Elbow Pain? Think Twice Before Blaming Your Elbow
There is much more to elbow pain than blaming the sport you play or implement you use. If you’ve had any experience with elbow pain then you’ve likely heard about “tennis elbow” or “golfer’s elbow.” Now, despite being named after a sport, neither of those conditions have very much to do with the sport itself. Yes, it is true that golfers and tennis players commonly experience elbow pain. There is another major commonalty that both sports share that is more related to elbow pain and is usually the key to breaking through elbow pain. When searching for solutions for these elbow issues there are a myriad of takes; “stretch your forearm!”, “perform isometrics!”, “strengthen your grip!” Unfortunately, all of these “solutions” miss the boat on what the actual issue is, and many times don’t resolve the issue at all. Anatomy Overview Golfer’s elbow, or medial epicondylitis, refers to stress and pain in the wrist flexor tendons that attach to the inner elbow. While Tennis elbow, or lateral epicondylitis, refers to the stress and pain in the wrist extensor tendons that attach to the outer elbow. While symptoms vary depending on which side of the elbow hurts, commonly, gripping, pulling/pushing, and throwing motions tend to be painful. A popular theory in Physical Therapy is the Joint- By- Joint theory. This theory states that all joints in your body will alternate between predominantly requiring mobility while the joint above and below requires stability. For instance, the wrist/ hand requires a great deal of mobility to perform daily tasks. The next joint up the chain, the elbow, predominantly requires stability. This is because the elbow is a “hinge” joint, meaning that it mostly moves in one plane of motion (flexion/extension) and lacks a great deal of rotational capability. If the elbow induces a lot of motion outside of it’s “hinge” like movement bad things happen. This is in contrast to the next joint up the chain, the shoulder, which has and requires a great deal of mobility to maintain its normal mechanics. As you can see, we have a predicament in which the elbow, which is not a highly mobile joint is stuck between two highly mobile joints. What happens when we veer off from what’s normal and lose mobility in places where we require it most? We will make up or compensate for that lack of mobility somewhere else. Commonly, it will be the joints closest to where the loss of motion occurs. A Shoulder Issue Masked as Elbow Pain A common missing piece in resolving pesky “golfers” or “tennis” elbow is taking the focus away from the elbow itself and identifying WHY the elbow might be under such a great deal of stress. Often, it is a lack of shoulder motion in specific directions that will force you to make up for that motion with excessive elbow motion and stress. An easy way to visualize how the lack of shoulder mobility will influence the elbow is in a baseball pitch. A baseball pitcher who lacks enough shoulder External Rotation (ER) to get into the proper arm position to initiate the throw will commonly create a gapping mechanism in the inner elbow. This will allow him to make up for the lack of shoulder motion to get into the proper arm position behind him. This gapping in the inner elbow will cause excessive tension on the wrist flexor tendons and over time can result in tendon irritation (tendonitis) or damage to the inner elbow ligament (UCL) that can require surgery (Tommy John). The problem in this instance isn’t the elbow, it’s the lack of shoulder motion that causes the pitcher to find motion in the next best place which happens to be the inner elbow. Addressing factors such as forearm flexibility and tendon strength may provide short term relief of pain. More than likely, those factors will be much more relevant once the root cause of limited shoulder motion is addressed. The next question becomes…how and why did you lose shoulder mobility in the first place? Please refer to our article on the missing piece in resolving shoulder pain to find out more!
