Finishing up this month’s Injury of the Month on Exercises for Frozen Shoulder was very eye opening for me.

I have been doing most of what I learned when I dug into the research, but I want to highlight 4 things that stood out in my search for frozen shoulder exercises.

#4 – Heat Up Your Frozen Shoulder Prior to Exercise

This is a point that I never knew.

I know when clients go to physical therapy, this is often done. But after they finish physical therapy, their is no encouragement to continue doing this, yet the research shows that it should be continued.

Leung 2008 made this comment in their research:

1. Heat ends up changing the viscoelastic properties of connective tissue.
2. Heat promotes vasodialation leading to better nutrition and oxygen supply and metabolite waste removal.
3. Heat also increases pain tolerance.

The researchers used machines to create deep tissue heating, but they also commented that similar results could be reached with a hot pack on the shoulder.

TAKE HOME MESSAGE ON EXERCISES FOR FROZEN SHOULDER => Heat up your frozen shoulder prior to doing your exercises.

#3 – Perform Pain-Free Frozen Shoulder Exercises

I always have explained this to my clients and everyone that has attended my Exercise Rehabilitation of the Shoulder course: frozen shoulder exercises should be performed in pain-free ranges of motion.

Diercks 2004 proved it.  They compared aggressive and painful frozen shoulder exercises with performing pain-free frozen shoulder exercises. Those that did pain-free frozen shoulder exercises had better results.

I have been teaching this but it is nice now to have evidence that backs up what I say and do.

TAKE HOME MESSAGE ON FROZEN SHOULDER EXERCISES => Perform all frozen shoulder exercise in pain-free ranges of motion.  Pushing into the pain leads to poor results when it comes to shoulder pain and shoulder range of motion.

#2 – Scapular Exercises for Frozen Shoulder

I have been on this bandwagon for a long time.

Scapular exercises are very important for shoulder health and shoulder injuries.

Celik 2010 showed how important they are when it comes to frozen shoulder.

When someone with frozen shoulder is assessed, the scapula is fixed during assessmen to put greater emphasis on the shoulder joint (glenohumeral).  After a confirmed diagnosis, often times the exercises just focus on the shoulder joint.

Celik showed the importance of doing specific scapular stabilization exercises to help with range of motion, shoulder pain and frozen shoulder recovery.

In the paper he goes through 10 scapular exercises for frozen shoulder.  I have included them along with photos, descriptions and videos of the exercises in the Frozen Shoulder Solution program.

TAKE HOME MESSAGE ON FROZEN SHOULDER EXERCISES => Do scapular exercises for frozen shoulder.

#1 – Chronic Conditions Increase Your Risk of Frozen Shoulder

This one for me was shocking.

Tighe 2008 did research on how big of a problem frozen shoulder (adhesive capsulitis) was for diabetics.

Diabetics have about a 39% chance of getting frozen shoulder while those that are pre-diabetic have a 33% chance (WoW!).

The chances are good if you are diabetic you will get a frozen shoulder. If you have any diabetic clients, soon enough you will have a client with frozen shoulder.

One more thing.  Doctors that are diagnosing patients with frozen shoulder are performing follow up tests to see if they have diabetes or another systemic disease.

Very interesting.

Okay…

TAKE HOME MESSAGE ON FROZEN SHOULDER EXERCISES => Those that are diabetic have an increased chance of getting frozen shoulder.  Those with frozen shoulder, might have something else going on so have your doctor look into it.

Research on Exercises for Frozen Shoulder

Here are the references for above, if you want go to the source of what I am talking about.  You can go buy and read all of these research articles. Also, I reviewed another 14 papers on exercises for frozen shoulder in the Frozen Shoulder Solution program:

• Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. (2008). Effectiveness of corticosteroid injection in adhesive capsulitis. Clin Rehabil. 2008 Jun;22(6):503-12.
• Celik D. (2010). Comparison of the outcomes of two different exercise programs on frozen shoulder. Acta Orthop Traumatol Turc. 2010;44(4):285-92. doi: 10.3944/AOTT.2010.2367.
• Diercks RL, Stevens M. (2004). Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elbow Surg. 2004 Sep-Oct;13(5):499-502.
• Leung MS, Cheing GL. (2008). Effects of deep and superficial heating in the management of frozen shoulder. J Rehabil Med. 2008 Feb;40(2):145-50.
• Tighe CB, Oakley WS Jr. (2008). The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. South Med J. 2008 Jun;101(6):591-5.

That is it.  I hope this helps you if you have frozen shoulder or if you have a client with frozen shoulder.  If you would like to check out the 3-stage, 7-step exercise program that I use for frozen shoulder, you can check it out here:

Rick Kaselj, MS

P.S. – I just got this feedback from one of my other Injuries of the Month:

“The Achilles Tendinitis Exercise Program is the NO BS, 100% reliable program. I read your blogs and posts daily and one thing I really love is that I can trust what you say (meaning a confident road to recovery)!

I also appreciate that you put the program in video form with step by step instructions and thorough, concise explanations. For a non-expert such as myself, it really helps me understand the program as a whole because there is no jargon.

Not only do you describe these exercises and its purposes in the presentations, you have additional videos dedicated to these specific exercises.

The Achilles Tendinitis Exercise program is extremely comprehensible for the average exercise blog reader yet detailed enough for someone who constantly reads Rick’s and other coaches’ newsletters to learn new things. The program is very valuable.”

Janila L

Before I finally go, I just recorded this.  Here is one more video about Frozen Shoulder Exercises:

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What Causes Frozen Shoulder?

Adhesive capsulitis or frozen shoulder has different causes, but before we get into that, let’s look at the two different types of frozen shoulder.

The Two Types of Frozen Shoulder

Frozen shoulder can be classified into two types: primary frozen shoulder and secondary frozen shoulder.

• Primary frozen shoulder does not have an initiating event or cause. It has been suggested that frozen shoulder may be attributed to specific genetic abnormalities (Roy, 2012). Cultures of the tissue obtained from the glenohumeral joint capsules of patients with frozen shoulder revealed aberrations involving chromosome 7 or 8 in the fibroblasts.
• Secondary frozen shoulder is often linked to a significant event, such as trauma, surgery, illness, or infection. Overall, secondary frozen shoulder is caused by any condition affecting the shoulder that results in inflammation of the joint capsule. This causes the formation of scar tissue, thickening, and the eventual shrinkage of the capsule that envelopes the glenohumeral joint. These changes leave less room for the humerus to move, thus, limiting the movement of the joint.

To be more concise, frozen shoulder may be caused by any injury involving the shoulder joint. The outcome of these changes in the shoulder causes pain, and tightens and restricts the joint’s movement.

Shoulder Injuries that Could Lead to Frozen Shoulder

The following injuries have been associated with frozen shoulder:

• Shoulder tendinitis. This frequently involves inflammation of the biceps tendon or rotator cuff tendon. Tendons are tough fibrous tissues that connect a muscle to a bone. In this condition, the tendon involved is usually red, sore, and swollen. Shoulder tendinitis is commonly caused by an injury, overuse of or repetitive shoulder motion, infection of the tendon, or chronic inflammation of the tendon which could occur with rheumatoid arthritis.
• Shoulder bursitis. As previously discussed, bursa is a sac-like structure that functions as a cushion between bones and tendons. This fluid-filled sac also serves as a shock absorber between bones and muscles around the joint. The bursa is filled with synovial fluid that is used to lubricate the articulating joints. Shoulder bursitis involves inflammation of the bursa in the shoulder joint. Bursitis may be caused by an injury, an underlying rheumatic condition, or infection.
• Rotator cuff injury. This mainly involves irritation or damage to one of the four muscles making up the rotator cuff. An injured or damaged rotator cuff tendon may lead to frozen shoulder symptoms. These muscles work as a unit to further stabilize the shoulder joint, assisting the shoulder as it moves in different positions. Inflammation of the rotator cuff tendon, impingement of any of the four muscles of the rotator cuff, or tearing of the rotator cuff tendon causes rotator cuff syndrome.

