Part I: Correcting the Shoulders

Last week my good friend and author of
Day by Day: The Personal Trainer’s Blueprint to Achieving
Ultimate Success
, Kevin Mullins, wrote an introduction
of sorts to the state of “corrective exercise” in the fitness
industry.

To summate: Stop it. Just stop. People still
need to train in order to get better.1

Today, in Part I, Kevin peels back the onion on the
shoulder.

Grab a cup of coffee.

This is good.

Shoulders, Yo

Excellent strength coach, and outstanding Canadian, Dean Somerset once
stated in an internet post, or maybe it was a blog, “there is
always a cost of doing business.” He meant it as a point of
emphasis when talking about the various effects of training
programs and specific exercises. But he also could have
extrapolated it outwards to reflect the stresses of our daily
lives.

Poor posture while seated for twelve hours is going to have a
cost associated with it just as German volume training.

Note From TG: OMG, German Volume Training
brings back the worst memories. I don’t know which was worse:
getting kicked on the balls or GVT?

For this reason, the fitness industry has made a major shift
towards corrective exercises. Once seen as the tools of progressive
physical therapists – these mobility, stability, and integrated
exercises have become critical elements in training programs for
elite athletes, nimble geriatrics, and the average Joe and Jane
alike.

The growth of corrective modalities in conventional personal
training is a good thing overall. However, as I pointed out in the
introduction to this article series –
HERE
– there exists a very big downside to
the obsession with movement perfection and body correction.

There needs to be a better way of correcting people’s movement
flaws, overcoming their specific weaknesses, and getting them to a
place where they can safely train hard. Far too many coaches are
“under-training” their clients because they are investing too
much time “correcting” things. At some point we need to get
people training hard towards their actual goals.

Using Your Head For Their Shoulders

There may be no part of the body more susceptible to
under-training than the shoulders. With multiple skeletal
structures, a bunch of muscle
attachments, and a relationship with the spine – there are a lot
of reasons that someone wouldn’t be “allowed” to train hard
with their shoulders.

Training them includes more than the traditional bodybuilding
approach too.

The glenohumeral joint is involved in all upper body pushing and
pulling motions as well as the specific isolation exercises that
are popular in bodybuilding programs (such as lateral raises or
chest flyes). The scapula and clavicle are too, but their
positioning on the body also impacts movement such as the deadlift
and squat.

Because of their high level of integration with every exercise
we do, the shoulders are often the most banged up part of a
client’s body. Our poor postures and ill-advised training
programs aren’t helping us. Often the two compound each other and
only worsen any dysfunction that exists.

Hence the need for correctives.

Really though, the shoulder itself is a bit of a miracle joint
– with all the muscles that cross it, the fascia, the nerves,
blood vessels, and obvious skeletal structures – it is amazing
that it functions as well as it does.

But there can be a whole host of issues going on, or there can
be just one. And that is what is most challenging about assessing
and correcting shoulder dysfunctions.

  • It could be as simple as improving someone’s ability to
    retract and depress their scapula, such as when someone’s posture
    isn’t where we’d like it.
  • Or as complex as improving external rotation of the humerus
    while also stealing more extension from the thoracic spine and
    stability from the scapula during upward rotation and elevation,
    such as when a client wants to get better at pull-ups.

No matter how intense the problem is it is important that we as
coaches keep our processes simple.

Removing the Restrictions

Yet, simple is not how most coaches approach shoulder
health.

In fact, if you were to follow many of the conventional
prescriptions that are floated through the industry, then you’d
avoid many of the things that produce big results for your clients
in favor of small correctives that make small changes. While some
clients do need more intervention with these corrective methods –
most simply need enough to create an opportunity for more
intense training.

If you were to follow many of the guidelines that accompany
something as notable as the Functional Movement Screen (the FMS),
then many of your clients would not be allowed to press, or pull
vertically, or load up abduction or adduction in the frontal or
transverse planes until they were able to get a “2” on the
shoulder mobility assessment.

While Gray Cook and Lee Burton did an incredible job creating a
screening tool that helps coaches discover dysfunction and lack of
movement prowess – they also created a system that is preventing
a lot of clients from actually getting better.

