Podcast Master Instructor Roundtable

Master Instructor Roundtable: All About the Shoulder – Part II

National Academy of Sports Medicine
National Academy of Sports Medicine
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 In Part II of our shoulder complex series, NASM Master Instructors Wendy Batts and Marty Miller review the most common compensations, provide corrective exercise techniques, and programming to increase your knowledge on this region of the body.
The “Master Instructor Roundtable” details all of this, and much more, in this comprehensive episode on this important, yet frequently mistreated, part of the body.
 

 

 

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TRANSCRIPT:
 
Marty Miller:
Hello everyone, this is Marty Miller, Regional Master Instructor. Here with my fellow regional Master Instructor Miss Wendy Batts. Wendy, how are you today?
 
Wendy Batts:
I am great, Marty, couldn't be better now. It's all good.
 
Marty Miller:
So we are back for our weekly Master Instructor Roundtable. And today is part two, we're going to do solutions and strategies for improved shoulder function. So when if you want to maybe, you know, kind of dig in a little bit to kind of give a tease on what we did with part one, and then we're going to jump into it.

Wendy Batts:
Yeah, so if you guys missed part one, we went over a lot of the anatomy of the shoulder. And basically, we're talking everything from bones to joints, to movement patterns, and what can happen with dysfunction. So today, like we've done with a lot of our part one and two series, we wanted to really kind of dive into certain and specific assessments that you could do in order to identify if there are some dysfunction or movement impairments that maybe you're unaware of, and then provide some solutions on how to fix those compensations. So therefore, you have better shoulder health.

Marty Miller:
That's a great recap. So as always, we'll jump into it kind of give again, you will see here on the slide, kind of an overview of what we're going to cover. And I'm sure like always, we'll get into some like side stories, of course on, you know, when we see these topics, what it means to us, and you know how we utilize this stuff in our everyday practice. So, as Wendy said, you know, we'd last week or two weeks ago, I should say, we went over all the anatomy. So it's a great recap, talking about the different bones, the four joints, and then the four rotator cuff muscles, the very common movement impairments that we see, and then the strategy. So this is where we're going to dive into from here.

Wendy Batts:
Yeah, so if we go to the next slide, just talking about some of the recap, again, you want to think about what is making up the shoulders. So basically, the four rotator cuff muscles that are key to shoulder function and health. And you can see them as they're listed below. And then you also have to think too, about the, you know, the bicep tendon, because of where it runs through there. So as we discussed, in part one, remember that it is a ball and socket joint, however, it's very shallow. And that's where we have greater degrees of freedom and motion in that particular joint. And so if there are some, you know, overactive muscles, or even weaker muscles that doesn't see the humeral head into the capsule correctly, then that's when we can start to get some impingement. And then over time can lead to slight tears, which is a very common thing we hear these days, unfortunately. And it is definitely preventable, as long as you know, you kind of know what to look for, and then how to correct it.

Marty Miller:
And I think when we look at the shoulder, and I classify this also, just like you would look at the core, we want to work from the inside out, we want to make sure, as we talk about what we do core training, all those little muscles that support the spine are rock solid, they fire the way they should fire, they do what they need to do. So that way the spine has that structural integrity, well, the shoulders are the same way is if these rotator cuff muscles aren't doing their job, and if they're out of position weak, or if they're, you know, have a lot of stress on them, you're going to have issues. And you know, Wendy, I know you and I've seen countless time people in the gym trying to do something for the rotator cuff. I appreciate that they're trying but they're really not doing it well. And or they go right to these heavy aggressive shoulder exercises with no attention to the importance of what that rotator cuff is really supposed to do to as you said, kind of center that ball and socket in the right position. So you have great shoulder movement. So then eventually, you can get into some more of these cool dynamic and, you know, traditional type of shoulder exercises.

Wendy Batts:
And I think even before we move on, remember, a common compensation that we see in so many individuals is around, you know, rounded shoulders and a forward head. And I know that's, you know, one of the things actually we're going to talk about in the future is that what can happen at your neck, but you know, when you're looking at the shoulder if you if you have if your shoulders are you know, rounded forward, and then you try to lift your hands overhead. So if you over exaggerate this just right now, even if you don't think you have that impairment, and then you try to lift your hands overhead, it's very painful, and you're not going to be able to get great range of motion. However, people could live that way because that is a compensation that their body has become accustomed to. And then as you said, morning, you lift heavy loads, think about the stress and demand that you're putting on to that particular shoulder capsule, and then why we end up with some of these major issues. And so just remember when you're thinking about the rotator cuff, this is a stabilizer you know, these are stabilizers that are really trying to stabilize your joints or your shoulder joints specifically and so you want to think about lighter weight, more repetitions and better range of motion, you know, versus how much can I lift, like what's the purpose of that and you know, it is okay to lift heavy because you do have to lift things over your head however, you want to have good range Emotion first before you start increasing the strength, and that's exactly what the OP t model is about. That's why we do stabilization first.