Shoulder injury typically involves pain. Pain limits movement of the affected shoulder and may impede an individual from performing his or her usual routine. Prolonged immobilization has been connected to frozen shoulder. The incidence of frozen shoulder is higher in patients with diabetes, especially those dependent on insulin. Diabetes mellitus is a metabolic disease characterized by increased blood glucose levels, and is caused by absence of or insufficient secretion of insulin. It has been suggested that excess glucose molecules stick to the collagen fibers in the joint capsule, contributing to joint stiffness (Sports Injury Clinic, 2012).

Diagnosis and Prognosis of Frozen Shoulder

Diagnosing Frozen Shoulder

Frozen shoulder syndrome is diagnosed by a physician who performs a complete medical history and conducts a thorough physical examination. Patients with signs and symptoms of frozen shoulder are often referred for an x-ray of the shoulder. The physician usually orders a magnetic resonance imaging or ultrasound in order to examine the soft tissues of the shoulder, such as the rotator cuff, or to get a deeper understand of the injury.

Common Outcome for Frozen Shoulder

The prognosis (probable outcome) for patients with frozen shoulder syndrome who receive the right treatment is generally favorable. Often times the first treatment options given are physical therapy, frozen shoulder exercises, and conservative modalities described in the next section, which all have a positive effect on frozen shoulder. Without a consistent and aggressive treatment, the effects of frozen shoulder can be permanent (Shiel, 2011).

Rick Kaselj, MS .

Hey, here is the Frozen Shoulder Client Guide

You can download it by CLICKING HERE or click the image bel0w.

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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

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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

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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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With the Super Bowl coming up, I got thinking about shoulder training and football.

I asked someone who works with football players and shoulders, every day.

I asked Jason Novak to share what he does working with in-season football players when it comes to shoulder training and health.

Enjoy!

Take it away Jason:

Training the shoulder is one of the tougher programming challenges we face with our players during the season.  Due to the nature of the sport and position specific demands, our primary objective in-season is to keep the training simple and be very consistent in doing it.

As a team, we train four times per week with each session lasting 30-45 minutes.  Each day begins with a functional warm up and mobility exercises that last 8-12 minutes and generally ramps up in intensity as it progresses and complements the workout for that day.

We utilize many tools during the warm up routines including jump ropes, suspension training devices, kettlebells, medicine balls, dumbbells and bodyweight  exercises to add variety to the routines and keep our athletes mentally in-tune with preparing for the training.

There are three phases of our In Season training broken down into training camp, early/mid-season, and late season/playoffs.

Training Camp (Phase #1)

Essentially, this phase is an extension of the off-season program.

We train fairly heavy during training camp due to the higher numbers on the roster and less reps our veteran players have to take in practice and games.

We try to balance out every “push” we do with a “pull” whether it be chest pressing or overhead pressing.

For “pulls” we use suspension trainer row variations, half-kneeling cable row variations and heavy, low rep single arm dumbbell rows along with pull-ups with various grips.

Our primary strength training for the shoulder during this phase comes from the Clean + Push Press.

We use bars, dumbbells and kettlebells for this activity depending on the athlete and any restrictions they may have.

Typically we follow this with one of three dumbbell complexes (reps will vary):

Example Training Day:

1. Clean + Press:    57.5-62.5% x 4 reps,    70-75% x 3 reps,     77.5-85% x 2 reps / 3-6 sets **
   **superset box jumps with top sets
2. Pullups :   Skill (WR, DB, RB) group x 30reps,  Middle group (DE, TE, LB, FB) x 25 reps, Linemen (OL/DT) x 15 reps
3. Turkish Getup x 4 on left and right side

Early/Mid-Season (Phase #2)

Once the regular season begins things change rather quickly and drastically with our training.

Due to the nature of this sport and roster size limitations etc…..our athletes play with quite a few injuries and through a tremendous amount of pain (especially in the shoulders).  A point of emphasis now becomes getting the training completed without causing further irritation to an existing injury or pain and hopefully aid in the healing process.

So, that leads you down a path of creativity to find a way for the athlete to get the work that they need done.

This is always one of the biggest challenges we face as strength and conditioning coaches.

We continue to do Olympic lifts throughout the entire season, keeping the percentages lower and emphasizing technique and speed of the bar.

It is also at this time that we begin to modify the exercises by using kettlebells and dumbbells for our Cleans, Clean + Presses and Snatches.

As the season wears on, many of our athletes prefer to use kettlebells in place of traditional Olympic bars for certain lifts because they tend to be easier on the shoulders and especially their wrists.

As for direct shoulder work like overhead pressing, we primarily stick to using dumbbells and kettlebells.

We do very little overhead work with straight bars unless it is a part of an Olympic lift like Clean+ Press or Snatch.

Our philosophy is to keep these exercises unilateral, so we typically only use one dumbbell or kettlebell at a time.  This keeps the total amount of weight a bit lighter and allows them to concentrate on form and technique.

Additionally, we perform most of our pushup variations and abdominal training using suspension devices such as TRX or rings with either our feet or hands elevated to require more postural and shoulder stability.

Two exercises that we use quite a bit during this time of year are the kettlebell windmill and the “half-version” of the Turkish Get Up which is made up of just the “ground” portion of the lift and not coming to a full standing upright position.  We introduce different implements during these exercises such as using dumbbells and bars instead of kettlebells.  This builds a great deal of stability in the shoulder and requires a tremendous amount of core strength to complete.

Mid-Season – Late/Post-Season (Phase #3)

During this time of year, our athletes are all dealing with some type of pain/injury, and their bodies have absorbed more punishment than seems possible.

Our goal is to help them maintain as much strength as possible, yet allow their bodies time to heal throughout the entire week.

We place a great deal of emphasis on incorporating chains and bands during the last half of the season.  This accommodating resistance works great for our athletes as it is easier on their joints due to the weight being lightest at the weakest angles and heaviest at the strongest angles.

The volume tends to be very low, but the relative intensity on the bar can actually be fairly high when accounting for the added resistance of the chains or bands.  At this point in the season, added volume is what has to be avoided.

For auxiliary shoulder work, we still incorporate mostly dumbbell complexes and continue with appropriate variations of the Windmill and Turkish Getup.

We tend to not eliminate anything from our training routine as the season progresses.  What we try to emphasize is rather than eliminating a movement, find a way to modify it so that it is still relevant and appropriate for the athlete.  Consistent training is crucial.  Once you stop using a movement pattern, you lose it.

Who Am I?

My name is Jason Novak.  I am the Assistant Strength and Conditioning Coach for the Tennessee Titans.  This is my eighth year in the NFL, all with the Titans.  Previously, I was the Director of Strength and Conditioning at Yale University and the Head Strength Coach at Alabama State University.  I have a Master’s Degree in Sport Management from Baylor University and a Bachelor of Science in Kinesiology from Stephen F. Austin State University.

Big thanks, Jason.

Great info, thank you for sharing.

Jason is a Muscle Imbalances Revealed – Upper Body Edition customer.  He email me and I saw what he did from the signature in his email.  After seeing that, I asked if he would share some info.

That is it for today.

Take care.

Rick Kaselj, MS

For products related to shoulder injuries and training, check out:

• Muscle Imbalances Revealed – Upper Body Edition
• Effective Rotator Cuff Exercises
• Scapular Stabilization Exercises

Here are some other shoulder injury and training articles that may interest you:

•  Injury free pull ups
•  Plank Exercises for Shoulder Injuries

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I get a lot of email.

Well who doesn’t.

I was digging through it and here were a few of the things that came in this week.

If you have emailed me a question, I am working on getting back to you and I will post some of them on the blog.

- rick

“Whole New Perspective”

“With Muscle Imbalances Revealed, I have learned to look at the way the body moves in a whole new perspective and learned some new great assessment tools.

I now have a greater understanding of how the body moves.”

Kristyn Mastroianni

Certified Personal Trainer

Coventry, CT

“I Will Use What I Learned for My Own Body First”

“I will use what I learned for my own body first and also share pointers and exercises with my class participants.

