I went to the weight room and did a workout yesterday.  While in there, someone caught my eye.  It was a person performing rotator cuff exercises.

As I went from exercise to exercise, he went from rotator cuff exercise to rotator cuff exercise.  Everything he did, in my mind I was saying why he should not be doing that.

Let me share with you what my mind was saying as this patron was doing things to injure his rotator cuff and how he could tweak things so he is helping his rotator cuff.

#1 – Start Off with the Right Kind of Warm Up

He should have taken 5 minutes and warmed up the upper body and rotator cuff.

I am not talking about going on the treadmill and walking for 5 minutes.

I am talking about a warm-up targeting the upper body.

An example of an upper body warm up that he could have done before he got into his rotator cuff exercises is:

• Jump Rope – 2 minutes
• Push Ups – 10 repetitions
• Shoulder Bridges – 10 repetitions
• Tubing Face Pulls – 10 repetitions
• Thread the Needle – 10 repetitions

These exercises serve to warm up the shoulder, activate the muscle in the shoulder blade area (scapular muscles), and improve the mobility of the mid-back, which all decrease the stress on the rotator cuff.

Now if you have Muscle Imbalances Revealed – Upper Body Edition – Josh Saunders goes through a great upper body dynamic warm up that he does for his bootcampers.

#2 – Doing WAAAAAAAAY too Many Scapular Exercises

I will pass on writing about this and let myself explain things in this video:

 (Resent research is Teyhen 2008.)

#3 – Stop Doing the Wrong Stretches Between Sets

It is common to see people stretching after they do an exercise.

For example, after doing a bench press you would see the person stretch out their chest.

Does this help or make things worse when it comes to the rotator cuff?

I would say it hurts the rotator cuff, and decreases your performance.

What he should have done  is stretch the antagonist muscle (the muscle or muscle group that performs the opposite action or movement).

For example, if you are working the back by doing a rowing exercise, after the exercise you would stretch out the antagonist, which is the chest. Doing this will help decrease tension in the chest, lengthen the chest muscles, and allows you to get greater range of motion and less resistance from the chest muscles when performing the rowing exercise.

#4 – Don’t Make Your Rotator Cuff Weaker by “Strengthening” It

Doing too many rotator cuff exercises can lead to injuring the shoulder.

The patron in the gym.  (Ya, at this gym, they call gym members, patrons.  I don’t know.)

The patron in the gym was doing a standing tubing external rotation exercise. He was not doing it for sets or reps, but to fatigue.  Not a good idea.

Often times, you will see people focusing on working their rotator cuff in an exercise. They will be performing repetitions with their maximum weight and going to fatigue. This leads to the rotator cuff not being able to do its job which is to hold the head of the humerus (upper arm) in place in the shoulder. With the rotator cuff fatigued, the upper arm will move upwards and increase the risk of impingement in the shoulder (Teyhen 2008).

You can do rotator cuff work in the warm up at a low load to warm them up, or you can do your rotator cuff work at the end of your workout, but doing it to fatigue is not a good idea.

#5 – Shoulder Blade Muscles are the Key to Rotator Cuff Health

When it comes to shoulder health and rotator cuff health, focus on the scapular muscles (Başkurt 2011).

Exercises like seated rows, diagonal pulley pull ups, straight arm deltoid rows, and bent over rows all hit your back and the muscles around your shoulder blade. That is, if you are at the level to do them.

The scapular muscles work to keep the shoulder blade in a position so the rotator cuff muscles can work at the best position possible. If the scapular muscles lack the activation, endurance, and strength, this leads to them not doing their job, which leads to great stress and risk of injury on the rotator cuff. The rotator cuff can do the job for a little while, but eventually micro-tears occur which could lead to a full blown rotator cuff injury and shoulder pain.

I go into scapular exercises in a lot more detail in the Scapular Stabilization Exercise Program:

#6 – Focusing on Eccentric Contraction of the Rotator Cuff

The patron was doing side lying dumbell external rotation exercises with a 2.5 weight plate.  This is a good exercise but he only focused on one of the contractions in the exercise.

He would externally rotate the weight plate, and then let gravity lower it back to the start position, avoiding the eccentric contraction. Not a good idea.

Many times when patrons work on strengthening their rotator cuff, they end up focusing on the wrong type of contraction for their rotator cuff. Let’s step back and talk about the different types of contraction a muscle has.

A concentric muscle contraction is when the muscle is shortening and the joint angle is decreasing. For example, look at biceps curls. If I take a dumbbell in my hand and go from straight arm and curl up until my elbow is bent to maximum, this is the concentric contraction of the biceps muscle.

An isometric contraction is when the muscles are activated and working but there is no joint movement. Let’s go back to the biceps curl. At the start of the biceps curl, my elbow is straight and my hand is holding the dumbbell. The biceps muscle is active but the elbow is still straight and there is no change in the joint range of motion. This is an isometric contraction.

Eccentric contraction is when the muscles are activated and the joint angle is increasing. Continuing on with the biceps curl example, this is when you go from the end position to the starting position. When working the rotator cuff, focus on the eccentric contraction (Holmgren 2012). This will help when it comes to overcoming a shoulder injury, especially shoulder impingement.

The guy in the gym could have got a lot more out of the exercise if he focused on lowering the weight plate by using the eccentric contraction of the rotator cuff, compared to using gravity.

Last Word on Helping and Not Hurting Your Rotator Cuff

There are a lot of things we can avoid and tweak that will decrease risk of injury and help protect the rotator cuff. Starting the workout right, stretching correctly, avoiding working the rotator cuff to fatigue, taking the time to work on the scapular muscles, and working on the eccentric contraction of the rotator cuff  are just a few of the things that you can to help prevent and overcome a rotator cuff injury.