3 Ways To Start Improving Your Wrist Pain
Wrist pain, especially on the thumb side of your wrist, can at best be a persistent nuisance, and at worst be debilitating and restrictive. You’ve tried stretching the muscles on the front of your wrist. You’ve tried icing it. You’ve maybe even tried wearing a splint or a brace, but this tricky condition requires a deliberate examination and prescription to make sure you’re addressing the right components of it at the right time to resolve it. What’s the first step? Use these quick and easy screens to begin understanding what movement options your wrist, and hand, have available to them so you don’t waste your time chasing the wrong issue. Understanding How Your Wrist Moves Here’s some simple self-exams you can use to get an idea of what motion your wrist has, and what movements it might be lacking in. [caption id="" align="aligncenter" width="1500"] Figure 1: Movements at the wrist. Source: https://www.crossfit.com/essentials/movement-about-joints-part-3-wrist.[/caption] Wrist flexion and extension, plus radial deviation (movement towards the thumb side, “abduction” in Figure 1) and ulnar deviation (movement towards the pinky side, “adduction” in Figure 1) are the motions that are available at the wrist joint. The wrist joint itself is the connection of the carpal bones of the hand and the radius and the ulna, or your forearm bones. (Figure 2) [caption id="" align="aligncenter" width="1024"] Figure 2: Bony Anatomy of the Wrist and Hand. Source: https://www.assh.org/handcare/servlet/servlet.FileDownload?file=00P5b00000tFPX8EAO[/caption] Step 1: Take your wrist through those motions above. Do any of them reproduce your discomfort near your radius? Which ones feel limited relative to the others? Most of the time, when I’m working with clients with wrist pain near their radius, I find that they are missing traditionally measured wrist extension and wrist abduction. Now, to really figure out WHY they are missing that, we have to appreciate how the position of the hand relative to the wrist. Enter the Pistol Test. If you’ve got a positive Pistol Test, as demonstrated above, you’ve got a hand that is positioned more internally rotated relative to your radius. What this means, is your wrist is biased towards already being in a position of wrist flexion, instead of extension! Most of my clients with this limitation frequently have their wrist pain occur when they’re trying to extend their wrist. Like in the bottom of a push up, or in most weight bearing positions through the hand. Having a hand internally rotated compared to your wrist is biasing your hand to be starting in a position of wrist flexion. If we can compare your wrist joint to an elevator and say that it is in a ten story building, that’s analogous to starting your wrist on the fourth floor and then asking it to go up ten more floors. You’d hit a constraint at the top of the building, which is happening when you’re trying to challenge your end positions of wrist extension, and then winding up with a jam at the inside of where your wrist meets the hand. Instead of trying modalities like icing, or wearing a brace that can alleviate your pain by keeping your wrist out of symptomatic positions, let’s address the movement impairments that are causing your issue. Let’s take the elevator back to the ground floor. First step: we need to get your hand to externally rotate relative to your wrist. I like Staggered Stance Curls to accomplish this. Use a light weight and make sure to hook your thumb behind the bar of the dumbbell to lock in the hand external rotation. [embed]https://youtu.be/N4WWxUmvcw8[/embed] Once you’ve worked on that for a while, recapturing your wrist extension requires you to learn to get your wrist to internally rotate relative to a fixed hand. Enter the Low Oblique Sit with Pronation! This side plank type activity uses a towel to fix your hand while you internally rotate your radius. [embed]https://youtu.be/D7LhuuTcMD0[/embed] We’ve recaptured our hand position, we’ve learned to move our radius relative to our hand, now let’s challenge our wrist position. I like bear crawling to progress to this point. [embed]https://youtu.be/1HdyUZsZr_c[/embed] As you load one side, you want to feel your weight shift from the outside of the hand towards the inside. Don’t lose contact with the outside of your hand when that weight shift happens! Begin working on appreciating what motions your wrist can or can’t do, and then work on training the movement strategies you need to obtain that motion, so your wrist has plenty of freedom to move. Using these activities can be a great start towards the end of your wrist pain!
