Tag Archives: rotator cuff

Wall Angel Series

This video is on our wall angel series which might be the best scapular movement we do.  When done correctly, wall angels are one of the hardest exercises I’ve ever done.  Simply put they aren’t fun and they will make athletes sore in area’s they didn’t know exist.  We generally perform wall angels for 3-5 reps with controlled tempos as in a 5 count up and down w a pause at the top and bottom.  Or we might do a 2-3 count up and down with a 5 count pause at the top and bottom.  In either case we want control.

Quick points:
1. Make sure athletes keep their spine flat on the wall.  Don’t arch or let the rib cage flare up.
2. We want them actively driving their arms into the wall not just sliding up and down.  Even if they can’t get their arms to the wall we want them actively trying.  This alone helps to stretch out the anterior shoulder and chest into more external rotation.

Progressions:
1. Once we have worked for several weeks on the wall angel we can progress to include more dynamic stability using the bands.  Athletes partner up and can move the bands in any direction.  The more the better.  The athlete on the wall is forced to stabilize in any number of direction at a given moment.
2. The last progression that didn’t make it in the video is performing the dynamic stability version with the eyes closed.  Athletes now can’t react to what direction they see the band moving.  This really requires much more stabilization and kinesthetic awareness.

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Scap Wall Slides for Throwing Athletes

Scap wall slides are great for the overhead athlete to activate the serratus anterior, a big time muscle for the overhead / throwing athlete. The serratus is an overlooked muscle in the grand scheme of shoulder function, but it might be on the of the most important for throwing athletes.  Right now, we’re perfomring scap wall slides as an activation warmup series prior to all our upper body work.  We usually focus on 2-3 sets of 5 reps with controlled movement and pauses at both ends.

Serratus Anterior Posts

Check out some of these previous posts for more info on the serratus and the scapular function and how to tie more serratus work into your training.

Activation Circuit

Ya, it’s been a while since my last post.  Life has been super busy lately.  Between fall ball officially ending and our true off-season training for baseball starting up, attending the ALDS, and World Series, as well as a few articles that you’ll see in the coming months, October was busy.  So with that behind me I can hopefully get back to it. 

This is a short video of an activation / recovery circuit that we did today.  This circuit had 4 exercises that were performed 3 times through with no rest.   We also perform some form of rotator cuff / scapula training that I didn’t include in the video as a part of this circuit. 

Our first exercise of the video is our Marching Man on a Stability Ball (Feet on Box) w/ WT.  This is 100% for torso stability.  We don’t utilize crunches, situps, Russian twists, etc.   All of our core work is in the form of stabilizing the lumbar spine.  This is how the body functions in sport.   Something stabilizes while other joints around it are mobilized, or moving.  The torso should be trained to aid in stability and transfer power to the linkages.  If you are in question about any of my philosophy on the spine, then look to any of Dr. McGills works. 

The second movement on the video is the Scap Pushup on the P.P.  w/ Feet Elevated.  In a study by Lear and Gross it was determined that the feet elevated pushup plus (scap pushup) produced much higher activation levels in the serratus anterior than with the feet on the ground. 

An electromyographical analysis of the scapular stabilizing synergists during a push-up progression.

Some form of glute activation is the final movement.  Today, this was the Outside Leg Raise w/ Resistance.  In a study presented a year ago in the Journal of Orthopaedic and Sports Physical Therapy the side lying abduction is far and away the best exercise, by over 20%, for stimulating the glute medius.

Gluteal Muscle Activation During Common Therapeutic Exercises

This small circuit usually takes right at 12 minutes to complete and goes a long way to developing some of the often over looked areas in an athlete.

Shoulder Series and the Sleeper – Part II

We’ll continue our shoulder series with Part II today.  Be sure to read Part I if you haven’t already. 

So with the athlete in question that we talked about in Part I the overwhelming question is what do we do with him now. 

Well the non glamorous answer is that we just have to stretch him.  We have to restore that range of motion quickly as our fall ball season is starting in less than 10 days and pitchers are already starting to throw bullpens.  I will manually stretch him every other day, and this is only due to our schedule this week.  Starting next week I will be able to stretch him everyday.  In the mean time he will still stretch himself at least two times a day, everyday, with a variety of different movements, as well as be stretched by our athletic trainer everyday.  I would rather have increased frequency when it comes to stretching than a high intensity only once per day.  Doing three sessions per day easily is in my opinion much more effective. 

Sleeper Stretch

When he stretches himself he will do so with the side lying sleeper stretch as well as the side lying cross body stretch.  We teach our athletes to be gentle with these two variations.  Depending on the severity of the deficit in the affected arm, we will hold our reps 5-15 seconds with anywhere from 3-7 reps.   The below photo is the athlete’s first time trying the sleeper stretch with our technique. When we’re in the weight room we have the availability to utilize the foam rollers as a head support, which I stole from Eric Cressey.  It also gives athletes a cue as to being in the proper position as well.  I’ve had a lot of good feedback from adding in the foam roller for support. 

From here on out we will re-evaluate his motion every week until he has regained that motion. 

He will continue with all his all important scapular stabilization work training the lower and middle trap, as well as the serratus anterior. 

Alongside of that we have active stretches that will help generate more internal rotation as well.   These are tied into our thoracic spine mobility program.  Obviously the t-spine is super important when it comes to shoulder health and directly tied into the act of pitching.  Here is one of our upper level t-spine progressions. 

Our final screen of the fall revealed a case that I find awesome.  I’m sure the kid was thrilled when I mentioned I’d never seen anything like that and to get my camera.  We took several pictures and videos of him and will be posting in the shoulder series I have going at the moment.  In the coming days I’m planning on going over impingement, the different forms of, and the treatment options to relieve the problems.  The beauty of having 10 new incoming athletes to our program right now gives me loads of information and I get to see a whole new host of problems and then talk about it fixing them here. 