Now I did not tell this to the patron, but I hope he reads the blog — or he can book a training session with me and I can help him out.

Where to get more information:

Başkurt Z, Başkurt F, Gelecek N, Özkan MH. (2011). The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24(3):173-9.

Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012 Feb 20;344:e787. doi: 10.1136/bmj.e787. 

Teyhen DS, Miller JM, Middag TR, Kane EJ. (2008). Rotator cuff fatigue and glenohumeral kinematics in participants without shoulder dysfunction. J Athl Train. 2008 Jul-Aug;43(4):352-8.

If you want more details on re-habbing or strengthening your rotator cuff, you can check out my Effective Rotator Cuff Exercise Program and yes, you can earn CECs with it:

Rick Kaselj, MS

I was not really filtering out my spam box. These are a few things that were in my inbox and on Facebook. Let’s get to it.

Cure My Elbow Pain

This was a question that came up for the Muscle Imbalances Revealed – Upper Body (MIRU) coaching call.  I thought the answer would be of interest to you.

Can you tell me how to cure elbow pain? Basically it hurts if I do chin ups, lying dumbell skull crushers (I think that’s where I hurt it and a little on bench press). Also, can you tell me the other types of elbow pain there is (if any other) and if the treatment for curing would be different for each one?

Of the MIRU crew, Dr. Jeff Cubos took on the question.  Just a reminder that the MIRU crew will be holding a seminar this June on Spinal Health & Core Training.  We hope to see you there.

“Unfortunately, it is quite difficult to answer clinical conditions online.

There are many components to the elbow proper and far more components to pain itself.

I will say this, unless there was an acute trauma or structural deformity, the tissues surrounding the elbow may likely be overloaded. Aside from training that progresses too quickly or with too much load, I’d look to the thoracic and shoulder girdle regions.

Often the scapulothiracic joint complex lacks requisite dynamic or static control causing the muscles that cross the elbow to do more work. I’ll often start by addressing mobility issues, then go after control.

I really like quadruped both on elbows and hands for scapulothoracic control ensuring that the scapula is properly positioned or centrated throughout the movement. The hand should also have good contact with the floor in a slightly external rotated position with load being put at the 1st and 5th mcp and base of the palm. The fingers should be spread out.

It may also be worthwhile to seek the help of a clinician who does soft tissue therapy to address the quality of the local tissues and mobility of the distal tissues.

I hope that helps. Sorry I couldn’t be specific but you are more than welcome to email me.”

- Dr. Jeff Cubos

It is back to Rick.  I would say, get it looked at and get an accurate diagnosis and approval to start an exercise program.  If what you have is lateral epicondylitis or tennis elbow, I will suggest this program:

What to do about Osteochondritis?

Tom, I would check out the interview with I did with Zach Moore on Exercise and Osteochondritis. I know this will help you out.

Funny Stuff

Since I do this injury stuff, I have been getting all kinds of nicknames, here is another one to add to the list:

I am Very Weak in the Push-up?

A question from Quebec:

Harold, I know you have both the Upper Body and Lower Body of Muscle Imbalances Revealed.

I would take the time to work on the scapular stabilizers.  You can do this in a plank position – Dr. Jeff Cubos talks about above or you can do this in an open chain fashion with exercises targeting the middle fibers of trapezius, lower fibers of trapezius and serratus anterior as I go through in the Scapular Stabilization Exercise Program.

I would also check out Tony Gentilcore’s Component #1 – Corrective Exercise Strategies for Athletes (and Meatheads, too) with Tony Gentilcore that is in MIRU.  He goes through some great exercises that you can do to help with upper body strength exercises.

My Shoulder Cracked?

A question from Brazil:

Sergio, I want to help you out but there is not enough to go on. My advice would be to get it looked at.  Get an accurate diagnosis, clearance to start an exercise program and written guidelines on what you can and can’t do.  Then we can go from there. My big advice: take the time to rehab your shoulder or you will get injured again.

Nice Stuff on Facebook

I am so glad to help fitness professionals and people with injuries.  Very motivating to get comments like this:

Kind Words

More amazing words for the Scapular Stabilization Exercise Program:

“I would describe the Scapular Stabilization Exercise program as very comprehensive, foundational and exceptionally accessible for clients, with a wonderful explanation for the “why” behind all exercises / approaches.

Exceptionally well laid out, with a great background review of the scapular, shoulder movement, and involved muscles to provide a holistic approach.

The exercises are very well described, LOVE the “errors” section to assist with improving accuracy of each exercise. Love the handouts and the E-book. Overall, the best thing is the ease of lay out/presentation of material, so all is easy to understand and implement immediately.”

Catherine Holden

Baltimore, MD

Occupational Therapist, Registered, Licensed

Nice that People Like EFI

 Ahhh, thanks:

Shoulder Injury Guide

Little feedback on the free shoulder injury guide that I give away at EFI:

“I think the gifts are wonderful.

I’m looking to take my knowledge in this direction (corrective exercise).

Where I am in Atlanta, (Roswell GA) there are a lot of tennis moms with the issues, back issues, plantar fasciitis and shoulder pain.

I want to be the go-to guy in this region”.

Thank you in advance,

Andre Coman

Roswell, GA

Personal Trainer

Effective Rotator Cuff Exercises

Feedback on the program:

“I currently work with clients who have past or present shoulder injuries due to overuse or athletically related. Because of Effective Rotator Cuff Exercises, I have a more in depth knowledge of the functions of the rotator cuff and it’s vulnerability to injury.”

