04-21-08 02:08 PM - Post#434123    

This is a reprint from the IOL blog. I thought it would be good to archive it here in the rehab forum, and also to encourage a conversation.

The last piece of the shoulder rehab puzzle fell into place recently, at least I hope it’s the last piece. Feels like the last piece. The 15-year progression went something like this:

Long-term trainees with aching shoulders always start with rotator cuff work using thin rubber tubing. We started doing that in the mid-‘90s and the trend continues, both for rehab and for daily warm-up.

A few years ago many added shoulder YTLWs to the mix, on a stability ball if they were bold enough to do that in public.

A couple years ago wall slides and joint mobility came to the forefront, and the forward-thinkers jumped on board. And the desperate.

These shoulder rehab efforts work, unless the damage done is serious enough to require medical intervention… er, surgery. For most of us, pretty good is good enough.

But is it really? What if there’s one more thing you could do that would make your shoulders feel young again? Would you try it?

A couple months ago in Florida, I had Bill Peel run me through the Gray Cook Athletic Body in Balance version of the functional movement screen. I passed the overhead squat progression, but it was nothing to brag about, and there was room for more range of motion in the backward shoulder movement. The worst of the lot that day was the thoracic mobility screen; I claimed a pass, but barely.

A month of focused attention to shoulder range of motion and remedial thoracic spine mobility work didn’t change much, so what was missing? I thought about some of the practices of the past months and remembered my problems with posture; specifically that in the end it wasn’t back strength to hold my shoulders in position that was missing, it was that tightened muscles in the front were pulling the shoulders forward. No amount of strength would be enough to keep my shoulders back until the muscles in the front were stretched regularly to give them the length to rest in good postural position.

Huh. What if that’s the problem with the rear range of motion in the shoulders? Huh! What do you know? It’s magic!

If your shoulder range of motion to the rear is lacking, one side more than the other or both sides equally, give this a try:

Lie on your back on the floor, knees bent, feet flat as if standing. Raise your arms overhead to rest on the floor; if both arms are flat on the floor, move along… there’s nothing for you here.

If only the backs of your wrists or not much more of the arms are touching the floor, or if one side if touching more than the other, rest in position, breathing regularly and deeply into the abdomen. Occasionally, breathe deep, expand the ribcage and keep it expanded by letting out a tiny bit of air and refilling the space. The point of this is to use your full air to hold the ribcage open and as far as possible from its connections at the spine. Stay there, arms overhead, knees bent until you begin to feel the backs of your arms flatten onto the floor.

This is probably going to take awhile, five minutes, ten, maybe more. You’ll probably be okay with that, though, because as it happens it feels a bit miraculous. The muscles and tendons of the upper torso and the thoracic spine and rib cage are relaxing, lengthening, and you can feel it happening.

In a few days, what was stressful and took fifteen minutes will be easy, relaxing and will only take five.

Couple of tips:

If you simply can't get your hands overhead, start with a lesser angle, such as hands outstretched in a T position. If (or when) the backs of your arms rest heavily on the floor, move your hands up a bit, heading towards a Y angle. This way you'll ease your way into the overhead position over time; it may take what feels like too much time, but in the end, it will work.

If there's a twinge in your upper back, different than the stretching that you feel throughout the upper torso, you may need to roll around on a tennis ball or medicine ball to address a triggerpoint or a tight lat before doing the stretch. The trigger point work can be outrageously painful, but the upside is releasing that triggerpoint may be a key -- and immediate -- factor in relieving your shoulder pain.

Final points:

Don't do this early in the morning; afternoon or after a workout is best. A light and easy doorway stretch -- not forced -- is good in the morning to reverse overnight sleeping posture, but your thoracic spine and rib cage aren't ready for this radical stretch before warming up to the day.

After resting with the arms overhead for awhile, has one side settled onto the floor with the other side still lifted? Try shifting the hip of the lifted side. Did the shoulder just flatten? Triple bingo going on here: Go back and read up on the troubles of hip rotation.

It’s remarkable, really. And it may be the answer to the last of your shoulder distress.

Re: Shoulder Range of Motion and Thoracic Mobility
04-22-08 10:50 AM - Post#434440    

I've had a few private notes about this from people who were amazed at how this worked for them. However, one person pushed too hard and tweaked his shoulder, so let me bring up two more points.

