It’s Rotator Cuff–Not Rotor Cup
Proper Strengthening Of The Rotator Cuff Muscles
In the gym, I see all kinds of shoulder exercises that I believe are meant to strengthen the external rotators of the shoulder. Unfortunately, many of the moves are more harmful than helpful. They are performed at fast speeds, in positions that foster shoulder impingement, and with no attention to spinal or shoulder posture. A simple and highly effective exercise to strengthen the rotator cuff muscles is the band “no money” drill. This exercise is time efficient–you train both shoulders at the same time. Resistance is provided by tubing or a resistance band and is easily altered to suit all strength levels. The best thing about this exercise is that it is hard to perform improperly.
Many of us are walking around with horrible upper thoracic, cervical, and shoulder girdle posture. Poor posture makes using your external rotator muscles properly very difficult. For the external rotators to work effectively they need to be on a solid, well anchored launch pad. Elevated and rounded shoulder blades are poor platforms for your external rotator cuff muscles—supraspinatus, infraspinatus, and teres minor. A forward head posture closes off the narrow neural openings between the cervical vertebrae. Compression on the fifth cervical nerve root can unplug the neural drive to both the external rotators and the deltoid muscle. Before you begin any rotator cuff strengthening exercise, always attempt to correct your posture before starting. If you cannot correct your standing posture this exercise is made for you.
Band “No Money” Drill
You need some resistance tubing or a band for this exercise. Stand up tall with the chest proud and the head pulled back. Hold the tubing in each hand with the elbows at the side and bent to 90 degrees. Keep the palms facing up and the thumbs pointed out. Tighten the muscles in back of the shoulder blades and pull the tubing apart. Hold at end range for three counts. Return slowly to the starting position—this should take at least three counts. Each repetition should take at least six seconds. Repeat for five to ten repetitions. This exercise should always be pain free. Start with a resistance level that permits you to perform at least five repetitions and do not take this exercise to failure.
If you are unable to perform this movement with shoulder blades pulled down and in, head pulled back, and chest proud, you need to regress the exercise to a foam roll. Position in supine and length-wise on a foam roll and perform the band “no money” just like you would in standing. Positioning on the foam roll will allow gravity to pull you into a better posture and create the proper stimulus necessary to strengthen the external rotators of the shoulder.
Strengthening the external rotators is only a part of keeping your shoulders healthy and strong. You must train the shoulder muscles as a team to produce more coordinate stabilization of the glenohumeral and scapulo thoracic joints. The more athletic and active you are, the more important coordination and timing exercises become for comprehensive shoulder rehabilitation.
Michael S. O’Hara, P.T., OCS, CSCS
The Downside Of Upside Down Exercise
Exercise activities that place the head below the heart have become more popular in fitness programs. In almost every gym you see decline bench pressing, incline sit ups, glute-hamstring developer exercises, and more recently, hand stand push ups as a regular part of many exercise programs. While these activities may have some value, you might want to reconsider training in an inverted position for some other reasons.
When you invert your torso, the contents of your stomach can more readily travel back up into your esophagus. Head below your belly with a hiatal hernia, a little extra mesenteric fat, and some strong contractions from the abdominal muscles, and you have the perfect environment for gastroesophageal reflux disease (GERD). Millions of Americans (14%-20% depending on the study) take medications to manage the symptoms of GERD—heartburn, chest pain, persistent cough, difficulty swallowing, hoarseness. Prilosec and Nexium are the biggest moneymakers the pharmaceutical industry ever created. Many Americans (10%-15%) have GERD, but are unaware of the problem because the tissue damage has not reached symptomatic levels. Erosive esophagitis or Barrett’s esophagus is a clinical finding of cellular change in the esophagus and a precursor for esophageal cancer. Esophageal cancer is one of the more deadly types of cancer.
Glaucoma or Retinal Disease
The head down position raises pressure inside the eyeball. As little as 30 degrees of decline has been shown to increase intraocular pressures. It is estimated that 2.2 million Americans have glaucoma, but only half of these know they have the problem. Individuals with glaucoma already have elevated intraocular pressures and should avoid these positions. The back of the eye (retina) is susceptible to changes in vascular pressures, so if you have any retina issues, avoid the head down position.
