Podcast Master Instructor Roundtable

Master Instructor Roundtable: All About the Shoulder – Part I

National Academy of Sports Medicine
National Academy of Sports Medicine
0

Your shoulders are a vital, yet often neglected, part of your body.
In this episode, NASM Master Instructors Marty Miller and Wendy Batts review the anatomy of the shoulder complex to provide a detailed understanding of how important the region of the body is in overall human movement.
 
Let the “Master Instructor Roundtable” shoulder the load in the first of this comprehensive two-part series.
 
 
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TRANSCRIPT:
 
Marty Miller:
Hello, everyone and welcome to this week's edition of the Master Instructor Roundtable. Marty Miller regional master instructor, as always, with my dear friend Wendy Batts, fellow regional Master Instructor How are you today? Wendy?
 
Wendy Batts:
I'm good Marty, how are you?
 
Marty Miller:
Great. I'm looking forward to this topic. I've always been kind of partial to shoulder, you know, from professional baseball, my first career was kind of something we dealt with a lot. And then getting into the fitness industry, we, you know, just one of the things where everyone seems to ask questions about the shoulder complex. So reading the Facebook posts reading the different questions we get, we figured we do a two part series on the shoulder.

Wendy Batts:
Yes, I think this is going to be super beneficial, because obviously, it's such a mobile joint, that there are so many things that can go wrong. So I think just, you know, I know today, it's gonna be pretty heavy and some of the anatomy when we're talking about, you know, the joints, the muscles and all that, however, I think it'll be very, very beneficial on, you know, considerations. So, you know, you'll have to join us next week, and we do part two, and talking about some of the actual program design component, because I think I think there's a lot of positive things you're gonna get out of this.

Marty Miller:
Great plug. I hope anyway, right? Through the anatomy, we're gonna go through it, so you have an understanding of the complexity of the joints. However, what I love about the OP t model, and what I love about overhead squat assessment, and now in correct as with our new mobility assessments is you don't have to fully understand the anatomy to the detail, we're going to get into it, because we have the C this do this type of formula with the OB t model. So again, we're bringing this in so you can advance your knowledge. But don't let it kind of freeze you what you've been doing each and every day, because the shoulder is what he said, there's some complexity to it. But you've got great resources on how to program everything that you're going to see with movement dysfunction. But why do you maybe we just jump right in here and go through the some of the anatomy,

Wendy Batts:
I think so. So just as an overview of what we're going to talk about today, we're going to talk about as we just said, the anatomy of the shoulder, we're gonna talk about some of the bones and joints, we're going to talk about some of the tendons and ligaments as well as the muscles. And we're also going to talk about, you know, concentrically, you know, the muscles that are firing and what it can do to those specific joints and what you're going to notice if there is compensations. Of course, we're going to talk about joint Arthur kinematics as well as some common movement impairments. Yep. So so so when we talk about the bones, we're going to just talk about three specific bones and Marnie is going to go more into the actual joints, but the bones that we're going to talk about is the clavicle. So that's what connects the sternum to the shoulder and connects, you know, via the cartilage of the stern, stern or COVID ocular joint, geez. And then we're going to talk about the scapula. So we're going to talk about basically the flat bone in the back of your back. Unfortunately, we see this often wing and so we'll talk about what can cause some of that, but it's basically the wide flat bone, which lays on the thoracic wall. And, and then if we go to the next one, and we think about, you know, basically the humerus, so we're talking about the the main upper arm bone, if you will. So it's the long bone or the upper extremity. And that's what's going to form the glenohumeral joint. And so, you know, one thing, Marty, this is totally off topic, but you know, when you hit your elbow, yes, people you say, Oh, well, you know, I used to hit my funny bone, and I never got it. And I had been doing anatomy for a long time. I've been teaching this for a long time. And I think it was like five years ago, where people are like, you know what, I call that your funny bone? And I'm like, No, because it's your humerus. But I never put it together. Like I never thought about it. Because again, it's like, this is a humerus bone. This is like, you know, I'm always so like, cut and dry. This is what it is that I didn't really get it. So okay, well, that's a that is a horrible thing that I admitted.

