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

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

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Back to doing research reviews.  This is fun.  It is great to go into the research to see what is new when it comes to exercise and injuries.  In this round of research reviews I found some great research on scapular stabilization exercises, jumper’s knee and osteoarthritis.

Let’s get into the research.

Should I be Wasting My Time with Scapular Stabilization Exercises if I have Shoulder Impingement?

What They Looked At:

The effectiveness of an exercise program on the shoulder with people who have subacromial impingement syndrome.

How Did They Do It:

They divided 40 subjects into two groups.

Group 1 did stretching and strengthening exercises while group 2 did stretching, strengthening and scapular stabilization exercises.

What They Found:

Both groups showed improvement but the second group had greater improvement in muscle strength, joint position sense and scapular dyskinesis.

Take Home Message:

If you or your client has subacromial impingement, make sure to add scapular stabilization exercises to your program, along with stretching and strengthening.

Let me take a minute to explain a little more on why you should do this.

The results above all make sense because in shoulder impingement clients you often see:

• increased upper trapezius activity
• decrease in middle and lower serratus anterior activity
• reduced rotator cuff activity
• delay in middle and lower trapezius activity with sudden perturbation

To get more information, check out: 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.

Also have a look at this one:  Phadke V, Camargo P, Ludewig P. (2009). Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement. Rev Bras Fisioter. 2009 Feb 1;13(1):1-9.

For the program that I use for scapular stabilization exercises, click here.

Want to Improve Osteoarthritis pain? Then Losing Some Weight is the Key.

What They Looked At:

They looked at 111 obese adults.   The researchers performed a baseline MRI and a 12-month follow up MRI to look at cartilage thickness.

Neat Stuff in the Introduction:

• Obesity is a major health problem
• The World Health Organization estimates more than one billion people are overweight and 300 million are obese
• Osteoarthritis is the most common form of arthritis and the leading cause for chronic disability among older adults
• Weight loss has been shown to decrease knee pain and to improve knee stiffness, function and disability

What They Found:

The average age was 52 years old, a BMI of 37 and average weight loss was 9%.

A decrease in weight led to an improvement in quality and quantity of medial articular cartilage but this was not observed in the lateral compartment.

This improvement in cartilage could lead to a reduction in the need for total joint replacements and decreased the impact on the health system.

Take Home Message:

We don’t talk about it often but with so many conditions in the lower body, an emphasis on decreasing weight will help overweight and obese clients recover from some injuries and prevent future ones.

Thinking beyond just exercise to lifestyle, nutrition and activity – even when injured – is key.

To get more information, check out: Anandacoomarasamy A, Leibman S, Smith G, Caterson I, Giuffre B, Fransen M, Sambrook PN, March L. (2012). Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012 Jan;71(1):26-32.

I go through more stuff on knee osteoarthritis in the course:

What is the Best Treatment for Jumper’s Knee?

What They Looked At:

The effectiveness of an exercise program, ultrasound and transverse friction for the treatment of chronic patellar tendinopathy.

Neat Stuff in the Introduction:

• Jumper’s knee or patellar tendinopathy
• common in sports involving jumping and landing, rapid acceleration and deceleration, cutting moves and kicking (basketball, volleyball, soccer, tennis, high jump, long jump, fencing, track)
• No correlation between intrinsic factors leading to jumper’s knee (malalignment, Q-angle, biomechanics).
• Principal cause of jumper’s knee is hard playing surfaces, increase in training involving repetitive eccentric movement and tight hamstrings and quads

How Did They Do It:

They had 30 subjects with chronic patellar tendinopathy and divided them up into three groups (exercise, ultrasound and friction). Each group received treatment three times a week for four weeks.

Then they looked at the pain level of each of the subjects at 4, 8 and 16 weeks.

What They Found:

They found the exercise program had better results than the ultrasound and friction.

Yay, exercise.

If you do get treatment for jumper’s knee and have ultrasound and friction performed, don’t discount the exercise. It may be the missing piece that will help you out the most with your jumper’s knee.

What the focus needs to be on is an eccentric exercise program.  I go through that in Achilles Tendinitis Exercise Solution for the Achilles tendon.  In a few weeks, I will be finishing up this month’s, Injury of the Month, which will be Jumper’s Knee.  Watch for it before the end of December.

To get more information, check out:  Stasinopoulos D, Stasinopoulos I. (2004). Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clin Rehabil. 2004 Jun;18(4):347-52.