Relax into this; don't push it. The point is to wait long enough to allow your body to relax. You can't make that happen... you have to be patient enough to lay there until it happens.

Which brings up point two: This may take days, weeks even. Dave's doing this, and his hands overhead are nearly a foot off the floor behind him. Seriously... no, I'm not exaggerating. No amount of forcing is going to loosen up his upper torso. He's going to have to wait it out, and so might you.

04-22-08 10:55 AM - Post#434443    

I had done this stretch actively, using some muscle action to achieve the position, but doing it with deep relaxation is something else entirely.

I am going to try it with some band traction added. I'll choke the band to one wrist, wrap it around an anchor, and choke it to the other, then lie down and set up so there's just a liiiiittle tension from the band giving me traction.

If you can't get your hands on the ground, I wonder if putting something under the arms would allow greater relaxation?

If you can get your arms resting on the ground, relaxed, you can increase the ROM a bit by lying on a mat or something, or a LOT by lying lengthwise on a foam roller.

The most important test a lifter has to pass is the test of time. -Jon Cole

04-22-08 11:29 AM - Post#434462    

• ccrow Said:

I suggested that to Dave, that he put one of the big couch pillows under his arms, then decrease the pillow size over time. He seems to want to do it the hard way. Big surprise!

There's value to any version -- relaxing into it, traction or muscular effort.

I feel bad for the guy who pushed it too hard... folks, please note that these techniques are all different, and useful, but may not be appropriate for you as you start this mobility process. This stuff takes TIME. It took us years to lose mobility and may take years to get it back.

04-22-08 07:34 PM - Post#434690    

Laree, is there anything to make of the fact that one of my arms clearly stretches further than the other? We're talkin over an inch of a difference.

Have Bucket. Will Travel... R.I.P. Kris. "If you train hard, you'll not only be hard, you'll be hard to beat."

04-23-08 11:51 AM - Post#434923    

I would definitely work on that if I were you, Rob. Even if it never causes a real problem in the future (which it probably will eventually), here's a simple reason you'll like: One bad shoulder will hold you back in your barbell work.

Looking at things a few decades older than you, I sure do wish I'd discovered these problems earlier. The sooner you even things up, the less likely you'll have trouble in the years to come.

Hopefully it'll be an easy fix, maybe coming from a one-sided activity (throwing a football or baseball, for example) or an old injury in the shoulder. If not, you'll have to dig deeper to discover the source; perhaps it'll be the hip. If that's the case, it's even more important to fix this now.

04-24-08 04:59 PM - Post#435442    

I would bet it's a combination of both propose sources, Laree. I played baseball for years, and year round for several of those. Also, before I began using dumb bells regularly, I often had shoulder pain. Thanks for the reply!

Have Bucket. Will Travel... R.I.P. Kris. "If you train hard, you'll not only be hard, you'll be hard to beat."

04-25-08 06:43 PM - Post#435777    

Laree,

Question from the OP diagnostic test. Should the arms be completely straight and flat on the floor, shoulder to wrist? I'm flat if I have some bend in the elbow, but not with elbows straight and arms in line with torso.

Bill

Above all else, guard your heart, for it is the wellspring of life. Prov 4:23 "I'm not a doctor just someone that gets injured a lot." irondawg "Confidence - the absence of doubt - is a distillation of hope, faith and knowing." Dave Draper, BISS, page 65 "Few things are more fulfilling than personal progress." Dave Draper, newsletter of 4/2/09 100 Day Burpee Challenge 08 Survivor squatting makes me sleepy

04-25-08 07:49 PM - Post#435799    

I'm with you, flat with an elbow bend and working toward elbows straight. This stuff takes time.

04-27-08 07:27 PM - Post#436163    

Here are two other emails from visitors who don't post. FYI.

