Putting it all together – the Hollistic Approach
I really need to get going with some research that is in my area of thesis but I know how important arm care is which is why I wanted to throw this series together, pardon the pun. I will be doing more in the future however I will give you a great list of resources where I have got the majority of my information from:
- Eric Cressey – web site and Optimal Shoulder Performance Videos
- Mike Reinold – web site and Optimal Shoulder Performance Videos
- Shirley Sharmann – Diagnosis and Treatment of Movement Impairment Syndromes
- Jeff Cubos – web site
- Gray Cook & Brett Jones – Secrets of the Shoulder DVD
- Dr. Nikita Vizniak – Muscle Manual
What I have learnt from these incredible resources is shoulder care goes beyond the strength of the individual rotator cuff muscles – we have to look at the entire body. While it is beyond the scope of this article to look at the entire body I will dig into 4 different areas that need to be addressed to ensure overall shoulder health.
- Reflexive Rotator Cuff Training – As a group the rotator cuffs job is the reflexively stabilize the humeral head so we need to train it do this.
- Scapular Stability – The scapula must be in the right position of the rotator cuff muscles to function properly – if the scapula is misaligned then the individual strength of these muscles matters not.
- Mobility in the Thoracic Spine – imperative for optimal performance as well as avoiding injuries.
- Breathing Patterns – we do this exercise all day everyday but if we don’t do it the right we might lock up some muscles that will restrict our mobility and steal power that we could have produced.
This holistic approach respects the fact that our bodies are essential long chain and a weak link can cause a host of problems almost anywhere along this chain. If you have an injury due to throwing and focus your attention solely at the site of pain you might miss the boat in trying to figure out what caused the problem in the first place. This is why top therapists will take a look at how the body is functioning near the site of the pain to look for some usual suspects which are at the root of the problem.
Let’s use an analogy here to explain what I am talking about.
Jonny and Billy are paired up to do a project and are both assigned 50% of the work. Billy is a slacker and doesn’t do his fair share which forced Jonny to do the majority of the work all by himself. Who do you think would complain about this situation? Jonny!!! But who do you think is causing the problem? Billy!!!
If your shoulder hurts you will probably have to do some work to repair whatever damage has been done but if you want to avoid this problem from reoccurring you are going to have to find the root of the problem.
This series went into great detail of what each rotator cuff muscle does individually when we concentrate on isolation which is important to ensure each muscle has the necessary strength to do its job. However as a baseball player you need the rotator cuff to dynamically stabilize the head of the humerus so that it stays in the “sweet spot” within the glenoid fossa because if it doesn’t then bad things can happen.
Throwing a baseball as fast as you can to a very specific spot with someone swinging a bat is hard enough as it is so imagine how tough it would be if you had to tell your supraspinatus to pulldown on the humerus just enough to centre the humerus within the glenoid fossa. Luckily your rotator cuff is designed to provide this stability without you having to think about which is why I refer to it as reflexive conditioning/stabilization.
Because the GH joint (a.k.a shoulder joint) is so mobile we need for the joints on either side to be stable (joint by joint approach – Boyle et al 2008 – not a real reference but it deserves mention). The joints that anchor the GH joint are the elbow and scapulothoracic joints.
It is easy to see why the elbow joint is made for stability with the bone on bone connections but the scapulothoracic joint pretty much just floats on top of the ribs with only one little bone on bone connection at the acromion-clavicular (AC) joint to provide some stability.
The rest of the stability demands fall on the muscles that connect it to other bones in the body and must keep hanging in exactly the right place. There are 18 different muscles that have some type of connection with the scapula; some have a tendency to become tight pulling the scapula out of position causing others to become weak and allow for a misplaced scapula.
These are some common muscles that need to be massaged and stretched:
- Pec Minor
- Teres Major
- Latissimus Dorsi (only some of the fibers attach but it’s a good to stretch anyways)
- Superior Traps
- Levator Scapula
These are some of the common muscles that need to be strengthened
- Serratus Anterior
- Lower Traps
When you where about the traps you think of big body builder with no neck from doing lots of shrugs. This big muscle does cause you to shrug your shoulders but only the upper part – the traps can be divided into an upper, middle and lower portion because the fibers run at different angles and do different actions. Just like the deltoids which are divided into an anterior, middle and posterior groups which each produce different actions.
- Upper portion – upward rotation and elevation (shrugging motion)
- Middle portion – retraction – pinching your shoulder blades together
- Lower portion – upward rotation and downward depression.
The lower traps are going to be the part of the traps that we are going to focus on the most because they are the most neglected and will help us keep our shoulders strong and healthy if they are working properly. The reason for this is that they help tilt our scapula posteriorly as well as external rotation during arm elevation which decreases the chances of a sub-acromial impingement injury.
This muscle holds our scapula against our rib cage. If this muscle is weak it allows the scapula to “wing off” from the rib cage. Its action along with the pec minor is to protract the scaulea – this means to pull your shoulder blades apart. Hold your arms out in front of your with your elbows locked standing nice and tall – should look like Frankenstein. Now try to reach just a little further by allowing your shoulder blades to be pulled apart – that is the action of your serratus anterior.