Marty Miller:
Yeah. And, you know, something you said triggered a thought of mine. So going back to, you know, you want to lift heavier weights potentially, and that's going to be dependent on the person and their goals, of course. But you know, the body can only produce as much force as it can first stabilize, like we do have these protective mechanisms in our body. And I remember a long time ago, you know, handful years ago say is I was doing a bottom of kettlebell press, because I like it during my stabilization training, because, you know, it's harder to stabilize. And that way the body has to really work to keep your form and technique and, and I had a friend of mine who had done more traditional bodybuilding, he's like, Hey, what are you doing, and I told him bottom up kettlebell press, and it was maybe 2025 pounds, which for that exercise is is challenging, but it's not the weight that makes it hard. It's the ability to stabilize it. And this guy could grab 70 pound dumbbells could load up any machine for overhead press, and do a ton of weight. But he honestly could not get his elbow higher than his shoulder because as soon as he tried to start pressing up and the stability needed to happen, the kettlebell would fall or he could, he just ran out of the ability to produce that force. And he was so frustrated, but when we spoke, then I want to explain to him what was going on about these little muscles, and your shoulders not stable, put them on a program, six weeks later, he comes back and his every exercise from a traditional strength standpoint went up. Because finally those little muscles were doing their job, keeping that humeral head in the right position, allowing the shoulder to move better, and then all of a sudden, he was, quote unquote, stronger. So that's why this you know, I know when you and I are very passionate about a lot of these types of things within the body that we've got to get the little muscles to fire properly. And that's why it's so important as we go through the rest of the slides here to truly understand the shoulder function, the right range of motion and how to create a really good program. So that way you can attack it. So then the clients maybe can do some of those other exercises they want to do at a higher level, but also probably with less pain.

Wendy Batts:
Now, Mike comes back to the old saying, as we've said, and what one of the foundational quotes, I think of the model, you're only as strong as you are stable. So there you go. So we move forward. And we really kind of think about some of the, you know, primary muscles, you want to think that you've got your stabilizers, obviously, we have the rotator cuff, but there are key muscles to have really good shoulder function that you want to pay attention to. And so when you think about this, if you you know, if you have rounded shoulders, that you know, think about what's happening in your mid back, they're in a lengthened, rounded position. So they're in a weakened state. And so when people are like, Oh, can you rub my neck, or can you rub my shoulders, it's not necessarily because they're overactive, it's just they're been in this, you know, this strict state of stress, because they're in that LinkedIn position for so long, that it really does feel good when people bring your shoulders back. And they kind of add a little bit of manual therapy or the rubbing, if you will, to the shoulders. And so the main shoulder or muscles, you want to think about if you notice that someone has some type of dysfunction or impairment in their shoulder complex are looking at what's happening at the rhomboids, the rhomboids specifically work on shoulder retraction. So trying to bring your shoulder blades together, same as with your middle, middle trap, for some reason people think that the middle trap is higher than it really is, when in reality, you're looking at your upper trap. And so you want to kind of think about where that's located. Because it really is, and you know, the the rhomboids and the middle traps, they work together because they do you want to think about they do the same thing. And then you've got your lower trap than actually, you know, is it, it works with shoulder depression. So trying to bring your shoulders down towards the ground, and then your serratus anterior, which, you know, aids in shoulder protraction. So, one of the things that we're going to actually talk about is, you know, all of these muscles, unfortunately, even if they're overactive, they're usually in a weak state. If they're under active, they're in extremely weak, weak state. So we want to have proper movement, and and alignment. So therefore everything is is working the way that it's intended to work. But when you're thinking about rounded shoulders, most of these are going to be very, very weak.

Marty Miller:
And, you know, as we go through our programming, we'll talk about things. You know, a lot of people put together shoulder program and I, you know, work out with somebody on Saturdays when I'm, you know, home and we did a whole shoulder program, and he's like, do we do shoulders, because in his mind, he was thinking, overhead press, lateral raises, shrugs, upright rows, you know, and he said, It jokingly, he's like, Wow, I've never worked my shoulders like that, but we were attacking inside out postural muscles. And we were doing the stabilization phase. And he was like, This is awesome. He just felt it. But in his mind, the only shoulder exercises were those traditional hypertrophy type of shoulder exercise that people tend to gravitate to. And then we wonder why there's so many issues when they load it like that. Plus, as you said, Wendy, everyone's gonna have that propensity to have bad posture to begin with.