The Infamous Tommy John & Baseball
If you were to assess how great a pitcher in baseball truly is, you might find yourself looking at a lot of statistics…specifically the ERA or Earned Run Average. With the goal to strike out everyone who dares to step into the box against them, they must not only possess a superior amount of talent and skills, but an ability to demonstrate a large amount of power. Multiplied by about 100…pitches that is. Across sports, only a small number of athletes have to exert the same level of power quite as frequently as a baseball pitcher. Now, if specialized at a young age to be a pitcher and across several teams per year, this amount of power, volume and overall stress placed on the elbow and its surrounding structures can not only take a toll, but potentially wreak havoc on the players future…at least that is what we thought. Typically beginning as a low level condition, such as Little League Elbow (a condition that is simply a byproduct of insufficient rest periods between pitching outings) or Acute bursitis (inflammation of localized fat pad), a baseball player’s elbow joint has to be able to absorb a tremendous amount of force and repetitive stress across seasons. This type of overhead throwing irritates not only surrounding tendons and ligaments that are responsible for support, but predisposes pitchers to more serious issues, such as an Ulnar Collateral ligament (UCL) injury. As a result of increasingly large prevalence in young players over the last few years, this once seen injury in mostly adults has prompted many governing bodies to change the rules. The American Sports Medicine Institute (ASMI), USA Baseball, Little League Baseball, Major League Baseball organizations to establish Pitch Count Guidelines. With many efforts being made to protect the new generations of baseball, higher level players continue to remain at risk. The Ulnar Collateral ligament (UCL) injury The ulnar collateral ligament (UCL) has been amongst the most commonly injured ligament in repetitive throwing / overhead athletes. In order to accommodate the large volume of power that is created to throw a baseball 60 feet, the ligaments stretch and elongate until it can no longer bear the capacity to maintain the elbow’s integrity. Like any ligamentous injury they can range in severity and true structural damage/complexity. They range from a minor sprain with light damage and inflammation to a complete tear. UCL Symptoms Include: Pain with throwing or inside of the elbow Instability Decreased strength or power in throwing Increased sensitivity around the ulnar nerve “funny bone” causing numbness and tingling in the ring and pinky finger Diagnosis and Treatment A UCL injury is diagnosed following the results and clinical presentation together after a physical examination, in conjunction with diagnostic imaging, such as X-ray & MRI. Indications on next best step are contingent upon severity of structural damage, healing time, rehabilitative exercises, inflammation management, further evaluation may be indicated. Further assessment with a physical therapist or athletic trainer may be warranted to determine if throwing mechanics, inefficient body positioning, compensatory techniques/strategies, and sequencing caused excessive stress on the elbow. Oftentimes if a pitcher does not have full access to shoulder motions required to pitch effectively, the torque to generate the power required needs to come from another place…I bet you know where that is! INSIDE THE ELBOW! Yes, inside the elbow. Now, normal pitching mechanics on average require 300 N (67 lbs) of torque along the inside elbow… normal. Can you imagine the level of stress taken on by the elbow due to abnormal pitching mechanics multiplied by 100 pitches per game over the course of a full season? Tommy John and His Influence Named after former LA Dodgers Pitcher, Tommy John, the surgery has dramatically impacted baseball and throwing athletes. Used as a last resort now for UCL injuries, outcome measures have drastically increased since this surgery gained traction in the baseball community. TJ Surgery is a surgical graft procedure where the injured UCL is replaced by a tendon graft taken from the forearm or hamstring tendons. The procedure is followed by an intense rehab program that consists of several phases on average lasting 6 to 12 months. What was once a career ending injury is now a symbol of hope for many overhead athletes looking to continue the sport they love! Today the UCL Reconstruction is a commonly performed procedure and emphasized in rehabilitation education programs. If you have any questions regarding this topic please consult your primary care physician or stop by Next Level Physical Therapy and we will gladly speak with you about it.
