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scapula

Keep your shoulders and spine happy and strong by following Mike O’Hara’s advice in “Pushing Up Performance”.  Video explanation and performance of pushups and their variations included.  Jeff Tirrell discusses the proper performance of pull ups in his article. “Movement You Should Master”. Is your mobility limited?  Try massage sticks or foam rollers with the information provided in “Pain, Pressure, and Pliability”.

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scapular_touchdownMost shoulder pain problems are brought on by the cumulative effect of poor posture and weak scapula muscles. Sustained slouched over postures create a faulty length-tension relationship in the scapula muscles. This produces adverse stress and strain on the joints of the shoulder and the nerves in the neck and upper back.

The muscles that keep the shoulder healthy and pain-free attach to the scapula (shoulder blade). They hold the shoulder girdle in a mechanically advantageous position on the body. They pull the scapula inward, toward the spine and downward, toward the hips. Making your scapula muscles stronger will help, but being mindful of your posture during the day is the most important factor. I like the quote from Physical Therapist and US Soccer team trainer Sue Falsone “You can’t out rep poor posture.”

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We all want fitness results, and we want them now.  We want to look, move, and feel better in two weeks.  We know it took us years to get into this overweight, weak, and de-conditioned state, but we have a wedding in three months, a reunion in six weeks, and a date next Friday.

Unfortunately, many of the physical problems that slow our progress toward specific fitness goals will not resolve with two or three exercise sessions a week.  Postural deficits, faulty motor control, mobility limitations, and joint restrictions require daily attention to elicit any meaningful change.  Short bouts of focused training, interspersed throughout the day, will produce the best results.  In physical therapy rehabilitation, we prescribe home exercise programs that are performed up to every two hours to reduce pain and restore function.  Fitness clients will more rapidly reach their goals with some daily Nano Sessions of exercise.

shakey_shoulder

Shakey Shoulder Nano Session

Your shoulder is held onto your body with a basket weave of muscles that connect the shoulder blade to the rib cage.  They function in a highly coordinated fashion to isometrically fix the upper arm to the body.  As infants, this scapula on thorax muscle control develops as we master crawling.  It reaches higher levels of integration with pulling and pushing activities found on the long forgotten monkey bars and the litigated away ropes of gym class.   A sedentary lifestyle and postural breakdown erode away the strength and coordination of our scapula stabilizers.  Poor scapula on thorax stability reduces performance and leads to shoulder and neck problems.

When the inside border of the shoulder blades projects up off the body, we call it “winging.”  Scapula winging is a hallmark sign of poor shoulder girdle stability and the first thing you need to remedy in your training program.  Upper extremity strength needs to be developed from the center out.  If you are unable to hold a solid push up position plank then performing Olympic lifts and bench pressing is getting the cart before the horse.

Push Up Position Plank 101

Basic Push Up Position Plank

Place the hands under the shoulders with the elbows extended.  Pull your shoulder blades down your back and keep your neck long.  Lift your pelvis so that your body is supported on the feet and hands.  The feet should be at least shoulder width apart.  Your body is held in one long line from the ears to the ankles.  Do not let your hips sink or rise up—check your position in a mirror.  The critical part of the exercise is creating tension in the core stabilizers by tightening the gluteal muscles and keeping the shoulder blades tight to the rib cage.  Hold for at least twenty seconds and work up to longer hold durations.  A good goal is a sixty-second plank.

Elevated Feet-Push Up Position Plank

Once you can hold a sixty second push up position plank with the feet on the floor, progress to elevating the feet on a step or exercise bench for more resistance.  Work up to a solid sixty second hold.

Alternate Arm Lift-Push Up Position Plank

This variation adds an anti-rotation stability component to the exercise.  Get into the push up plank position with the feet up on a bench.  Shift slightly over the left arm and then lift the right hand up off the floor.  Reach the right arm out at a 45 degree angle and hold for five seconds.  Lower the right hand back down and repeat with the left arm.  Perform three to five repetitions on each arm.  Work up to longer hold times instead of more repetitions.  Five repetitions on each arm with a ten second hold is a good goal.

Shoulder Carry

If you are new to this exercise, use a dumbbell, and as you get stronger, you can progress to a kettlebell held in a bottoms-up position.  Using a strong grip, position the implement with the shoulder flexed approximately 85 degrees.  This should place the upper arm in front of the body and the elbow just below the shoulder.  Maintain a strong hold and pull the shoulder blades down the back.  Try to keep the biceps muscle from working too hard.  Keep a tight and tall cervical posture and perform a steady walk.  Do not allow the lower back to arch and keep the front of the rib cage flat.  Switch the implement to the other hand and walk back.

Shoulder Carry Regressions and Progressions

Many people can only travel fifteen feet before they must rest.  Start slow and build up to a thirty yard carry with each arm.

Keep the weight you use light and work on maintaining a stable shoulder posture with a steady gait.

Start with a dumbbell and progress to an inverted kettlebell.

Walk greater distances to build up more isometric strength endurance in the shoulder.

The task of balancing an unstable upside down kettlebell while you walk creates a reflex activation of the rotator cuff and scapula stabilizer muscles.  This exercise teaches your shoulder girdle muscles how to work as a team.

The repetitive shoulder stress of throwing, swimming, and overhead racquet sports often leads to the development of muscle imbalances in the shoulders.  The bottoms-up kettlebell carry will train away those imbalances.

Many athletes and fitness clients have difficulty keeping the neck relaxed when they use the shoulder muscles.  This exercise will help resolve this abnormal movement habit.

If you have a shoulder winging problem you need to retrain your motor control with frequent sessions of exercise.  Perform the push up position plank (PUPP) and the shoulder carry twice a day for the next six weeks.  Work on greater duration of the hold on the PUPP and start with a light weight on the carry,  gradually adding distance.  Thirty yards on each hand is your goal.

To view video demonstration of the above exercises, click on the link below:

https://www.youtube.com/watch?v=kJ9shseIyTM&feature=youtu.be 

-Michael O’Hara, P.T., OCS, CSCS

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