Marty Miller:
You know, it's in, it's recorded forever, but is recorded forever. But the key thing about this area, and again, this goes for any of the body parts that we kind of pull apart is that all these things are going to work together. So the SC joint, you know, you hear that that's the sternoclavicular joint, and we're not going to get into all of the anatomy. But when there's dysfunction in the cervical spine with the muscles, it can affect the clavicle, which now you'll see is connected right with the scapula and the humerus. So this is where we have to take this full integrated approach in the assessments because you'll start to see as we go through more in the shoulder, how many things are kind of tied together as we go through just this upper extremity?
 
Wendy Batts:
Yes, it's amazing because I mean, think about forward head, rounded shoulders. And then I mean, if you're sitting down right now listening to this, and you put your head as far forward as you can, and you round your shoulders and then you keep your arms completely straight and try to lift them over your head. He can't do it, and if you do it, it's probably going to either You know, you've got some serious dysfunction that's allowing that to happen, or, you know, there's probably something seriously wrong. So. So you want to go through the joints?

Marty Miller:
Yeah. And just so I'll date myself, I call that the ET neck. So again, I'm going back to the 80s. So you would see you can visualize that he can, he can. What is that, and it's like, we're just older, that's all. So the four main joints you got to worry about worry about. So we have the three bones that when you just went through, now there's four joints. I'm sure these are very familiar with you. So again, we're just going to kind of highlight these. So you got the glenohumeral joint, that's the one that everyone looks at when they're seeing their shoulder move when we're throwing a baseball throwing a football. So this is formed where the humerus fits right into the glenoid cavity on the scapula. So it's that ball and socket, you heard things like it's a soccer ball and a plate or a golf ball on a tee. So with this massively mobile joint, you do give up stability, we'll talk about some of the things that try to create the stability there. We touched on the SI joint a little bit ago, we'll come back here, then we have the chromeo clavicular joint. So it's a synovial joint that's located on the outside or lateral end of the clavicle. And it articulates with the chromium that sits up here. And that's one of the joints when people fall that they separate is the AC joint, already talked about the SC joint where it's now where the clavicle and sternum meet. And it's the only bony connection of the scapula to the entire axial skeleton by the way of the clavicle. So you can see that there's a lot going on here. And then finally, I think the joint that's kind of most misunderstood when we look at shoulder issues is the scapula thoracic joint. So this is now it's not a true joint, but it's that articulation that is formed by the convex surface of the post your thoracic cage, and the concave surface of the anterior scapula. So as Wendy so eloquently said, the scapula is kind of floating on the rib cage. And there's not a lot of ligaments and things like that that connected. So there's going to be the 17 muscles that connect it between the rib cage and the scapula. And imagine if just one or two of those muscles are not firing properly, whether we have the forehead, whether we have the rounded shoulders, what happens to the position of the scapula, what happens to the length, tension relationships, then of the muscles, how we lose thoracic mobility, all of these things. So when you're dealing with shoulder biomechanics, let's definitely look at the scapula thoracic joint as well, it's plays a very important role. And a lot of our clientele would not think about that with shoulder work, because it's like way back there. And they don't understand how it really works. To help have a healthy shoulder.

Wendy Batts:
Yes, very, very important area for sure. I'm telling you, yes. So and so when we talk about the thoracic spine, you know, one thing that we talk a lot about was when people have shoulder issues, the first thing we'll say was, don't forget to foam roll your lats because it you know, it can help with your shoulders being forward. Well, you also want to think about that thoracic spine, if you're in a forward rounded position, think about what's happening at your mid back, it's in a lengthened, rounded position for hours on it. And that's someone's normal, you know, normal normal position. And so one thing you want to like just as a reminder, we want to think about the, the cervical spine and the lumbar spine, they shouldn't be mobile, but the thoracic spine should. So we've got stable mobile stable. And so unfortunately, what we're noticing is because we are not really that mobile in that, that area, we're having to get more mobility at the cervical and lumbar spine. And that's when we start to really have some issues within the inner, you know, inner table muscles or the little muscles that protect the spine. And so when we're talking about the thoracic spine and the shoulder, we're looking at the upper body, because we want it to have some high level of mobility. And as Marty said, when you're thinking about the ball and socket of the shoulder, it's very, very shallow. I mean, when you think about the hip, it's very deep. This is very shallow. So one small little muscle that's pulling it out of its actual capsule where it's supposed to lie can really inflict a lot of pain and dysfunction. And so when we're talking about optimal thoracic spine mobility, we're combining that with scapula and the scapula and the shoulder. So therefore we do get that what we call degrees of freedom meaning that we can move our arm in so many different areas in different ways to where we can't necessarily go up as high and everything with our pit because of the the depth of that ball and socket joint.