Note From TG: For anyone interested (I.e.,
everyone) I wrote about my experience taking the FMS and what I
took from it HERE.

The protective measures and governing principles of systems put
the fear of God in personal trainers who use them. Many are afraid
of loading anything until they see a two on the scoreboard. It is a
steady dose of low intensity or no intensity correctives until that
day.

Which is where the problem with corrective exercises starts:

Low to no intensity corrective exercises aren’t why clients
improve over time. Instead, it is the strengthening exercises that
come after these correctives that matter most.

If we are to improve how we utilize corrective exercises in our
programs, then we must be willing to accept that what we now know
isn’t perfect. We must be willing to entertain the idea that
there is a better way of doing business. It is this exact mentality
that drives innovation in technology.

It will drive innovation in fitness if we let it.

—-

(It is important to pause here and make a statement – this
article is not meant to treat, diagnose, or prescribe methods or
modalities for someone who is dealing with diagnosed injury or
dysfunction in their shoulders. Traumatic injuries, conditions such
as frozen shoulder, cervical kyphosis, and others require a finer
touch from qualified medical professionals.)

If Not This, Then What?

Corrective exercises are like the bore that drills tunnels in
the side of a mountain. They create the space for the construction
to take place, but they aren’t the construction. You wouldn’t
want to drive through a tunnel that hasn’t been reinforced with
steel supports and millions of pounds of concrete, so why
do you think that corrective exercises are enough to create a
finished product in fitness?

The mobility and stability exercises that we define as
“correctives” simply create the space for more optimal change
to take place. They create the opportunity for well-selected
strength exercises to change the tissues for the better.

For shoulder health we find that the classic approach of
wall-angels, thoracic roll-overs, and cat-cows are simply creating
the opening for which exercises like loaded carries, supinated
pulldowns, and banded retractions fill with strength and stability.
Our goal needs to be to do enough to get to the exercises that
stimulate adaptation and create positive change; in the shoulders
and in the rest of the client’s body.

Our responsibility as trainers is to help our clients overcome
dysfunctions and improve their movement quality – sure. But our
job also implies that we help our clients burn calories, build
muscle, and come just short of conquering the universe.

Before diving into the actual corrective exercises that will
open the gates for us to train with the intensity our client’s
want and need, let’s ensure that everyone reading is on the same
page on the anatomy and physiology of the shoulder joint.

The Basic Anatomy and Physiology – Skeletal

When looking at the
shoulder joint you are presented with three major bones: the
clavicle, the scapula, and the humerus.

  • The clavicle (or collarbone) is the most stationary of all of
    these structures, but its lateral aspect does elevate and depress
    in reaction to movements of the other bones. The humerus, the upper
    arm bone, is designed for external and internal rotation within the
    socket – known as the glenohumeral joint.
  • The humerus can move through flexion, extension, abduction and
    adduction, and horizontal abduction and adduction by rotating
    around the glenohumeral joint in each of the three planes
    (sagittal, frontal, transverse). These movements are aided by the
    function of the scapula.
  • The scapula (or shoulder blade) is the large bone in the back
    of the body. It is capable of six motions: elevation, depression,
    upward rotation, downward rotation, protraction, and retraction.
    These movements are also correlated to the three planes of motion
    too – sagittal, frontal, and transverse respectively.

The spine is also involved in shoulder mobility and stability is
often left out when looking at function. We will explore this
relationship in the next section when we begin looking at how core
function can impact shoulder mobility as well as how thoracic
extension is necessary for optimal function of the shoulder
joint.

The Basic Anatomy and Physiology – Muscular

The human shoulder functions as incredibly as it does because of
the incredible number of muscles that are involved. Some control
the humerus, others control the scapula, and others control the
spine.

Most of these muscles are found in the back.

When looking at the muscles that contract at the shoulder, we
must separate the muscles that control the external rotation and
internal rotation of the humerus from the muscles that create the
six motions of the scapula. While some muscles share functions –
it is important to identify its primary action and what it acts
upon in order to better understand how the shoulder wants to
function.

