photo credit: screenrant.com
The shoulders are a very common area of the body that are plagued by pain and dysfunction. As mentioned in my previous posts 3 Ways to Get Out of Shoulder Pain, Part I and Part II, there are multiple reasons why someone may suffer from shoulder pain.
Time and time again, when someone suffers from shoulder pain, I see physical therapists or strength coaches providing their patients/clients with exercises that come from a pre-fabricated sheet of exercises that are given to everyone with shoulder pain. Some of those exercises include: I's, Y's, T's, Full Can, etc.
Now, don't get me wrong, there is a time and place for these exercises. Typically, after someone has had shoulder surgery, the muscles of the rotator cuff and muscles surrounding the scapula are dysfunctional and have atrophied. In turn, they become weak and unstable and need to be strengthened in order to provide a stable base for the shoulder to work off of.
Muscles of the rotator cuff and the ones surrounding the scapula need to be BOTH STRONG and provide adequate STABILITY. Those two words do not mean the same thing.
In prior posts, I've used the slingshot example.
Strength is the ability to pull the elastic band back and Stability is the ability to hold the slingshot stable and not let it come flying towards you. It is the ability to resist a change in position.
The rotator cuff consists of 4 muscles:
photo credit: http://physioworks.com.au/injuries-conditions-1/rotator-cuff-injuries
There are many functions of the rotator cuff. It acts in the movements of:
and is also active during other various arm movements as well. But the true function of the rotator cuff is to dynamically stabilize the shoulder.
What this means is that during any type of shoulder motion, the rotator cuff reflexively fires and centrates the head of the humerus into the glenoid.
photo credit: http://singaporeosteopathy.com/2015/05/06/shoulder-101/
What does that mean? When the rotator cuff reflexively fires, it causes the glenoid to become centered in the joint and move about an axis of rotation that is conducive for the health and function of the shoulder. By moving about a certain axis of rotation, it keeps the stress on the muscles of the shoulder and off of the passive structures.
If the cuff is having issues with centrating and maintaining a stable shoulder, then this can cause issues from rotator cuff tendinitis and subacromial impingement to rotator cuff and labrum tears. If your shoulder de-centrates one time, bad things will not happen. What happens over time through repetitive stress and strain is micro-traumatic damage that can eventually lead to one of these potential diagnoses.
The exercises mentioned above do well at strengthening the muscles of the rotator cuff and surrounding musculature, but they aren't the best for helping to improve dynamic stabilization of the shoulder of the rotator cuff.
Ways to Improve Dynamic Shoulder Stability
There are various ways to improve dynamic shoulder stability. One is through something called Rhythmic Stabilization.
Rhythmic Stabilization is any activity that causes the rotator cuff to have to reflexively fire to stabilize the arm in an attempt at being moved.
Here is a video of an example of rhythmic stabilization at the shoulder:
You can also vary the angles that rhythmic stabilization is performed at. Start with the arm at approximately 110 degrees of shoulder flexion (basically arm straight up to the ceiling) and eventually bring the arm farther and farther overhead. As you go farther into shoulder elevation, the more difficult it will be to stabilize the arm.
You can also apply the pressure starting proximally near the shoulder and then work distally towards the elbow and wrist which, in turn will make the exercise more challenging.
This should not be something where the coach or physical therapist who is administering this should be trying to over-power the patient/client. This is a technique for the athlete/client to work on controlling the position of the arm and we are looking for good quality movements.
If this is something you or your client does well at, there are other various methods to improve rotator cuff dynamic stability.
For this next series of exercises and progressions, I prefer to use a kettlebell. I like to use the kettlebell because it can be used to add in an element of instability. With this element of instability, the arm, shoulder, and rotator cuff have to work to stabilize the arm in a certain position.
I first heard of using a kettlebell for various shoulder stability from Mike Reinold. He did a webinar a few years back speaking specifically to kettlebells and their use with the shoulder. Some of the information here I learned from him and his webinar series. Check out his Inner Circle for various webinars each month on topics ranging from physical therapy and injury prevention to strength and conditioning and performance.
