The Top 4 Shoulder Stability Exercises You Aren’t Doing… Yet.
We need reflexive stability and proper joint positioning to express true savagery. Incorporate these four exercises into your training or movement prep to develop stable, fully integrated shoulders capable of moving big weight. What You Need To Know Reflexive stability of the shoulder and mobility of the scapula are vital to maintaining long-term shoulder health and optimizing athletic performance. Like any other joint, the shoulder requires a delicate balance of mobility and stability in order to function properly. Development and maintenance of these qualities is essential to ensuring that an athlete is able to express and improve physiological qualities like strength and power over a long-term training program without sustaining injury. Let’s be honest though, there is nothing sexy or fun about training shoulder stability. No one, regardless of sport or goal, wants to spend all their time in the gym developing scapular mobility and reflexive stability of the shoulder. We train to develop power. We train to increase force production. We train to build muscle mass. We train to dominate in whatever athletic endeavor we choose. Don’t get it twisted though; if the goal is to optimize athletic performance, mobility and stability of the shoulder girdle are essential. Athletes who cannot express full range of motion of the scapula and glenohumeral joints, and who cannot reflexively fire deep stabilizers to maintain joint centration and allow prime movers to perform work, are setting themselves up for injury. Nothing will derail a program and halt progress like chronic pain or injury. Here are four exercises that we use to maximize the efficiency and effectiveness of our shoulder stability and mobility training so we can keep our athletes healthy and devote more time to what really matters: unleashing the beast within them.
“Advancing the Science of Coaching… What You Say Matters.”
By: Cody Plofker It really is true what they say: it doesn’t matter how much you know if you cannot communicate and get it across to your athletes and clients. The best coaches in the world always know exactly what to say to their athletes at the right time to achieve certain results. There are plenty of very knowledgeable people who do not have the ability to communicate their ideas into effective coaching cues, and there are just as many less knowledgeable coaches who are producing champions because they know exactly what to say to get their ideas across. Coaches should obviously always aim to increase their knowledge, but they must always strive to find ways to make their knowledge base to transfer over to help their athletes. Learning how to best cue your athletes and clients is one of the most important things that can be done if you want to instantly be a better coach. There are two main types of verbal cues that we as coaches can use to get the results we seek. They are internal cues and external cues. Internal cues are coaching cues that reference a specific part of the body. An example would be to tell your athlete to squeeze their glutes during a tall kneeling exercise or at the top of a deadlift. If you are in most gyms, you will hear an abundance of internal cues being given to athletes and clients. These cues are always well meaning, but they often fail to achieve the desired effect as the athlete struggles to grasp what the coach is asking of them. Several other examples of internal cues are chest up, brace your core, shoulder blades back, and knees out. In contrast, external cues are cues that do not reference any parts of the body and instead focus on how ones body influences their outside environment. An example of an external cue in place of an internal cue would be to say, “show me the logo on your shirt” instead of “chest up.” Another common example would be to “spread the floor” during a squat instead of “knees out.” One external cue that I have stolen from Parabolic coach Mike Baker and seen great success with is “ bring your belt buckle to your nose” to elicit some posterior tilt of the pelvis instead of saying something along the lines of “tuck your tailbone under you.” There has been a great deal of research in the past several years that has highlighted the value of using external cues instead of internal cues in may situations. External cues compared to internal cues have been found to result in: Increased: -Accuracy of motor tasks – Efficiency in motor tasks – Learning in motor tasks -Jump height and joint torque during jumping tasks – Agility -Running speed – Swimming speed – Cardiorespiratory endurance – Muscular endurance in both dynamic and isometric tasks – Whole body coordination patterns -Decreased: – Oxygen consumption -Heart rate In over 80 studies, external cues have been found to be superior in almost all cases (Wulf, 2013). The null findings (no effect) might be due to the methods and samples of the studies, but no studies have found performance advantages of internal cues. In contrast, internal cues have only been found to increase EMG activity and result in increased co-contraction of agonist and antagonist muscles. I know what you’re thinking right now, as was I when I first read the research. If internal cues increase EMG activity and co-contraction then shouldn’t they result in increased force production and power? Not so fast. Increased muscle activity actually interferes with whole body coordination patterns, which in turn decreases whole body force production. According to Wulf (2013), “The production of maximum forces requires an optimal activation of agonist and antagonist muscles, as well as optimal muscle fiber recruitment. Unnecessary co-contractions, imperfect timing, and/or direction of forces would result in less than maximal force output.” We need antagonists to shut off and allow the prime movers to work in a fluid fashion to create great levels of force. When we have too much muscle activation, we limit degrees of freedom and become constrained and less fluid limits how much force we can produce. Practical Applications Now you’re probably swearing off internal cues forever and asking why anyone would ever use them again. They certainly have their time and place, but that place is very limited to a few scenarios. Hypertrophy work where you want to get somebody to feel a muscle working, like a bicep curl is a great time to use an internal focus to create more bicep muscle