Marty Miller:
Oh, great information. And when do you know last time I saw you in person or the maybe the time before I was having some mild discomfort in my left shoulder blade and really, instead of just going after you know that the muscle that was it caused me problems. I we did the assessment I went back and it was my sternocleidomastoid that was overactive. I'm on that side. And I had a lack of thoracic mobility to my left. So I could have sat there and did foam rolling just on like, you know, that trigger point. But as soon as I got back into proper biomechanics, and started working on the cervical stability, getting that sternocleidomastoid, to allow the clavicle to move, and then got back into my thoracic mobility outside, now I didn't, I still don't have that discomfort in my rhomboids. But a lot of people don't understand the complexity of what we're talking about where that thoracic spine has to move with a nice, stable cervical spine, they end up with shoulder problems, and they just, you know, start doing rotator cuff exercises and all these things, but they don't change the postural position to let those muscles get back into the right length tension relationships and take pressure off the joints.

Unknown Speaker 10:46
Well, I think you made and I want you to see if you don't mind going to a little more detail, the clavicle should move. And I think a lot of times people don't realize that and when the sternocleidomastoid locks that down, can you talk about what will end up happening and we're talking about moving, we're not talking about it, you know, we're talking just a little bit. So yeah, go into little detail about that.

Wendy Batts:
The way I look at it is now that the cameras back on me so if my arm I'll just use one here because I'm limited space is a clavicle on this side of my body is as my shoulder would go up, the clavicle is supposed to upwardly rotate just slightly. So if any of you that are watching if you stick your head forward, and then try to move your arm, and then keep your head in the back in the regular position, move your arm you should hopefully feel that the clavicle at that SC joint has more motion when your head's in the better position. But if I stick my head forward, which basically activates the sternocleidomastoid, it can lock down that portion of the clavicle. So as I go debris my arm up, it's gonna it's gonna be awkward Lee or locked into a position where it doesn't want to fully rotate. And that just starts to trigger of events, then imagine what happens at the rotator cuff, imagine all these other things that would happen. So sometimes it's so simple. And we all spend so much time with our head forward that we neglect that soft tissue work or we neglect that range of motion. And we get into a couple big other things, but then we wonder why we still have some lingering issues. So I truly spend a lot of time on my posture as well now is I have taken the time to make sure that I do my sternocleidomastoid stretch and a couple other cervical stretches. And thoracic mobility takes me an extra six or eight minutes a day in my normal routine. But it has made a tremendous difference in the issues that I was starting to show in my left shoulder.

Marty Miller:
And as a manual therapist, I go in and do manual work on people's sternos as well as dig in behind or underneath the clavicle itself. And it is amazing, the tightness that most people have, especially when you know they've been looking down at their phones and we think about all the positions that require us to look down or bring it forward or your bring your head forward. So yes, it is something that oftentimes we just spend so much time on the lat thinking about where it attaches to the you know the anterior portion of the shoulder. However, there's so much to be said about the actual neck itself and what it can do to the shoulder complex for sure and a negative way.