Hope you enjoyed the research review.

Let me know what you think. Please feel free to share a recent article that you have read in the comment area.

Rick Kaselj, MS

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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 »

One of my most popular programs is the scapular stabilisation exercises program.

I really like it when I get emails from people that are working on the program so I can help tailor the program for them, so they get the results they are looking for.

This is an email I got a few days back and thought it would be best if I shared my answer with you:

Hi,

My name is Ron and I ordered your scapula stabilisation program and had questions about doing exercises in my current situation.

I have a shoulder impingement and also a winged scapula, and my posture has always been poor, which I’ve been working on.

I went through PT twice, the first time they worked on my rotator cuff strength and it got better so I went back to work but three months later I was back out again. I went back to PT they worked on rotator cuff and lots of pulling and pushing exercises for my scapula.

I’m back to work which requires a lot of pushing pulling motions. I work 3-4 12 hour days a week. My problem is I don’t know if I should be doing rotator cuff exercises and scapula stabilization exercises together, or don’t do rotator cuff exercises and with me working I don’t want to overwork my muscles but at the same time I don’t want to not do enough.

I haven’t tried doing the exercises you provided as I know if I try to do them myself without coaching at first I probably won’t do them correctly.

Thank You.  Ron

Thank you so much for the questions Ron.

#1 – Should You Be Doing Rotator Cuff and Scapular Stabilization Exercises at the Same Time

Yes, do both of them at the same time.

Start with the scapular stabilisation exercises as they will improve the scapular muscles but also help with the rotator cuff muscles.

The specific rotator cuff exercises will help target the rotator cuff muscles.

#2 – Not Wanting to Overwork Your Scapular and Rotator Cuff Muscles

You are on the right track with this.

Recent research came out on this:

Chopp JN, O’Neill JM, Hurley K, Dickerson CR. (2010). Superior humeral head migration occurs after a protocol designed to fatigue the rotator cuff: a radiographic analysis. J Shoulder Elbow Surg. 2010 Dec;19(8):1137-44. Epub 2010 Jul 3.

If you fatigue the rotator cuff, it decreases the effect the rotator cuff has on the shoulder and increases the risk of injury. Especially with clients with shoulder impingement.

What I suggest is:

• Perform under 12 repetitions of rotator cuff exercises.  You can do 3 sets of the exercise but just perform under 12 repetitions to minimize fatigue.
• Perform your rotator cuff and scapular exercises at the end of the day because if you fatigue both of the muscles prior to work, you increase the risk of shoulder injury.

#3 – I am Not Sure if I am Doing the Scapular Stabilization Exercise Correctly

Print out the manual that comes with the program and bring it to your next physical therapy session and ask if they can help you will these exercises or see a personal trainer that specializes in post injury rehabilitation and have them take you through the exercises.

They will make sure you are doing the exercises correctly and you will feel better knowing you are doing them right which will lead to the results you are looking for.

I think that is it.

I hope this helped answer your questions about scapular stabilisation exercises.

Ron, if you have any more questions email me at support(at)ExercisesForInjuries.com .

Take care and have a great day.

Rick Kaselj, MS

P.S. – If you have a shoulder injury are are interested in my scapular stabilization exercise program, CLICK HERE.

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I have had a question about what the scapular muscles are so let me take a minute to explain what they are.

What are the scapular muscles?

These are all the muscles that connect and attach to the scapula (shoulder blade).

These muscle are very important for shoulder health and often ignored when it comes to an exercise program or the recovery of a shoulder injury.

What are the names of the scapular muscles?

There are 16 primary scapular muscles that connect to the shoulder blade:

1. Pectoralis minor
2. Coracobrachialis
3. Serratus anterior
4. Triceps brachii
5. Biceps brachii
6. Subscapularis
7. Rhomboids major
8. Rhomboids minor
9. Levator scapulae
10. Trapezius
11. Deltoid
12. Supraspinatus
13. Infraspinatus
14. Teres Minor
15. Teres Major
16. Latissimus Dorsi

As you can see there are a lot of muscles that have an effect on the scapula.

What do these scapular muscles do to the scapula?

Read the rest of this entry »

I have a guest blog post for you today on suspension training and the shoulder.  It is from Zita Alves.

Enjoy the post and make sure to try out some of the exercises.

Take it away Zita…

I love to do bodyweight exercises but there comes a time when you know that something is missing – the pulls.

There are not many people, especially women, who can just hop up onto a bar and bang out a set of pull ups, particularly if they are overweight.