The four muscles of the rotator cuff are most responsible for
the external and internal rotation capacity of the humerus.

  • There is evidence to support that the triceps are involved in
    external rotation, especially under load (just turn your arm around
    as far as you can right now, and you’ll feel the lateral head of
    the triceps contract). Therefore, the triceps join the
    supraspinatus, infraspinatus, and teres minor as external rotators
    of the humerus.
  • With that claim we can also ascertain that the biceps and
    pectoralis group are involved to some degree in internal rotation
    (although there is significantly less IR available at the shoulder
    joint). The subscapularis is the internal rotator of the cuff.

When examining the muscles that move the scapula, we are simply
looking at the muscles of the upper back; the lats, teres major,
rhomboids, trapezius, levator scapulae, the serratus and the three
external rotators of the cuff. Each of these muscles have specific
functions on pieces of paper, but it is imperative as coaches that
we realize that most exercises performed in a gym setting involve
more than just one of these muscles doing one of these
functions.

It is easy to point at the traps and say “oh, they are
elevators and contribute to upward rotation.” It is less easy
being able to look at a flawed motion and know exactly what is
wrong:

For example, many coaches will point at someone having issues
with retraction and think “ah, the upper traps are overactive and
the teres major/minor need strengthening.” They could be right
and probably are in a population of people who sit with rounded
thoracic spines and internally rotated shoulders.

Add in forward neck and shrugged shoulders and this
“diagnosis” seems spot on.

However, getting just the teres group to fire without activating
the infraspinatus or supraspinatus is nearly impossible in a
traditional training setting. Getting someone to stay out of their
upper traps sounds like a great coaching cue, but that requires
getting them to fire the muscles that contribute to scapular
depression; the lower traps, pectoralis minor, and latissimus dorsi
at the same time – something most clients (or you) can’t do
consciously.

In fact, a lot of scapular depression comes from the ability to
put the thoracic spine into extension. Doing so involves activation
the lowest fibers of the traps, the lats, the upper abdominals, and
a whole host of muscles that are so deep and connected to the
individual vertebrae that considering them in training is
pointless.

When these muscles contract and thoracic extension takes place,
you find that the scapula better slide into the depressed
position.

The Core Connection

Yet, thoracic control isn’t completely isolated either.

It is very hard to contract the thoracic muscles without some
level of core control. In this instance, the core includes the
anterior muscles of the core that we know (rectus and transverse
abdominals, internal and external obliques, and Psoas Major.

It also includes the muscles of the posterior core: the
quadratus lumborum and the erector spinae.

Conscious contraction of these muscles allows for the core to
hold tension, which better stabilizes the lumbar spine, which
better allows the thoracic spine to go into extension, which better
allows the scapula to depress, which better allows the humerus to
externally rotate. As you can see, everything is connected, which
is why we can’t use such generic correctives to solve complex
problems.

A Less Important Factor?

You’ll notice that we haven’t yet mentioned the deltoid –
the most known shoulder muscle. For all the attention it gets in
bodybuilding circles its function is not as critical to shoulder
function as you’d believe. The anterior fibers assist in internal
rotation and drive flexion of the arm while the posterior fibers
aid in external rotation and initiate horizontal abduction. The
lateral fibers function to create abduction of the arm in the
frontal plane.

From a corrective standpoint, it is very rarely an issue with
the deltoid that proves to be the problem. In fact, it is often the
overdevelopment of the deltoids and upper traps and
underdevelopment of the rotator cuff muscles that create
impingement issues in dedicated lifters. Great corrective exercises
keep the deltoids involved and avoid shutting them out.

The Hidden Gem

In recent years we’ve come to learn that the fascia in our
bodies is more than just a covering and more than just extra tissue
that gets cut through in surgery. It is a living tissue that is
involved in our function on a day by day and minute by minute
basis.

In fact, research from Michol Dalcourt and the team at the
Institute of Motion have proven that the fascia can communicate
information across the body faster than any muscle tissue. Its
ability to compress and expand is crucial for athletic
development.