Hand Going Numb? Check Your Thumb – How the Relationship Between Your Hand and Wrist Movement Can Affect Your Carpal Tunnel Syndrome Symptoms (Part 1/2)
Carpal tunnel syndrome is a collection of symptoms that most commonly appear in the thumb, index and middle fingers on the palm side of the hand. The hallmark symptom of this is aching or a loss of sensation in those three fingers specifically. Typically, these symptoms are arising because the median nerve is experiencing a prolonged compression where it crosses into the hand at the “carpal tunnel” – or a small loop of tendon overlapping several muscles that run into the hand and the median nerve at a very small space near the bones of your wrist. (Figure 1). [caption id="" align="aligncenter" width="600"] Figure 1: Anatomy of the carpal tunnel region and the median nerve. The nerve in the middle that runs to the thumb and middle finger is the median nerve. Source: https://qph.fs.quoracdn.net/main-qimg-2effc0be8c4ff02f065339aebda08596-c[/caption] The most common courses of treatment that I see recommended are prolonged static stretches of the muscles on the front of the wrist and forearm, active range of motion exercises for the wrist and hand in all motions, stretching of the thumb muscles, and tendon and nerve glide activities. What all these activities have in common is that they are being prescribed with the goal of reducing the compression on the median nerve. Nerves love movement, blood flow, and space around them. The intent of what needs to happen during treatment is spot on – it’s why the surgical option to try to alleviate the symptoms is to cut that white-colored tendon you see running between the thumb and pinky muscles, to make more space over the median nerve. While there is nothing wrong with these activities, not all interventions have the same effect. If we are trying to create room around the carpal tunnel, we need to appreciate the position of the hand versus the wrist, because many of the muscles that cross the carpal tunnel cross or directly attach to these bones. Stretching muscles statically mostly just increases the tolerance of a muscle to being lengthened, and does not do much to address the qualities or behavior of muscles or tendons from what the latest research on stretching tells us (PubMed ID# 28801950). Plus, prolonged tension put onto a nerve that is already compressed can be like stretching an already taut rubber band more – it’s not going to help to reduce the tension in that structure. So, instead of just focusing on a muscle or muscles that are “tight”, let’s instead focus on helping the bones of the hand and wrist be able to get into a position to “unstretch” the rubber band and help give that nerve more space around it to help it be able to move more freely. The picture below shows an example of a thumb that is internally rotated (the yellow area) relative to the position of the wrist. The blue arrow shows a thumb that is better able to externally rotate relative to the wrist than the yellow arrow. (Figure 2) [caption id="" align="aligncenter" width="960"] Figure 2: An example of differing thumb and wrist orientations. Source: https://i2.wp.com/plasticsurgerykey.com/wp-content/uploads/2020/06/10-1055-b-002-98003_c049_f001.jpg?w=960[/caption] Can you see how stretching the muscles of the yellow hand might have a completely different result than the blue hand? The same solution applied to these two different hands does not yield the same outcome. In the next part of this discussion, we’re going to talk about how to tackle getting a more effective solution to create space and movement around the median nerve and possibly eliminate symptoms in the carpal tunnel that are tailored to the specific presentation of the yellow hand.