It can be really hard to achieve muscle balance without using any gym equipment/dumbells etc as pulling movements using the lats, rhomboids, trapezius and biceps cannot  always be overloaded enough by gravity alone – they need an external force.

How many people do you see who have internally rotated shoulders and an overdeveloped chest.

Not only from a postural point of view but also from a sports specific standpoint should we be looking at working the back musculature in equal measure. Given where the lats insert, isolated lat exercises or overtrained lat muscles can exacerbate this internal rotation which is why “rowing” movements are so beneficial in order to hit the rhomboids,mid/lower traps, serratus and posterior deltoids.

By using a suspension trainer you are able to do both horizontal and vertical pulling movements to target different muscles and the great thing is that by tiny adjustments in hand, elbow or body position you are able to hit the whole back from every angle.

Be sure to set the scapula, shoulders down away from ears, neck long for every movement.  Here are some great exercises to try include:

REVERSE FLYES

Start

• Arms out in “T” Position in line with shoulders
• Hands facing forward
• Standing almost upright

Movement

• Lean back as arms come forward in front of chest, hands facing each other
• Lift arms back to start position keeping arms slightly bent, leading with top of hand
• Wrists strong, core braced, keep chest up, squeeze shoulder blades down

HIGH/WIDE ROW

Start

• Arms out in-line with shoulder
• Bent elbows , hands face down in-line with elbows
• Lean back slightly

Movement

Lean back more as arms straighten in-front of body, hands facing down chest up, core braced, back straight, wrists strong

LOW ROW

Start

• Arms by side, elbows bent
• Hands facing each other, inline with elbows
• Lean back slightly

Movement

• Lean back more as arms straighten in front of body, hands facing each other, chest up, core braced, back straight
• Pull leading with elbows, keeping shoulder blades down to bring arms and body back to start position
• Pull leading with elbows, keeping shoulder blades down to bring arms and body back to start position

ROTATIONAL SINGLE ARM ROW & SQUAT

Start

• Hold 1 handle only
• Feet hip width apart, slightly in-front of hands
• Bend knees to sit back, bottom towards floor
• Arm straight and rotate body to let other hand touch floor  Hands facing forward

Movement

• Push into legs at same time as pulling handle to bend arm and row body up to standing position, other hand can cross over strap
• Straighten the arm and bend the legs to return to start position

Y OVERHEAD RAISE

Start

• Arms in “Y” position
• Hands facing forward
• Standing almost upright

Movement

• Lean back as arms come forward in front of chest, hands facing each other
• Lift arms back to start position keeping arms slightly bent, leading with top of hand
• Wrists strong, core braced, keep chest up, squeeze shoulder blades down

Once the exerciser has mastered  the basic movements with good form they can work on some great combinations such as the following:

• Low and high row combi
• Low row, reverse flye combi
• High row to Y raise combi

One of my favourite combinations is :-Y raise, high row, low row to bicep curl. Perform 1 rep of each after the other in a continuous movement aiming for approx 5 reps in total, or more reps depending on the foot positioning. The advantage of suspension training is that during a set if form deteriorates the feet can be very slightly moved to make the exercise easier and maintain the time under tension.

One of the coolest ways to use the Ztrainer is for MYOFASCIAL STRETCHES. The body has lines that run through the it and tightness in these lines is very common and can lead to dysfunction. For example one of the lines that I love to stretch for both myself and my clients is the anterior lines that runs from the head down the front of the body through the hips down the legs into the feet. A great way to prepare the body ready for activity is by incorporating the following movements.

Lunge and chest openings

Facing away from the anchor point, holding the handles lightly, arms straight and wide in T position step forward into lunge, tucking pelvis under. Make sure fingers pointing back to add a slight nerve stretch.

Alternate feet and repeat with arms in more of a Y position

Developing this further you can get an even deeper stretch. Step right foot forward into lunge position, tuck pelvis under and lift left arm. Keep right arm down by side and rotate upper body slightly to right to get a great stretch down the left side of the body. There are not many people who won’t feel this one!

Curtsey lunge and lat stretch

Facing the anchor point standing back with arms straight, take 1 leg behind into a curtsey lunge and drop chest to feel the lats stretch.

Side Stretch

Standing sideways to anchor point, grab both handles with arms straight, feet under handles and drop hip slightly to side, eg if anchor point is on left, drop left hip out to side to feel left side of body stretching

Do as many of the above as you feel your body needs.