From Muscle Imbalances Revealed I have learned how much imbalance of muscles affect the function of the body, self care techniques for the shoulder and the fascia information was new and helpful.”

“Stop with All the Email”

“Stop with all the email.

 

I can’t keep up.

 

You keep sending me great articles, interviews and videos.  

 

Thanks for sharing such great information.  Keep the emails coming .”

 

Brenda Morgan

“Filled in A Lot of Knowledge Gaps”

“I’ve had scoliosis since age 11 and this is the first course/manual I’ve seen devoted specifically to scoliosis specific exercises.

Effective Exercises for Scoliosis filled in a lot of knowledge gaps about correct exercise prescription for scoliosis.”

Karen Plansinis

Dietician, Strength Coach and Personal Trainer

Kittanning, PA

“I Never Completely Understood the Shoulder Joint Until I Took This Course”

“I work with many seniors who have rotator cuff problems.

I found Effective Rotator Cuff Exercises provided a very good understanding regarding which exercises target certain muscle groups.

Effective Rotator Cuff Exercises was very thorough – I learned a lot. I never completely understood the shoulder joint until I took this course.”

Martha Andebon

Occupational Therapist / Registered Nurse

El Paso, Texas

 ”I had Tears Running Down My Face”

“Dear Rick,

Thank you so much for sharing your son’s dance moves with us. I had tears running down my face. How wonderful to be so uninhibited and full of joy.

I was laughing at you laughing.”

Brenda Champagne- Locken

If you missed the video, here it is again:

“I Turn to Rick for Injury Anaswers”

“I meet Rick 2 years ago at a fitness seminar.

I admired his passion and knowledge for helping people with injuries.

As a trainer my goal is to help people maximize their health and fitness.

Once in a while I get a client who gets a nagging injury. When this happens I turn to Rick and he has the answers that help my clients get back to maximizing their health and fitness.

If you want to get maximize your exercise plan and spend less time on the mend.

Check out Ricks injury prevention or rehab tips!”

Brian Stecker
Master trainer
Vancouver, Washington
BoomerFitness.com

“To find a Wealth of Knowledge like thins You Usually Have to got to a Fitness Conference”

“If you want to be like a fraction of the greats in this industry and separate yourself from the joe personal trainers. I highly recommend you buy Muscle Imbalances Revealed.

To find a wealth of knowledge like this you usually have to go to a fitness conference somewhere and for a owner/operator like myself this cuts down costs to a minimum because you can watch and learn on your computer!”

Scott Bisbee ACE-PT
Owner/Operator
Bisbee’s Fitness Experience Inc
www.bisbeefitness.com

“Stop Showing Me the Poppy Uppy Thingy!”

“Stop showing me the poppy uppy thingy!

It just won’t go away.

- Anonymous

Rick’s Answer – The Pop-up is a way of giving new people to my website, a piece of my best stuff.

It just takes 1 second to close the pop-up.  Just hit the “X” in the top right hand corner.  I show you here:

For some people there is no “x” to click.  You can try to refresh your web browser or view the page in a different web browser.

“Easily Digestible Product Based Around Current Evidence”

“Hi Rick

Thanks for the Tennis Elbow Pain Solution (TEPS), as always you’ve delivered an easily digestible product based around current evidence.”

Regards

Simon Tydd

Physical Therapist

Simon Tydd Physiotherapy

Tamworth NSW
Australia

“Impressed with the Wealth of Information Provided”

“Hi Rick, I have viewed the video presentation for the UTG for Cancer Survivors and can honestly say that I am impressed with the wealth of information provided.

Being a cancer survivor of 40 years this summer I can relate to many of the points made by the presenter. I’ve been there, done that, got the t-shirt – as they say! This program definitely affords a personal trainer the opportunity to better understand how a person with cancer would like to be treated and how to put together a suitable exercise program for his/her cancer client.

Also, the information on cancer, types of treatment, side effects, etc., are all very helpful in helping the trainer to better understand and prepare for the cancer client.

Again, great program!”

Kevin Garnier

Personal Trainer

Pasadena Fitness

Pasadena, NL, Canada

Thank you for all the kind words and negative ones.  If you ever want to get a hold of me, just email me at support(at)exercisesforinjuries.com .

Talk to you soon.

I got a little lost with this interview.

The interview was with Elliott Hulse.

CLICK HERE to listen to the interview.

(To listen to the interview, scroll down to the bottom of this page and click the play button.  If you do not have time to listen to it right now, just click the “download” button and download it to your computer.  Then you can listen to it on your computer when you like or subscribe to the itunes podcast.  Enjoy!)

Thinking Beyond the Physical

• He talks about how he went from strength training and into strong man competitions
• Different techniques he has combined into his training
• How his biceps injury expanded this thinking when it comes to training and lift
• Elliott give a little background on who he is
• Talks about how he tore his biceps
• What it looked like when he tore his biceps
• What not to do if you tear your biceps
• How an injury forces you to slow down and look back at your life
• The overlooked yin and yang of an injury
• How the autonomic nervous system affects ones injury recovery
• The yin (parasympathetic nervous system) and yang (sympathetic nervous system) when it comes to training and rehab
• We focus to much in the yang so how can we stimulate the yin
• Exercises and movements that stimulate the yin/parasympathetic nervous system in the body
• He focused on more than just the physical side of his biceps injury
• How his injury has changed how he organized his new gym
• Some references on where to get information on these exercises and movements
• One quick test to see which part of the autonomic nervous systems is being stimulated in yourself

CLICK HERE to listen to the interview.

Elliott Hulse is a strength coach and personal trainer in Florida that does a lot of unique things when it relates to helping people get stronger.

Here is a photo of Elliott and I at a conference in California last year.

Rick Kaselj, MS

Here are some other articles that may interest you:

• Mental Tricks to Help Injury Recovery
• Video on explaining how to download the interview recording

If you are looking for a live course when I go through shoulder injuries, you can check this out:

• Exercise Rehabilitation of the Shoulder

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Thinking Beyond the Physical with Elliott Hulse [ 32:39 ] Play Now | Play in Popup | Download

I got a great Q and A for you today.  It is on the very important topic of Post-Rehab.

As you know, I am an injury guy.

A huge trend that I am seeing is more and more people going into the gym, recreation centre, studios, home training and bootcamps with previous injuries.

If you don’t believe me that injuries are a big deal, have a look at this:

Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JW. (2011). Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011 Sep;32(9):703-11. Epub 2011 May 17.

• 43.3% of powerlifters complain of problems during their routine workouts
• Injury rates were calculated at 0.3 injuries per lifter per year – or 1000 hours of training equalled 1 injury
• Most common areas injured were the shoulder, lower back and knee (No surprise)
• READ THIS ==> Use of weight belts increased the injury rate of the lumbar spine (WoW!)
• Upper body injuries increase with age and gender (female)

Okay, I am not a powerlifter. You may not be a powerlifter either.

These people lift heavy stuff and train hard which can lead to injuries, but in order for them to lift for a long period of time they have to have good technique.

Let’s look at regular people and the issues they have.

Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA. (2010). Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res. 2010 Jun;24(6):1696-704.

• 45 million Americans who engage in strength training regularly (that is a lot of people.)
• For those that do resistance training, the shoulder complex is the most common area of injuries (interesting)
• Reviewing the research, the researchers found that intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors like improper exercise technique lead to the majority of injuries in the shoulder (good old muscle imbalances.)

Interesting, interesting, interesting.

To sum it up, there is a good chance we will train someone with an injury and we need to know what to do about it.

In order to get a little more info on post rehab, I reached out to my friend, Dean Somerset to chat a little more about post rehab and what health & fitness professionals need to know about it.

Rick – Let people know a little about you.

Dean – I’m a kinesiologist in Edmonton, Alberta, and I’ve built a practice around the gap that exists between rehabilitation in the classic sense and gym-based workouts.

Most patients will be discharged from physiotherapy or chiropractic and still have needs to build strength, mobility and flexibility through a lot of their movements, and will need someone to walk them through the process.