Wendy Batts:
And we're going to move forward here but you know, even my pillows I get the middle as pillows possible because I don't want my head in that type of position for our so but again, we can always come back to a neck. cervical spine wanted someone hey, yeah, moving forward. So work on that. thoracic mobility. That's that's one key. Yes. So when we look here, the thoracic spine, a scapula, now these are the muscles of the scapula that do not cross the glenohumeral joint. So they would include your serratus anterior, so that's that push up with a plus tight muscle or pec minor, or trapezius or levator SCAP then or rhomboids. So these collective five muscles all originate on the thoracic spine and ribcage and insert on the scapula and are responsible for controlling the motion of the scapula. So these are muscles that need to have the right length tension relationships as also the right ability to fire in the right sequence or not to fire too much like our pec minor and our trapezius and relive your scapula, you know, so they're kind of playing tug of war, the serratus anterior and the rhomboids. So those are, you know, key muscles that you want to get the balance back to where it doesn't mean you can't train the pec minor or the trapezius. But we just need to make sure that there's the right sequencing of these muscles in the right proportion. So that way, there's not an over activity. I have yet to find someone that had rhomboids that were overactive walking in this, or the serratus anterior that's overactive. I'm not going to say never. But those middle three muscles tend to predominantly be the over dominant in this group of five.

Wendy Batts:
Absolutely. And I know in my years of experience, I'm going to agree with you wholeheartedly that usually the pec minor, I mean it is it is super overactive, and individuals as well as the elevator and you know, you've got to think You know, if you've got some elevation and rounded, you know, forward shoulders, I mean it think about what it does not only just to your shoulder, but to the rest of your body, I mean, even in your breathing, so it can affect a lot of different things.

Marty Miller:
Yeah, and one thing I know both you and I have worked with countless people who have had rotator cuff repairs, that we're not from traumatic injuries, and the effects on their shoulder long term. And it comes down to the biomechanics, if you can get people in better posture. And if they can maintain better posture while they exercise, there's a few exercise, of course, we want to stay away from. But you know, I'm not talking about someone that's makes a living pitching, and I'm not talking somebody slips and falls. But there's so many rotator cuff injuries that are preventable in the fitness center. And once you start going through that surgical route it, things change. So we're not saying that you can't come back from it. But you know, this topic here is to get you to understand how to really get people dialed in. So hopefully, we can prevent those type of issues.

Wendy Batts:
Yes. And so next we're going to talk about dynamic stabilization. And so the major ligaments of the glenohumeral joint. So when we're thinking about this, guys, we want to think about the ability of the you know, the movement system itself to control minimize, obviously, unwanted joint motions during movement. There are certain times we want things to move certain times, we absolutely don't. And so there are we rely so much on the stabilizers, because even though we've got the prime movers, we want to think what are the muscles that are going to support that particular joint in order to get the full available range of motion that we're trying to do when we're working out. And so that's what's it. That's why we spend so much time really in corrective exercise, as well as in phase one is we're focusing more really on the stabilizers to make sure that the stabilizers are playing nicely with the prime mover, and that we don't have one muscle that's working kind of out of sync in order to, you know, do somebody else's job, if you will. And so you know, it's very important to really kind of think, alright, when I'm doing a chest press, think about your what's happening, all the muscles in the, you know, in your anterior portion of your shoulder have to work in order to do a chest press. However, if you're not really thinking about that, and you're, you're we're trying to realize someone's got rounded shoulders, I'm having him do a chest press, but I didn't do the right stretches, or tried to get my shoulder in better alignment, or actually not helping get stronger. And my pecs, if anything, I'm causing more impingement issues, and an area that is shown to be in an in an area that's not seated correctly. So it's not firing the way that it's supposed to. And so when we go back, and we really look at all this, we're really trying to think that we're only as strong as we are stable. And I've said that so many different times. And so the static stabilizers, you know, includes the structures, you know, such as your late ROM, you'll hear people talk about that, and the glenohumeral joint capsule itself. And when you're thinking about these two areas, that's going to consist of two major ligaments. And so it's the middle and inferior glenohumeral ligaments itself. And as you can see on the chart, I know it's hard to visualize. So Marty actually pulled this picture, and I think it's actually a great one, you just see how everything has to play nicely together. And if you have your ball and socket and your humerus, and it's not seated, or meaning it's not sitting in that capsule correctly, you don't have the right amount of space for all the muscles that make up your rotator cuff, as well as everything else that's playing around it. Because something is shifting your humeral head into a different position that can cause impingement, when you tried to get that degrees of freedom, you know, that you should have. But because of that impingement or because it's you've got over activity and specific muscles, it's going to lead to serious injuries that could lead to tears that Marty was just talking about. So it's a postural thing.
 