Zita Alves has been a Personal Trainer for 13 years after a career change in 1998. As a non-exercising, overweight asthmatic she has found her true passion in helping others. In 2009 Zita set up Bath Bootcamp in Somerset, UK which currently runs 15 classes a week. In 2010 she launched the Ztrainer Suspension Fitness Training System which already has customers around the world and is being used by some of the UK’s leading Fitness Professionals.
For more information go to www.ztrainer.co.uk

Thank you so much Zita.

Thank you for reading, until next time.

Rick Kaselj, MS

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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 »

Lets talk about trigger points today.

I want to share with you a tool that I use for my trigger points and for self myofascial release (SMR) while I am traveling.

Quick Traveling Tool for Trigger Points

In the video, I am coming to you from Orlando, Florida.

I share with you in the video:

1. A tool that I travel with.
2. Why I am a huge fan of foam rollers.
3. Why a 1 foot foam roller is useless to travel with.
4. Something a foam roller can’t do, but helps.

Sitting on the plane for hours does not help the body out.  So it is nice to land and take a few minutes in the hotel room to relax. I find if I roll out for a minute are two, it makes the stretching more effective.

Take 128 seconds to watch the video on:

==>  Travel Tool for Trigger Points

If you are looking for a trigger point course, make sure to check out the upcoming course on the topic in April.

Muscle Imbalances Revealed Review

Muscle Imbalances Revealed 2.0 has been out for 4 months and the kind words about the program keep coming in.

I just got another great review for MIR2.

“Product Muscle Imbalances Revealed by Rick Kaselj is complete and is an important tool in my repertoire of works in practice. It is easy to use and understand. The various presentations allow us to touch a wide variety of muscle imbalances that may apply to both a general sports population. Its content will be definitely very helpful to me to optimize the training of my clients.”

Xavier Roy
Montreal, Quebec
Performance Specialist

Xavier did a detailed review of the MIR2 resource.  To read the full review from Xavier, click here.

The cool thing was Xavier’s review was all in French.  I am from Western Canada and did learn French in grade school but it has been some time since I have had to use it.  I used an online translator to help me translate things.

Thank you for the kind words, Xavier!

Helping People with Shoulder Pain

As you know, I am very passionate about helping people with their shoulder injuries and pain.  It is great to hear when those with shoulder pain follow my Scapular Stabilization Exercise Program and get the results they are looking for.

“I used Scapular Stabilization Exercise Program on myself and it was very helpful. My right serratus anterior is a lot bigger than my left, probably because I kept training while I had problems with my supraspinatus.  My right scapula used to move really bad, I would feel a tingle around the medial border when I would abduct my arm. I used the program and no more tingling anymore. My right shoulder complex still isnt 100%, but it’s a lot better.”

Thanks again,
Nick Mudaliar

Few Kind Words for the Exercise Rehabilitation Courses

I have a little break from courses but here are a few kind words from a Pilates instructor who attended my Exercise Rehabilitation of the Lower Back and Shoulder.

If you are looking for upcoming courses:

==>  Upcoming Fitness Education Courses

That is it.

If you have any feedback, positive or negative, make sure to send it to me at support(at)exercisesforinjuries.com .

Take care.

Rick Kaselj, MS

Today was the day to dig into what is new in the research world.

To be honest, I started it in yesterday’s blog post.

In yesterday’s blog post I talked about new research in muscle imbalances.

Yes, there is research about it. More and more keeps coming out.

Now to today’s research.

Harrington S, Padua D, Battaglini C, Michener LA, Giuliani C, Myers J, Groff D. (2011). Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv. 2011 Jan 12. [Epub ahead of print]

I know this is a little new for me, to be talking about breast cancer and exercise.

I have been having more questions about this of late, plus it reminds me of the group of breast cancer survivors that I trained while working in Penticton, BC, Canada.

The ladies were a group from a local Dragon boating team that were all cancer survivors.  It was amazing to train these ladies and they were so much fun.

Here we go into the research.

What They Looked At:

Read the rest of this entry »

I have been doing research this week.

A colleague, Brenda Adams, emailed me and asked if I had any reference on what muscle is being used during the bench press.

I know what muscle works, but I did not know if what I knew was right; so I hit the books.

I found the answer but also some information on grip and bench press; plus which is better  – machines or free weights – when it comes to the bench press.

Enjoy!

What Muscles Are Working during Different Bench Presses?