Over the past decade I’ve formed relationships with over 100 allied health professionals in my city who refer me their patients to continue their rehab, and who I refer clients out to if I feel there is something deeper than just a tight muscle or a weak muscle. I run a large component of my companies (World Health) continuing education program, including the Post-Rehabilitation workshop.

This is the first exposure a lot of trainers have with any concepts involving injury, what to do with them and what not to do with them to get them stronger and not risk re-injury.

Post-Rehab and the Trainer

By teaching other trainers how to increase the results they can get with a broader base of clients, as well as how to prevent and help recover from various injuries, their perceived value goes up in the eyes of their clients and their potential clients, and also lends a degree of reputation to our organization by having a standardized course all trainers have to take to work with any medical referrals we receive.

Dean’s Story of Post-Rehab

My main interest in Post-rehab came from my own injuries after playing competitive athletics for the majority of my early years. I wasn’t very good. I managed to get injured a lot, so I spent a lot of hours in physio clinics, chiropractic clinics, and doctors offices. A lot of the time my questions of “what should I do now?” fell on deaf ears. I wanted to know if there was anything I should do more of or less of on my own to help the process out, but found getting any specific guidance was difficult. Because of that, I had to do a lot of research, trial and error, and find out on my own what worked of different injuries and problems, then I refined that by working with over 1000 different post-rehab clients over the course of my career.

Here is a clip from Dean’s presentation from MIRU:

Rick – What is “Post-Rehab”?

Dean – Post-Rehab is the gap that exists from the time a patient is discharged from their treatments until the time they could be considered to have a complete recovery from their injuries.

Many clinicians will discharge when the person is:

• able to return to work
• when their insurance runs out
• when their insurance company deems they are ready

They are not necessarily discharged when the person is physically capable of preventing their injury from coming back. As a result there are a lot of people with recurrent injuries that weren’t addressed properly in the first incidence, and have to go through further rehab.

A Post-Rehab Example

To give you an idea, I recently started working with a client discharged from physio following a motor vehicle accident in 2010 that resulted in a broken ankle and a rotator cuff tear.

He was still walking with a noticeable limp, acute tenderness through the foot, and reduced range of motion in his shoulder. He wanted to get back to playing recreational hockey and be able to rough house with his kids without feeling like the tin man, but the way he was presenting if he would have strapped on the skates he wouldn’t have made it to the second period without some serious problems, and the first flying body slam would have sent him to the ER.

He needed a lot more strength, balance and range of motion through his ankle before we could put him on the ice, so we trained to get him ready for it.

After 2 months of training, he now skates three days a week, no problem and hasn’t had any issues in his shoulders since prior to starting.

Post-Rehab is also about helping those with long-standing injuries who don’t necessarily fit nicely into the mix of the “average” population. Considering the fact that nearly half of people over 60 show evidence of rotator cuff tears on MRIs, you could say that if you train anyone over the age of 50, you would need to be proficient in managing shoulder injuries.

Likewise with spinal issues, knee problems, and other musculoskeletal conditions. As I said earlier, I had a lot of my own injuries, and training for the first little while was a crap shoot of wondering if this set of deadlifts will make my spine buckle or if there was another way to get strong without the risk, and sifting through the confusion of where physio should end and where training should begin. This series helps reduce the confusion and get trainers off on the right foot to help people when they can, and understand when they need some additional assistance.

Here is a clip from Dean’s Post Rehab Essentials course:

Rick – Why is it important for a fitness professional to know about post-rehab?

Dean – Post-Rehab training services are going to be the next wave for fitness professionals to capitalize on as the population continues to age.

Trainers who know how to work with post-rehab clients will be able to work with a broader array of clients, and through a larger portion of the wellness continuum.

To put it another way, if your clients get injured and you can’t work with them, you’re out of business. This will help keep you in business and keep your clients in the game.

This has nothing to do with post-rehab or injuries but it is a very funny video:

Rick – From talking and teaching fitness professionals, what common mistakes or misconceptions do they have about post-rehab?

Dean – Aside from thinking they’re fragile little birds who can only do tubing exercises and walk on the treadmill, some of the biggies would be the biomechanical components that go into an injury development pattern.

If a client says their shoulders are sore, performing sets of side raises and military press will probably make it worse sooner than Kim Kardashian can file for divorce.

Along the same vein, trying to give an exercise to everyone because it’s good for a shoulder or a hip, even if the person doesn’t need to develop that specific area in that specific way.

We go through assessments in the videos and learn how to tailor a workout around what those assessments show, be it tightness in the ankle, weak balance in one hip versus the other, limited internal rotation in the shoulder, or a flexion bias through the spine.

Exercise is like medicine: the right medicine for the right reason produces the best benefits, whereas the wrong medicine can produce either no benefits or massive repercussions.

============================

Thanks so much, Dean.

Dean has come a long way since I met him at a conference in Edmonton a few years back.

It is great that he is sharing more of what he does with fitness professionals around the world.

Dean has recorded his course that he teaches for trainers in his company on Post-Rehab.  It is awesome.  I am still going through it but I am picking up some great tips.

If you are a fitness professional and would like to better know what to do with a client that has an injury, I would highly recommend Dean’s Post-Rehab Essentials course.

==>  CLICK HERE to get More Information on Dean’s Post Rehab Essentials Course  <==

That is it.  Thanks for reading the post on post-rehab.

Rick Kaselj, MS

.

I get lots of email. Let me answer some of the questions that came in over the last week or so.

What to Do About Bootcampers with Painful Knees?

Brenda found me on Facebook.

“Hi Rick, I’ve got a couple of clients with dodgy knees and a lot of my boot camp has running, which is too painful for them – can you offer suggestions that will give them just as good a workout and that are safe? Thanks, Brenda”

If you are looking for a program to help you out, I recommend this:

Working Towards 10,000

I mentioned this in last week’s questions from readers.  I am working towards helping 10,000 health and fitness professionals help 1,000,000 clients become pain and injury free by 2020.

It is an ambitious goal but you got to have big goals to bring the best out of you.

I think I am on the right track especially when I get emails like this:

“Hi Rick,

Thank you very much for the free gift!

I am just starting out as a personal trainer.

However, I have been involved in physical fitness, getting in shape, nutrition for quite a number of years. Your website is really incredible!  You’ve opened my mind up to things that I did not know about.  This will definitely help me out when I train people.  The last thing I want to do is hurt them when they’re coming to me for help.  The information you provide will definitely help me do that.

I now feel better ‘armed’  to train people properly if they have an injury.  Thanks, Rick.
Larry”

Thank you so much, Larry. I am glad all the free stuff on the website has helped you and your clients out.

This is what Larry was talking out, yours free.

Yes, free.  Click here to get it.

Even Fit Pros Get Injuries

A few years back, I got chatting with another fitness professional on injuries that fitness professionals have.

After that conversation, I asked other fitness professionals about their injuries.  I was shocked to see how many of them had some little ache and pain that was not forcing them to stop working, but slowing them down a little.

Here is an example.

“I love learning more about how unbalanced I am.

I just ordered the Achilles tendinitis package last night from your site and am going to get started on that right away.

I went out and bought new shoes and that seem to help a bit, but I’m going to work through the exercises so that I can avoid any future problems.

I can’t remember if it was Eric Cressey or Mike Robertson that recommended your site, but I think that’s how I found about you and your site.

I like the name Exercise for Injuries and the concept behind it… I just don’t like being injured.   Thanks for your help,

EK”

Thanks EK, let’s get  you uninjured.

Seniors in a Care Home

A neat trend that I have seen over the last 12 years of teaching fitness education courses is more fitness professionals in senior care homes.

This is very cool and exciting.

From talking with the few that are in them, what they do is an activity class, stretch classes, core classes and some personal training.

I know these seniors are getting a lot of benefit from exercise at their age.

One thing that they all said was a big issue for seniors is shoulder injuries and many of them have come to my Exercise Rehabilitation of the Shoulder course.

If you do work with seniors, it may be an idea to come out to the class.

Muscle Imbalances Revealed – Upper Body Edition – Exam

Things are rolling with MIRU and people are getting their CECs and CEUs from it.