Unfortunately, many fitness professionals see it as tissue that
is addressed with foam rollers, lacrosse balls, and other release
methods. This isn’t wrong of course as these implements can do
well to increase blood flow, increase hydration of the fascia, and
improve mobility of the joint in question. However, we can also
train our fascia just as we train our muscles. We must look to
incorporate the variety of slings that Thomas Meyer’s discusses
in his text Anatomy Trains.

In our solutions section we’ll explore a few ways to do that
to improve the function of the shoulders and truly correct any
issues that exist.

But first, we must identify a few of the most common
problems.

Common Problems 1) Desk Posture (UCS)

The most common problem that a client will present in regard to
their shoulder health is the classic “desk posture”. The
scapula sits in protraction and elevation while the humerus’ are
internally rotated. This posture is held for eight, ten, and twelve
hours a day. Over time the pectoralis muscles get tighter, the
trapezius muscles lengthen, the muscles of the scapula and
glenohumeral joint get weaker, and the client continues to
worsen.

The most advanced form of this condition is known as Upper Cross
Syndrome (UCS) – a severe condition of immobility that usually
involves additional intervention with physical therapists, and
sometimes, orthopedic surgeons. This posture often presents forward
neck as a well – a dangerous condition of the cervical spine.

The treatment for individuals in this position is to correct
their posture and work to move them in better retraction,
depression, and external rotation. However, many of the common
methods do not provide enough intensity to stimulate muscle growth
or strength adaptations in the muscles of the upper back. It is
crucial for trainers to invest time in building their clients upper
backs and coaching optimal patterns if the corrective interventions
are ever going to stick.

2) Poor Scapulohumeral rhythm

For many people the pain they experience in their pressing and
pulling motions is a result of a poor pattern being present. Of
course, there are others who have legitimate issues such as
shoulder impingements, strained muscles of the rotator cuff, or
overactive trapezius muscles that make doing certain movements
nearly impossible. The rest though, simply need help reworking
their patterns and an emphasis on strengthening the muscles that
control those patterns.

The scapulohumeral rhythm refers to the quality of movement that
occurs when we consider the scapula and glenohumeral joints
interaction. People with great rhythms typically an exercise
pain-free while people who lack control and patterning struggle to
accomplish even the most basic tasks.

This topic is quite deep, but in short realize there is a
relationship between the position of the humerus and where the
scapula “should” be.

For example, in a traditional dumbbell overhead press the
scapula should be upwardly rotating and elevating as the humerus
adducts towards the midline at the top of the press. Many people
will execute their press and have little to no movement out of
their scapula, thus causing increased stress on tissues that
shouldn’t need to encounter them.

3) Lack of External Rotation

One of the issues many clients face is the inability to rotate
their humerus back. This is more than just the presence of too much
internal rotation (such as with U.C.S.). The muscles responsible
for external rotation of the shoulder are powerful muscles that
also engage in the motions of the scapula. Lacking strength in
these tissues can cause someone to become more internally rotated,
but also makes it incredibly hard to achieve external rotation at
the glenohumeral joint.

This matters for more than just mobility.

Popular exercises such as pull-ups require a person to own a
certain amount of external rotation in order to execute the motion.
So too does the overhead press. Lacking the ability to achieve
optimal end range of E.R. makes both movements, and so many others,
hard to accomplish.

It is important to understand that the exercises we use to
improve external rotation put the humerus in a greater rotation
than we would normally encounter in traditional lifting. But, this
sort of work is necessary to strengthen and stimulate the muscles
that create E.R. and maintain it in an isometric contraction (such
as during a overhead press).

4) Weak Core and Poor Thoracic Extension

As stated earlier, the core and spine play a major role in
whether the shoulders function optimally. A lot of lifters never
develop optimal shoulder health because they create mobility by
overextending their lumbar and thoracic spine to compensate. This
is especially prevalent in ego lifters performing an overhead press
with a massive amount of “layback”.

Lacking the ability to contract the anterior core and stabilize
the lumbar spine makes it significantly harder for someone to
master true thoracic extension. The ability to lift the ribs and
extend the thoracic spine allows for better..

Source: FS – All-FitnessBlogs
Part I: Correcting the Shoulders