What They Looked at

This experiment investigated the effects of varying bench inclination and hand spacing on the EMG activity of five muscles acting at the shoulder joint.

What They Did

Six male weight trainers performed bench presses under four conditions of trunk inclination and two of hand spacing at 80% of their predetermined maximum.

What They Found

- The sternocostal head of the pectoralis major was more active during the press from a horizontal bench than from a decline bench.

- The clavicular head of the pectoralis major was no more active during the incline bench press than during the horizontal one, but it was less active during the decline bench press.

- The clavicular head of the pectoralis major was more active with a narrow hand spacing.

- Anterior deltoid activity tended to increase as trunk inclination increased.

- The long head of the triceps brachii was more active during the decline and flat bench presses than the other two conditions, and was also more active with a narrow hand spacing.

- Latissimus dorsi exhibited low activity in all conditions.

Where to get more information – Barnett C. (1995). Effects of variations of the bench press exercise on the EMG activity of five shoulder muscles. 1995 Nov;9(4):10-14. (Yes, it is an oldie but a goodie.  Let me know if you have something more recent.)

If the research above interested you, make sure to get my free seminar that I did on exercise and shoulder injuries, you can get it here.

Read the rest of this entry »

I just finished off my review of last weeks journals.  I have chatted about what I do in a previous post.  I talk about it in my 6 Must Read Journals for Exercise and Injuries .

I came across two articles that are great and will be helpful when it comes to neck pain, shoulder pain, scapular stabilization and poor posture.

Lets get to the two articles.

Can Head Posture Affects Neck Pain, Shoulder Pain and Scapular Muscles?

In this research they assessed the effects of forward head posture in a sitting position on the activity of the scapular upward rotators during loaded isometric shoulder flexion in the sagittal plane.

Three Keys I Got Out of This Articles:

#1 – With forward head posture there increase in EMG (muscle activity) activity in the upper trapezius and lower trapezius and a decrease EMG activity in the serratus anterior during loaded isometric shoulder flexion.

#2 – Forward head posture may contribute to neck and shoulder pain during loaded shoulder flexion in sitting.  This can be an issue for all of us.  Poor head posture could be lead to neck pain and shoulder pain when driving, working and being at our computers.

#3 – Neutral head position is advantageous in reducing upper and lower trapezius activity and enhancing serratus anterior activity as compared with forward head posture during loaded shoulder flexion

Read the rest of this entry »

Hey, it is Friday, lets ramble.

Well, let me ramble.

More Rambles about Facebook

It is very cool to get comments like this on my Facebook account:

Read the rest of this entry »

Foundations of Upper Body Conditioning

DESCRIPTION:

OBJECTIVES:

As you know, I am really big into scapular exercises and teaching an effective rotator cuff exercise program.

I have another perspective on the shoulder for you.  It is a guest blog post from Tara Keller.  It is the third part of her series.  Enjoy!

Addressing Shoulder Dysfunction Beyond the Shoulder Itself

By Tara Keller, BSc.(KIN), MES

Part III: The Silent Triggers

Leading into this final segment of this article we have discussed the kinetic chain response and how cueing can play an integral role in the retraining of functional movement. This week we are looking beyond the shoulder to the silent triggers of shoulder dysfunction.

Read the rest of this entry »

What’s My Cue? (Part 2)

The lats pulldown is a great exercise for the scapular muscles.

It is also important in working shoulder adduction and abduction plus working the latissimus dorsi and rhomboids muscles.

There are a couple of key things to remember when performing the lats pulldown machine in order for it to work your scapular muscle better.

Don’t Move Your Shoulder Blades Down and Together at the Start

Read the rest of this entry »

Today I have an interview of me to share with you!

When I was in Orlando at the Fitness Info Summit, I ran into a Fitness Professional that had taken some of my courses.

His name is Belton Lubas and he is from Seattle.  In the fall of 2008 he came up to Vancouver and attended a series of courses that I had.

Belton did a quick interview with me on exercise programs for clients recovering from injuries and what to do with a client with a shoulder injury.

Enjoy the interview.  There is a mix of a transcript of the interview and  video.

Interview with Belton Lubas

Belton Lubas: Hey this is Belton here of Element five Fitness. Basically we’re here at the Fitness Info Summit. I got Rick Kaselj. What’s up, Rick?

Rick Kaselj: I’m doing great.

Where Do Fitness Professionals Fit In When Working with Clients with Injuries?

Read the rest of this entry »

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 »

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!