Wendy Batts:
Yeah. So then if we move on, because I know some of this is a quote a recap, we want to thank, you know, how are we going to identify these. And it's always important to think about starting and there are five kinetic chain checkpoints. We've said this, every time we've done a webinar, you want to put someone into proper alignment. So when you're doing assessments, you can see where they deviate. And so if you don't set someone up correctly, you don't know where anything goes south, because if their feet already turned out, they already have, you know, things going on, but they're just not aware of it. And then you put them in proper alignment, have them begin movement, you can see if their feet are turning out because of over activity, and weakness, or is it just because that's how they stood and they didn't know what they were supposed to do. So remove the shoes, start on the five kinetic chain, check points, and then you're going to see right there, we're going to start performing the overhead squat. So again, you're going to do anywhere from, you know, five squats from the anterior from the lateral, and the post your review, and you're marking anything that you see. And then we're going to do the modified overhead squat. So when your heels are elevated, so remember, let's say you put your heels on like a two by four. So that's basically the the height that we're looking for. And you have your hands go over your head, you're still looking to see do those compensations get better? Or worse? And if so, if they get better, where do they get better? Because remember, when we elevate the heels, we're really looking at the ankle to see if if there was less compensations at the foot and ankle when you're elevated, or was it at the hip. And can you see the hip cleanup because remember, think about where the lats insert and where they the origin and insertion of the lats and the lower back and then again in the front of the shoulder. So when it's overactive, it can increase in anterior pelvic tilt or cause the shoulders around or they had to fall forward and the arms to fall forward. So again, those are the two more transitional movements that you would do. And then to really look deeper into it Marnie, and I have done the mobility assessment webinar, I think if you really want to find out an easy way to determine if muscles that are showing or when you've got compensation was the overactive muscles that really was the primary cause, or was it the underactive that was the primary cause or truly wasn't both. And while there is, you know, obviously, when a LinkedIn whatsover active and strengthen what's weak, there really are more things to focus on, if you notice that the range of motion is good, however, the compensation is there. And that really does indicate that you want to focus a little bit more on the weaker muscles. And so when you're looking specifically at the shoulder, you're looking at shoulder flexion, internal and external rotation. And then if you are still using the goniometer, which I'm a big fan of the goniometer. I love it. And but I've also used it for many, many years, you can also measure range of motion, choosing in flexion, as well as internal and external rotation of the shoulder to see if you have ideal ranges of motion. And then one other assessment that that as long as it's safe, and the client can do one of the ones I love to do especially to find out what's going on at the the upper body, not just the shoulder. But what's happening at the head, the shoulder as well as the back in the shoulder blades, because you get a very good visual, is you put the client in a prone position, so they're in a push up position, you have about 36 inches of tape, so from end to end, and then they spread their hands out to each piece of tape. And for 15 seconds, you have them touch the outside of the pinky as fast as they can, maintaining proper alignment. And you note anything that you may see that is not proper alignment or proper movement is there, a lot of turning in the torso does your head fall forward is that are winging. And then you're also going to record that score. So even if you notice something is slight, or let's say the range of motion is off even a little bit, or if you're doing the new mobility assessments, and they can't, their arm truly can't lay flat and there's just a slight bend in the elbow all fails, that means there's this function, you're gonna mark it it is like you want to note that because as that person gets tired, those compensations will get worse. Absolutely couldn't agree more with me. And I wanted to also mention, if you're still new to this, pull out your solution stable, the solution stable will help you if you see this, roll this stretch this, activate that super simple, but please just print out that solutions table.