Let's start with the easiest progression and work our way up to more difficult options.
Kettlebell Bottoms Up Static Holds
Supine Kettlebell Press
Kettlebell Press and Twist (Screwdriver)
Incline Kettlebell (KB) Press w/ or w/o Screwdriver
This can be useful for someone who lacks shoulder stability above 90 degrees of shoulder flexion. The incline bench allows them to work on it above shoulder height in a pressing fashion without doing direct overhead pressing.
KB Side-lying Arm Bar
KB Side-lying Arm Bar to Press
All of these options can be used in either bottoms down or the bottoms up position. If one movement is too difficult, then regress to the previous option, decrease the amount of weight, or go from a bottoms up to a bottoms down position.
These are just a few options you have if someone is returning from a shoulder injury, rehabbing an injury, coming back from surgery, or are just looking to maintain healthy shoulders.
Stay tuned for my next post on more advanced shoulder stability options!
Push-ups are an amazing exercise! They can improve so many different areas throughout the body such as.
Some of the positive effects from push-ups mentioned above may seem obvious. But for the ones such as the neck, core, hips, and body tension, let's discuss.
For the neck, when performing a push-up, the neck should remain in a neutral packed position throughout the movement as seen below. By focusing on maintaining this position, it helps to improve the stability of the neck, especially the deep neck flexors, which are major players in the health and function of the cervical spine.
Whether it be throughout daily life or various aspects of exercise, the deep neck flexors have a tendency to not function at a high level.
For the core, when performing a push-up, gravity is attempting to make your lumbar spine extend/hips drop down towards the ground. By bracing your core and maintaining a neutral spine, you are basically performing a moving plank when performing a push-up.
Push-ups can improve hip stability. Now, you may be wondering how an upper body dominant exercise can affect the hips. When you are bracing your core and using rectus abdominis/obliques to maintain a neutral spine, the gluteus maximus should also be contracting to help to posteriorly tilt the pelvis and in turn maintain a neutral spine.
Rectus abdominis, obliques, and gluteus maximus all act to posteriorly tilt the pelvis. By doing a push-up, this will help to maximize the muscle groups that work to improve the ability to posteriorly tilt the pelvis and in turn maintain a neutral spine for other weight training endeavors.
Lastly, by incorporating all of these areas together, push-ups can help someone improve total body tension. Total body tension is imperative to be able to attain during big lifts such as the bench press, deadlift, and squat, to name a few. By attaining total body tension, this allows movement to occur in certain areas during certain movements while keeping movement in other areas to at least, very minimal.
So, now that we have listed the multiple benefits of of the push-ups, many people mention that push-ups are not difficult for them. They can do push-up after push-up after push-up for days and not feel a "pump" or feel fatigued. You want to make sure that you can maintain proper form with a body-weight push-up before trying a more difficult version.
3 Ways to Make Push-Ups Harder.
1. Add some form of External Load.
Doing body weight push-ups can become obsolete for some people if they get to a point where they do not find the exercise difficult. Besides increasing someone's body weight to make the exercise more difficult, finding ways to progressively overload the exercise can become more challenging.
Instead of continuing to do body-weight push-ups, add some form of external load.
Whether it be using a weight vest, weight plates, chains, or resistance bands, these are great ways of adding external load to the push-up.
Out of all 4 ways of adding an external load, the chains and resistance bands are a nice tool because they use accommodating resistance. What this means is that as you lower yourself to the floor, the resistance will be the easiest at the most difficult point in the movement. The bands will have the least amount of resistance/the chains will be partly on the ground when you have to change from the eccentric to concentric phase of the movement and press back up to the starting position. The movement will then become harder as you continue to press because the bands will increase in tension or more of the chains will be adding weight to the movement.
With the weight vest or weight plate option, the load remains constant throughout the movement and in turn will be more challenging than chains or bands because the resistance doesn't accommodate throughout the movement. If performing with a vest or plate on your back is too challenging due to the constant tension, start with chains or bands first.
photo credit: exrx.net
photo credit: http://www.criticalbench.com/exercises/pics/band-pushups2.jpg
2. Elevate your feet.
Another way to make a push-up more challenging is to elevate your feet. Place your feet on a step, bench, or box. While maintaining good form, slowly lower yourself to the ground.