The #1 Missing Piece In Resolving Shoulder Pain
Are you Treating the Problem or The Result? Shoulder “problems” are incredibly common amongst the athlete and active adult population that we see. As therapists, we see traditional diagnoses such as shoulder impingement, tendonitis, and rotator cuff injuries daily. Traditionally, these common issues are blamed on weak rotator cuff muscles, scapular winging, imbalance of muscle activity, etc. One major thing to understand about these diagnoses is that they are not the actual problem…they are a result. A result of deeper-rooted movement habits and mechanics that usually go unaddressed in the traditional rehab process. Typical solutions for these “results” are equally short- sighted. Frequently these solutions, which include stretching, rotator cuff strengthening, and general strength training, miss the mark as far as resolving pain. Why? Because they are addressing symptoms and not the thing that has caused the faulty mechanics, the need to over- use certain musculature or orient musculature in a disadvantageous position. To truly understand what the biggest missing piece is in resolving these common shoulder issues we first need to understand how the shoulder behaves. A Quick Anatomy Lesson of the Shoulder Complex The shoulder complex is made up of 4 major components: The glenohumeral joint (ball and socket), the scapula (shoulder blade), the sternum and clavicle, and the rib cage. Shoulder movement in any direction requires rotation of the humeral head (ball) within the glenoid (socket). Because the shoulder has so much freedom of movement, stability of the joint needs to be ensured. That is why every shoulder movement is accompanied by scapular movement. Since the actual socket of the shoulder joint is on the scapula, its movement is vital in maintaining the humeral head centered within the glenoid during shoulder movement. When the humeral head doesn’t stay centered within the socket is when things like shoulder impingement occur, proximal biceps tendonitis rotator cuff injuries occur For a shoulder joint to move well, you need a scapula that can move in congruence with the humerus. What allows the scapula to move? The scapula has a slight curvature to its shape. The scapula sits on a rib cage that has a roundness to it due to normal thoracic kyphosis or curvature of the upper back. The roundness of the upper rib cage and the curvature of the scapula allow the two to maintain congruency with each and allows the scapula to rotate about its normal motion in support of the humeral head. The position of the rib cage and its ability to expand appropriately to support the scapula is essential for normal scapular movement that allows for normal shoulder movement without compensation. Rib Cage Position and Expansion The rib cage, under normal circumstances should be able to expand circumferentially (360 degrees) during normal breathing. During every inhale, the lower ribs should move outward in what’s called bucket handle movement while the upper ribs and sternum move up and out in a pump handle movement. The backside of the rib cage should reflect a similar movement, especially in the upper rib cage. It is when the rib cage lacks these normal, requite movements that things like scapular position and as a direct result, shoulder mobility, are negatively affected. For example, when the back side of the upper rib cage becomes too restricted in its movement or flattened due to chronic muscular tension in the upper back you will see a limitation in scapular movement. A curved scapula on a flat surface does not achieve the same movement and rotational capabilities as one that is on rounded, congruent surface. Remember, without scapular movement the shoulder joint either cannot access normal movement or will have to move through compensatory mechanics to get there. Chronically moving in to ranges that you don’t have access to or compensating for movement limitations is exactly what leads to frequent pressure and tension in the same area i.e., shoulder impingement, biceps tendonitis, wear and tear of rotator cuff tendons, etc. How does one lose normal rib cage mechanics? This is easiest to see in an activity like resistance training. Most movements in the gym emphasize “shoulder blades back and down” for “stability.” No matter whether you’re pushing or pulling, back squatting or deadlifting, the rib cage and scapular position are relatively the same. A similar effect occurs from the ill-fitted advice to pull your shoulder blades back and down for “good posture.” Chronically spending time in a scapular retracted position will both prevent normal scapular movement and flatten the upper rib cage resulting in the need to compensate to achieve the desired shoulder movements. The Solution To truly resolve shoulder pain, you must start at the source. Yes, there are many other factors involved in shoulder pain; rotator cuff strength, dynamic stability, local tissue inflammation, etc. Regardless of these issues you must understand and resolve what lead to these issues in the first place, otherwise you are just treating a symptom. If your goal is to improve the mechanics and motion at the shoulder joint, you need to ensure proper scapular movement. To have normal scapular movement requires a rib cage that is positioned properly and can expand in all directions to provide a foundation and support for the scapula. Once you have established a proper foundation, all factors mentioned before can be addressed with much greater success. Below are 2 examples of drills to implement into your program to improve ribcage expansion: Seated Zercher Breathing Video [embed]https://www.youtube.com/watch?v=3CtDqIZnC_U[/embed] Seated Back Expansion Video [embed]https://www.youtube.com/watch?v=24K6f7OMDXE[/embed]