Marty Miller:
Yeah, be nice. Your stabilizers, there's one thing I think we can hopefully you guys take away from hope there's more than one is we'll probably cover more of this in the next one. So there's my shameless plug for part two is be very selective in all the exercise you pick, we're talking about the shoulder, but there are so many common shoulder exercise, see where people are forcing internal rotation, they're doing shoulder elevation, they're letting their head come forward. And I can't help it with that, as an athletic trainer, you know, people, somebody who studied biomechanics, I see that and it's like, I hear their joints screaming for help. And I mean, you're just you're really forcing those structures that they don't have a lot of blood supply to them. Once you start rubbing 10 in a bone on bone with a tendon in between bad things are gonna happen. So you know, that's where when you see the exercise that we choose, in our books, there's a very distinct purpose for that. So be very careful with the exercise you pick form and technique and understanding some more of the biomechanics of the shoulder, hopefully will help you understand Okay, that this is why these exercises are at higher risk compared to these exercises. Awesome. So. Are you know me, I'm passionate about shoulders?

Wendy Batts:
Yeah, so you want to take us through the course or the first couple relationships? I know we have two slides on this one. 

Marty Miller:
So the key thing we talked about this With every body part, but we're more focused here on the shoulder, we talked about how the you've got, you know, the different bones with the different joints, and there's not a lot, keeping the shoulder blade in place, right? So we really need those 17 muscles that attach to really do their job. And when we look at doing their job, it's can they fire at the right time in the right amount of force? in concert with everything else? It's not how strong one of them gets, it's are they moving? Well, and I have always thought about this as like a concert, where there might be 100, or 200, highly skilled professionals. If they're all doing their job in sequence, it just flows well. But if you took one of those musicians out, I know, it's hard to believe I am not a qualified musician. I don't care which one of the 100 you took out, I will rear my ugly head at some point, if I'm allowed to play an instrument, the other 99 cannot make up for me. They get they'll gonna work hard. But at some point, you're gonna be like, something's off tonight. And so something's horribly wrong. And it was 1% change, right? So we look at for this is why Wendy and I are such sticklers for biomechanics, because it all it takes is one little thing. And then bad things can happen. So when we look at force coupled relationships, it's are the muscles in the right position, posture Really? And are they firing sequentially, at the right time, with the other muscles that are supposed to guide that motion. And when you do that, we have better joint Arthur committed maddix we have all kinds of other beneficial things happen. But when we have altered force, couple relationships, other muscles kick in their length, tension, relationships change. And then we know that there's altered joint arthro kinematics. So this is why we are absolutely sticklers and when you look at how the shoulder moves, and when we'll cover this in the next slide, there is a proper sequencing of how much motion you should get in comparison to the humerus to the scapula. And that is so critical to ensure that you're getting that if you want your client to progress with some really cool fitness progressions.

Wendy Batts:
Yes. And we often see this I mean, the one that I always point out to you is the winging and I know I mentioned that earlier. But you know, and what I mean by that is, if you're in a pushup position, and you notice that your shoulder blades are coming up, and so you can actually pick somebody up by their shoulder blades, that shoulder whinging. And you know, unfortunately, you've got to think if your shoulder blades are not lying flat on the rib cage, as we discussed, there's going to be serious dysfunction that's happening, because obviously, everything that's keeping everything flat isn't working the way that it's supposed to, and it's causing that to pop up. Usually, that's an underactive serratus anterior, as Marty said. And when we talk about the push up plus next week, and we go over some program design concepts, you guys will see the importance of that. But we want everything to play well together. So you need to have perfect harmony, as you said, using your orchestra example. So but think about this, guys, if you've got tightness in your pec minor, and think about word inserts, then it's going to limit the effectiveness of the straightest interior to upwardly rotate and post early tilt the scapula. So that's what I was just talking about, which I guess I should have just waited to this slide. And so this is going to alter your link tension relationship with the rotator cuff, and your traps and your rhomboids, which is going to decrease their ability to stabilize that actual glenohumeral joint that we've been talking about. And one thing that's out of alignment guys will affect you know, this one muscle that's not firing correctly can affect the entire kinetic chain. And so that's why we, when we do all of our assessments, we look at the feet and work our way up. Because it may be something that's happening at the foot and ankle that can be causing that dysfunction that's going on in the shoulder. But because everything has been like a domino effect, it's led to that, and that's where the pain is. And so that's why we try to look at everything as one complete unit. However, this is a big one. And this is one that you often can see. And it's it's a pretty easy fix, as long as you spend time, you know, working on the muscles that are overactive and really trying to get those underactive muscles to fire correctly, as well as always working on your posture to know that grammar is important. And posture, posture posture, right?
 