Marty Miller:
Exactly. Learn that right? learn that exactly. But it's a resource. You don't have to memorize it right away. But if you keep referring to it, it becomes easier to memorize it because it doesn't change. So cool. So I can jump in here. Wendy, I know. You and I talked about this all the time here. But really, we don't want to look at a joint just by itself, we have to look at how these joints move together and how they affect other parts of the body. So when you look here at this slide, we're going to talk about how the joint really needs to work. So we're going to look at scapula humeral with them and then scapular dyskinesia, so when your arm moves, there is a normal ratio, we'll show a slide here in a little bit on the actual ratio that you'll see. So the scapula humeral rhythm is the interaction between the scapula and humerus. And this is incredibly important for shoulder function. Because you're not going to stop or classic I've set up my scapula didn't move too much, I'm going to stop using, you know, my humerus here, they're going to find a way to get their arm where it needs to be. And there's a price to pay when you don't have that normal rhythm between the scapula moving, and the humerus moving. This is where a lot of those impingements that we talked about, in part one, where things get squeezed together between those two bones, you've got your rotator cuff tendons, you've got a Bursa, you've got the bicep tendon, there's not a lot of space in there, it's called the subacromial space. And tendons don't have a lot of blood supply to them. So it's very easy for them to fray. So as you're starting to work with your clients, as you're looking at your own movement, you really, if you want to be active in the fitness space, and be able to exercise you need good scapular humeral rhythm. So that's where again, going back to the assessments that Wendy talked about going back to the old PT model, and following everything we show you, you will get that normal scapular humeral rhythm back in the proper or close to the ideal range of motion and the percentages. But what happens though, frequently is that scapular dyskinesias, is when the scapula does not move, it can almost get stuck on the rib cage. And it doesn't want to upwardly rotate at all, as I bring my arm above my head, and I go to the humerus has to do more of the work, and you get an upward migration. And that's where these bad things happen. So this is where again, we're going to show you that now with the ratio, but this is where, like Wendy's talked about with the Davies test, you can see what happens at the scapula, or just the passive ranges of motion. And the different mobility tests that you have or the overhead squat is if that SCAP is not working, you're going to see it, it's not going to be hard to identify. And then from there, you can put together your ideal strategy.

Wendy Batts:
Now it's perfect. And I mean, if we Marty, I mean, why don't you take on the next slide sheet because that is the ratio slide. And I think the diagram I think is perfect for this, but you know you're on a you're on a good roll. So go ahead.

Marty Miller:
So we are looking, we say it again, when we bring it up in the NSM. We're looking at that 180 degrees of motion, we never tell you where it's coming from, right. But we are telling you to look for compensations because the head come forwards is the shoulder elevate, do they bend the elbow did they flare their rib cage, that is a way to identify that they're not getting the ideal range of motion. And if they're getting artificial range of motion, it's with a compensation. So now we can dig deeper on to where that cure ratio should come from. So when you look at this here at scapula humeral rhythm, you'll find it very easy to if you want to dig deeper to find information on it. What we're looking for is the scapula and humerus move in a two to one ratio when the arm is abducted. So I do like this picture here, that you'll see that the scapular upwardly rotate 60 degrees, and then the humeral head goes up double that amount, but it can't do it all by itself. So imagine where you see that dotted line there. Imagine the humeral head going up, but the scapula staying put where those dotted line czar, imagine what would be happening in the torque and the torsion and the impingement that would have to happen at the shoulder joint. If the scapula does not rotate doesn't have to rotate as far but it does have to rotate upwards close to that 60 degrees if you want ideal range of motion. So this is why it's so important to look at the whole body and to understand how important the scapula really plays into the overall health of the upper extremity.
 
Wendy Batts:
Nicely done, Marty.
 
Marty Miller:
Thank you.
 
Wendy Batts:
I love this diagram. I was like Sorry. I'm okay. Well, yes, very clear. So to me, this is a common compensation that I see so often that I think just goes unnoticed or people notice it but they really don't know how to fix it. And what we're going to talk about as you can see is scapular winging and so when we're looking at scapular winging, it's the impairment that affects the shoulder blades. And remember, as Marty has just said, your shoulder blades should lie flat onto your rib cage. And so you know, if they don't and there's some kind of like where they pop up, this winging is going to occur so it looks like your shoulder blades at the tip of the shoulder blades are sticking out. And I always tell people It looks like they have like angel wings. And so basically if someone's in a prone position, and you have them, let's say in a push up position, and you can pick someone up basically by their shoulder blades, then they are a winger, meaning they have scapula whinging. And so there are specific exercises, but remember what it what the what the that well basically when you see when you The Prime indication is that your serratus anterior is weak. And so you want to think about what the service does is we talked about this in the beginning is it does shoulder protraction. And so when we teach and we've talked about, and you're going to see even in our program today, when we talk about doing a push up with a plus, we're doing kind of a pushup with a little punch. So we're adding protraction, to anything that involves a pushing motion, because what that does is it's trying to help the serratus actually activate and get, you know, working appropriately, or appropriately. So therefore, it's going to minimize this specific compensation. And so just remember, when you're adding the plus or you're doing protraction, there should be no movement in the spine, you're not doing any kind of flexion of the spine, it's literally like you're just punching without moving your spine to really get the serratus to activate.