Ditch The Theraband To Build A Confident Shoulder
The foremost principle that guides rehabilitation is the SAID Principle – or “Specific Adaptations to Imposed Demands”. Simply put, this principle of physiology tells us that our body adapts to the specific demands that are placed upon it. Perform enough aerobic exercise and your heart adapts by increasing the size of the muscles in your left ventricle. This increases the amount of blood your heart can pump with every contraction, and your resting heart rate drops. The same adaptations effect the hormonal function of the nervous system and tend to decrease your resting blood pressure as well.1 The tendons of sprinters become increasingly stiffer as they train to be faster and faster. This is a positive adaptation – think of the last time you struggled to change the roll of bathroom tissue because the spring was stiff and kept snapping back quickly. A stiffer spring (tendon) releases more energy when it is deformed (stretched) and makes the sprinter more likely to win his race. When an injury is present, either to a muscle, or a tendon, or another part of the structure of the joint, this has happened because that area was applied a stress, or repeatedly more stress, than it could positively adapt to. When you trip over something and roll your ankle in the classic position shown below in Image 1, you sprain the ligaments and strain the muscles on the outside of your ankle because you loaded them at a speed and magnitude in which they were not adapted for. Meanwhile, in the Far East, there are historical truths about mixed martial artist practitioners being able to break stone with their shins without hurting themselves, because they have repeatedly exposed their shins to those compressive forces by kicking trees and harder objects for years. [caption id="" align="aligncenter" width="652"] Image 1: Despite this being Klay Thompson of the Golden State Warriors, my left ankle was in this same exact situation about a year ago. Source: https://i2.wp.com/b-reddy.org/wp-content/uploads/2016/07/klay-thompson-right-ankle-sprain.jpg?ssl=1[/caption] How does this relate to a shoulder injury though? If we want to restore the function of someone’s shoulder to being able to tolerate more and more physical stress and use without a negative adaptation like injury, we must now follow the Goldilocks Principle of rehabilitation (image 2) and find a dose of stress that is “just right”: not so much to drive a negative adaptation, but enough of a stress to start to drive a positive adaptation. When it comes to our ability to produce force or restore freedom of motion in a joint following injury, this chart below is a useful illustration of that Goldilocks principle. Image 2: Volume vs intensity threshold for gaining an adaptation. (Joel Jamieson’s “Ultimate MMA Conditioning”) Resistance tubing, often used by the commercial brand name of “Theraband”, is one of the most common images conjured up when folks are asked what they think of physical therapy. And despite the title of the article, I am not against the use of Theraband or tubing. For people in the early stages of rehabilitation from a shoulder injury, resistance tubing can be a very useful tool for giving a low dose of resistance that may be enough of a challenge to recapture strength, or to give enough resistance through a range of motion to help someone improve their ability to control their arm in challenging positions. Tubing can also be very useful for helping to give you external resistance so you can feel your body and shoulder getting into different positions to help you restore range of motion (link to an article about “position restoring range of motion”). If our goal is to build a shoulder capable of producing and absorbing significant forces, we need more force than just the band can provide, so that we can find the right dose of “volume and intensity” to help us get stronger. Sidelying Kettlebell Arm Bar Activities like the kettlebell or dumbbell arm bar, shown above, are a great entrance point to retraining rotation at the shoulder with greater loads. They are also effective at retraining the ability for the shoulder blade to turn to accommodate improving smooth total movement of the arm. Hooklying Dumbbell Pullover The hooklying dumbbell pullover is another way to improve range of motion, and strength across a whole range of motion. This is a way that I commonly help clients improve their ability to go overhead without using a substitution from their lower back, and to get them confident in keeping heavier objects overhead. Staggered Stance Landmine Press Landmine pressing, shown above, is a great way to load all the muscles that work around the shoulder, and eventually with a substantial amount of load. Landmine pressing is easy to modify to train the timing of rotation of the ribcage with rotation of the shoulder and shoulder blade to improve different aspects of upper body performance. If you’re returning from a shoulder injury, make sure that you’re aware of what you’re trying to accomplish with the exercises that you choose to do. Not all rehab has to look like bands and two-pound weights. It should be intense enough to prepare you above and beyond what you need your shoulder to do. Make sure you’re getting the adaptations your shoulder needs with the time you are investing in your rehab. References Farrell C, Turgeon DR. Normal Versus Chronic Adaptations To Aerobic Exercise. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572066/