activation. Using corrective exercises to activate a certain muscle such as the glutes during a clamshell is also an appropriate time to use internal cues, although you may find external cues to be effective in those cases as well. When should you use external cues? Pretty much the other 98 percent of the time! If the task your athlete is performing happens to fall into the above “benefits of external cueing” categories, find an appropriate external cue to suit the goal and watch performance skyrocket. Below is a list of external cues to get you started: Internal Cue External Cue Tuck your pelvis underneath you Belt buckle to nose Chest up Show me the logo on your shirt Hips back Tap the wall behind you or close the door with your butt Rotate your hips (on med ball throws) Throw the ball THROUGH the wall Those are just a few examples. Do you have any favorite external cues of your own? References Wulf, Gabriele. “Attentional Focus and Motor Learning: A Review of 15 Years.” International Review of Sport and Exercise Psychology 6.1 (2013): 77-104
The Art of Half – Kneeling
The half-kneeling position is a developmental position that provides tremendous benefits including reflexive core, hip, and split stance stability. Unfortunately, many people still perform it improperly, rendering it largely ineffective. Use the kneeling to half-kneeling progression to ensure that you’re getting the most out of half-kneeling training every time. Core stability is a term that gets thrown around quite about in the health and fitness community, and more times then not, the purpose is missed. Core stability is not achieved or trained through repeated flexion and extension of the spine, but by learning to fire the muscles of the midsection in sequence to create a stable and neutral spine position, which allows the transfer of force and expression of movement through the arms and legs. The body prioritizes spinal stability above all else, and will not allow full movement and mobility of the limbs until the primary need for spinal stabilization is met. One needs to look no further then the squat for a perfect demonstration of how lack of core stability can impact movement. Many untrained individuals will present with restrictions and compensations in their squat patterns such as knee valgus (knees caving in), butt wink (lower back rounding), and/or the inability to squat to at least parallel without falling over. Often times, coaches respond to this with tried and true cues like “knees out,” “chest up,” and “sit between your knees,” or by stretching and trying to lengthen areas of the body they feel are “tight.” Unfortunately, if the individual lacks strength and stability where it counts, all the cueing and stretching in the world isn’t going to fix the problem, because the brain absolutely will not allow the individual to achieve the desired movement pattern until proper core stabilization and positioning is achieved. In addition to improving movement quality, a strong core is vital to force and power production both in and out of the gym. In any athletic endeavor, whether it is lifting, jumping, sprinting, cutting, skating, or blocking an opponent, the person who can reach maximal force production the fastest is going to have a higher probability of success. The ability to rapidly recruit the motor units and muscle groups necessary to produce force at high velocities is known as rate of force production, and is one of the baseline goals of strength and conditioning programming for athletes. While there is no doubt that training to improve rate of force production is important, all the power in the world won’t matter one bit if the athlete has the core strength and control of a caterpillar. I believe Eric Cressey put it best here (http://www.ericcressey.com/6-reasons-anterior-core-stability-exercises) when he said, “the research on core function is pretty clear: its job is to transfer force between the lower and upper body.” In that capacity, it is a basic attribute that all athletes should possess to optimize performance. Benefits Of The Half-Kneeling Position While there are many ways to train core stability, one of the most effective tools we have found is the half-kneeling position. The half-kneeling position is a developmental position that we use as infants to learn to move from crawling to standing. It is useful to incorporate developmental positions such as supine, quadruped, tall kneeling, etc. when trying to improve movement patterns or improve core stabilization. These positions provide a great deal of proprioceptive feedback and limit compensation patterns so that the desired training goal can be reached. In the half-kneeling position, one knee is placed on the ground with the glute contracted and the hip fully extended while the other hip is flexed with the foot flat on the ground directly in front of the hip. The spine remains in a neutral position with the ribs drawn down. With a narrow base and the pelvis in a neutral position, it is difficult to compensate and find stability through faulty movement, which leads to improved neuromuscular stabilization of the core and body awareness. It is truly amazing how “self-limiting” exercises like landmine presses, Pallof presses, single arm overhead presses, and cable chops and lifts become when performed in half-kneeling. Most of the clients at Parabolic who perform one of these basic exercises in half-kneeling for the first time find themselves falling all over the place even with very little external resistance. They have become so dependent on compensations for distributing force and performing work that when they are put into a position where stabilization can only be achieved through properly timed firing of the core musculature, they are lost. Over time, the brain and body adapt to the demand for trunk stability, and the same clients who weeks before were falling to the ground with a light band Pallof press are challenging the limits of our heavier bands and reaping the stability benefits in more complex movements like squats and deadlifts. Dr. Quinn Henoch of Darkside Strength and Juggernaut Training Systems wrote a great article about the half-kneeling position titled, “Three Reasons Why The Half-Kneeling Position Will Improve Your Training” which you can read here (http://jtsstrength.com/articles/2014/06/17/3-reasons-half-kneeling-position-will-improve-training/), for more detail about the benefits of working in half-kneeling.