High Blood Pressure / Hypertension
Your heart, lungs, and arteries are conditioned to pump blood with your body in an upright position. Many vascular alterations occur when we flip into a heads down position. When you assume the head below your heart position, the arterial pressures inside the skull increase. Elevated cranial blood pressures can lead to headache and much more severe problems such a stroke. One in three Americans are walking around with high blood pressure. Add in an exercise induced elevated heart rate and some less than pliable carotid arteries and you have the ideal environment for a big bad brain event. If you have hypertension, I would not go about using any inverted positions in the gym.
Apart from going blind, having a stroke, and developing an incurable cancer, you should be fine.
Michael S. O’Hara, P.T., OCS, CSCS
Poor choices in exercise selection are often the cause of injury and pain. Most gym members are unaware of the damage that is created until it is too late. The joint stress produced by activities that manipulate body position in an effort to isolate a certain muscle very often create significant articular irritation. If your fitness goals are to stay strong and injury free for an entire lifetime, I suggest you avoid certain exercise activities.
A staple of Self and Shape magazine, this exercise probably will make your triceps muscle work hard if you possess enough shoulder mobility to drop down and bend the elbow 90 degrees. Unfortunately, bench dips also produce excessive stress on your neck and shoulders. During a bench dip, your neck is forced forward and the shoulder girdle is pushed into extreme positions of extension and internal rotation. Most of us have poor neck and shoulder posture and this activity feeds into the forward head–rounded shoulder posture that is epidemic in today’s computer based world. The movement of the shoulder joint during a bench dip pushes the humeral head forward and makes the long bicep tendon take a severe twist over the front of the humerus. This position stretches the anterior capsule of the glenohumeral joint making you more susceptible to shoulder subluxation or dislocation. Biceps tendonitis, tendonosis, and complete ruptures are one of the more common injuries we see every day in physical therapy. At the top of this exercise (elbows extended), the shoulder is loaded in a manner that compresses the subacromial space, making you more prone to impinge on the superior rotator cuff tendons.
Women typically have less stable shoulder joints and more sensitive necks, yet they seem to gravitate to this drill. MRI imaging tests of non-symptomatic shoulders reveal that many of us are unaware that we are walking around with rotator cuff tears and bone spurs in our shoulders. An exercise that places the shoulder into a stressful position may be all that is needed to make that tear or spur start waking you up at night. For athletic performance purposes, the bench dip movement is worthless as it is not similar to any movement pattern you ever perform on the field of play.
The gym is full of exercises to train triceps that are safer than bench dips. Try getting better at push ups, and remember that you cannot preferentially “burn fat off” the back of your arm with direct triceps training. If you speak with any of the strength and conditioning coaches that make their living getting athletes ready to perform at optimal levels, none of them use the bench dip.
Michael S. O’Hara, P.T., OCS, CSCS
Multi Directional Power Training
We have recently added a new training tool to our physical therapy clinics. The Surge 180 is a simple and incredibly effective training device for rehab patients. The patient stands on the platform, grasps the handle, and works against resistance provided by three pistons. The physical therapist can use the Surge 180 to improve many different areas of performance.
Safe and Effective Power Training
Most physical therapy patients are severely underpowered. Not only do they need to get stronger, they must also get better at creating force quickly. The patient can accelerate against the handle of the Surge 180, and because the overall mass is so small, there is no damaging inertia to overcome. The mass of a weight stack, barbell, or dumbbell creates so much inertia that when you attempt to move the load quickly it creates damaging joint stress.
In life and athletics, our bodies move in all directions. The Surge 180 handle moves forward–backward, right–left, diagonally, and into rotational movement patterns. The handle excursion is big enough to accommodate patients of all heights.
It Demands You Stand
Rehabilitation is all about getting better at functioning in standing positions. Patients need to learn how to efficiently transfer forces from the ground up through their body. On the Surge 180 platform, the patient can be positioned in-line, split, straddle, or single leg stance. Connecting the shoulder to the opposite side hip, through an active core is the essence of rehabilitation training.
The coordinated performance of the team of muscles that control the hips, pelvis, and spine is more important than simple strength. Standing, walking, climbing stairs, and carrying all require the synchronous transfer of forces from right to left and back again. The resistance provided by the Surge 180 creates the neural feedback to fire those reciprocal motor patterns.