I have just got approval from NSCA, BCRPA and BCCMT.

Here is a specific question as it relates to the MIRU exam.

“Hello Rick,

How do I go about in submitted MIUB in order to receive .7 credits through the NSCA?

I won the product a few months ago and I do not have a receipt for them for approval.

What do you suggest?

AZ”

It is really easy.

The exam is in the membership area in the exam and there are no plans on taking down the membership ares so it is there when you need it.

Print the exam out and fill in the answer sheet.

Send me the answer sheet and I will mark it.

If you get over 80%, I will send you the certificate for NSCA CEUs.

That is it, pretty easy.

Some More Kind Words about MIRU

“MIRU provided a different perspective about movement.

First, because of the different background of each presenter and second was a sort of the “holistic” approach, meaning that, breathing and myofascialtraining aren´t  too common findings in other materials related to exercise.

Best,

Please do send me your questions via Facebook or email.  I will do my best answering them and please do not be angry if I do not get to it.  I get a few hundred a day.

Plus, here are some more videos that may help when it comes to bootcampers and knee pain:

Let’s try something new today: answering questions.

I was going to do them by video but I got kick out of the pool area at the Hard Rock Hotel in Vegas.

Something about no cameras in the pool area, oh well.

“hi rick,

yes the sessions were  a success.

I have myself experienced  the tight hamstrings , the sore gluteus, etc

I went to physio and submitted to IMS. What do you think of using IMS?

I still  feel the discomfort I described above. I also have scoliosis on the right side and  I noticed that when I have  discomfort it is on the right shoulder, hip and gluts  on the right side. Iis there a co-relation?

I am looking forward to receiving the notes for the SI Joint lecture along with the description of the exercises.

Thank you and have  a great day”

AD

Rick and IMS

I like IMS.  As I say, it is painfully good.

When I was having SI joint pain, it is something that I tried.  I went for 3 sessions in order to help jump start my body when it came to muscle imbalances.

For me, things were so tight that stretching and foam rolling was not helping so I got IMS and that helped relax things.

Then it was up to me.

I started working on the problem that was leading to the symptoms of muscle imbalances.

What I worked on was core stability when it relates to activation, endurance and strength.

Then I modified my exercise program, especially when it came to my running. Since I am not a natural runner, I need to give my body more time between runs.

I should have started with this, “What is IMS?”  Since doing IMS is out of my scope of practice, it is not something that I focus my time on.  How I understand it is, it is dry needling that addresses overactive parts of the muscle.

Scoliosis and Seat Pain

Yes, the pain in your seat area could be due to the scoliosis, especially depending on what activities you do.

If you do a lot of impact activities like running or step classes, that would do it.

In the SI joint presentation, I talked about the research that showed the link.

You can work on your scoliosis with the exercises in Effective Exercises for Scoliosis and include some of the stretching and foam rolling I talked about in the session.  All of it is in the handouts that I emailed you.

“Hi Rick,

I attended the BCRPA sessions on SI Joint and Muscle Imbalance but didn’t leave my name for the handouts to be sent to me.

Would you please forward these to me. I really enjoyed your presentations.

Thanks.”

E

Thank You

This is not much of a question but I wanted to say thank you.

It is great to hear that I have been able to help you and help your clients.

Any feedback on how I can improve is always welcome.

Even after 12 years of fitness education presentations, I can learn and get better.

Yes, E, I sent you the handouts to both of the presentations.

“Hey Rick, I was at your session on Muscle Imbalances on Saturday. You were busy so I didn’t get a chance to say hello.

I enjoyed the session very much. Thanks for the great 10 “Must do” exercises.

One question: when doing a plank I noticed your elbows were not directly under your shoulders. What’s your take on that?

On floor prone exercises, should there be alignment to protect the shoulder?

Thanks.”

J

Elbow Position on Planks

I have never thought about this.

When I do a plank, I have my elbows at my side compared to having my elbow/forearm under my shoulder.

3 Reasons Why You Should Do the Plank This Way

1. For one, to me it feels more natural to have my elbow tight up against my body compared to my elbows/forearms under my shoulder.
2. When you bring your elbows/forearms under your shoulder it moves the shouders forward and protracts the scapula which is not a position we want to promote.
3. When your elbows are tight against your body, you can activate your scapular muscles and rhomboid muscles in order to put the shoulder and mid back into an ideal position.

What Alignment Shoulder the Shoulder Be in a Plank?

• Step 1 – I have my elbows tight to my side.  I activate my rhomboids in order to retract my shoulders, not just my scapula so I am in good alignment from the lateral view.
• Step 2 – Then I activate the scapular muscles.

Step 1 aligns the shoulder and the second step protects the shoulder.

That was a great question, J.  Thank you so much.

Now to the final question.

“Good morning, Rick.

I have a couple queries for you: Does laying your knee flat & contracting the muscles around the knee (almost making the knee dance) strengthen the knee?

Is it possible to safely strengthen a sore shoulder (pain concentrated in the area of the anterior deltoid)?

I’m sure the info is on your site but, as I surf on my iPhone (I know, it’s so small you’re wondering how I don’t fall into the drink!), it’s difficult to go through the plethora of information. If you could just point me in the right direction…

Supine, either sitting or laying down as long as knee is relaxed & relatively straight. Q2: Looking forward to it! ”

Activating Muscles Around the Knee

There are three points to remember to this exercise:

This exercise would be good for someone recovering from a knee injury or has arthritis of the knee where they need to work on activation, endurance and strength of the muscles around the knee.  For the healthy and fit person, they would not get any benefit.

For some people that have injured their knee or have arthritis, they need to work on their end range extension in their knee.  This exercise will do that.

Lastly, activating the quads and straightening the knees, makes it easier to activate the gluteus maximus.  Which is important for people with lower back pain or SI joint pain.

Now onto the next question.

Strength Training a Sore Shoulder

Yes, you can.

A lot of times when the pain is in the anterior  deltoid, try focusing on scapular stabilization exercises.  This will work on an often ignored muscle group in the shoulder and decrease the stress on the anterior part of the shoulder, plus make sure that the shoulder is in good alignment with all shoulder exercises. Take a look at the answer to the plank question above.

Thank you for all of your questions, this was great.

Please do send me your questions.

I will do my best to answer them.  I won’t be able to answer all of them but I will be able to do some.

Have a great day.  I am off to spend my Friday at a Fitness Conference and prepare for my presentation on Saturday.

Take care.

Rick Kaselj, MS

Before I go, here is a video about the importance of posture and shoulder injuries:

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 »

Today I would like to talk about scaption.

The question is based on a Facebook message I got from a reader.

Thanks so much Steve.

Thank you for everyone who follows me on Facebook and sends me questions.

I have a tough time calling myself an expert, but thanks.

The debates about shoulder pressing, hmmm.

This is my take on it.

#1 – The Afraid Physical Therapist

I hate generalizations.  Some people throw me into the pool of dumb personal trainers even though I have two degrees, numerous publications, trained thousands of people and have been doing this for a few years.

I can’t generalize all physical therapists because I hate being generalized.

I see numerous personal trainers telling their clients not to press overhead, which I think is wrong.

Lets start with not generalizing.  If I look back at what I did when I started training or even what I did last year, I shake my head at it.

#2 – What is the Big Deal About Shoulder Pressing?

The statement of not pressing over the head being bad has been around for a while.

I think people feel that everyone who shoulder presses could run the risk of a shoulder impingement.

This is another bad generalization.  Most clients will not have shoulder impingement with pressing and need to be doing overhead movements.

Plus avoiding something is not always the best answer.  Looking at why it hurts and what can be done to move it out of pain is more important because not addressing it could lead to other issues.

#3 – What to Do About the Fear of Overhead Pressing?

If you are a geek and like reading journals like me, you would know that you can move the overhead press exercise into the scapular plane.

If you don’t know what the scapular plane is or scaption, let me explain what scaption is:

What is Scaption?

==>  Scaption <==  What is it?