Why Stretching Isn’t Always the Answer
When working with athletes we often find ourselves having to adjust highly developed programs on the spot. While it’s great to have a plan and periodized program, it often times works as a road map that we efficiently have to detour around. A combination of countless variables such as a lack of recovery, poor nutrition, training right after a practice or a game, stress, or obviously pain, can act as road blocks causing a coach to acknowledge that the best option for an athlete on any given day may be to make adjustments and scale back. A situation like this does not mean that progress cannot be made to and one should completely scrap a training session. The time for lying around and catching up on your reality TV cannot wait for another day. For beginners or really anyone in the fitness industry that doesn’t have the proper skillset to deal with pain a good rule of thumb is if it hurts – don’t do it. Simple. If it persists – seek out someone who is skilled and get some answers. But how do we figure out what we can do? Sometimes it just takes a little digging. Recently I had a conversation with an athlete that went like this… Nick came in and said his back was “inflamed” and that his doctor told him he “needed to stretch”. Coach: Stretch what? Nick: “He didn’t say”. Coach: What makes it hurt? Nick: “Touching my toes”. Instead of abandoning any productive strength work he planned on doing, we took the approach of finding out what movement patterns could be done well and pain free. Below is the video of his initial toe touch.
Doctors of physical therapy develop programs to prevent ACL injuries
The ACL is located in the center of the knee joint and connects the femur (thigh bone) and the tibia (shin bone). Its primary purpose is to provide stability to the knee. It prevents the tibia from moving too far forward and from rotating too far inward under the femur. There are essentially four separate ligaments that stabilize the knee joint. On the sides of the joint lie the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) which serves as stabilizers for the side-to-side stability of the joint. The MCL is a broader ligament that is actually made up of two ligament structures, the deep and superficial components, whereas the LCL is a distinct cord-like structure. This ligament is frequently injured in contact sports (such as football) and pivoting sports (such as soccer and skiing) – although there are many scenarios for injury to this ligament. Usually the patient complains of a sudden injury to the knee and the inability to walk right after the accident. Often, there is a significant amount of swelling that occurs relatively soon after the injury. In contact sports, such as football, the injury typically occurs when another player impacts the side of the knee. Non-contact ACL injuries are more common in women – such as a female soccer player who suddenly changes direction and feels a pop in her knee. Naturally, women are built differently than men. These differences are evident when examining the muscles and bones of their hips and legs. Compared with men, women have a wider pelvis, and their hips are more flexible and have more rotation; their femur is tilted forward more at the top and is angled more toward the knee; their lower leg is turned inward and angled more toward the knee, but there are forces pushing outward; they have less developed thigh muscles, making the knee more dependent on the ligaments for stability; they have increased flexibility and hyperextension in their joints; and they have a narrower notch in the femur where their smaller anterior cruciate ligament is attached. Why do these anatomic differences cause women to be more prone than men to ACL injuries? Because the thigh muscles are lax, the ACL must serve as the main stabilizer of the knee. However, the small ACL often cannot handle the forces put on it during sports participation, so it tears. Other contributing factors are associated with the sport and with the physical make-up of a woman. Her position, coordination, skill, talent, and coaching affect the way the female athlete uses her body and can affect whether she is at increased risk for ACL injury. A poorly conditioned or overweight body puts more pressure on the knee joint and puts the athlete at greater risk for ACL injury. Hormonal levels at certain times during the menstrual cycle and extremely low percentage body fat cause the ACL to be more lax and, therefore, at increased risk for injury. Recent research is pointing towards a biomechanical difference predisposing them to increase stress and risk of ACL. Some of these differences are weak hip musculature (Abductors and glute max and med), delayed muscle sequencing and poor body mechanics and lack of hip loading playing key roles in the tear of ACL’s. Doctors of physical therapy are continuing to do research to find the exact reason for this problem in women and to find the best ways to prevent it. The majority of ACL injuries suffered during athletic participation are of the non-contact variety. Three