Marty Miller:
Yes, yes. Who knew? They always knew better than us, right? Yeah, yeah. So here's just some statistics. Again, a lot of this, if not all of it has been pulled right out of the DSM content. This is what we we do we go out and do the research and we bring in the best information. So you'll see here with the alter thoracic spine and shoulder movement, there's the self reported prevalence of shoulder pain estimated to be between 16 and 26%. And that's from 2005. And, you know, I just watch people you know, I travel a ton. I see people in airports, and I see people they just look like they're stuck in in pain when they have that. You know, thoracic hypo says the forward head, you see the shoulder elevation, that can't feel good, it just can't and then I start to think about what's going on if they had to lift something above their head or, you know, and then you start to look kind of inside the joints and watch what would be happening. And eventually they end up with some type of shoulder pain. And now that could make them not want to move even more. So then we have other issues with their health. But again, these are, you know, we can get ahead of this. And it's something that's correctable as long as a person is not in chronic pain and being treated for an injury is just again, working back, going back to our corrective exercise, going back to our postural techniques, back into stabilization, after you do their assessment, and just getting people to get back and kind of I call it like a posture reset, to get them as part of their programming just to understand what their best posture can be.

Wendy Batts:
Well, and I think it's important, I mean, you might you, you really did hit a key point, if somebody has rounded shoulders and a forward head, guys think about this, if they have to lift something overhead, or if they have to, like Marty said, if they're in the airplane, and they have to put their luggage overhead, or, you know, if you're, you know, working in the kitchen, and you're putting dishes away, and you've got stuff that goes into an upper cabinet, or if you have a baby and you're you know going to lift them up or put them in a car seat, or whatever it is you have to do those movements. And so if you don't have the correct range of motion, then something else has got to give. And that's this happens across all you know, all of our joints all you know, and over time, that overuse and repetitive patterns, it's it's going to be our new normal, however, think about what's happening specifically in that joint, because what does it mean for rotator cuffs and your bicep tendon have to pass through the the, the shoulder complex itself, so space, and then we have a Bursa in there, too. So not a lot, not a lot of room laundry room with a lot of degrees emotion that you know that we're expecting to get out of our shoulders. And so unfortunately, our shoulders take the hit the neck takes the hit. And there are so many, so many different areas that can be affected with just specifically those two main compensations.

Marty Miller:
And the crazy part is if your rotator cuff, you know, I'm simplifying it because there's a couple of things not firing properly, as I go upward. It's supposed to have a force couple relationship, that kind of key, almost, I kind of viewed as like a bit of a distraction. So that way, as I bring my arm up, it doesn't migrate superior in that joint. Because if it does migrate superiorly Well, the four rotator cuff tendons, the bicep tendon, the bursa, they're not going anywhere, they're still going there. So now you're starting to squish them in between. And that's where you see people, they kind of shake their arm out, or they feel that pain, well, you can't create more space, right? So what you need to do is you need to give people in their best posture, get the muscles to fire properly, so that way the joint is allowed to go through that range of motion, unimpeded.

Wendy Batts:
Yes. And you know, and you'll hear common common or common issues that you're we're hearing more and more about is a torn rotator or frayed rotator, or now they've got, you know, and think about, as Marty just said, if you've got all this rubbing intention over and over again, on those, it's just like, if you have a rope and you've got something and you just keep doing this, and this over and over again, on the rope, it's gonna start to fray and then eventually tear. And, you know, you hear people with torn labor rooms and all this stuff. A lot of that is so prevented, you know, it's so preventable. It's just you've got to be able to identify it, and then make sure that you correct it accordingly.