Brian Bobo

That is it.

Have a great weekend.

Rick Kaselj, MS

.

It has been a rough week.

I don’t remember the last time I was as sick as I was this week. It definitely throws you for a loop and gets you thinking. I will write more about it later.

Let me highlight a few of the things that have happened since getting sick on Sunday.

By the way, I am feeling a lot better. Thank you for everyone’s emails.

Still Helping People Overcome Injuries

“The Effective Plantar Fasciitis Exercise program looks AWESOME… exactly what I was looking for.

What exercises to do, how often, how to progress… I like having an action plan and this is going to help me for sure!!

Thanks so much Rick, you’ve given me hope that I might be running (at least part of it!) my Ironman in August instead of walking like I was starting to resign myself to!

BH

Very cool!

It is awesome to help people overcome their injury and get them back to doing what they want even when you are in bed sick.

That is More Than Other Companies

Hi Rick,

Thanks for the reply. That is more than I usually get from most forums, companies. Thank you.

I train for “life” since I currently sit behind a desk all day at work. It beats getting crippled by not moving. haha.

I train my oldest 17 y.o. son and one or two of his team mates for their high school varsity soccer team in the off season. They put on some muscle and got a LOT stronger in the seven months we trained last year. They made it to state, and had a good season. We will be starting to train again in a couple of weeks as I felt it would be good for them to just relax and be kids and do anything besides soccer or training for a month.

Thank you for the gift. I believe I will select the rotator cuff exercises program since I recently injured mine falling through the attic hole and catching myself in a bent elbow iron cross. Beat hitting the concrete floor. My PT has been working on it and it is doing OK. I still can’t do hand stand push ups, but I will get my party trick back with time. Patience.

Which program is it that you think will help my knee pain?

Your programs are good simple basic advice that will help the majority of people with their injuries.

I look forward to your response.

Best,

SR

SR,

I just sent you the rotator cuff program.

Great attitude on the “Training for Life”.

Very cool that you train your son. I hope I get that chance when my kids grow up.

When it comes to the knee program, I like what Bill Parravano talks about. I have an interview with him that I will put up soon.

Plus the article from Anthony Mychal on Cure Chronic Knee Pain has got a lot of good feedback.

Is this Good for Golfer’s Elbow?

Hi Rick,

The release of your new tennis elbow course is just in time for
me. However, my issue, which has come and gone and come again
over nearly four decades of lifting weights, is medial instead
of lateral epicondylitis. Will your new course help with that,
too? I’m hoping so! Otherwise, you need a golfer’s elbow course
now.

Best regards,
MT

I would have to say the Tennis Elbow Pain Solution would not help you with your medial epicondylitis or golfer’s elbow.

In the next few months, I will work on putting together an exercise program for golfer’s elbow.

As you know, this month’s Injury of the Month is shin splints.  The program will be coming out next week.  Then the next injury that I will focus in on will be frozen shoulder.

To Push or to Pull for Patellofemoral Pain Syndrome

Dear Rick Kaselj,

I am 32 years old from Israel (so sorry on my broken English). Anyway I’m
struggling/ suffering from patellofemoral pain syndrome more than 2 years..I tried almost everything although I had better times, so I am trying to get there again with a new rehabilitation program.

My question is about the squats on the study (*The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis. J Strength Cond Res. 2010 May;24(5):1256-62.)

On the study they perform a squat with a pillow between knees to work on the hip adduction too, but most of the programs include your Patellofemoral Syndrome Solution suggest to do the squats with band around the knees which mean the opposite ( hip lateral rotators group / obturator)

Can you tell me which one is better for patellofemoral pain syndrome?

Sincerely yours,

Best regards

SN

SN,

Thanks for emailing me.

Very cool that you have dug in the research to see what is best for yourself.

My suggestion would be to do the the tubing around the knees.

If you want more details, have a look at my articles:

• The Best Exercise for Patellofemoral Pain Syndrome
• What is New with Patellofemoral Pain Syndrome (PFPS)
• Can Gait Training Help with Running Mechanics with those with PFPS?
• Runners Knee Exercise Program

About Your Gluteus Medius Exercise Article

Hi Rick,

Wondering if you might like to look back at your superb research post on best glute medius exercises for hip replacements and look to do a video post on each of the selected, effective exercises.

As you know there are lots of ways to execute each of these individual exercises and we also sometimes call different exercises different names.

I think a lot of your readers would find this most useful and helpful in order to make sure that we are giving the correct exercise and that the exercise is done in the manor that the research shows was most effective.

I am still away on sabbatical touring North America and enjoying it immensely…will look forward to touching base with you in the spring when I am near Vancouver or in the summer when I return home, as I would like to purchase a few of your products. All the best to you…out for a dessert hike with the dogs…we are in southern Texas on the Mexico border…very desolate countryside, but beautiful. Thanks for considering my glute medius request.

CN

CN, great to hear from you.

Thanks for taking the time to contact me and give me some feedback.

A few people have mentioned this to me.  I will work on getting this done.

I looked over the gluteus medius exercise post and a few videos would have helped a lot.

(CN, rough life girl.)

Do You Have any Pre-Surgery Stuff?

Rick,

I have seen your website and saw your Spinal Fusion Exercise Program.
I am waiting to be called for spinal fusion surgery.
I have been on a specialist’s list for just over a year now, and I waited 14 months to get in to see him!

I see you have a lot of exercises for post surgery.
Do you have some specific exercises for pre-surgery?

I would appreciate hearing from you

thank you

M

Excellent point, M. At this time, I do not have any specific to pre-surgery.

A lot of what is covered the the post-surgery is what I would give someone for pre-surgery.