Your Scapula Is NOT Dysfunctional
I think we can all agree that shoulder pain sucks. Personally, I use my arms all of the time. To put on clothes, shower, feed myself, drive, lift weights, do pushups, write this article, and a whole lot more. If you’re anything like me, you do too. There are a lot of possible causes of shoulder pain, but if you’re in a group of people diagnosed with scapular dyskinesis, scapular instability, or scapular dysfunction, which are essentially the same thing, I have something to tell you. It’s the truth, but I don’t know if you’re ready for it. Are you sure? Really really sure? Alright, you asked for it... There is no such thing as a dysfunctional scapula 😱 I know, you must be shook, but allow me to climb onto my soap box for a minute. I believe that the word “dysfunctional” has no place in a discussion about how bodies move. It reinforces unhelpful narratives around our bodies being fragile or broken, which can lead to hesitation, fear avoidance, and increased risk of repeat injuries. How? Our good friend Dumbledore said it best: (his beard is filled with wisdom) Using the word dysfunctional implies that there is a functional, normal, and/or correct way for a shoulder to move. Those who are dysfunctional are therefore abnormal, incorrect, and at risk for harming themselves. The terms dyskinesia, abnormal mechanics, and instability have similar issues. They’re binary. You’re either normal or abnormal with no room in the middle. It’s unintentional mental framing that leads to a self-limiting belief. People with these diagnoses commonly avoid activities out of a fear of making things worse, which in the end actually makes things worse! Just because your shoulder doesn’t work as well as you want doesn’t mean there’s something wrong with it. You just need to figure a few things out. The anatomy is important here. There are three main structures to consider when thinking about the shoulder: the ribcage, the scapula, and the humerus. The scapulo-thoracic joint is between the ribcage and scapula while the glenohumeral joint is between the scapula and the humerus. The scapula is responsible for about 30% of your total shoulder motion, and the scapulo-thoracic joint operates as a “floating” joint with no direct bone-to-bone attachment to the body. Your upper arm bone, the humerus, connects into a socket on the outside edge of the scapula. Your shoulder blade floats because as it moves so does the socket. It can therefore orient and position itself in a wide variety of ways, allowing you to get your hand into a lot of different positions. The shoulder has more range-of-motion than any other joint in the body. The more motion you have available the more complex movement becomes, and the harder it is to control. This is where the conversation of stability comes in. For the sake of this discussion I’m going to define stability as the ability to resist unwanted motion and/or to return to a desired state after being moved. This is why the common treatments for an “unstable” shoulder include activities like bosu planks, having your therapist slap your arm around while you hold it in one place, lifting and carrying weights hanging from bands, etc. The intent is good but the application is often poor, leading to inconsistent and incomplete results. These activities are complex, with a lot of variables to control. For someone who is already having issues, it’s a lot to ask. A better approach would be to start with development of passive motion, allowing access to the arm positions needed. Next step would be active motion within this newly acquired motion. From there we need to start producing force in all of these positions and developing both strength and consistency in the desired motor patterns. If the issue still exists at this point then, and only then, do we get into the fancy stuff. For example, I wouldn’t have a client do any form of an “unstable surface” pushup until they can clearly demonstrate 20 crisp and consistent repetitions of the strict pushup first. While complex, highly variable, dynamic activities might look sexy they are the top of the pyramid, not the bottom. You need to properly build the foundations before you get there. If you’ve been struggling to get your shoulders back to where you want them to be, and you feel like you’ve tried everything, I highly encourage you to go back and master your basics using the progression above. If you can’t figure it out, hire a skilled professional who truly understands the process. There’s nothing wrong with your shoulder, it’s just struggling to manage complexity.