Let me go back to the research thing.  When I did my master’s project, a lot of the research had test protocols that moved the subjects out of pure abduction and into the scaption.  They did this in order to do the best they can to eliminate impingement being a factor in the study.

Let me go through an exercise example.

For example, with the traditional shoulder press with dumbbells.  When you press overhead, you traditionally bring the ends of the dumbbells together at the top of the movement.

You can move the elbows so they are not only in the frontal plane (abduction).  You move them about 30 degrees in front of the frontal plane.  Then you perform the shoulder press movement.  Instead of hitting the ends of the dumbbell at the top of the movement, you would hit the corners of the dumbbells.  This puts the shoulder in a happier position and less likely to pinch.

#4 – Overhead Pressing Is Evil!

This probably needs another post but I do at least one overhead movement in a workout.

I don’t feel a shoulder press is the best or only overhead press movement to do.

It could be a diagonal pull up or an incline bench press but I do want to do movements over 90 degrees of shoulder height for shoulder health.

I hope that helps.

One thing I talked about in the video was the Effective Rotator Cuff Exercise Program.

That is it.

Rick Kaselj, MS

Here are some other articles on shoulder pain or rotator cuff that may interest you:

What is Shoulder Impingement?

What Causes Shoulder Pain?

Read the rest of this entry »

Today I wanted to talk to you about shoulder pain exercises.

The question came from a client who is having difficulty performing a corner stretch.

She is having pain when performing the exercise and is wondering if there are any alternatives to the exercise that she can do.

I thought the question was a great question and decided to share my answer with you.

Here it is:

==> Shoulder Pain Exercises

Let me take a little time to expand on things in the video.

This is a corner stretch:

Corner Stretch

The corner stretch is a great stretch for the pectoralis major (chest).  I often recommend my clients perform the stretch in a doorway.  They reach up to the corner of the doorway and then move into the stretch.  Hence, I call it a doorway stretch.

In the video, I use a tree.  The big thing is the arm is at 135 degrees or in line with the muscle fibers of the chest (pectoralis major).

I find some clients with shoulder pain are not able to do the exercise because:

• They are not able to get their arm into the position
• They lack scapular stability in the shoulder
• They lack isometric strength in the shoulder
• It is too much stress on the AC (Acromioclavicular) joint

Many would say “don’t stretch the shoulder, if you have pain.”

This is a bad response.  There are numerous ways of modifying the stretch in order to eliminate the shoulder pain and stretch out the chest.

Here is one of those ways, doing a a Low Doorway Stretch:

Low Doorway Stretch

If my client is not able to do a doorway stretch, I move them into a low doorway stretch.

This stretch modifies things by moving the arm down to the side.  It is away from the body about 45 degrees.  It is not as effective as the doorway stretch but it puts less stress on the shoulder and most people can do it.

Bonus Tip

Feel The Stretch.  Really, FEEL THE STRETCH – You can see in the above two pictures and the above video, that I am touching where I should feel the stretch.  This is something that I teach my clients.

Put your hand on the muscle where you should be feeling the stretch.  This makes your clients better aware of the stretch and a better understanding of what is being stretched.

Open Up Collar Bones

If you are not able to do the doorway stretch or the low doorway stretch, try the open up collar bones stretch.

I like this one because it is great for someone who has poor movement in the shoulder.  They can focus on moving the collar bones back by activating the muscles between the shoulder blades (rhomboids and middle fibers of trapezius).  They activate the scapular muscles, work against rounding out the shoulder and stretch the chest.

I really hope this helps you.

Leave a comment below if you have any other ideas or thoughts on this article.

On another note, I just released my Shoulder Pain Solved Program:

If you or your client have Shoulder Pain, then I know Shoulder Pain Solved will help you.

Rick Kaselj, MS

P.S. – If you have been reading the blog, you know I have a lot of other videos and articles on shoulder pain.  Below are some that may help you out.

Here are a few other articles that will interest you:

• Focus on Scapular Muscles
• Bench Press Shoulder Pain
• Exercises for Shoulder Impingement

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

.

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 »

I am always looking for stretches for the shoulder and I came across this one.

I really liked it because it opened up the back part of the ribs and provided a lats stretch.

Here, let me break it down for you.

90 – 90 – Lats Stretch

Start		End
Purpose:	To stretch out the lats (latissimus dorsi) and open up the ribs (posterior-inferior area).
Starting Position:	In a side-lying position with the bottom forearm below the shoulder and propping up the upper body.  The legs are positioned so the top leg is extended at the hip and the knee is bent to 90 degrees and the bottom leg flexed at the hip and knee to 90 degrees.
How to Do the Exercise:	1)  Keep the hips relaxed and reach with the top arm looking for a stretch in the lats and an opening up of the posterior aspect of the ribs on the same side as the top arm.  2)  Hold the position for 20 seconds and relax. 3)  Perform twice on each side.
Progressions:	- You can reach the top arm in various positions in front, over or behind until you get the desired stretch or feeling  - You can add a light weight in the top hand in order to get traction from gravity for a more intense stretch - You can move the hip of the top leg into great extension in order to intensify the stretch
Contraindication & Common Mistakes:	- Be cautious of excess twisting in the lower back

I hope you enjoyed this exercise and give it a go with yourself or your clients.

Rick Kaselj, MS

P.S. – Thank you to Chad Benson for showing me this stretch.

We are moving to part 2 of the shoulder pain series.

Treatment and Management of Shoulder Pain

Shoulder pain may not be a life threatening medical condition but without the right approach, the pain may limit your arm movement and affect the quality of your life.

Your shoulder pain may affect your activities of daily living, such as:

• brushing your teeth
• combing your hair
• putting a book on a shelf
• sleeping on that shoulder
• opening doors
• reaching to the side to grab something
• holding your cellular phone
• carrying your purse or lap top bag

The above tasks may require a great deal effort and irritate your shoulder pain. It is important to keep in mind that all types of shoulder pain should never be overlooked.  Whether the pain is mild or severe, the best option is to consult your physician to determine the cause of the pain and to obtain the right treatment regimen for you.  Shoulder pain can be progressive in nature and lead to other problems.

Shoulder pain is initially treated with conservative or non-invasive measures. During the early stages or uncomplicated cases of shoulder pain, the goals of the treatment are relief of pain and restoration of the normal function of the shoulder.  These goals are mainly achieved through rest, ice and heat application, compression, use of pain medications and exercises.

#1 – Active Rest for Shoulder Pain

If your shoulder is injured or in pain, the most immediate and important action is to reduce or stop using the injured arm for about 48 hours.  Prevent performing activities that aggravate your shoulder pain.  It is also recommended to avoid heavy lifting and overhead activities until your shoulder feels better, which could take around 4 to 7 days after the occurrence of the shoulder pain.  Resting the affected shoulder can reduce the swelling and the pain.  It is important to emphasize that complications may arise when the shoulder area is immobile for a lengthened period of time.  It is important to keep moving your shoulder in movements that are pain free.  It is suggested to perform simple isometric exercises during shoulder pain in order to activate the muscles of the shoulder.  This is discussed in the next section.

#2 – Ice and Heat for Shoulder Pain

Application of ice reduces the pain and inflammation during the first 24 to 48 hours following your shoulder injury. You may put an ice pack, a bag of frozen vegetables or a towel filled with ice on the affected shoulder for 15 to 20 minutes at a time, 4 to 8 times a day.  Apply ice for about 20 minutes. Never apply ice directly unto the skin as it may cause a skin burn.  Use a protective barrier between the ice and the skin, such as a towel.  You can also apply ice after activities to control inflammation and pain.  Everyone responds to ice differently.  Try it out and see how your shoulder responds.  It should help with decreasing inflammation, decrease pain and recovering from activities or exercise.

Heat applications are not recommended within the first 72 hours. Heat can cause vasodilation and may cause more swelling and pain. After 72 hours, when the pain and inflammation have improved, you may start heat applications to relax tightened muscle tightness.  Heat should be limited to 20 minutes per application.