main non-contact mechanisms have been identified: planting and cutting, straight-knee landing, and one-step stop landing with the knee hyper extended. Pivoting and sudden deceleration are also common mechanisms of non-contact ACL injury. Basketball, soccer, and volleyball consistently produce some of the highest ACL injury rates across various age-groups. Other activities with a high rate of injury are gymnastics, martial arts, and running. In most sports, injuries occur more often in games than in practice Notably female athletes have been shown to perform athletic maneuvers with decreased hip and knee flexion, increase quadriceps activation, decreased hamstring, glute medius recruitment leading to increase valgus moments and stress. Some other factors that may contribute to ACL’s in both men and women is, decreased proprioception, and impaired motor control and patterning. Ligament injuries are usually graded in terms of their severity: Grade I sprain – some micro-tearing or slight stretching occurs, however the overall integrity of the ligament is preserved. The ligament hurts if stressed but is stable. Grade II sprain – partial disruption of the ligament. Painful to stress, there is detectable laxity but the ligament has an eventual endpoint. Grade III tear – complete ligament tear and laxity with no endpoint or stability to testing. As the nerves in the ligament are torn too, there is often minimal pain with stressing the joint If you tear your ACL there are several techniques that can be used to repair it, with a patellar tendon graft being the gold standard. We will forgo this discussion for another time. How can one prevent an ACL tear is the more important question? One should see a qualified health professional, one who can perform an in depth evaluation and analysis ranging from strength, range of motion testing and movement pattern analysis. Once this has been performed and one has been medically cleared to start a training regiment, here are some exercises and key points that should be focused on. Proper hip hinging / hip loading pattern should be developed, this can be developed with exercises like squat, deadlift and straight leg deadlift. Hip strengthening and sequencing focused on glute medius and max should be developed, some exercises that have been shown to have the greatest recruitment have been clamshells with the hips flexed to 60 degrees, sidelying abduction, and side steps. Another component that is key is proprioceptive or balance training, which should be performed on double or single leg and on a variety of surfaces to challenge the bodies system. Once these basics areas are addressed, higher level and more sport specific activities maybe be performed, with focus on plyometric training, accelerating and decelerating, cutting with emphasis on hip flexion to decrease the stress on the knee. At Parabolic Performance and Rehab in Montclair our Doctors of Physical therapy can perform a thorough evaluation of an athlete in order to determine if they are at risk for an ACL injury. The assessment will serve as a road map for the areas that need to be addressed, and the athlete will be given a program to continue to perform on their own in order to stay injury free.
Instrument Assisted Soft Tissue Mobilization
The way in which physical therapist are performing soft tissue mobilization or massage has changed recently. A growing number of physical therapists are moving towards IASTM, or instrument assisted soft tissue mobilization. This entails using some sort of hard edged instrument made of metal, plastic or ceramic in order to apply a force to soft tissue in an attempt to increase the body’s healing response. The tools provide advantages for both patient and therapist. They provide palpable feedback as they cross the affected fibers of the patient’s soft tissue, thus allowing the therapist to be efficient in their treatment. The other advantage is that they allow for an increased, focused amount of force to the affected area without significant discomfort to the patient or increased stress to the therapist’s hands. The most popular theory on how the instrumentation works is that the contact between the tool and the underlying tissue causes micro-trauma that results in an increase in the number of high quality fibroblasts. Fibroblasts are cells that are produced by the body during the healing process of tissue. The “scrapping” of the tool over the affected tissue also helps convert collagen scar tissue to functional tissue with proper alignment of the tissue fibers. This will allow for normal elasticity of the tissue and as a result decreased pain with movement and functional activity. The doctors of physical therapy at Parabolic Performance and Rehab frequently use IASTM on conditions that range from scar tissue build up after surgery, to tight muscles resulting from overuse injuries. If you have any questions regarding how IASTM is performed, and if it could help your particular condition, feel free to contact one of our doctors of physical therapy at either our Montclair or Little Falls offices.