Thanks for sharing your article about shoulder mobility. I have had a case of biceps tendinitis in my right shoulder down into the biceps since Christmas. Got a cortisone shot that didn't do much and doctor wrote a physical therapist prescription which I never got around to doing. Interesting thing was, I could still work out pretty well, but afterwards was when my whole front shoulder and biceps hurt. Anyway, I put off going to PT and tried your routine in the April 16 online letter and it is working. I am amazed and tickled to death that it is that simple. So thanks again. No, I won't do anything foolish and will keep doing a little more shoulder mobility work as time goes on.

and from another friend:

As a shoulder/ortho/challenged guy, I read your thoracic-shoulder stretch with greedy interest. Being an incorrigible whack-case every bit as bad as your young husband (I hit the big 77 in January), I've pushed it a step farther. Lie, back down, arched on a ball with LIGHT weights (I use three pounds). Gradually allow arms to drop down as in your described stretch. Occasionally, apply a counter-force lift toward ceiling to trick recalcitrant muscles, then drop the outstretched arms down a little more. You'll feel it in your chest as never before.

Before you get too carried away, don't forget this (posted earlier): One person pushed too hard and tweaked his shoulder, so let me bring up two more points.

Relax into this; don't push it. The point is to wait long enough to allow your body to relax. You can't make that happen... you have to be patient enough to lay there until it happens.

Which brings up point two: This may take days, weeks even. Dave's doing this, and his hands overhead are nearly a foot off the floor behind him. Seriously... no, I'm not exaggerating. No amount of forcing is going to loosen up his upper torso. He's going to have to wait it out, and so might you.

04-27-08 08:14 PM - Post#436172    

That second email reminded me of something. If you have a Total Gym or similar, doing pullovers with a very shallow setting, emphasizing good shoulder movement, is a great mobility exercise for this same range of motion. I had one temporarily, and if I ever see another in the classifieds for cheap, I will buy it. I wouldn't use it for much strength work, but I think there's a lot of mobility type stuff it's great for.

The most important test a lifter has to pass is the test of time. -Jon Cole

05-04-08 10:20 PM - Post#438676    

In response to Laree:

From personal experience, Active Release Therapy (www.activerelease.com) works almost like a miracle for those areas of pain and restriction I just couldn't get to by myself. For example, one of the cuff muscles, the subscapularis (literally, underneath the scapula - not accessible) was an area I just couldn't get to or get loosened. Among the younger trainer/coaches (Cressey, Robertson, Boyle, Abel, and others), ART has become the standard recommendation. And I'm certainly guilty of having referred upwards of three dozen people to ART practitioners in the last few years - some having cuff problems they'd put up with for thirty years (no kidding) fixed in a few sessions. Some even cancelled surgeries as unnecessary.

Due to my cuff problem largely being subscapularis, regaining function and mobility has been especially helped with pullovers using barbells, single dumbbell, two dumbbells, on benches, stability balls, even decline benches to low pulley using a triceps rope - every which way I can think of to regain mobility and function and lose the pain.

05-04-08 10:28 PM - Post#438677    

• Laree Said:

So might - most likely - most of us. The other side of the coin is how long did it take for us to get ourselves that way? Amazingly, the restoration might well seem like it's taking a long time, yet if we had some way of doing an audit on healing versus getting that way, then we'd appreciate just how fast our bodies restore themselves.

What's most tragic, in my opinion, is watching people in most commercial gyms doing lat pulldowns in a manner that reinforces and amplifies protracted shoulders, shortened tightened pecs, tendonitis all across the upper/mid back. The same series that published The Seven Minute Rotator Cuff Solution (now reprinted by Iron Man Magazine) had other books in their remarkable series of the late 80s. In them they taught what they called the "J shrug". Imagine hanging from an overhead bar, arms totally straight, lifting yourself an inch or two by rotating the scapula, pulling them together as if you were holding a pencil between your shoulder blades. Can be done with a lat machine, too. The shoulders roll down and in, sort of forming the letter "J". Can be done with rowing machines, cables, or one arm dumbbell rows. Many people have a terrible time trying to do that simple muscle control, while many older people struggle with it for a few weeks before mastering it. Remember, your arms have to remain straight and locked. Once mastered, then begin lat pulldowns or chins with the scapula roll. Goes miles in fixing cuff, levator scapula, rhomboid ills.

05-05-08 02:49 PM - Post#438926    

I've been really frustrated by this stretch the past several days. I can't get my wrists closer than 4" or so to the floor with arms straight overhead.