Marty Miller:
Yeah, I always say it's like, you know, the push up with a plus or like that jab, if you're, you know, if you're a boxer, you know, trying to get that extra little bit of range of motion without that forward flexion. And it is so crazy. I've worked with a lot of power lifters, you know, people that can bench four or 500 pounds or more, you'd be shocked how they can do that easily or fairly easily, but they can't do a proper protraction, you would think that like that's the 500 pound exercise, I'll lay them on their back and just give maybe I'm a florins giving like a 50 pound dumbbell and they're like, they can't get that muscle to fire. But yeah, they're loading their upper extremity with, you know, God knows how much weight and benching, and then they wonder why they get up off the bench and they do one of these things, right? It's so they don't have any rhythm. He must have rhythm. Yeah. Yeah, this is, this is something that I put into my clients in my own personal program. Anytime I do upper body, there's, you know, a lot of things that I go through working on my neck range of motion, which we'll get to in in another webinar in a couple weeks or soon. But I always, always get that serratus anterior firing before I do any upper body pushing exercise program, whether it's going to be a shoulders or chest. And I don't care what phase of training I'm in, like, this muscle is so critical. And it's so easy for it to go unnoticed that, you know, it's something that I've just now put into my program, just like rotator cuff, anytime I do upper body, I'm warming up with a rotator cuff series,

Wendy Batts:
I add this in as well. So I think it's super, super important. And it's easy to do, you're already pushing on it, add that little extra bump. So pretty simple. So we move on to the next slide. You know, when we keep talking about the assessments, again, we're looking for common compensations that you're going to notice, and very often we're going to see the arms fall forward. And you know, just keep in mind when when you set someone up in the five kinetic chain check point, their arms should have no bend in the elbow. And there, they should be directly in line with their torso. And so we used to say have it directly in line with the ear. But then we've noticed that so many hat people have a forward head posture that it's like, if you really look in, you don't notice that their head is really forward, but their ears are still in line, or their arms are still in line with their ears, even though their heads forward, their arms are really forward, that was a bad way of like trying to say look for this. So just think that when you're looking at the lateral view, when the arms fall forward, you want to see if your arms stay in line with your spine and your torso. And if they can, then they don't have the arms fall forward. If they come down, even if it's slight, then you are going to mark that. And if you're going to mark both sides, or it may just be one arm, because it's very common that only one arm may be overactive, while the other ones fine. So just mark what you see. But remember, you know, you're looking for optimal range of show or range of motion in your shoulder. And if they don't have it, this can be an easy fix. You know, so the thing is, you've got to identify it. And so if you see that the arms are falling forward, this could be based on overactivity of the picks, so the major and the minor, as well as the lats. And you want to think, you know, if you also notice, too, that they you know, have rounded, rounded shoulders, obviously, all of that plays a part, you know, plays a part and you may not even have to have them raise their arms, you're gonna see this right away, just when they're standing there. So very common. And, you know, it's it's one of those that I have to work on a lot with a majority of my clients.
 
Marty Miller:
Absolutely, especially the men. Yes. So this is a program that we put together and you're going to notice that we also included the thoracic spine. And remember when we talk about the spine, and we talk about mobility, you know, we always think that the spine should be stable and that is true, but the one area of the spine that you want to have some mobility is the thoracic spine. It's super, super important. And one thing that I do to try to help with mobility of the thoracic spine is used My foam roller with my clients, I'll have them lay over it. And remember when you're foam rolling the thoracic spine is from the top of the shoulder blades to the bottom of the shoulder blades. And don't go lower than that. And I see everyone like rolling all the way up and down their their their back. And remember you have floating ribs, you want to take in consideration, you want to think about your kidneys, you want to think about all that stuff in the lower region of your back. When you want to think to that we're really trying to focus on getting some better blood flow, getting some relaxation to the thoracic spine. But then after you've kind of you know, found those tender areas, you've held them, then allow yourself to go back like put the foam roller in them in your mid back, put your hands behind your head gently, and then just lean back and just do like you're almost doing like a crunch. Like go back as far as you can and then come up and then do that a few times to really try to work a little bit on the mobility. And it feels phenomenal when you do that because you really are opening up the chest that we found to be overactive. Like I said, if they've got rounded shoulders or arms are falling forward, the pecs are tight. So you're kind of stretching and doing some mobility at the same time. And to me, you get, you know, get more out of it, then why not do it. But you're going to focus on the overactive muscles in the beginning. So think about the corrective exercise, you know continuum, we're going to think about inhibiting, lengthening, activating and integrating. And so with the muscles that are shown to be overactive, you're on a foam roller, or use some kind of vibration device or some way to open up those areas or inhibit those areas, then you're going to add length to them to get them to restore proper length. So again, you know, people are like, Oh, I'm gonna overlay stretch. Well, no, if the muscles under are overactive, you're trying to get back to proper length tension relationships, you know, within the body. So the ones we're going to focus on specifically are your lats, your pec major and minor, your levator scapula, as well as your thoracic spine. And then you're going to actually go into some upper trap stretches, and then you're going to stretch out your biceps brachii at absolutely, do you want to talk about activate.