I would suggest you take a look at the Spinal Fusion Exercise Program.

The fitter you can have yourself enter the surgery, the faster your recovery will be.  That is one of the reasons why professional athletes have such fast recovery times compared the the regular population.

All the best M.

Rick Kaselj, MS

.

As you know, last month’s Injury of the Month was tennis elbow.

It has been a few weeks and I am starting to get feedback on the program.  One person has been having issues with their tennis elbow pain and the program has made it worse.  She has asked me if I could help.  We have been emailing back and forth.  Here are some clips from our email conversation.

“I think my pain has increased a bit so I’m cutting back in intensity but I’m hoping that if I keep at it, it will eventually go away. Bursitis in my shoulder really flared up after starting the program. Not sure if it is related but that is the only thing different that I was doing.”

This brings up a number of points to remember about injuries.  They apply to tennis elbow but to all injuries when you are using exercise to help them recover.

4 Key Things to Remember when Exercising for an Injury

• Intensity – How aggressively you do the exercises has an effect on your injury recovery.  I always suggest to be conservative when staring an exercise program for an injury.  Go easy and light.  See how things feel after the exercises, a few hours after the exercises and the next day.  You should feel like you have done something but your symptoms should not increase.
• Resistance – Once again, the resistance you use will determine the stress put on the injured area.  We want to stress the injury but not irritate it.  It is a fine balance.  Once again, start off light and see how it feels.
• Cumulative Stress – If you are doing exercises for an injured area, you are adding more stress to that area.  If you do not decrease or eliminate other things you are doing that add stress to the injury, this will lead to more irritation and pain.  Make sure to look at things that are putting stress on your injured area and decrease or eliminate them.
• Pain Techniques – Do the pain techniques in the evening.  Doing the ice, stretching and self massage are most effective before you go to bed or a few hours before you go to bed.  It relaxes the tissues and then the tissues get a chance to heal while you are sleeping.
• Nutrition – Staying hydrated, properly fueled and focusing on inflammation lowering food is important as well.  This will help you in your injury recovery.

Now let’s get to the shoulder bursitis.

I am not sure what the cause is of the shoulder bursitis (inflammation of the bursa in the shoulder).  I would focus on shoulder position, rotator cuff exercises and scapular stabilization exercises.

When it come to tennis elbow pain exercises leading to shoulder pain, I cover this in the video presentation of Tennis Elbow Pain Solution but also Stasinopoulos 2011 says it well:

“If the affected arm is not supported, our experience has
shown that patients complain of pain in other anatomical
areas distant from elbow joint, such as the shoulder, neck,
and scapula.”

I would suggest you do the tennis elbow pain exercises with your arms supported.  You can look at the exercise descriptions and videos for Exercises 9b and 10b in the program.

“Regarding my bursitis – I took a break this past weekend from exercise and the tennis elbow program and it seemed to be less painful.

I am doing mostly stage 2 exercises but am sticking with a modification of scapular exercises #6.”

It has only been a week or two since you have got the program. You might not be ready for stage 2 exercises.

If you are getting elbow pain from the exercises, look in the exercise descriptions and I give you ideas of what you can do if you get pain from the exercises.  Here are a few things to remember:

• Conditioning – If you are getting elbow pain from doing the exercises, do exercise #3 for two to three weeks.  This will help work on the conditioning of your elbow muscles.  By being in stage 2 so early, you are getting pain because of the points that I covered at the top of this article.
• Posture – Look at your posture when you are doing the exercise. Make sure it is ideal which is ear-shoulder-hip in a straight line.  Being out of alignment puts greater stress on the shoulder.
• Technique – If an exercise is irritating, go back and make sure you are doing the exercise correctly.  Look at the exercise description and watch the video of the exercise.

“My left elbow and left shoulder are super tight. When I do the tennis elbow program my arm feels worse. Should I work on my shoulder first? Should I stop? Would be happy to have your feedback!”

Follow what I wrote above.

What caused what:  What I have seen in many people is a shoulder injury leads to your tennis elbow pain.

I know you have the Shoulder Pain Solved program of mine.  Make sure to the pain techniques that I talk about in that program for your shoulder but remember the key points that I talked about above.  They are very applicable to all injuries.

“Does my tennis elbow cause my shoulder pain or does my shoulder pain cause my tennis elbow? Is it possible to work on both at the same time or should I focus on one first and then the other? If so, which should I focus on first? Which program would be most helpful – tennis elbow, shoulder, scapula?”

From my experience, one injury often times leads to others.

I feel you can do both but follow what I said above in the article.

If what I said above does not help, go get your diagnosis confirmed by a qualified health professional and have them rule out that there is something else going on.  Then take the programs to someone that can help you with the program.  You can go to a fitness professional that focuses on injuries or another health professional.  The key thing is that they will spend the time with you to go through the exercises.

Remember the points that I said above.

These would be your priorities:

• Work on your scapular stabilizing exercises as this will provide stability for your shoulder and decrease the stress on your elbow.
• Work on improving your posture as this will decrease the stress on your shoulder and elbow.
• Work on the pain techniques in order to relax the muscles around the shoulder and elbows.
• Work on strengthening the shoulder and elbow as per the Shoulder Pain Solved and Tennis Elbow Pain Solution program.

Thank you for your question Chris, all the best.

Rick Kaselj, MS

.

Today I have a great guest blog post on Shoulder Pain and Anterior Humeral Glide.

The excellent info is from Zach Moore.

Take it away, Zach.

How can Anterior Humeral Glide Lead to Shoulder Pain?