I've found a few other shoulder stretches that I'm also not very good at, especially stick ups (40 seconds into the video). I can't even come close to getting my butt, shoulders, and elbows (let alone wrists) to touch the wall.

So, finally to my questions.

1. Are there other stretches that I can do that will help my performance in this stretch? I'm planning to keep at it, but my frustration level is growing since my shoulders have such a long way to go.

2. I'm afraid that doing resistance exercises with my shoulders will compound my current mobility problems. Is this an unfounded fear? Are the face pulls and scap pushups that I've been doing lately going to help or hurt me?

3. Are shoulders really supposed to be this flexible? I can hardly get my head through the hole. I'm impressed and envious...

05-05-08 03:08 PM - Post#438935    

Ok, tried a few more shoulder dislocations with a longer broomstick that allowed me to take a wider grip. I was successful, but my grip was so wide that the stick nearly hit the top of my head on its way by. I'm going to keep at the dislocations and see if I can gradually narrow my grip.

05-05-08 03:20 PM - Post#438941    

• WillVT Said:

I do dislocates with rubber bands. You might give it a try.

I can't do it with a broomstick at all. The lighter the band, the easier the motion. I have Jump Stretch bands. "Micro-mini" is easy, "mini" is OK. I will get to "light" one of these days.

jej

05-06-08 09:07 PM - Post#439471    

question: are your hands together directly overhead like thumbs touching or just straight up from the shoulders? if hands are together, i'm not flat. hands up from shoulders or even a little closer together and i'm flat.

BEAST MODE. NOW.

05-07-08 10:59 AM - Post#439647    

Thumbs touching would be a little better, but straight up is pretty good!

The most important test a lifter has to pass is the test of time. -Jon Cole

05-07-08 11:04 AM - Post#439653    

great! something to work on but not debilitating at this point. so that and my metatarsals are pretty good.

BEAST MODE. NOW.

05-07-08 11:27 AM - Post#439687    

How about shoulder internal and external rotation, Michelle? Have you checked that? You could work on that next if you're looking for a shoulder issue to address.

05-07-08 11:35 AM - Post#439696    

• WillVT Said:

Hey, Will, first off: Yes, keep at it. This stuff took me months, and I'm still not done... won't ever be done if you get right down to it. Still, I did overhead barbell presses the other day for the first time in months. Head went right through the hole, nice and easy; there were no crunching sounds coming from my shoulders for the first time in literally decades, and even though I didn't test max strength, I'm certain there was no loss of shoulder strength. In fact, with more pain-free motion and more muscles working better, I may even be stronger.

Face pulls and scap pushups are helping. Stick with the program.

Finally, to your first question, I wonder if you have triggerpoints in your mid and upper back that might be holding back your progress. There are places where those hide that are so painful your body simply won't let you move over them. Try some triggerpoint work before your next shoulder stretching session, first with a quick foam roll to loosen things up, then more intensely with a tennis ball.

05-07-08 11:53 AM - Post#439712    

• Laree Said:

I'm good on those. the pt measured all of my shoulder ROM before he released me last week. so, if i understand correctly, there's an impingement in my right shoulder, which is skeletal, but no muscular imbalances or limits on ROM. i have to keep the rotator cuff muscles happy with YTLs and bands...and this will prevent further impingement. right?

BEAST MODE. NOW.

05-07-08 03:22 PM - Post#439845    

Thanks for the advice, Laree. I've been doing a bit of foam rolling the past few weeks, mostly on my upper back. Reading the descriptions others have posted of the pain that can result from rolling, I was prepared for the worst. However, I haven't come across any painful spots yet. I'll try to do more targeted work with tennis balls to see what I can find.

Shoulder Range of Motion and Thoracic Mobility
05-07-08 06:29 PM - Post#439924    

• michelle Said:

I so wish that were true, Michelle. Unfortunately, there are no guarantees. Once you go back to powerlifting, you can do YTLs and internal/external rotations before and during every workout as well as between workouts and still get impingements, if you don't cycle off heavy bench presses when you need to. Just happened to me.

I think the Westsiders gave us the key when they started promoting frequent changes to the max effort exercises. My shoulders were injury free until I went back to benching every week again before my last meet.