Wendy Batts:
So now if we go to the other side of the continuum, so we've lengthened tissue, or calmed it down. So we'll go back one more slide here. There we go. So those are all the ones that we want to down regulate. Now what are the muscles or movement patterns we want to upregulate so ball combo one and two, I'm sure you guys know this. This is where we get into like our YT, and a, so we're really getting the mid trap low trap. Getting those SCAP, those reset. Both those combinations are great Cobras I know Wendy absolutely loves Cobras. I do a lot of different variations. One of them, the ones I like to do is like a standing hinge Cobra just in the morning, as I'm getting my movement pattern going push up with the plus when you're talking about if you're going to be pushing, why not do the plus, then we have our internal external rotation. The key thing here is we really need to limit the range of motion. When you look at the internal external rotation, we're looking at about 45 degrees. And I see a lot of people when they do internal rotation, they make it into a pec exercise. So I can't stay away from internal rotation for a while. Because a lot of times they are internally rotated doesn't mean that that muscle is firing properly, but just saying that I might teach them something else first. But even with extra rotation, the elbow has to stay at 90 degrees, I don't want to see that elbow extend because that gets into tricep, people go into way too much range of motion almost get into thoracic rotation as well. So it's very limited. And then scaption, we both love coming up, thumbs up at that about 45 degree angle. It's just the humeral heads in the safest position there compared to being internally rotated, if you did it a different way. So those are just some of the great exercises, there's a lot of band polling and face polls and different tubing exercises you can do. But if you cover these, and have a couple variations, you will be servicing your clients very, very well with this type of movement patterning that you need to do. And then clearly integrating is Now that everything's ready to go on both sides, we're just trying to get the body to play nice together. And getting back into pulling progressions, pushing progression single leg RDL to a PNF squat to row, of course will always be in there for d&i. So these are some of the integration not the only but just you know, something that you can kind of focus on.

Marty Miller:
Yes. And remember to guys, when you're following you know, the corrective exercise strategies, you're going to pick two to three, you know, foam rolling things to do, then you usually will statically stretch those same muscles or you can actually do some of them a little bit differently to depending on on what you feel is in the best interest of your client and if they're doing stuff at home, and then again, you're going to do anywhere from my two to four, you know, activation and then usually you choose one to to integrate. So when we provide you with this list, think about it as just that these are some options to choose from, especially if you're going to put this on there. front end of a resistance program, you want to look at this section of it as an extended warmup. And it shouldn't be the primary, you know, muscles that you're focusing on. If you're, you know, putting it into a stable or stabilization, total body exercise. However, to me, this could be a program on its own, but you still may want to limit it, especially if there are these, you know, a significant amount of compensation that you're trying to work to alleviate, it's going to take four to six weeks for the body to start to, you know, get used to the demand that you're placing on it, as well as seeing some of maybe these compensations start to diminish. So it takes time. And, you know, Rome wasn't built in a year. So you or, or a day, I know.
 
Wendy Batts:
Yeah, my everyone's like, why do you say a year I'm like, it's just it wasn't built in a year. So. But these are some, you know, high caution exercises, that that Marty and I have discussed multiple times, and we I still see them so commonly used at the gym, especially when these compensations are very apparent individuals, even when they're not doing an assessment. And the one I'll take on first, and it's because I've seen really bad things happen is the dip. Now people love to do the dips during COVID dips were like the thing to do, because you didn't need any equipment, you just needed yourself, you needed some kind of, you know, something that was elevated, and you put your hands behind your back, and then you go down and work your triceps. Now, while I understand triceps are a very important, you know, complex to work on. Because I am all about the arms too, I get it, you want to think about the safety of the shoulder complex and what we talked about.
 