Michael S. O’Hara, P.T., OCS, CSCS
Suspended Push Up Animation
Atomic Push Ups Are A Fitness Blast
Your muscles work as a team to carry you through the day. They never function alone, so training them with isolation exercise will produce less than optimal results. The muscles over the front of the body are linked together through interwoven layers of fascia to form what Thomas Myers, in his book Anatomy Trains calls the “superficial front line”. The shoulder girdle is slung onto the body in a basket weave pattern of muscles. One of the best exercise activities to activate this team of muscles is the Atomic Push Up.
The guys and gals at TRX named this exercise because of the metabolic response it produces. Although the TRX company popularized the Atomic Push Up, you can use any type of suspension trainer that has foot straps. This exercise helps build a better connection between your shoulders and hips. It will strengthen the push pattern and activate the frequently neglected hip flexors. Unlike a bench press type drill, the Atomic Push Up requires core control and the active participation of your legs. Atomic Push Ups require a great deal of neural control as you must coordinate muscles from the hands to the feet to properly perform this drill. The Atomic Push Up is not a bodybuilding type exercise that will “sculpt your outer pectorals” but it will help you move better.
Atomic Push Up Performance
Attach the suspension trainer overhead with the foot straps eight inches off the floor. Sit on the floor and place the feet in the straps. Roll over and assume a push up position with the feet suspended off the floor in the straps. The top of the suspension trainer should be directly over your feet. Descend toward the floor, and as you push back up, pull the knees up toward your chest. Use a steady cadence of lower down–push up–knees in–knees out. Beginners should aim for sets of five repetitions. Stop before the performance of the drill deteriorates. Common faults are sagging in the middle, lack of depth during the push up, and poor head position. For men, twenty repetitions of Atomic Push Ups is a worthy fitness goal. For women, eight is great.
You generally do not see Atomic Push Ups performed in commercial gyms because suspension trainers are rare and this exercise is difficult. Beginners may wish to place a mat under the torso and head in case of a sudden face plant. You can use a pair of parallellettes if you find weight bearing on your hands is difficult. Moving the body forward so the suspension strap is pulling you backward makes the exercise more challenging.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Our shoulders and spine must endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping. The important postural muscles that keep us tall become weak and the muscles in the front of the shoulders get tight. The spinal muscles that hold our 24 vertebrae upright and stable functionally fall asleep and forget how to work together as a team. Prolonged sitting creates all sorts of neuromuscular problems that can be managed with restorative exercise. One of the best exercises you can perform to mitigate the damaging effects of prolonged sitting is the suspension row.
Better Than Seated or Bent Over Rows
Suspension rowing requires your spine to stay in a neutral position from the head to the pelvis. Most of the bent over rowing I witness in the gym involves the same slumped sitting posture you see in every office in America. Rows performed with a flexed thoracic spine are far from optimal and often help reinforce postural deficits. Properly performed suspension rows improve communication between the spinal stabilizers and strengthen the muscles that retract the shoulder blades.
Mastery Of Your Bodyweight
Being able to maneuver your body using the arms makes you functionally fit. During suspension rows, the resistance is not a plate or weight stack, but rather the weight of your body. You alter the resistance by moving the feet and changing the angle of the body in relation to the floor.
Friendly Force Curve
Suspension rows produce an accommodating resistance that is easier when you are at the weakest part of the rowing motion. The force necessary to perform a suspension row decreases as you move from the arms fully extended to the arms pulled in close to the body. This makes it a good exercise for people with weaker than average shoulder muscles.
Many people have no idea of how to correct the posture of their head and neck. Prolonged sitting, driving, and computer work have damaged their positional awareness or proprioception. The movement of the head and neck during suspension rows produces a neurological training of the cervical proprioceptors that can help fix this problem.
Improve the strength and endurance of the team of muscles that keep your posture tall and shoulders strong with suspension trainer rows. At FFAC, several TRX suspension trainers are located throughout the gym. For home use, attach the suspension trainer to the top of a doorway. Adjust the suspension trainer length so the handles are at your waist level or lower. Stand facing the TRX and grip the handles firmly. The position of your feet will determine the amount of resistance. Move the feet forward and the exercise is more challenging. Keep the entire torso straight, one long line from ear to ankle. Brace the abdominal muscles and gluteals and lean back. From the arms extended position, pull the handles into your side. As you perform the rowing motion, focus on moving the shoulder blades down and back. Return to the starting position and repeat. Perform two or three sets of six to ten repetitions. As you get stronger, progress to a full inverted row with the legs on a bench.
