6 Shoulder Health Morsels from Eric Cressey
Last Friday I got done treating a bunch of shoulder patients earlier than usual, jumped in my SUV and drove 7 hours to get to Vigor Ground Fitness in Renton, WA. This particular trip was for a chance to learn from one of the best in the shoulder performance biz, Eric Cressey. I ended up driving 14 hours in a 28 hour period to make good on this learning experience. As usual, it was worth it. Here’s 6 brief takeaways, some reminders from previous learning, some new outlooks on the same knowledge base, and some logical ways of applying accepted knowledge to the shoulder.
1. Work proximal to distal with shoulder care programs.
- I love a good logical and systematic approach to anything, and the shoulder is no different. Being one of the most freely moving and unstable articulations in the body, one cannot expect to simply address all possible issues as they could relate. So where do you start? Proximally, where the locus of control originates. Thoracic Spine (accounting for core control), scapular control, then glenohumeral health. Clinically, it obviosuly becomes much more complicated than this. In the Prehab/Rehab world. I think this only makes sense.
- To quote a handout, “Once you’ve found neutral at the spine and ribcage, you can best evaluate how the scapular stabilizers and rotator cuff function”. How you achieve that neutral is a whole other ballgame.
2. The same exercises, cued differently.
- I have found this time and time again in the clinic. You tell three people to “reach forward” and you get an interesting threesome of arm dances. One will scapular protract, one will unilaterally flex their thorax while retracting the scapula, and the other will do an odd robot impersonation, keeping everything perfectly still and hinging at the GH joint because that’s what they think will please me (shoulder down and back, right?).
- Assess, don’t assume!
- Rehab is a means to get result, not moving for the fun of it. Just because they are doing the corrective exercises doesn’t always mean they are doing it in a way that will accomplish the desired outcome. This becomes especially true once we move from isolated to integrated movements. And yet, I had a patient yesterday who couldn’t keep his scap in place while internally or externally rotating at the GH jt. It took the proper cue to fix it, whereas others naturally accomplished what I was after.
- An exercise created to fix the problem you are facing will not always work, especially if cued wrong. The same applies in reverse.
3. Anterior Core vs Lats
- Anterior core stiffness (control/strength) is needed to overpower overactive or short lats in order to allow for stable overhead shoulder position without compensation.
- If you’re short in the lats, you need to be working on anterior core stabilization (anti-extension moment) and soft-tissue quality (long head of tris, capsule, lats) to save your low back in an overhead position.
4. Athletes are less likely to be “normal”
- Just because the “common” thing that shows up in research, in the media, and in our offices is one way, does not mean that athletes are that way.
- Athletes tend to be extended and hyperlordotic more often than the average population.
- Just because Dr McGill doesn’t want you to continually load spinal flexion, doesn’t mean you shouldn’t be able to produce it and control it at will. If you can’t do that, you don’t have proper alignment and control. So stop assuming your athletes into extension for all their exercises, especially those that require overhead movement.
- If you can’t control an overhead reach with a bit of lumbar flexion moment (aka, anterior core stiffness), you’re not suppose to be doing typical overhead work…yet.
- Most people are protracted, kyphotic, anteriorly tilted, internally rotated, butt-less, valgus, pronated, and toight as a toiger. Your athletes…maybe not. Assess, don’t assume.
5. Same outcome, different mechanisms
- Athletes can keep their shoulders healthy in many different ways. One may have exceptional thoracic mobility and control, another exquisite scapular stability, another rotator cuff perfection.
- When it comes down to it, it’s better to have acceptable levels in all of them rather than showing a huge imbalance that has been overcome by compensation elsewhere.
- In the FMS, it’s 2s across the board that will save people’s limbs, not a 14 with many 3s, a bunch of 1s, and several 3/1 imbalances. The same applies to complex movements of the shoulder girdle.
- Our job is to find the weakness and bring it up. 2’s across the board. before worrying about 3’s, so to speak.
- Hence, you can’t trust the “standards” in terms of testing, ROM, and even the FMS/SFMA, because they don’t tell the whole picture. They are just the beginning.
- Finally, 2 athletes may achieve the same outcome but by different mechanisms. One mechanism may be injurious…care about the mechanism when assessing for “standards” and outcomes.
6. Dead Bugs can be hard…if cued for you.
- Ok, this is not so much a morsel as a re-iteration. One of the exercises I was using the change my personal shoulder issues was the dead-bug. After hearing it coached slightly different during the course, it has brought a whole new level of difficulty to the exercise.
- In may case, it was because I have that “athlete” problem of being stuck in extension all the time. Pulling the lumbars into neutral (flexing to neutral) while allowing for hip extension and overhead position found me fighting myself in a good way.
Until next time.