One mistake that people will make when the elevate their feet is that they try to touch their chest to the ground. The problem that arises is hyper-extentension through the thoraco-lumbar (TL) junction and lumbar spine in order to get the chest to touch the ground. Instead, slowly lower yourself until your face comes within an inch or two of the ground.
To make that version harder and you want to be able to go lower than stopping when your face reaches the ground, elevate your hands slightly on two Reebok steps, dumbbells, or the "push-up handles" that can be seen at various gyms.
photo credit: tonebodyfitness.com
photo credit: dickssportinggoods.com
Just make sure not to go too deep where the shoulders are hyper-extending and causing pain and irritation to the anterior structures of your shoulders. Stop when the elbows and shoulders are in line and the shoulder blades cannot retract any further.
3. Adjust the Tempo
The third way to make push-ups more difficult besides combining ways 1 and 2 are by adjusting your tempo/speed when performing push-ups.
You can incorporate Pauses a.k.a. Iso Holds in the bottom position for a certain period of time, ie. 2-4 seconds.
You can also add in Slow Eccentrics during the eccentric component of approx 5+ seconds.
Last, you can incorporate both Iso-Holds and Slow-Eccentrics into the movement.
Push-ups aren't sexy and they aren't usually thought of as an addition to most strength training programs, but they can bring up sticking points in certain bench or dumbbell pressing movements and can also help keep your shoulders from feeling cranky.
Give these a try and let me know what you think!
photo credit: askmen.com
For as long as I can remember, push-ups have been around. They are a simple movement that most people can do because it only involves you and the ground. It is used in physical fitness testing ranging from elementary school all the way up to the Marines and everything in between.
It is an excellent exercise and movement due to its simplicity, but also the bang for your buck that you are getting by performing it. When performing it, besides working the pectorals and triceps, it also works scapular stability as well as hip and core stability. Besides muscular strength and stability, if performed quickly enough, it can be used for an aerobic workout and can increase the heart rate rather quickly.
The push-up is a great exercise for all ages and levels of experience. Time and time again, I see the male population performing push-ups on the floor, but on the flip side, some women and also some men are performing the "girl push-up" or the "modified push-up."
photo credit: youtube.com
I completely understand that a push-up from the floor may be too difficult for some people, male or female, to perform. When performed correctly, it can be a challenging exercise on multiple fronts. The problem with performing the modified push-up is that you aren't reaping the benefits like you would be with a regular push-up.
Instead of performing the modified position, perform a push-up with your arms/hands elevated. For example, instead of performing push-ups on the floor, perform them against a bench, countertop, bar in the squat rack, etc. You name it, it could probably be used.
Man or woman, if they are having a difficult time performing a push-up on the floor, these are great regressions you can perform while still reaping the benefits of a normal floor push-up.
Yes, the elevated push-up will be EASIER as compared to the floor. But, with the elevated push-up, you can still work on proper scapular mechanics, core/trunk stability, and improve your pressing strength.
The modified push-up is by far not as hard on the core and less demanding of the performer to have to maintain a neutral spine. With the elevated push-up, you still need to maintain a neutral spine because you are performing the movement on your hands and feet, therefore increasing the difficulty with a longer lever arm vs the modified version. This will in turn increase the demand on the core musculature versus a smaller demand with the modified version.
Time and time again in my strength:rehab world, I NEVER have a patient or client perform the modified push-up from the knees. Man or woman, if they are having difficulty performing a push-up from the floor or if someone is coming off of a surgery to the shoulder/arm, we will perform an elevated version before progressing to the floor for the various reasons mentioned above.
The great thing about performing the push-ups elevated in a squat rack is that you can monitor your progress quite easily. Whether you are performing the push-up against a bar in the rack or on the crash bars, you can easily progress or regress the exercise. By observing where the bar or crash bars are located in the rack, ie. 10 holes from the floor, this is an easy way to monitor if you are getting better at performing the push-up and also know where to set the bar each time you go to perform them.