Caution: Make sure you use a solid suspension trainer product when performing this exercise. I have treated two patients with injuries that occurred when their homemade units malfunctioned and sent them flying to the floor. Do not skimp on safety with suspension training exercise. The emergency room visit and CT scan of your skull will be far more expensive. The TRX and Lifeline USA suspension trainers are the most well known units on the market.
Michael S. O’Hara, P.T., OCS, CSCS
SINGLE LEG STANCE OPPOSITE
ARM REACH AND ROW
A Long Name For A Great Exercise
In life, most of the challenging tasks happen in either single leg stance or with much more of our weight on one leg. We must be able to support, decelerate, and change directions with one leg. Our muscles are aligned so that the hip is mechanically linked to the opposite shoulder. In physical therapy, we know that having one side of the body function efficiently and the other side falter sets you up for injury. Your exercise program should revolve around training to meet these physical demands. One of my favorite life enhancing exercises is the single leg stance opposite arm reach and row.
Fall preventative activity that helps improves single leg balance.
Sure cure for the epidemic of gluteal amnesia.
Gives athletes the hip to opposite shoulder connection they need for performance.
Identifies any asymmetry in single leg control.
Enhances the single leg deceleration skill necessary for injury prevention.
Makes you stronger when you lift, carry, push, and pull.
Single Leg Stance Opposite Arm Reach and Row
You need a cable column machine or resistance tubing anchored at knee level or lower. Hold the tubing or cable handle in the right hand and stand on the left leg. You must be at least five feet away from the attachment point of the tubing or cable. Initiate the movement simultaneously at the ankle and hip and reach forward with the right hand. Attempt to get the hand down to knee level. Return back to standing and pull the handle toward the body in a rowing motion. Perform five to ten repetitions and then repeat on the other side.
Common mistakes are bending at the hip only and slouching over at the spine. The ankle, knee, and hip all move together, and the spine should stay stable. Holding the handle on the same side instead of the opposite side. Performing repetitions past the point of technical failure. If you start wobbling around, stop the exercise. Getting the arm and legs out of sync. Do not reach with the arm and then move the legs—the motions should happen together. Remember to come all the way back up to a tall standing position before starting the next repetition. Start with light resistance and try to create a steady smooth pattern before adding more resistance. Watch the video and give this exercise a try.
Michael S. O’Hara, P.T., OCS, CSCS
GET IN YOUR CAGE
Stretch Station Mobility Restoration
Invented by Gary Gray, a physical therapist from Adrian Michigan, the Stretch Station has been a primary piece of equipment at all of our facilities. It enables the physical therapy patient or fitness client the ability to perform three dimensional mobilization of the major peripheral joints and spine. I have not found another piece of exercise equipment that is as beneficial for improving movement as the Stretch Station.
It Has To Happen In Standing
The Stretch Station allows you to mobilize joints and move in the anti-gravity, standing upright position that it functions in every day. Gravity eliminated, floor stretching programs often fail to produce better movement when gravity comes back into play. Any new movement you develop with mobility training is only beneficial if it can occur in a standing position.
A Little Lift Goes a Long Way
Traction force (pulling apart) of a joint is a key component of all manual medicine. It helps relieve pain and makes greater joint mobility easier to achieve. The overhead bars of the Stretch Station enable you to lift up and partially decompress the spine, hips, knees, and even ankles during mobility training. This low level traction force assists in the development of better mobility. Deconditioned and overweight patients can perform hip and knee mobility training and remain pain free with the assist of the Stretch Station.
One Good Turn…
Most floor mobility training does little to develop better rotation at the joints that are supposed to produce
rotation–thoracic spine, hips, and ankles. The Stretch Station has an angled floor and multiple handle sites that enable users of all sizes to work on improving rotation. Thoracic spine and hip mobility work is particularly beneficial for athletes that must swing a club or throw a ball.
Identification of Asymmetries
Using the Stretch Station, patients and fitness clients can immediately identify when one side of the spine, one hip, or one shoulder is more restricted than the other. Training away asymmetries at a single joint or movement pattern is important for injury prevention and optimal performance.
A Bridge to Better Performance
I have fitness clients perform thirty seconds of mobility training on the Stretch Station followed by a complimentary strengthening exercise. The idea is to neurologically reinforce the new motion achieved with the Stretch Station using an appropriate strengthening activity. This pairing of the Stretch Station work with a strengthening drill has been very effective in restoring movement and decreasing pain.
Michael S. O’Hara, P.T., OCS, CSCS