Anterior humeral glide (AHG) is a common problem among many individuals and occurs when there is excessive or abnormal anterior movement of the humeral head during shoulder motions. AHG can occur during any movement where the humerus moves into extension or horizontal abduction.

It is important to spot and correct this mistake because AHG can eventually lead to, or further aggravate, anterior shoulder pain, AC joint problems, pec and lat strains, as well as impingements. Therefore, today I want to look at some common exercises where this often occurs and then go over possible solutions to help address it.

Again, this problem can occur during any exercise where the humerus moves into extension or horizontal abduction, but I am only going to cover a few popular exercises.

The fixes and mistakes for each will usually be similar, so you can apply them to other exercises as needed.

Horizontal Row

Video Demonstration of Anterior Humeral Glide during a horizontal row along with cues to help correct this:

Cues and Possible Fixes:

• Place your hand medial to their scapula and cue them to squeeze back.
• Point to the anterior part of their humeral head and tell them to pull that back.
• Help guide them into the proper position. Place one hand on the anterior part of their humeral head and the other on their scapula. As the person begins to row, guide their scapula into retraction and apply posterior pressure to their humeral head.
• Lastly, have them try rowing with both arms. Sometimes their inability to retract is just a coordination problem and this will better allow them to feel their shoulder blades being squeezed together.

Dumbbell Row

Video Demonstration (first two reps demonstrate AHG, last two reps demonstrate correct form):

Cues and Possible Fixes:

• Same cues and fixes as described with the horizontal row above.
• Make sure spine is neutral. If upper back is not flat then you are more likely to see a faulty rowing pattern.

Push-Up

Video Demonstration (first two reps demonstrate AHG, last two reps demonstrate correct form):

Cues and Possible Fixes:

• Make sure spine is neutral. This will help to better position the scapula on the rib cage, which will help facilitate proper retraction on the eccentric (lowering) phase.
• Cue them to squeeze their shoulder blades together in order to activate their scapular muscles as they lower their body.
• Use an incline or raise the incline to make the exercise less challenging.
• Shorten the range of motion (i.e. do not have them lower as far).

Chin-Up

Video Demonstration (first two reps demonstrate AHG, last two reps demonstrate correct form):

Cues and Possible Fixes:

• Tell them to think about putting their shoulder blades into their back pocket.
• Have them demonstrate to you how to squeeze shoulder blades down and back before they perform the movement. This will ensure they know what you mean.
• Use a band or increase the band tension to make it easier.
• Try a Chin-Up ISO. This is an exercise we will usually give to clients at IFAST before progressing them to a full chin-up. You basically get into the top position of a chin-up with chest to the bar and scaps depressed. You then hold this position for max time. It is very effective for teaching people the final portion of this exercise.
• Lastly, if the above strategies do not work then I would take them to a Lat Pulldown where the stability requirements are less demanding.

Bench Press

Cues and Possible Fixes:

• First, I would make sure the person could perform a push-up properly without AHG before giving him or her a bench press.
• If AHG is occurring during this exercise, then you know they are not keeping their shoulder blades retracted, which is desirable when performing a bench press.
• Make sure the client knows that he or she should not protract (i.e. make arms long) at the end range. This will better allow him or her to keep shoulder blades together.

Final Points

Never be afraid to lighten the load or decrease the stability requirements. Performing an exercise over and over with incorrect form (in this case, anterior humeral glide) will not fix the problem/form.

If the cueing and loading strategies above do not work, then you may need to resort to other corrective strategies such as soft tissue treatment and/or rotator cuff exercises.  For soft tissue treatment, I would first examine the posterior shoulder capsule as it can often be stiff and restricted, which will not allow the humerus to glide posteriorly as it is flexed.  Next, examine the pecs as they can become dominant and pull the humeral head anterior.

For the rotator cuff, I would examine the subscapularis.  If the subscap is too long or weak, then its downward and posterior pull will not be able to offset strong muscles, such as the pec major, that pull the humeral head anterior. Therefore, strengthening exercises for this muscle may be appropriate.

Summary:

Learn to retract/depress properly by squeezing the scapula back/down without allowing the humeral head to glide anteriorly.

Common Cues and Fixes:

1. Make sure person is in a good spinal position.
2. Put hand back by shoulder blade and tell person to squeeze shoulder blade back to touch hand.
3. Point to anterior part of humerus and tell person to pull it back.
4. If performing a unilateral pulling exercise try to pull with the other arm at the same time, which may allow for better proprioception.
5. Lighten the load.
6. Reduce stability requirements
7. Make sure the problem is not due to soft tissue restrictions and/or a weak cuff.

Read the rest of this entry »

I just got an email from an online training client.

She is testing out my upcoming shoulder pain program.

It is so cool getting emails like this:

Dear Rick,

Thank you for your email. Sorry for not replying to your email earlier. I had a friend in crisis staying at my house, I was helping her all week and she just left on Friday.

Today I have completed the first day of your program ( Sunday 1st May ) and I am very happy with the result.

Both shoulders are getting a bit more movement and I look forward to doing these exercises each day to see how much improvement I can get by next Sunday.

I will be going on my 3 month camping trip around Australia next Tuesday and I will have my computer with me. I might not be able to email you when I am at a remote location. My plan is to report to you at the end of each week, however depends on when I can get a signal to send emails.

Thank you for your help and I look forward to talking to you next week.

All the best,
DF

It is great to get great feedback like this and also to be able to help people around the world.  Plus I love the fact she is doing the exercises where ever she is, even on her camping trip.  Camping in Australia would be fun, I have yet to do that.  Soon enough.

One other thing she said in her email was she was having difficulty with some of the stretches for the shoulder and was wondering what she could do.  I will do another blog post on what you can do if the typical shoulder stretches cause you pain.