#3 – Pain medications for Shoulder Pain

Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen or naproxen may help reduce mild to moderate shoulder pain.  It is important to talk with your doctor to see what pain medication is most suited to you.

#4 – Compression of the Shoulder

Compressing the injured area with elastic wrap may be helpful as well.  This could help with controlling inflammation, keep the shoulder out of painful movements and your body in a posture that is more comfortable.

Exercises for Shoulder Pain

Exercises are an essential part of preventing and overcoming shoulder pain and injury.  Above we talked about what you can do to manage your shoulder pain but it is important to move and exercise the shoulder in order to overcome and recover from your shoulder injury.

The most valuable exercises when resolving shoulder injuries and pain are range of motion, stretching and strengthening exercises.

Exercises You Can Do Soon After Your Shoulder Injury

Prolonged immobilization of the shoulder can result in a wide range of complications, including increased joint stiffness or tightness, which consequently worsens shoulder pain. Although you need to rest the affected shoulder during painful periods and limit your activities, it is recommended to perform the following exercises to maintain muscle strength without risking joint damage as you recover. The next two exercises contract the shoulder muscles without moving the joint.

#1 – Grip Strength Exercise.

1. Using the hand of the involved arm, squeeze a small ball, either a stress ball or a racquetball, with gentle and consistent pressure as many times as you can throughout the day.

#2 – Isometric Triceps Exercise

1. Position the involved arm on a tabletop with your elbow at 90-degrees.
2. Make a fist and push the tabletop, using the force coming from the fist to the elbow, and hold for 5 to 10 seconds.
3. You should feel the muscle on the back of your upper arm contracting without moving your arm.
4. Gradually release the contraction.
5. Repeat the exercise 5 times

Range of motion exercises

Gentle and early active, active-assisted or passive range of motion exercises are the most recommended exercises after shoulder pain has been controlled and managed.  These exercises are helpful in gradually restoring the affected shoulders range of motion.  Codman or pendulum exercises are commonly included in the earliest stage of treatment to improve muscular relaxation, a pain free range of motion and to prepare the shoulder for more complex activities.

#3 – Circular Pendulum Exercises (Arm Circles)

1. Use your good arm to hold onto a sturdy chair or tabletop.  Bend at the waist and then at the knees.  Let the involved arm relax, hanging in a resting position. Remove all tension from the shoulder blade.
2. Using the involved arm, create small circular patterns in the air.
3. Make 5 circles in a clockwise direction, and 5 more circles in a counterclockwise direction.
4. You can gradually draw bigger and more circles as your shoulder improves.
5. Repeat the exercise 5 times a day.

#4 – Flexion-Extension Pendulum (Arm Forward and Back)

1. Use your good arm to hold onto a sturdy chair or tabletop.  Bend at the waist and then at the knees.  Let the involved arm relax in a resting position.  Remove all tension from the shoulder blade.
2. Swing the involved arm forward and back, 5 to 10 times.
3. Repeat the exercise 5 times a day.

#5 – Shoulder Flexion (Lifting Arm Up)

1. Stand tall with both arms on your sides.
2. Raise the involved arm, reaching the ceiling as the elbow is kept straight.   As you reach the highest point, hold for 10 seconds.
3. Release, and return to your standing position. Repeat 5 times.

Shoulder Stretching Exercises

Stretching exercises regain and maintain the flexibility and mobility of the soft tissues, such as the muscles, tendons and fascia in the injured arm.  These exercises improve the range of motion, prevent muscle stiffness and reduce the risk for shoulder injuries.  All of which encourage long-term pain relief.

#6 – Posterior Stretch

1. Stand tall, and grasp the elbow of the involved arm using the hand of the good arm.
2. Gently pull the involved arm across the chest with the good arm at the shoulder level, or at whatever level you can lift it which is pain-free.  You should feel a light stretch in the back of your shoulder. Hold the position for at least 10 seconds.
3. Release the stretch. Repeat the exercise 3 times.

#7 – Chest Stretch

1. Stand tall in the doorway, and extend both arms out at a right angle. Bend elbows at 90-degrees.
2. Position the forearms against the door jamb and lean forward.  Hold the stretch for at least 10 seconds.  To stretch the upper chest area, position the elbows below the shoulders.  Stretching the middle fiber requires the elbow placed at the shoulder level. To stretch the lower fibers, elbows are positioned above the shoulder.
3. Release and repeat the exercise 3 times.

Rotator Cuff Strengthening Exercises

For improved shoulder strength, the use of dumbbells, tubing and your own body weight are commonly combined with other types of strengthening exercises. Isometric exercises, a form of strengthening exercises, contract and build muscles without moving a joint or bone. Strengthening exercises are only introduced or included in the exercise regimen if the involved shoulder is strong enough to tolerate the pressure and is able to complete the exercises in a pain-free range.

#8 – Shoulder Extension

1. Stand tall with your back against the wall. Move the involved arm behind the back. The pinkie (ulnar) side of the hand should be resting against the wall.
2. Push the involved arm against the wall. Keep the elbow extended. Hold the position for 5 to 10 seconds.
3. Release. Repeat the exercise 5 times.

#9 – Shoulder Abduction with Tubing

1. Stand tall with your straight arms at your side.
2. Lift the tubing away from your body until the arm holding the tubing reaches the shoulder height, or to the point that you can do it pain free.
3. Gradually return to the starting position. Repeat up to 10 times.

Key Points to Remember

• If any of the exercises cause or aggravate pain, stop doing the exercise and make sure you are doing them correctly.   You may have to limit the shoulder range of motion as you exercise.
• Do not overdo things. Later in the day and the next day, you should feel like you have done something but your shoulder pain should not increase.
• It is recommended to start slowly and gradually increase the intensity of your exercises. If you are using weights, you may need to lower the weight or completely get rid of the weights until your shoulder is well enough to tolerate the exercises.
• After the exercises, you may have to use some of the pain management strategies we talk about above.
• If you have any concerns about these exercises, contact your doctor to see if they are appropriate for you.

I hope this program gets you started on the road to recovering from your shoulder pain.

If you would like to read the first part of this series, click the below link:

==>  What Causes Shoulder Pain?

Rick Kaselj, MS

I was at a conference a few weeks back and I got chatting with a fitness professional that had a client with frozen shoulder in both arms.

She asked my opinion on what to do with this client.

She was looking for safe exercises that she could do.

I wanted to share the answer I gave her with you.

3 Exercises to Remember if You Have Frozen Shoulder

You can also go here to see the video:

==> Frozen Shoulder Exercises

Let’s sum up what I went through the video.

3 Exercises to Remember if You Have Frozen Shoulder

#1 – Scapular Exercises

I would make sure to do some scapular exercises.

A variety of exercises that target the shoulder blade, making sure I hit all the main movements of the shoulder blade. For example elevation (up), depression (down), protraction (away from spine) and retraction (towards spine).

You can begin with just movement of the scapula and then progress to resistance with body weight or resistive tubing.

#2 – Rotator Cuff Exercises

For many with frozen shoulder, the range of motion or movement is poor in the shoulder but you still want to work on the rotator cuff muscles in order to maintain activation and strength in the rotator cuff.

#3 – Isometics of the Shoulder

Work on isometrics of the shoulder in the range of motion that you can do pain-free.

I hope this helps.

A guide that I recommend to clients that are not able to meet up with me is this one by physical therapist, Brian Schiff:

==>  The Ultimate Frozen Shoulder Therapy Guide

Rick Kaselj, MS

P.S. – If you are looking for other resources when it comes to shoulder pain, injuries and recovery, these may help:

Other articles on shoulder pain, injuries and recovery:

• What Causes Shoulder Pain?
• Posture and Scapular Muscles
• Focus on Scapular Muscles
• Buns and Shoulder Pain
• Bench Press Shoulder Pain
• Getting the Most from Your Scapular Exercises

Fitness Education Courses on shoulder pain, injuries and recovery:

• Exercise Rehabilitation of the Shoulder
• Core Stability of the Shoulder

Books and products related to shoulder pain, injuries and recovery:

• Effective Rotator Cuff Exercises
• Scapular Stabilization Exercises

If you have any questions or thoughts, please do leave a comment!