Marty Miller:
Now remember with it being a ball and socket and being very shallow look at the individual there. While she has a beautiful smile on her face. Look at the positioning of her shoulder. And so you want to think a common compensation that Marty and I have talked about multiple times is when somebody has internal rotation, or they come in with rounded shoulders. Well, if somebody has rounded shoulders, think about the member I talked about where the humerus was seated into the shoulder capsule, well, if they're rounded, it's already more on to the anterior portion. So the humeral head is really tilted in a position more forward than it should be, which is going to decrease the rhythm. So the scapular thoracic rhythm that already talked about an increase impingement, because we're it's not working the way it was intended. And then now I'm going to increase that by adding dips. And so it's really one of these things. And again, we've done multiple webinars about risk versus reward. If you want to work your triceps, stand up, use a cable, use tubing, you know, lay on a ball, or even just do a two arm not a one arm because again, one arm, you have to move your head forward, you know, and do some kind of tricep, you know, or elbow extension, which is going to get the triceps. And so it's just a safer way to not harm or put excess stress not needed on the shoulder. Because I've said this before, I've seen as the humerus come out of someone's shoulder capsule doing this when they have an impairment, and he was a baseball pitcher and it ruined his career. And when he won, I think the most underrated exercise are again, like we always say I trick people into what I want them to do with what they think they need to do or want to do is I love a cobra. So I get them in shoulders back, you know, or in that position, get him into a hinge and then do a double arm kick back. They think they're working triceps, but the entire time I'm focused on what's going on at the scapula. And they asymmetrically keep their scapula retracted in that depressed position, why they're in like a hinge doing a kick back. Now the weights not going to be heavy, because they're in an unsupported position. But I'm getting core stabilization. I'm getting a hedging. I'm getting the shoulders back and retracted, and they think they're doing their triceps. Right? Everything that we just talked about before we got to this, but I'm like, Oh, yeah, here's a great tricep exercise.

Wendy Batts:
Now I will get this question. Well, so are you saying I shouldn't do dips? Yeah, I'm not saying don't do dips. I'm just saying what is the risk versus reward? And is there something that you could do that's possibly safer for your client? And if you can answer Well, yeah, there's probably something else then just do that.

Marty Miller:
I can, I can speak for myself, but not NASM. I don't teach tips. I don't either. That's a me thing. That's not an NASM thing. That's a me thing. But there's just, I just don't see the value in it. So again, that's a me thing. Why don't you Why don't you take us through the upright row? Yeah, that's another one that I struggle with. Because as an athletic trainer, if somebody has potentially shoulder impingement, the first thing I would do after I talked to him, I would put them in that position. I would internally rotate their elbow at the elbow. So the shoulder is internally rotated, say, and then I bring them into that position to see if when you close everything down upon itself is there a pain so an upper Row is just a weighted version of a shoulder impingement test. So again, I can do scaption, I can do all these really cool exercises, but put the shoulder joint in a anatomically safer position. So that's why again, risk to reward. It's not something that I'm a huge fan of myself, you know, I don't need generally speaking to fire up someone's upper trap, I'm looking, how do I keep them here? Right. So it's not my go to by any means it's just higher risk. So many other cool exercises I can do without putting that shoulder in a compromised position.

Wendy Batts:
And that's another one too, you know, when people are doing lateral raises with their thumbs down, I always call it the MD can test because that's how do we determine if there's a torn rotator cuff or you know, a rotator that's not in good health. And so when I see people lifting really heavy weights with their thumbs down, and then going into in thinking about this to internal rotation, what's happening, you're internally rotating something with, you know, somebody within rounded shoulders, then you're closing up something that's already an overactive and shortened position, and then you're adding a ton of weight. And of course, there's a lot of momentum and everything. So your poor shoulders screaming for help, and you're like, yeah, I feel the burn. I'm like, don't feel feel the break. Please stop doing that. Don't ever do that again. So yeah. And then what about the chest press,

Marty Miller:
You know, I grew up bench pressing just was what we did. But at this point, if you're not going to have to compete in that, if you're not a division one football player, and NFL football player that matters, I like dumbbells better once somebody has earned the right to go to that strength phase. Remember, that's not a stabilization exercise. That's a strength exercise. So that means I've cleared them up and given them good range of motion stability, I like dumbbells better, because I'm not locked out here in this external rotation, the bar won't move, I have to move to the position of the bar. So you can see even here, once I get to that position, how I can potentially elevate my shoulder. And a lot of people's when he said won't have the external rotation. So I find dumbbell safer, I can do a close grip, dumbbell press, I can limit my external rotation, and it's just, again, safer for me to get the better desired outcome. Yeah, so saying never, but it's just again, it's not my go to like it used to be for years.