Back to today’s post.

This past weekend at the Exercise Rehabilitation of the Lower Body course, a fitness professional asked me about the tricep dip exercise.

She had been giving it to a client and it had been causing her shoulder pain.  She wondered why it would be causing her pain and if she should be doing it.

I cringe when I see someone doing a tricep dip.  It is not a great exercise for the shoulder.  Let me explain why:

Few Thought from Rick on Tricep Dips:

I Used To Do It

This was an exercise that I was taught when I started out doing personal training.

I thought it was good for the triceps but I always did not feel right doing the exercises as I felt a lot of stress in my shoulder.

Now that I have trained a few people and have a better understanding of the biomechanics of the shoulder, I have put this exercise in the museum of exercises.  Right beside ballistic toe touching in leg warmers and spandex.

Rotator Cuff and AC Joint Injuries

Just like leg extensions are not the best exercises for a client with a knee injury, tricep dips are not the best for someone with a rotator cuff or AC joint injury.

Great Way of Sawing Your Rotator Cuff

I know we are all fans of Jillian Michael’s kettlebell technique.

How about Bob:

Can you hear her rotator cuff being sawed?

Way to go Bob!  100 reps!  CrAzY.

Can you image a client who is overweight and needs to lose 50 pounds doing Bob’s challenge?

With every repetition her scapula anterior tilts and digs into her rotator cuff.

I shake my head.

Why would anyone do 100 reps of a small muscle group?

Whatever.

Read the rest of this entry »

Here we go to the rambles.

Nice to look at the week that was.

These are a few things that happened.

MIR Approved for Fitness Australia CECs

I just got the word from down under that Muscle Imbalances Revealed has been approved for CECs.

Fitness Australia has reviewed Muscle Imbalances Revealed and approved it for 6.0 CECs.  Now the 23,000 fitness professional that are part of Fitness Australia can earn continuing education credit when learning and watching Muscle Imbalances Revealed.

Very cool!

I just got the details and will be finalizing everything with them.  Working with Fitness Australia is a new thing, so I need to figure out how they work and what they would like their members to receive.

Effective Rotator Cuff Exercises

Just to finish off, here are some kind words I received about Effective Rotator Cuff Exericses:

“The Exercises Rehabilitation for the Rotator Cuff course was excellent! Rick really brought together a course that was thorough, effective, and was easy to apply to my clients as a personal trainer as well as myself, who up until recently had shoulder issues. Thanks Rick! “

Leah Seaton
BCRPA/ ACSM Personal Trainer
Vancouver, BC

“Even if the money spent only helped one of my clients, Effective Rotator Cuff Exercises would have been a worthy investment. The great part about the course is that not only does it allow me to help those with rotator cuff issues, but it also allows me to design better programs for all my clientele.”

Brent Campbell

“Dear Rick, I would be happy to help you out with the Rotator Cuff program. I have reviewed the program and have found it very beneficial for use in the clinic. As a physiotherapist, it is always challenging to provide patients with all the information and handouts they require. Rick’s systematic approach and reliant/clear patient handout have helped me keep on top of patient education. In the long run, this equals more compliance and better results. I also think the way the program is divided into goal focused sections helps keep patients focused on their exercises and their rehab goals. Overall I think it is a great program and it has really helped me address rotator cuff injuries within a clinical setting. Thanks Rick.”

Katie Ireland
Registered physiotherapist
Ottawa, Ontario

Positive Vibes

Ending things on a positive note.

Thanks for everyone that says such kind things on my Facebook page:

Thanks for reading.

Have a great weekend.

Rick Kaselj, MS

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There is a lot more awareness when it comes to muscle imbalances.

The incredible success of Muscle Imbalances Revealed 2.0 has really taken the industry by storm.

Trainers, coaches, and therapists from around the world have been using it to help their clients overcome injuries, bust through fitness plateaus, and prevent injuries.

It has been amazing to see how this little product has helped thousands of fitness & health professionals, which in return has helped hundreds of thousands of people.

Sad to say, the battle continues.

We need to do more to better understand, assess, and prescribe exercises to eliminate muscle imbalances.

In 2011, there will be more and more emphasis on muscle imbalances.

Muscle Imbalance is my #8 Exercise Rehabilitation Prediction for 2011

 
In fact, I just got approached by an Australian outdoor magazine to write an article on muscle imbalances and how it can affect the outdoor athlete.  Very cool.  I will let you know how it goes.

With the media starting to focus on it, so has the research.

Muscle Imbalances in the Research

Read the rest of this entry »

I know these days we all get lost surfing the internet.

A site I visit, and visit to often, is Pub Med.

Pub Med is a site that is full of the latest and oldest research.  I always go to take a look at what is new when it comes to exercise and injuries.

I know, kind of strange.

One injury I have been seeing more of is tendinosis.

Just last week I got an email from a fitness professional that does group fitness classes that has had 5 months worth of Achilles tendinitis issues from all the step classes she has been doing.  My guess, it is Achilles tendinosis.

So, I will call the increase in tendinosis as Prediction #7 in Exercise Rehabilitation 2011.

Tendinitis versus Tendinosis

The first step is to define what tendinitis is and tendinosis is.

Better yet, I found a table that describes it much better than I could.

Read the rest of this entry »

It was some time ago when I heard a reference to: Rotator Cuff of the Hip.

I think it was way back in undergrad at Simon Fraser University.  I was reading an article on the topic and found it very interesting.

This past weekend, I was at a course and it was brought up again.

Mike Robertson talking about the Rotator Cuff of the Hip:

After hearing about it, it got me thinking.