I'm not knocking the shoulder rehab exercises, by the way. I do YTL's, cuban presses, internal/external rotations, face pulls, and reverse shrugs at least three times a week. They get the job done.

Be strong. Be in shape. Be a man among men, regardless of your age or circumstances.

05-07-08 08:13 PM - Post#439950    

Impingement happens when the bones are out of their proper positions during movement. That is what impingement is, when soft tissue gets pinched between the bones. If the bones were moving correctly, they wouldn't mash the soft tissue. In this case the soft tissue is usually the tendons at the insertion of the rotator cuff muscles.

If you do certain exercises that put the joint in a position that force the bones into a bad position, you're going to get impingement. Upright rows and bench presses to the neck come to mind. The cuban rotation too.

If your internal rotators are tight, and / or your external rotators are weak, your shoulder is going to get pulled into the impingement position. The internal rotators are the pectorals, the lats, and the subscapularis (part of the rotator cuff) - you stretch these. The external rotators are the infraspinatis, teres minor, and the supraspinatis.

If your scapula don't move properly in concert with the arm, again, you are prone to impingement. Strengthening the serratus, lower traps, etc. gives you a base for healthy movement, but by you also need to learn to move the right way, which may take some doing if the habits are ingrained.

If your thoracic spine is not mobile, is stiff and unable to extend, your shoulders again get forced into a bad position. There are deep muscles in the upper back that extend the thoracic spine. Pendlay rows helped me develop them, but of course there is more than one road to Rome. Rolling on a foam roller will also get the area moving which is a good first step.

That's all you need to do to avoid impingement: strengthen what's weak, stretch what's tight, re-learn how to move your arm, and avoid hazards. Simple.

The most important test a lifter has to pass is the test of time. -Jon Cole

05-07-08 08:31 PM - Post#439957    

heheh, simple, Byron says. actually that's all very helpful. is there anything that can be told by the fact that it was my supraspinatus that was impinged? also, i've never had shoulder problems before the last few months when i started doing bench pressing more than once every 2 weeks and trying to do a more PL bench with feet, legs, and a little arch.

BEAST MODE. NOW.

05-07-08 09:48 PM - Post#439985    

• WillVT Said:

With the upper back we don't hear much about painful foam rolling; that's reserved more for places like the side of the leg. I suspect when you plant yourself over a tennis ball, we'll be hearing a different story... possibly the yelps over here on the left coast.

Roll yourself down the tennis ball from the back of the neck along the meat down one side of the spine to the end of the rib area. From the top again, still on the same side, roll out and around behind the shoulder and down the upper back, out the sides and down the lat. Then roll down the other side of the spine in the same way.

Go gently and make note of any sore spots, but don't spend too much time in any one place because there's still a bit more research to be done: You need to check the upper arms, too. Roll your triceps over the tennis ball; then roll over a bit so you can repeat the process on the front of the arm between the deltoid and just above the elbow.

NOW you know the spots you need to go back and attend to.

Yeah, oh yeah... I hear ya, brother.

Shoulder Range of Motion and Thoracic Mobility
05-09-08 09:57 AM - Post#440559    

• Laree Said:

Thanks again for your advice, Laree. I picked up a tube of tennis balls last night. It took me a while to get the hang of it; I had a hard time controlling the pressure and getting the ball to move where I wanted it to. After several tries, I've found that the carpet in my bedroom is the best surface.

I started out rolling along side my spine, and without knowing how much pressure to apply, probably went a little too hard. I was wondering to myself if the discomfort I was feeling was the pain you told me to expect. I got through both sides and was still wondering. Then I started on my right lat and felt a sharp pain that forced the air out of my lungs. Bingo.

I found a similar spot on the left, but in a slightly different location. I rolled around on the left side quite a bit, felt a bunch of little clicks and pops, and the pain slowly abated. It isn't completely gone, but it eased considerably. My right lat is still pretty tender, but I wasn't able to work it to the same extent as my left since it was so much more sensitive.

Do you have any advice or are there any existing posts on tennis ball technique? How frequently should I do this?

Edited by WillVT on 05-09-08 09:57 AM. Reason for edit: messed up quote tags

05-09-08 10:55 AM - Post#440582    

Sounds perfect!