Marty Miller:
Yes. I mean, these are just some of the primary movers guys. So when you're thinking about, you know, what are these different, you know, muscles do and how will it affect what's going on and the key muscles of shoulder motion. These, like Marty said, he just pulled this straight out of the book. And so these are just good things to think when you're doing, you know, when you're trying to work your lateral deltoid, you got to think abda, or, you know, abduction. And so, if you're trying to specifically work muscles, look at this chart, it's going to help you, because it's important to know prime movers and what you're doing with them in order to execute proper movement patterns. So you're not working in overactive muscle more than an underactive muscle.

Wendy Batts:
And there's another slide here, but if I'm not mistaken for some more muscles that we'll see next. So there's a lot, but I think the key thing is again, what I love, love, love our model, go back to the movement assessment. And if you see, you know, faulty movement patterns, and you can pull through here and say, Okay, what muscles are pulling me into this, that or the other, then you know what muscles, maybe you don't want to attack from a strengthening standpoint, and you can reverse engineer everything. But you know, I think the key thing is when we look at the core, and the shoulder is we have to work from the inside out. So I know people want to get right into presses and all these other exercises. But if the internal mechanisms in your shoulder just like our core, their deep intrinsic core stabilizers, the muscles that support the vertebrae, if they're not firing, you're shouldn't be doing a bunch of heavy core work, right, the twists and the crunches and leg lifts, etc. Same thing with our shoulder. If the Little muscles that almost our clients, they might know they have a rotator cuff, but they're not telling you sub SCAP in for smiles, Terry's minor that they're not rattling them off. If those muscles aren't firing properly with ideal posture plus the muscles that work the scapula, you got to be careful getting them into some of those other shoulder exercises that they're probably more familiar with.

Marty Miller:
Great point. So if we move on, we just talked about this a little bit with a rotator cuff. So when we're thinking about this, you know, we've got to make sure that we have the perfect harmony, as we were talking about. So we're looking for ideal movement. So therefore, the force couple that is controlling the humeral head in the transverse plane, is we want to make sure that everything in the in the rotator cuff is working the way that it's intended to, because if not, that's when we hear about those tears or that impingement.
 
Wendy Batts:
And, and, guys, seriously, it's it really I shouldn't say it's an easy fix, because unfortunately, people have been in pain for a long time. And now we're trying to redo someone's new posture that they've had for you know, 30 something years. And so it does take a lot of time. However, we really want to make sure that the sub SCAP itself and the post your rotator cuff, that we have got perfect harmony there because we want to focus more on activating the posterior side more than the anterior. So usually, depending on what the compensation is, you're noting in the assessment, it's going to be usually opening up the front, strengthening the back. So therefore, again, we've got better rhythm throughout our shoulder blades, our shoulder capsule itself, as well as you know, the three main bones such as the clavicle and everything moving the well way it's intended to move.

Marty Miller:
Yeah, and if I get some hair just from this is my personal belief system. I've worked in professional baseball, I know when you did with a lot of athletes that throw ball. So definitely, I've seen my fair share of rotator cuff issues. Remember, they're small endurance muscle. So it's high repetitions, slow controlled tempo, work, the pause, work the centric, but every single day that I do upper body, I don't care what phase of training I am doing, it can be a power workout, it could be a strength endurance workout could be max strength, I still target my rotator cuff in the postural muscles as my specific corrective exercise warm up, that's me, that's the way I do it. But if I'm going to start lifting heavier weights or doing explosive things, hard for me to justify, now, I don't need to get those little muscles fired up and ready to go. And I do see a lot of people now that have gravitated to quads rotator cuff in a gym, and it's horrific. Because they haven't done the four step process of corrective they haven't done the foam rolling, they haven't done the lengthening, they don't understand proper biomechanics, all of a sudden, they're doing extra rotation, and it might as well be thoracic rotation, and or tricep extension, I appreciate the effort because they're not they don't know what we know. But it's got to be executed with precision just to get those most of the fire within a range of motion that I have. You know, so I, it's awesome that I see more people trying to do it, but it's really probably one of the things that is I guess I could use the word butcher frequently with people that are novices not knowing what we know, with what they're going to try to do with some type of rotator cuff exercises.