The most common exercise for the serratus anterior is what’s called a pushup plus where you do what I described previously only that you do it from a pushup position. In order to make it better try elevating your feet and placing your hands in a diamond position underneath your forehead. (Lear et al. 1993).
As a society we have the tendency to sit down way to often and for too long which results in hunch backs rob of us mobility we could have used to generate more velocity. When we sit down most of us go into a flexed position within our T-Spine and when we throw we want to have the ability extend and rotate.
My next post will give you a couple of drills to do that will help restore some of this lost mobility but you need to avoid being in a flexed position as best you can no matter if you are sitting or standing. Thirty to Sixty minutes a week of mobility drills do not stand a chance against countless hours of poor posture.
Often times you hear a coach telling their athletes to relax and breath – this is great because it will help free up this locked t-spine area. Breathing is really important and often overlooked if you think about it half of each day you are in a state of inhalation while the other half is spent in exaltation. If you do something all day everyday you need to master this movement to ensure you are doing it the right way.
Again it is well beyond the scope of this article but try this drill:
Lie on your back with your knees bent at 90 degrees so your feet are flat on the ground – place one hand on your stomach and the other on your chest. Take deep breaths pulling in lots on air then exhale about 90 percent of the air in your system – this is essentially exaggerated breathing but you should only feel the hand on your stomach moving while the one placed on your chest needs to be still. This means that you are using your diaphragm to breathe which is what is it specifically designed to do. “Chest” breathing puts undue stress on muscles like your pec minor which as a result can become tight and overactive restricting your mobility.
Practice this one as much as you can and since you need to breathe all day everyday don’t tell me you don’t have the time.
Here is a video that goes into more detail:
The “new” arm care program/pre-hab must go beyond your basic rotator cuff muscles to ensure that the whole system is working.
I will try my hand doing a couple of videos to show you my favorite drills and exercises for all of these different areas that I discussed.
But in the mean time….
SIT UP STRAIGHT!!!
If you have played baseball I can guarantee that you have done some form of shoulder exercises that are aimed at keeping your throwing arm healthy. These drills are now a staple of any good throwing program and have been integrated into the game of baseball. The problem that I see is that these exercises are so common that very little attention is given to which exercises we should be doing, how we should be doing them and with which tools (bands vs. weights). I see players today performing the same set of arm drills that I did back in the mid 90’s (I’m almost 30, yikes!!) yet there has been plenty of research performed in this area.
This is the first blog in a series that looks into how we can train the shoulder not only for injury prevention but for performance enhancement as well.
The Shoulder – Mobile Yet Hostile
The shoulder is delicate structure that literally hangs off the side of our body being held in place by a series of tendons, ligaments and muscles. Yet it can produce and harness extremely high forces. To give you an idea of the power that can occur at the shoulder you don’t have to look any further than research produced by Dr. Glen Fleisig that states the shoulder reaches rotational velocities of 7200 degrees per second during the acceleration phase. That is the equivalent of your arm doing 20 full revolutions in one second – that’s crazy!!
When you look closely at the shoulder joint, known in the medical community as the glenohumeral joint, you will discover that it is able to perform more movements with a bigger range of motion when compared to any other joints in the body. This is because has what is classified as a ball & socket joint and is relatively unrestricted by bulky muscles (the hip is also a ball and socket joint but doesn’t have the same range of motion)
The ball is the head of the humerus (the upper arm bone) and socket is the glenoid fossa/cavity which is part of the scapula (the shoulder-blade).
This mobility comes with a price and that is that is lacks stability. The shoulder couldn’t do many of its movements if it were bound up by surrounding muscles and bones which stresses the importance of strengthening the muscles that do stabilize the shoulder. This where the rotator cuff comes into play.
SITS down and learn
Anatomy professor’s commonly use the acronym “SITS” to help students memorize the names of the muscles that make up the rotator cuff.
S – Supraspinatus
I – Infraspinatus
T – Teres Minor
S – Subscapularis
Each of theses muscles performs its own role when individually fired however as a group their role is to dynamically stabilize the shoulder – this is the way that we use when we throw a baseball (Lee et al. 2000) When you do an overhead activity, like throwing a baseball, your deltoid muscle (a.k.a shoulder muscle) wants to pull the head of the humerus up and unless there it is counteracted by the muscles of the rotator cuff it will rub up against the top of socket, the acromion process (Brossmann et al. 1996) and potentially cause an impingement type of injury (Sharkey et al. 1995).
The Sweet Spot
Within the glenohumeral joint is an optimal spot where the ball (head of the humerus) rotates inside of the socket (glenoid fossa/cavity). I like to think of it as the “Sweet Spot” since every baseball player knows about this magical spot on a baseball bat where good things happen. The same is true with the shoulder joint – if we can train our rotator cuff to keep the head of the humerus in the “Sweet Spot” good things will happen and the chances of injuring our shoulder due to throwing go way down.
The next blog post will look at the each rotator cuff muscle individually and tell you what are the best exercises and how to do them properly.