You'll probably be sore for a day or two. What I do is go back to the foam roller for a couple days to continue moving the blood through the area, to get a little stimulation without the intensity of the tennis ball.

Then you're back on the tennis ball. One or two of the spots will be easier, one or two will be as hard, and you may even find another couple as you get into it.

Over the course of the next couple weeks, taking a day or two backing off to the foam roller after each long session, the bad spots will probably be gone. If they aren't, it's time to dig a little deeper and find out what in your current activity is causing the triggers.

Since the spots you found were in the lats, you'll probably want to add some lat stretching to your regular workout plan.

06-25-08 11:11 AM - Post#456016    

Eric Cressey offers a terrific explanation of thoracic spine mobility in this newsletter.

06-27-08 07:44 AM - Post#456716    

• michelle Said:

Michelle,

How have you been feeling? Any improvement?

06-27-08 01:58 PM - Post#456862    

• michelle Said:

Come to think of it, the last time my shoulder got inflamed was when I practised throwing my whole body into the bench press and tried to get off the bottom using my lats.

Be strong. Be in shape. Be a man among men, regardless of your age or circumstances.

06-27-08 10:14 PM - Post#456985    

Saw the chiro tonight.....he said the problem was my posture. Not only was my mid-back curvature off, but my shoulders were pulled forward (a result of many years in front of the computer at work). The foam rolling would work for my back curvature but not for my forward rolled shoulders. He showed me a trick....roll a towel into a ball and while laying on a flat surface, place the "ball" in between my shoulder blades. This would help pull my shoulders back effectively stretching my pecs etc.... Do this a for 15 min a few times a day and work on my posture the rest of the day, I should be able to reverse the effects of my desk job. He also reinforced what I already knew....work my back more and chest less.
Mike

06-27-08 10:25 PM - Post#456988    

Yeah, that's a good one, Mike.

Doorway stretch a couple times a day will really help, too. Just a minute or so each time.

I think all that forward pulling also messes up with our thoracic spine mobility. Working on that helped bring my posture back to normal.

Don't get too frustrated. If you do these things, in a week or so you'll notice some progress, the pain will begin to subside and you'll regain your enthusiasm.

11-15-08 03:37 PM - Post#501722    

Shoulder ROM exercises:

11-16-08 06:17 PM - Post#501988    

Because my shoulder dislocation is a worker's comp issue I will be undergoing physical therapy. Probably the same stuff I would do on my own, but it will be beneficial and I will probably learn some new things.

Doug DougJantz.com Facebook My Blog

Shoulder Range of Motion and Thoracic Mobility
01-21-09 11:03 AM - Post#520499    

Along with my public challenge, I started using a tennis ball on my shoulders....

"If there's a twinge in your upper back, different than the stretching that you feel throughout the upper torso, you may need to roll around on a tennis ball or medicine ball to address a triggerpoint or a tight lat before doing the stretch. The trigger point work can be outrageously painful, but the upside is releasing that triggerpoint may be a key -- and immediate -- factor in relieving your shoulder pain."

Ain't that the truth? I rest the tennis ball on a convenient door jamb and drive my rear delt into it. I alternate between rolling the shoulder around on the ball and just holding hard (and uncomfortable!) pressure on the most painful sites.

The increase in pain free mobility has been gratifying. I haven't yet added any weight training to the mix...I don't want to rush the process.

Who would have thought something so simple would be so effective? Probably a combination of released endorphins and released adhesions. Whatever. The important point is that this little "trick" has addressed something fairly well that conventional medicine hasn't. Passes the Wicked Willie Frugality Standard, also.

"I'm in good shape for the shape I'm in." "Jesus said to him, I am the way, the truth, and the life: no man comes to the Father, but by me." John 14:6

Edited by Wicked Willie on 01-21-09 11:09 AM. Reason for edit: No reason given.

01-21-09 12:19 PM - Post#520519    

WOO HOO!

Love it.

The upper traps are notorious for knots -- not even adhesions, just knotted up muscles. Getting in that uncomfortable position with a tennis ball against the corner of a wall every day or so will help a whole lot of us in keeping shoulder tension at bay. Don't miss this one, folks.