I went looking for the old article but could not find it.

There was a lot of other information when it came to rotator cuff of the hip that has come out the last few years.

A lot of it had to deal with rheumatologists and orthopedic surgeons coming across a tear when doing a hip replacement.

What is the Rotator Cuff of the Hip?

The rotator cuff of the hip is the hip abductor tendon which is made up of gluteus medius and gluteus minimus.

Gluteus medius has the function of:

1. Abduction of the hip (femur) – anterior and posterior fibers.
2. Transverse abduction of the hip (hip flexion at 90 degrees and hip abduction) – anterior and posterior fibers.
3. Internal rotation – anterior fibers.
4. External rotation of the hip during hip abduction – posterior fibers.

Gluteus minimus has the function of:

1. Abduction of the hip (femur).
2. Transverse abduction of the hip.
3. External rotation of the hip during hip abduction.

Looking at the above function, you can see how they related, or can be compared to, the rotator cuff of the shoulder.

The muscle of the rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor) of the shoulder have a function of:

1. Shoulder abduction of the humerus – supraspinatus.
2. External rotation of the humerus – infraspinatus, teres minor.
3. Internal rotation of the humerus – subscapularis.

I know when I had done my masters’ degree in rotator cuff exercises, looking at the research there is all kinds of argument on how much each muscle is involved with each movement.  It looks like we see this when it comes to the rotator cuff of the hip.

Looking at Al-Hayani 2009 dissection of the rotator cuff of the hip, these are the functions he suggests:

1. Gluteus medisu had three distinct parts.
2. Gluteus minimus had two distinct parts.
3. All parts of the muscles had separate innervations from the superior gluteal nerve.
4. Anterior and middle parts of gluteus medius, and anterior part gluteus minimus, have a vertical pull and initiate abduction, which is then completed by tensor fasciae latae.
5. Posterior parts of gluteus medius and minimus stabilize the femoral head into the acetabulum during different stages of locomotion.

Then I look at course notes from Robertson 2010 and the functions are:

1. Gluteus medius anterior fibers – hip flexion, hip abduction and hip internal rotation.
2. Gluteus medius posterior fibers – hip extension, hip external rotation, hip abduction.

I think we can argue about the specific function of each muscle, but it is clear that the rotator cuff of the hip is made up of the tendon that makes up gluteus medius and minimus.

Read the rest of this entry »

Another research update.

I am so glad I take the time to do this.

There is all kinds of great stuff that comes out every week.

The Problem with Overtraining Your Abs

The article focused on those performing Olympic lifts but they did bring up some interesting points that can be carried over to injured client.

In order to hold a load over head you need good stability in the flexors and extensors of the trunk plus good deceleration of the flexors of the truck.  Not being able to do so increases your risk of injury and decreases you ability to hold a load overhead.  This is important for the athlete but also the general public.  Overhead movements are essential for all and have been avoided of late in the fitness industry due to the perceived risk of injury.  I make sure I do a least one over head pressing movement with my clients but if your client can’t do a proper overhead weighted movement make sure to look at their trunk flexors and extensors.

Many times truck flexion (abdominals) exercises are done on a daily basis while lower back exercises maybe done 2 to 3 times a week.  This leads to muscle imbalances in the flexion and extension muscles of the trunk.  This imbalance could lead to an alteration in the tilt in the pelvis which had an effect on latissiums dorsi which an increase the risk of injury in the shoulder.

The writers provided a sample exercise program to train the trunk flexors and extensors.  The exercises were lever abdominals, medicine ball seated twists, bridge with arms lifted, marching bridge with arms lifted, dumbbell farmer’s walk, supine weighted extended hold, hyperextensions with arms out straight , hyperextension to row with
weight (medicine ball or plate), hyperextension with weight (plate or medicine ball), and barbell over head circle walks.

I wrote a little report on core training that may interest you.  Here you go:

Read the rest of this entry »

Exercise Rehabilitation of the Shoulder

DESCRIPTION:

“Nearly 6 million people a year visit their doctor for shoulder pain, strains, dislocations or other shoulder related problems”

 

In the Exercise Rehabilitation of the Shoulder course, functional anatomy of the shoulder joint will be reviewed. In addition, common shoulder injuries (frozen shoulder, shoulder impingement, rotator cuff tear and shoulder instability) will be discussed, and rehabilitative principles and exercises for each will be presented.

OBJECTIVES:

Foundations of Upper Body Conditioning

DESCRIPTION:

OBJECTIVES:

It has been a bit of a crazy week.

I have been in Orange County at a Fitness Conference.  It was a little more than a fitness conference, it was a fitness mastermind group.

After the fitness mastermind in Los Angles, I was off to Seattle for a fitness business conference.  The people presenting were Tom Plummer and Bill Parisi.

Just Marked Her Rotator Cuff exam

The great thing about the scoliosis and rotator cuff manuals that I have written, I have been able to help people with these injuries and fitness professionals better understand these injuries.  These manuals have helped people around the world.  I just sent off a scoliosis manual to Seol, Korea.  How cool is that.

Here are a few kind words from a fitness professional in Calgary, Alberta, Canada had to say about the Effective Rotator Cuff Exercises.

“Thanks Rick!  Always great to read your manuals though – I find them very thorough and I really like the progression that you write them in – anatomy, purpose of exercising, etc.”

Fiona Yeoman
Wellness trainer, Kinesiologist
Talisman Centre, Calgary

Read the rest of this entry »

What’s My Cue? (Part 2)

I was at the NSCA Washington State Fall Clinic.

It was a great event.

Let me share a few of the highlights.

