Dealing with Shoulder Injuries

This is an article I wrote that appeared on Strengthcoach.com and I have had many questions so I thought I would reprint it:

There is a common belief in the strength and conditioning community that overhead pressing exercise should not be used for the typical “shoulder athlete.” These athletes being from the sports of baseball, volleyball, tennis, and swimming. This belief is that the overhead pressing exercise will lead to injury, primarily a shoulder impingement.
When looking at typical overhead shoulder problems, there is usually a lack of certain mechanical requirements that enable a healthy movement. These are proper scapular control, good thoracic spine mobility, lumbar stability, and good hip mobility. I will also mention good C-spine stability is another preventor of many shoulder problems. Gray Cook calls this the joint by joint approach to movement and it makes things quite simple. Shoulder impingement problems are rarely caused by the shoulder, but rather a collection of poor function of the surrounding joints.
In working with swimming athletes, we find that a swimmer does not perform much in the way of co contraction due to the effect of gravity or being in a closed chain environment. With the exception of a few microseconds at the start and in open turns of the breast stroke and butterfly the swimmer is purely using concentric contractions. This alone, can result in a variety of injuries to the shoulder with repeated stresses to the extensors and internal rotators without the stabilizers kicking in. Take a look at the reasons why we switched away from machines using an open chain movement. No co contraction, no joint stability, which led to injury in the sporting activity. This is why swimmers are known to have shoulder injuries of the when, not if, variety.
The standard dry land training program typically consisted of simple rotator cuff exercises of internal/external rotation, flexion, and extension exercises with tubing.
It was economical and strengthened the shoulder to prevent injuries. This was usually combined with some push ups and some “ab” work consisting of crunches and straight leg throws. The isolation of the shoulders and the hip flexor dominant training has led and continues to cause the overuse shoulder injuries that swimmers endure.
Look at most swimmers and you will see a very anterior dominant musculature:
• large pecs
• wide lats
• six pack abs
• tremendous quads

From a postural viewpoint, the scapulae tend to be winged out, shoulders internally rotated, thoracic spine kyphotic, zero gluteal development, and little calf development.
When looking at the causes of shoulder injuries and returning to the joint by joint approach, we have found that the flexor dominant training of the hip leads to very tight hip flexors and poor glut utilization. The tight hip flexors, when kicking will lead to a hyperextension of the lumbar spine causing stress. The kyphotic thoracic spine will not allow good gliding of the scapula, which will lead to poor GH action and therefore, overuse injuries will occur.
To avoid such injuries, a total body approach to the shoulder must be taken. We build the shoulders from the ground up. We strengthen the shoulders by building a good foundation from the hips. Remember that when building a house, you need a strong foundation, then a good framework, a roof, and finally, you make it look nice. The hips need to gain good mobility and posterior strength in order for the (again repeating myself) lumbar spine to be stable, thoracic spine mobile, etc. Proper instruction and technique for our swimmers need to happen in this order to establish a relationship between the hips, core, and shoulder:
• correct squat
• correct lunge
• proper plank
• plank with rotation
• correct push up
• overhead squat
• single arm overhead walk
• single arm overhead lunge

Once the athlete has established this relationship with the core and the hips, we can begin pressing exercises. All of our pressing exercises are done with a dumbbell or kettlebell. I like the kettlebell because of the added stability requirements by not holding its center of gravity and you cannot “balance” the weight overhead. The pressing exercises utilizing the entire kinetic chain will work in the following progressions:

1. Good hip work
2. Static overhead hold and walk
3. Static overhead split squat
4. Static overhead hold and lunge
5. Lunge and press (to many variations)

The shoulder is a complex joint and is prone to injury in isolation. Many of the exercises that are used here for swimming athlete can transfer over to other athletes as to not be too “sport specific” in nature. Since we have put this program together for our athletes, we have had no issues with the shoulder in a very “shoulder injured” sport.
The key to good shoulder stability with the athlete is to look at the whole system instead of isolation in the shoulder itself. Good strength and good mobility are the foundations of the healthy athlete. As strength professionals, it is our duty to keep the athlete playing and competing in their sport, not to make a great lifter out of them.
©2009 Unlimited Athlete, Inc.

Proud of "My Kids"

Yesterday was my birthday.  I had a very nice day and had many well wishes from folk all around.  Thanks to all.
I had a great evening watching "my kids",  as I like to call them, swimming at the Washington HS State swim championships. My own children are not in HS yet, but I went to a swim meet on my birthday.  It is always exciting watching all the hard work that they did in the gym pay off.  In nearly every final event, I was rooting for someone who has trained in my gym.  That is a very exciting thing.  I shared the successes with the kids, their parents, their friends, and their relatives.  I have a tendnecy to get close to the kids that train with me.  Not only am I their strength coach, but many times, I'm a father figure, a mentor, or just a sounding board.
I watched with pride each race and celebrated each success and felt the pain of some of the dissapointment.  The good thing was that the success heavily outweighed the dissapointment!
So, for anyone who trains athletes, make sure that you go to see them compete every once in a while.  It's well worth it.

Presenting at the NSCA-WA State Clinic

This weekend, I presented at the Washington State Chapter of the NSCA(National Strength and Conditioning Association).  I have been presenting for this organization for several years.  My topic at this clinic was "Functional Training for Seniors". We looked at many of the challenges that face both seniors and the trainers who train them.  You can find this presentation on my website in a .pdf format by clicking on Functional Training for Seniors.

It was a great pleasure and honor to speak at this clinic with experienced pros like Susan Kleiner, Carmen Bott, and Guido Van Ryssegem, as well as great newcomers like Rick Kaselj, Joshua Fitchitt, Dave Suprak, and Clark Masterson.  Great speakers, all of them.  There was a lot to be learned on this day.

Accountability

During my own workout today, I thought a lot about accountability.  Some of this accountability is a motivator.  To most, it is.
When you workout with a partner, you are held accountable to show up and participate in the training session.  This, for most people is one of the best motivators to start up or stay with a program.  It's been proven to work well.  You drive eachother, set a good competative environment and get a good quality workout.
This aslo holds true when you hire a trainer.  Not only are you held accountable to your appoinment time, but are financially accountable as well.  Now, what about combining training with someone AND a trainer?  Small group training is a very popular trend right now. With the economic climate the way it is, most folks don't have the money to spend on one on one training.  Let's face it, it is expensive.  But, when you come into an appointment with a few others, it not only costs less, but it is a lot of fun as well.  We, at Unlimited Athlete. like to offer small group training.  Great accountability at less cost!  What a way to go.

First Post to a blog

As this is the first post to my blog, I must say WELCOME.  Hopefully, through this blog you will gain some knowledge, insights, and information on the fitness world, training, and life.
I hope to be able to provide some thought provoking posts that will make you re-examine how you look at a variety of issues.  I'll try to provide regular updates on my appearances, links to sites I think are worthwhile to visit, and some of the happenings and results of soome of my clients.
As we teach, we learn.  There should be a lot to share...hold on!

This Sunday, November 8th, I'll be speaking at the NSCA-WA Personal Trainers conference.  I'll be speaking on Functional Training for Seniors.  The one day conference will be at the Pro Sports Club, in Bellevue, WA.