Wendy Batts:
Yeah, so the two things that I will add to that. So I do have my clients when they get to the strength phases, you know, a lot of people just love the bar. And that's what makes them feel manly, or womanly. And if that's what, you know, again, a client's choice, if that's what they want to do, then I want to give them something they want to do. But to Marty's point, he said it very specifically, as long as I know that they have good external rotation, because of that, that they're going to end up compensating. And so I want them to be able to perform whatever exercise I can without compensation. And if someone is limited in range of motion, they will compensate when they use the bar plus, they know, you know, they'll bounce the bar off their chest. Well, for me, I like to do dumbbells as well, more often than not, because I can increase my range of motion, if my clients can go down past 90 degrees, I'm going to train them for what is available to their range of motion and not stopping them only at 90 if they can go further, however, further without compensation. So to me, I want to get more range of motion, which means more, you know, working through better and greater range of motion, which is going to carry over to more activities of daily living. And so I do use the bar and strength. I do use it and supersets and all that. However, again, it's instability. I do not.

Marty Miller:
Yeah, and I'm a no, it's not a never for me with the barbell, it's just not my first go to unless the person really specifically requires it. But I like the dumbbells also for what you said the range of motion, but also it helps me to figure out are they equal? Because eventually sometimes you'll start to see one arm slack a little bit. Sometimes you can't pick that up on the bar. So again, I'm not opposed to a chest press, if the person's earned the right to be there. It's just if most people if I had dumbbells, I probably gravitate to that.

Wendy Batts:
Yes. Well, and again, these are just we want you to use with caution and the caution tape. But very well said but you know, that brings us to our key takeaways. I mean, guys really just think about the anatomy and think about like Marty said, There's got to be good scapula thoracic rhythm, he want to have, you know, good mobility, because of the degrees of flexion and freedom that your shoulder allows us to have, it's not going just forward and back, we can go forward and back inside the side and make all kinds of circles at a greater range of motion than we can do in our hip, which is also a ball and socket because of how shallow it is. But think about all the the, you know the tendons and muscles and ligaments and like you said the bursa and just the small amount of space that's within that shoulder capsule, that if we don't keep it in proper alignment, how impingements can happen, pain can happen, and it can actually lead to so many other issues with the neck and you know, and the chest and the back and other other products. Marry areas because of the attachments. So think about all of that. And really think about what assessments make sense to your clients. Again, we talked about some transitional ones, we talked about mobility assessments, we even talked dynamic using the Davies test, pick the ones that make sense where it's going to provide you with the best information, and then again, focus on what was not moving correctly. And even if it's minimal, you're going to note it down in those assessments, and then use your solutions table and the OBD model, we've taken the guesswork out, we've helped you whether you're using the CES protocol with the 4g, you know, the four, and you know, inhibit, lengthen, activate integrates the four parts of the continuum before adding resistance, maybe you're just doing CES only combo, both, it's really up to you, which is making sure that the exercise selection makes sense. Think about your choices, things that think about proper alignment and quality of movement throughout everything. And if you can do that, you're really helping your client long term move better, feel better, perform better. And everybody uses their shoulders and arms so much that they need a break. And you know, you're you're there to really help them and you're going to notice that there will be ratios and how you train often that if someone has a lot of forward, round shoulders forward head, then maybe for every pushing thing you do you do two or three polls or something to to kind of counterbalance those, those overactive and underactive muscles to get better alignment, but then also allowing them to do exercises they they enjoy.

Marty Miller:
Now a great point. And I think that shoulder health, shoulder integrity is critical. You know, you get into people into their 40s and 50s and 60s, and if their shoulders are having issues, it really becomes a problem for them to be active like they'd like to be so set that tone early and think about a shoulder health program, not just about max strength type of programming that people are kind of accustomed to.

Wendy Batts:
Yes, little muscles first make a big difference. But if you guys you know, want to contact us or you guys have questions after you know, I would strongly suggest you go back really listened to part one. And then you know, take into consideration what we said today and then piece it together. But if you come up with questions, you can easily contact Marty or myself. But if you want to reach me directly, you can find me on Instagram at Wendy dot batts 13 or you can email me directly at wendy dot batts@nasm.org.
 
Marty Miller:
And then my informations right there. Marty Miller at NASM dot o RG and then Instagram is Dr. Marty Miller seven two and maybe we'll give him a little tease that you know we did the shoulder. Next week. If we move into the cervical spine, they're gonna see some correlation there that we take care of this that also helps the shoulder so just kind of you mean it's connected a little bit, a couple of different areas. So I'll just throw that out there that Hey, stay tuned for next week we're going to continue on with some awesome content. So as always, Wendy, thank you so much for joining in. I know we have a blast doing this and we look forward to seeing you all next week. 
 
 

 

 

The Author

National Academy of Sports Medicine

National Academy of Sports Medicine

Since 1987 the National Academy of Sports Medicine (NASM) has been the global leader in delivering evidence-based certifications and advanced specializations to health and fitness professionals. Our products and services are scientifically and clinically proven. They are revered and utilized by leading brands and programs around the world and have launched thousands of successful careers.