Related Posts:

Are Your Scaps Working?

The Other Shrug

Bench Press vs. Pushup

Rotator Cuff and the Towel

I’m no stranger to shoulder problems as I suffered through four shoulder surgeries during my time as an athlete.  Throughout all my rehab I always wondered what was the purpose of placing a towel under the arm during external rotation movements.  Well if you don’t know why you’re doing it either then you’re in the right place. 
Cable External Rotation
The towel actually increases activation of the rotator cuff 23% according to a study in the Journal of Orthopaedic and Sports Physical Therapy.  It helps to de-activate the deltoid and avoid compensation patterns.  Without the towel the deltoid can assist in the movement and actually overpower the rotator cuff. 
Side Lying External Rotation
When this happens the humeral head can superiorly migrate.  This isn’t a good thing when doing anything as the two main functions of the rotator cuff are to 1. stabilize and 2. depress the head of the humerus in the glenoid fossa.   This is why its important not to overdevelop the deltoid, or negate training the rotator cuff. 

 

Deltoid pulls humerus superior

The deltoid and rotator cuff are in a constant battle for humeral head placement.  A weakened rotator cuff or too much deltoid strength causes the upward shift, and with this upward movement comes impingement, bursitis, rotator cuff tears, etc.  The sub-acromial space is already small enough and we don’t want to shrink it even more. 

We don't want to close the sub-acromial space anymore!

Sleeper Stretch

Many of the athletes associated with throwing sports have experience with the sleeper stretch.  The sleeper stretch is for those with glenohumeral internal rotation deficits commonly known as GIRD.  This problem occurs most often in overhead throwing athletes.  Every time an athlete throws a ball there are huge distraction forces that occur at the release of the ball.  This repetitive stress causes the posterior capsule of the shoulder to tighten and a loss of internal rotation occurs.  When this deficit becomes too large the risk of injury increases.  Eliminating this deficit is very important when we do find one.  Properly teaching the sleeper stretch is by far the most important aspect.

1. Set the scaps first and foremost
Too many athletes perform the stretch incorrectly.   The most important aspect of correctly performing the sleeper stretch is making sure the scapulae are retracted and depressed throughout the movement.  Stabilizing the shoulder blades allows for the stretch on the external rotators.  Without keeping tight, the stretch becomes ineffective and can actually cause problems a host of other problems to the shoulder capsule.

Depress and retract the scaps

2. Stack the shoulders. 
From that stabilized position we roll up onto the shoulder making sure to keep the scaps drawn back and down.  Keeping the scaps stabilized means we need to keep the shoulders stacked on top of each other when we roll on to the shoulder.  When the shoulders don’t stay stacked and we have an angled slope from our top shoulder down to the bottom, the scapula isn’t stabilized. 

Stack the shoulders
Good setup! Shoulders stacked.

3. Light stretch
This should be a relatively light stretch and not to the point that it causes pain.  With this setup placing a foam roller under the head would be ideal.  Many times athletes won’t always have access to a foam roller to keep the cervical spine in a neutral position.   Athletes should take note of when they’re doing the stretch wrong because they shouldn’t be able to get anywhere close to the ground with the forearm.  Most athletes won’t get to a 45 degree angle even.  If you’re athletes can get to the ground, check their scaps.  The range of motion is gained through the moving scapula. 

Keep shoulder down on the ground

 Here’s a quick example of not keeping the scaps retracted and depressed with the shoulders stacked.  You’ll notice the angle from the top shoulder to the bottom.  Also, take note that the posterior aspect of the shoulder is coming off the ground.  That’s a sure sign that the scapula is moving.  In this picture it appears that this person has a good degree of internal rotation.  Remember, I said most athletes won’t even get to 45 deg. in this stretch.  He really doesn’t have as much motion as it appears.  If he were to stabilize his scaps he would have considerably less motion.  The scapula compensates for lack of motion giving the appearance of a big stretch. 

Improper position
 

The Scap Dip

A great movement for training scapular depression is the scap dip.  Scap depression is extremely important for shoulder health as well as stability.  Depression helps to keep the scapulae out of a rounded over, and pulled forward position.  The pec minor as well as the lower trapezius are responsible for scap depression.  Often, the lower trap is inhibited, and has been lengthened through training, or as a result of lifestyle.  Any work we can do activate the lower trap is important.   When we do pulling movements we want to emphasize not only retraction but depression as well.   I touched on the importance of that in a post found HERE  a few days back.    

Scap Dip - Bottom

 

An important muscle that often gets left out of scapular health is the lats.   The lats can play the role of the devil as it is an internal rotator of the humerus.  However, in the case of the scap dip the lats assist in scapular depression as well.  By focusing on depression we can even out the pull exerted upward by tight levator scapulae, and upper trap, as well as the rounded posture possible with tight pec major / minor.  With this posture comes an increased risk for shoulder problems, and instability.    

Scap Dip - Top

 

 Again, it’s important to focus on technique when utilizing scapular movements.  A perfect example is in the  top portion of the scap dip.  If poor technique is used the scap will move into anterior tilt at the top of the motion.  The movement is now completed by the pec minor.  This takes out the lower trapezius and actually puts it on stretch rendering it useless.  We know that the pec minor is commonly a tight, overactive muscle.  We don’t want to make it any shorter causing a natural anterior tilt of the scapula, again putting the shoulder at risk.  All too often athletes don’t maintain proper technique throughout the scap dip to gain any true benefit. 

 

Don't let your athletes do this at the top

 

Athletes have to make sure they keep a tall chest throughout the scap dip and the shoulder blades pulled back and driven down to complete the movement.  This will fully activate the scapular depressors, which is what we’re after in the first place.