Besides using the variations mentioned above and are close to performing a full push-up from the floor, but it is still too difficult, here are some quick variations to help with some sticking points.
Slow Eccentric Push-Ups
Push-Up Iso Holds
So, there you have it, whether you are performing the modified push-ups on the ground because you can't do a regular push-up on the ground OR you are recovering from an injury or surgery, STOP doing the modified push-up and elevate your hands and start performing them from an elevated surface.
As you get better on an elevated surface, you can continue to progress the difficulty and eventually be on the floor doing a legitimate floor push-up.
photo credit: eventbrite.com
I just finished listening to the audiobook, The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results.
In the book/audiobook, authors Gary Keller and Jay Papasan basically talk about how there is no such thing as multi-tasking. There have been research studies done on the efficacy of multi-tasking by an individual and in the brain and the results were that... no one can multi-task!
Some people may think that they can multi-task and are really good at it, but what happens is that when trying to do more than one thing at a time, the brain can only devote its attention and effort to one thing. The other "thing" or activity suffers. The same goes for trying to perform multiple activities at the same time.
After informing the readers about these points, the authors luckily go on to inform the reader/listener of ways that they can improve their ability to focus on one thing at a time and ways to be more productive.
After finishing the audio-book, there were a two points that I took away that were valuable lessons.
1. Successful People Wake Up Early
photo credit: https://en.wikipedia.org/wiki/File:Digital-clock-alarm.jpg
The authors studied people over the years who have been successful in various fields. Whether it be business, medicine, entrepreneurs, etc., people who were successful woke up earlier than everyone else.
Now, I am not saying that everyone who wakes up early is going to be an overnight success nor am I saying night owls cannot be successful. Personally, I have found waking up early allows me to take care of the tasks at hand prior to the rest of the world waking up. I wake up early so that I can focus on my One Thing, which is writing for this blog, and give my complete and undivided attention.
I don't check my e-mail, I don't go on social media, etc. I sit down and focus on doing one thing: writing. This allows for greater focus and for me to be more productive. Then, when the rest of the world awakens, I can give my undivided attention to my wife, son, family, and work.
There are other successful people who are night owls and can stay up late to get their work done. One of the common trends between people who wake up early and people who are night owls is that they have found the time of day where they can focus on their one thing. It is all about finding the time of day where you will be the most productive with the least amount of distractions.
2. Focus on The One Thing with your Clients/Patients.
Whether you are a personal trainer, chiropractor, physical therapist, etc., when we are assessing and/or treating a client, there are usually multiple areas of dysfunction that we find during our assessments. Not too often do we only find one thing that will fix everything and that's it.
We may find that someone lacks internal rotation of the hip, has poor core/trunk stability, as well as soft tissue restrictions in XYZ muscles.
All of this information can become somewhat overwhelming. You start asking yourself, "Where do I start?" , "Should I treat everything on this client that needs to be fixed?" "I'll treat/address a little bit of everything and that'll work."
If it is fat loss, improving someone's movement quality, or getting them strong, focusing on one thing at a time is less stressful for you and also for the client. This type of laser focus allows you and the client to keep an eye on the goal at hand.
photo credit: http://stevefitz.com/wp-content/uploads/2015/04/Bruce-Lee-Laser-Focus.jpg
Gray Cook has also used the phrase, "One Shot, One Kill." Being able to treat one area and that improves other areas that may not have been directly treated, this is mastery.
If we try to spread our resources too thin and fix everything that we see is dysfunctional, then we can frustrate ourselves and/or our clients.
It can take years to attain mastery in a particular skill or field, but by continually focusing on one thing at a time and directing your efforts at one thing, this will allow for better focus and better productivity.
If you found this post helpful and/or interesting, please share it with your friends and family.
Here I will be writing and posting about topics ranging from physical therapy, injury prevention/reduction, and strength and conditioning.