Top 5 Exercises For Instant Shoulder Pain Relief
Shoulder pain is a commonality amongst many; from our high level athletes, to our weekend warriors, and everyone in between. Despite being such a common complaint, there are a variety of reasons and causes why someone might be experiencing shoulder pain. Some of the most common causes can include: overuse conditions, which may be common in someone like a baseball pitcher; degenerative conditions, or gradual wear and tear over time; or an acute injury to the shoulder, like falling on an outstretched arm. Regardless of the cause, oftentimes the best way to get out of pain and let this area begin to heal is by changing the position and posture that your body is in. By changing our body’s posture, this can open up more space in the shoulder area and allow for healing to occur. If you are currently experiencing shoulder pain, I always first recommend getting evaluated by a licensed professional in order to get a customized plan to best fit your specific needs. However, in the meantime, here are my top 5 exercises for instant relief from shoulder pain. These are by no means a long-term solution, but will get you feeling good so you can get through your day and your workouts without pain holding you back! 1. Banded Shoulder Distraction 3 sets x 30 sec hold [embed]https://www.youtube.com/watch?v=foTgEqbKGUQ[/embed] Grab hold of the band, straighten out your arm and bend forward slightly at the hips. Try to relax into this and let the band pull your shoulder. This will provide a nice traction force, which will open up room in the shoulder joint and take pressure off of any impinged or injured tissues. You should also get a really nice lat stretch with this, which is something all of us avid gym-goers could always use! 2. Banded Bully Stretch 3 sets x 30 sec hold [embed]https://www.youtube.com/watch?v=7JHZwYrSDoY[/embed] Hang a 1-1.5 inch band from a squat rack, pull up bar, or something else high up and sturdy. Put the band around the top part of your humerus (upper arm bone), as close as you can to where your arm meets your shoulder. Face away from the band, and place your hand behind your back as though you were being handcuffed. Step forward until you feel a good amount of tension on the band. You should feel a nice stretch deep inside the shoulder. This is another move that is really great to open up more space in your shoulder joint and make you feel better! Try this one out before or after an upper body lift. 3. Seated Back Expansion 5 sets x 5 breath cycles [embed]https://www.youtube.com/watch?v=OCUzQOT0Ij0[/embed] Set yourself up in a chair at a table about knee height. From here, put your elbows on the table straight in front of you. Make sure elbows are directly in front of your shoulders and palms should be facing you. Lean slightly forward, and reach your chest away from the table. Try to keep your abs tight, and take 5 deep breaths while holding this position. You should feel a nice stretch right behind your shoulder blades and throughout your upper back! Oftentimes cranky shoulders are a result of a stiff thoracic spine, or upper back. The following two exercises are great ones to open up your upper back and put your shoulders in a better position to move freely. 4. ½ Kneeling T-Spine Rotation 3 sets x 8 reps each direction [embed]https://www.youtube.com/watch?v=njY2DlYMnPo[/embed] Find a wall and a foam roller. Get as close to the wall as you can in a half kneeling position. Put the roller between the wall and your outside knee, and keep your knee pressed against the wall the whole time. Hold both arms out in front of you at a 90 degree angle, with the inside arm against the wall. Rotate torso and outside arm, and try to touch the wall behind you. Go as far as you can while keeping your knee against the foam roller. Make sure to hit both sides. 5. T-Spine Bench Mobility 3 sets x 10 reps, 3 sec hold [embed]https://www.youtube.com/watch?v=n2iwe5LNVmY[/embed] Grab a PVC pipe or stick and a weight bench. Sit on your knees in front of a weight bench. Hold the PVC in both hands, palms up, and place your elbows on the bench in front of you. Slowly sit your butt back, drop your head, and bend at the elbows to feel a good stretch through your upper back.