Dave Suprak of Western Washington University was there chatting about shoulders.  I picked up a few great tips from Dave.  He had some great information on what happens to the scapula and scapular stabilizers when your client has poor posture. He gave me some great resources that will help me improve the scapular stabilization exercise program and effective rotator cuff exercise program.

One presenter that I wanted to see was Guido Van Ryssegem. Guido was presenting at the same time as I was, but I got a copy of his presentation. Wow, it was packed with high level shoulder exercise information!  When I get home, I will have to digest it more.

During our learning lunch, Susan M. Kleiner had an evidence based talk on proteins and amino acid supplementation.  Some great information!

Read the rest of this entry »

What I am going to chat about today is rotator cuff exercises and why/when/how to use a towel when performing rotator cuff exercises.

When I was working in a large rehabilitation centre, I work with a wide variety of physical therapists. They all had different ideas on exercises for the rotator cuff. The majority of them would not support the elbow when performing rotator cuff exercises but the odd one would.

Rotator Cuff External Rotation Exercise Set Up

How I  set up a client for the rotator cuff external rotation exercise would be to have the client stand with feet hip width apart and toes pointing forward. The core would be activated in order to prevent any trunk rotation. Upper arm would be at the side and elbow bent to 90 degrees. The pulley or tubing would be adjusted so it was parallel to the floor. The focus of the exercise would be external rotation in the shoulder from 0 degrees to maximum.

Read the rest of this entry »

Dumbbell Lateral Raises - Long Arm (End)

A lot of my rotator cuff clients complain about rotator cuff pain with the lateral raise exercise.

Before I talk about what  you can do to relieve lateral raise rotator cuff pain, let me explain why I do the lateral raise exercise with my rotator cuff clients.

Why I give my rotator cuff clients the lateral raises exercises?

The movement of lateral raise is abduction of the shoulder joint (glenohumeral joint).  For clients with rotator cuff injuries, often times this is a movement that is weak.

I want to improve the strength in abduction of the shoulder joint from 0 degrees to 85 degrees of abduction.  I can do this with the lateral raise exercise.  I can the exercise use dumbbell, tubing or pulleys for resistance.

Read the rest of this entry »

On Wednesday, the Effective Rotator Cuff Program officially goes on sale at 9 am EST.

Today’s your one and only chance to win a copies of the “Effective Rotator Cuff Exercise Program”.

And it will only take you a few minutes to enter.

Just leave a short message for me about…

“Why the Effective Rotator Cuff Exercise Program would be the perfect resource to finally help you with your clients with Rotator Cuff Injuries?”

.

Feel free to share about your past and current struggles working with rotator cuff injuries and in what specific ways an effective rotator cuff exercise program will help you get better results with your clients with rotator cuff injuries.

I’ll go through every single one of your responses before Tuesday at 5 pm EST and I’ll choose ONE winners.

If you win, you’ll be notified by email and I will mail you the complete Effective Rotator Cuff Exercise Program.

Good luck and thanks for your participation!

I look forward to hearing from you,

Rick Kaselj,
Author, Effective Rotator Cuff Exercise Program

PS – Don’t miss the amazing SALE that starts on Wednesday…

…you’ll also get FAST ACTION bonuses and of course, the Effective Rotator Cuff Exercise Program.

I want to hear from you about your challenges working with clients with rotator cuff injuries.

NOTE: The contest ends on Tuesday, November 24th at 5 pm EST.

PSS – Again, here are the steps.

1) Answer the question from above.

2) Write a little post in the comments section about how an effective rotator cuff exercise program can  help your clients.

3) I’ll pick and announce 1 winners on Tuesday.

4) The winner will each get…

A copy of the Effective Rotator Cuff Exercise Program

Good luck to everyone!

I give tubing exercises to all my clients with rotator cuff injuries.

When I started out, I used to fly through the rotator cuff exercises with my client.  I would show them the exercise; then get them to do it and finally move onto the next one.

With time, age and experience; I have improved on that rookie technique when using tubing exercise for rotator cuff injuries.

There are three things that you need to remember and highlight when designing an exercise program for a client that has a shoulder injury especially when you’re using tubing.

The three things that you want to remember to highlight when you’re explaining the exercise to the client with a rotator cuff injury are:

#1)  Distance Specific

You want to be specific on the distance away from where the tubing is fixed.  If the client ends up changing the distance of how far they are away from where the tubing is fixed, it ends up changing the exercise.

#2)  Fix the Range of Motion

The second thing, you want to be specific when it comes to the range of motion that you want your client to perform.

Do you just want them to perform 45 degrees of extension, or full range of motion when it comes to the shoulder?

You need to be specific on the range of motion that you want them to cover when doing the exercise.

#3)  Length Matters

And then thirdly, you want to be specific on the length of the tubing that you want them to use.  If they end up grabbing the tubing and wrapping it around their hands, they end up changing the length of the tubing and that ends up changing the exercise again.

3 SPECIFIC TO DO’s If you Give Tubing Exercises to a Client with a Shoulder Injury:

==> CLICK HERE for 3 Shoulder Injury Tubing Exercise Tips

I know, sometimes we just show our clients the tubing exercises and leave them alone.  So make sure you’re clear on how far away they are from the tubing anchor.  Make sure you’re clear on the range of motion that you want them to do when it comes to tubing, and make sure that you’re clear on the length of tubing that you want to use.  If your client has a rotator cuff or shoulder injury, it is important to be clear about these three things or it leads to irritation, re-injury or not getting the most out of the exercise.

So this is Rick Kaselj for Exercises for Injuries.

Thank you very much for reading the blog and watching all the videos.

Rick Kaselj, MS