I have had a few clients with shoulder pain of late so I decided to sit down and write a little about shoulder pain.

I wanted to put something together that I could print out and give to them so I could educate them on their shoulder pain.

This is the first part of the shoulder pain series – What causes shoulder pain?.

Enjoy!

How Big of a Problem is Shoulder Pain?

Musculoskeletal disorders are the second leading reason for physician visits each year with about 132 million physician visits occurring in 2006 (American Academy of Orthopaedic Surgeons, 2009).

It is estimated that musculoskeletal disorders cost the United States almost $850 billion annually, and about 440 million work days are missed due to these health conditions.

With about 7.5 million physician visits each year, shoulder pain is a major contributor to the increasing disability caused by musculoskeletal disorders in developing nations (AAOS, 2009).

I always like to start off with some numbers.  The numbers are impressive.  It shows how big of an issue injuries are, especially shoulder pain.

4 Key Parts to the Shoulder

The shoulder girdle is composed of 3 bones and 3 main joints held together by ligaments (structures that connect bones to other bones), tendons (structures that connect muscles to bones), bursae and muscles.

Bone of the Shoulder Joint

The shoulder consists of these three bones:

• humerus (upper arm bone)
• scapula (shoulder blade)
• clavicle (collar bone)

Joints of the Shoulder

Acromioclavicular Joint - A key structure on the the outer end of the scapula, protruding away from midline of the body is the acromion.  The acromion forms the highest point of the shoulder.  It is a key area for ligaments to attach and forms half of the acromioclavicular joint with the clavicle.

Glenohumeral Joint – The head or ball of the humerus fits into the shallow socket on the scapula, called the glenoid fossa, to form the glenohumeral joint.  This is the main joint of the shoulder and the joint that allows the high level of movement the shoulder has.

The head of the humerus is larger in comparison to the glenoid, and only one-third of the humeral head is in contact with the glenoid fossa.  A larger humeral head in contact with a shallow socket enables great movement in the joint but decreases the stability of the shoulder and leads to its increased risk of shoulder injuries.

The glenoid fossa is made deeper by a ring of fibrous cartilage surrounding the glenoid, called the labrum.  Extending and making the fossa deeper enhances stability of the shoulder joint.

Sternoclavicual Joint – The inner end of the clavicle connects to the sternum (breastbone), forming the sternoclavicular joint.  This joint is the only link of the shoulder and arms to the rest of the skeleton of the body.

Scapulathoracic joint – Is where the scapula moves up and down against the rib cage. This joint is not an actual joint as it depends entirely on the surrounding muscles during shoulder movements.

This shows that the shoulder is a very complex structure.  One specific shoulder joint may be injured but it will affect all of the other shoulder joints.

Muscles of the Shoulder

Rotator Cuff Muscles – A key set of muscles that stabilizes the shoulder joint are the rotator cuff muscles which have a key function of keeping the humeral head centered within the glenoid fossa. The tendons of supraspinatus, infraspinatus, teres minor and subscapularis muscles form the rotator cuff.  Injuries involving the rotator cuff and their tendons are one of the leading causes of shoulder pain.

Scapular Stabilizers – The set of muscles that connect to the scapula and assist in stabilizing and moving the scapula.

Shoulder Muscles - These are the large superficial muscles that you see when you look at the shoulder joint.  Examples of these muscles are the deltoid and latissimus dorsi.

Bursae of the Shoulder

Bursae are fluid-filled sacs that allow smooth gliding between two surfaces that move against one another.  There are many bursae associated with the shoulder joint.

Inflammation of the bursa located between the acromion and joint capsule that surround the glenohumeral joint and the bursa between the subscapularis and the joint capsule are the most common areas in the shoulder that can lead to shoulder bursitis and shoulder pain.

6 of the Most Common Shoulder Injuries

Any injury or disease affecting the supportive structures of the shoulder, such as the bones, tendons, bursae, cartilage, and ligaments can result in shoulder pain.

In general, wear and tear, overuse or repetitive overhead movements and trauma play a major role in the development of shoulder pain. The following are the common causes of shoulder pain:

#1 – Rotator Cuff Tendonitis

Tendonitis is the inflammation the rotator cuff tendon resulting from overuse or repetitive movements affecting the rotator cuff.

#2 – Rotator Cuff Tear

Overuse, repetitive overhead motions, aging or falling my result in degeneration of the rotator cuff tendon, which can cause incomplete or complete tearing of the rotator cuff.

Rotator cuff tears usually cause pain in the deltoid muscle, especially when the affected arm is lifted from the sides.

#3 – Shoulder Instability

Shoulder instability occurs when the humeral head is not sufficiently maintained within the center of the glenoid fossa.

If the joint becomes too loose, the head of the humerus may slide partially out of place, termed shoulder subluxation, or it may completely come out of place, a condition called a shoulder dislocation.

#4 – Frozen shoulder or Adhesive Capsulitis

Frozen shoulder is a tightening of the capsule that surrounds the shoulder joint which leads to poor movement of the shoulder and shoulder pain.

#5 – Shoulder Impingement

Shoulder impingement (squeezing of the rotator cuff tendon), most frequently occurs in the supraspinatus, underneath the bony arch of the acromion.

#6 – Arthritis of the Shoulder

Arthritis is a degenerative disease that usually occurs due to wearing and tearing of the affected joint, as in osteoarthritis, or due to a systemic inflammation, as in rheumatoid arthritis. Arthritis results in loss of protective cartilage in the shoulder joint which can cause pain and limited shoulder movement.

Other causes of shoulder pain include shoulder fractures, labral tears, calcific tendonitis, superior labrum from anterior to posterior or SLAP tears and biceps tendon ruptures.

Common Causes of Shoulder Pain

Increased Risk with Age – Shoulder pain is more common in individuals older than 40 years and is often the result of wear and tear on the shoulder.

Previous Shoulder Injury – In younger adults, shoulder pain is commonly associated with a previous injury.

Related to Sports Played or Work Performed – In addition, about 21% of shoulder pain associated with injuries was related to work (Wofford, Mansfield & Watkins, 2005).

Athletes and workers who execute repetitive overhead or throwing motions have greater risk for shoulder injuries and pain.  Examples of sports where athletes have greater risk of shoulder pain are swimming, tennis, baseball, volleyball and javelin.  Examples of occupations that are at greater risk of shoulder pain are carpenters, painters, construction workers and workers performed repeated overhead movements.

Posture - Bad postures and body mechanics also increase the risk of shoulder pain.  For example, forward rolled shoulders increases the risk for impingement syndrome. This type of posture can reduce the space to which the rotator cuff tendons or muscles goes through, which increase the risk of squeezing the structures underneath the acromion.

Diagnosis of Shoulder Pain

The cause of shoulder pain is mainly determined by medical history, results from a physical examination and findings on the diagnostic imaging tools.

If the pain is severe or if the cause is still undetermined through physical examination, your physician may recommend diagnostic imaging tests to obtain the accurate cause of the pain.  X-rays, a magnetic resonance imaging or an ultrasound may be ordered in order to provide better clarification of the injury and the severity of the injury.

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I hope you enjoyed part one on Shoulder Pain and have a better idea of the magnitude of shoulder pain, the make up of the shoulder, common causes of shoulder pain and ways of diagnosing shoulder pain.

Rick Kaselj, MS

P.S. – If you are looking for other resources when it comes to shoulder pain, injuries and recovery, these may help:

Other articles on shoulder pain, injuries and recovery:

• Posture and Scapular Muscles
• Focus on Scapular Muscles
• Buns and Shoulder Pain
• Bench Press Shoulder Pain
• Getting the Most from Your Scapular Exercises

Fitness Education Courses on shoulder pain, injuries and recovery:

• Exercise Rehabilitation of the Shoulder

• Core Stability of the Shoulder

Books and products related to shoulder pain, injuries and recovery:

• Effective Rotator Cuff Exercises

• Scapular Stabilization Exercises

That is it for now!

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