Wendy Batts:
No, I agree. And guys, you want to think about even in your body builders, I mean, look how small those muscles still are. So you know, when you're lifting extremely heavy weights, and, you know, if you're arching your back, if you're you know, if you don't have like Marty's point, if you're doing you know, external rotation with the cable and you've got something underneath your your arm for support to try to keep it in, and then you're just going out into a 90 degree angle. If you've got your back bending, and you've got you know, you're throwing yourself into it, there are so many compensations that are happening plus think about what's happening at the lat. And now your lat is in a shortened position that actually, you know, because of its assertion in the front of your shoulder, it can cause some issues, because now you're arching your back in order to try to do a post your adult and what's the purpose of that. So it's very, very important to you, to your point, precision is everything.

Marty Miller:
Absolutely awesome. So we will move forward here to our next slide. So I I know that there's a lot that we can talk about what shoulder but really what we didn't want to do. Wendy, I know you and I talked about where do we go with this, we want to make this eye opening but not overwhelming. There's plenty of resources out there. If people really want to get into the biomechanics of the shoulder and really dig into it. We are going to cover some more biomechanics next week, because we did purposely kind of put a couple points say, okay, that'll be good for the following one, then we'll get to the program design. So there's more to come even with the biomechanics, but you know, when if you want to maybe take us through our key takeaway.

Wendy Batts:
Sure. And you know, assessments are always going to be your key. And the wonderful thing is, if this seems overwhelming, and you guys are listening to us and like I don't have any idea what they're talking about, I know what the clavicle is, I know what the humerus is, you know, when he's got some crazy thing with the elbow, you know, there there are a lot of things to consider. What the four major joints those are four major joints, guys that you also want to keep, you know, in optimal, you know positioning in order to get better execution of the muscles and make to ensure safety, if you will. So assessments are always going to be key, if you've got forward, head around and shoulders, you're going to mark it, but then look at that solutions table the NSM has provided you that is always going to be your go to, especially when you're new with some of this anatomy, you know, always work on the faulty movement patterns. And we're going to say this, probably every single week, you're going to lengthen by, you know, doing some kind of self myofascial technique as well as stretches with the overactive muscles, and then provides some kind of activation on the underactive muscles. Again, those can be found on that solutions table. Always think about regression, if you start to see someone, when you're, you know, trying to pinpoint, you know, exactly the example of the posterior doubt. If you notice that there's a lot of compensations, it is not the appropriate or the exact exercise that's going to benefit someone. So you're going to always want to regress it, you know, think about the model. Think of its purpose. Phase One, ideally is working on the stabilizers, working on proper movement patterns and faulty movement patterns, trying to correct those. But you know, just to prepare you guys for part two, I think it's important to also think about scapula thoracic rhythm as Marty said, he, you know, that is really, really important. And if you want to have, you know, shoulders that are going to stay healthy, he got to have good rhythm. Everybody needs good rhythm, right? Yeah. So, so that is that is my key takeaway. Because if you can get yourself more custom and understand truly how everything works together, then you're going to this stuff will become second nature, without having to know specifically origin, insertion, and even really activation or, you know, function.

Marty Miller:
And the, you know, key thing here too, is, there's a lot of important parts of everything we do and not one body part or regions more important than the other. But if you can get somebody's posture, better, their shoulder mobility and their shoulder function better, it does open up the door to potentially more progressive exercise progressions for these individuals, if they're not limited with what's going on in their shoulders, for sure.

Wendy Batts:
Yes, awesome. And as always, if you guys want to contact us, you can find me at wendy dot bats@nasm.org or you can find me on Instagram at wendy dot bats 13.

Marty Miller:
And then you'll see my information right there below Marty Miller at ndsm dot o RG and then my Instagram is Dr. Marty Miller seven two. So Wendy great work as always, and I look forward to next week's part two. Yes, hope see you guys there.
 
 
 

 

 

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.