.

 

How to Enhance Your Success After Rotator Cuff Repair Surgery

Rotator cuff tears are very common injuries for people of all ages, even though our ability to evaluate and treat shoulder impingement has improved..  Depending on the study you read, it has been reported that 13% of people over the age of 50 years and 50% of people over the age of 80 years will have a rotator cuff tear.  Naturally, rotator cuff repair surgery has become equally as common.  Over the last several decades we have made great progress in our rotator cuff repair surgical techniques, transitioning from an open procedure, to a less invasive “mini-open” procedure, and now full arthroscopic.

arthroscopic rotator cuff repairThe newer arthroscopic rotator cuff repairs tend to less painful and allow people to do more sooner.  However, one mild little fact that we often do not hear about is that the failure rate after rotator cuff repair surgery is still too high.

Past studies have shown up to 75% of people following a rotator cuff repair will technically “fail” if you define surgical failure as the cuff is not intact again after surgery.  A recent systematic review published in JOSPT reported a failure rate between 18% and 40% over 10 different research reports.

Despite these “failure” rates, most research studies have shown that patient satisfaction after surgery is still very high.  This tells me that the rehabilitation process may be far more important than the actual surgery.  That is great news, even if the rotator cuff is found to not be intact again after surgery, pain, motion, strength, function, and satisfaction can all still be improved significantly.

Regardless, we should all be doing everything we can to maximize your success after rotator cuff repair surgery.

A recent systematic literature review publish in JOSPT sought to determine the prognostic factors associated with a successful recover following arthroscopic rotator cuff repair surgery.  Based on this paper, we can identify several factors that can help maximize your outcomes following surgery.  While, not all of these factors are easily addressed, many are, and it is always my goal to assure you put yourself in the best position to succeed.

Factors Associated with Successful Recovery Following Rotator Cuff Repair

The review focused on 10 papers that met the authors’ strict guidelines for inclusion.  Based on these 10 papers, they were able to identify 12 factors that were correlated to better outcomes following rotator cuff repair surgery.  These 12 factors were divided into 4 categories: demographic factors, clinical factors, factors related to the rotator cuff integrity, and factors related to the surgical procedure.

I am going to discuss the first 3 as they relate to things we may be able (or not able) to do to enhance outcomes following rotator cuff surgery.  In regard to surgical factors, one study showed that performing additional procedures to the biceps or acromioclavicular joint was associated with poorer outcomes.  We can’t really control the surgical procedures, but perhaps this information may be beneficial to the surgeons.

Demographic Factors

The most significant finding in regard to general demographics was related to patient age at the time of surgery.  Older age had a negative effect on recovery.

The studies demonstrated that the older you are, the less your chance of tendon healing.  Those under the age of 55 years have the best outcomes with between 88-95% chance of tendon healing.  In contrast, people aged over 60 years had between 43-65% chance of tendon healing.

While you can’t control when your rotator cuff becomes troublesome, these results do imply that we should not ignore symptoms and allow your shoulder and rotator cuff to gradually become more degenerative.  Addressing issues earlier should help with outcomes.  We have all seen it, most people put off addressing their shoulder soreness for years, attempting to work through the discomfort.  We don’t usually seek help until our functional level is significantly impaired.

Clinical Factors

Not surprising, bone mineral density and diabetes were both associated with poorer tissue healing.  Obesity was also associated with less successful outcomes.  People that were considered obese had a 12% less chance of successful outcomes.

I thought a very interesting finding involved your activity level prior to surgery.  People who rarely participated in physical activities had poorer outcomes that those that participated in medium- and high-intensity sports, such as golf, swimming, cycling, running, and tennis.

In regard to strength and motion, it was determined that the best predictor of final strength was initial strength.  Preoperative should stiffness also had a negative effect on recovery time, delaying return to activity.

While some of these factors, like bone mineral density and diabetes, may not be avoided, you can assure that these are under control medically before surgery.  However, factors such as obesity, activity level, strength, and mobility are all likely related and can be addressed prior to surgery.  This underscores the importance of performing physical therapy PRIOR to surgery.  I always say, the better you look going into the surgery, the better you’ll look coming out of surgery.

Rotator Cuff Integrity Factors

rotator cuff tear retractionThere were 4 factors in regard to the integrity of the rotator cuff that related to poor outcomes: tear size, the number of rotator cuff muscles involved, the amount of tendon retraction, and the amount of fatty infiltration.  These factors are all associated with tissue degeneration, and perhaps even associated with age.

Essentially, the more degenerative the tissue, the worse the outcomes.  Over time, your cuff tear will progress in size, potentially start to pull off the bone (retract), and become weak.

These factors are probably more associated with my comments on age above.  Perhaps we should be more proactive with our decisions regarding taking care of our shoulders prior to the tear becoming more involved and the tissue more degenerative.  Something to consider, repair of a small rotator cuff tear had a 96.7% chance of healing after surgery in comparison to a 58.8% chance if that tear becomes large.

What You Can Do to Enhance Outcome Following Rotator Cuff Repair Surgery

I feel like this study shed some light on several things we can do to enhance your outcomes following rotator cuff repair surgery:

  • First we should do our best at evaluating shoulder impingement, and then treating shoulder impingement symptoms to try to minimize a rotator cuff tear in the future.
  • Do not unnecessarily put off surgery as outcomes are less successful the older you are at the time of surgery.
  • In regard to the above, also consider that putting off surgery may allow the rotator cuff to become degenerative.  The larger the tear and the more degenerative the tissue, the less successful the outcome.
  • Being physically active and losing weight are both associated with better outcomes.  Get off your butt.
  • Begin physical therapy prior to surgery.  The stronger and more mobile your shoulder is at the time of surgery, the better off you’ll be after surgery.  You’ll be stronger and return to activities sooner.  Plus, some studies have shown that physical therapy can help you avoid rotator cuff surgery.
  • Assure that medical conditions, such as bone mineral density and diabetes, are being addressed and under control prior to surgery.

For the clinicians reading this, we can also use this information to determine our rate of progression during rotator cuff repair rehabilitation.  The more prognostic factors that your patient may have indicating a less successful outcome, the more conservative you may need to progress.

Would you progress some that is a 52 years old physical active person with a small rotator cuff tear and no other health issues at the same pace as a 74 year old with a large tear, weakness, and diabetes?  Of course not.  We can’t just blindly follow a protocol.  Protocols are useful and necessary, but they just provide structure that you adjust if factors dictate that you should be more conservative.

There are ways to enhance your success after rotator cuff repair surgery, many of which are controllable.  Use these findings to help you or your client’s maximize your outcomes following surgery.