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Old 01-27-2010, 07:34 AM   #26
Mark Fenner
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Default SA Re-Programming

Dr. G asked me to post this into the sticky. Here goes:

Hi folks, long time, no post ... but this is an issue near and dear to me.

In about June of 2008, I developed some severe shoulder pain that, of all things, completely destroyed me while squatting. I got bad enough that I did some squatting and then attempted to bench press and ..... presto, I had to limp home holding my arm as if it were in a sling. Not good. One note, my downhill slide with the shoulder issue was accelerated by a transition from hi-bar to low-bar squatting. That is neither here nor there for this discussion. One other note, I was a "overhead athlete" for sometime: LOTS of volleyball in my history and some of my soccer career was spent as a goalie. My shoulders have also been dinged up from judo.

My pain was primarily on the posterior side of the left deltoid: sometimes coming at the top left of the scapular triangle, sometimes at the delt-tricep intersection. For the summer of 2008 I did a bit of this, that, and the other thing to rehab it. Mostly, I rested it. It healed up enough to let me do two rounds of Sheiko in the Fall of 2008. In spring 2009, I followed Cressey's Maximum Strength programs, partially b/c of the lack of direct back squatting. I really enjoyed it (great program! my wife is doing for her second time now), but at the end my back squat was in sorry shape and my shoulder pain while back squatting was substantially worse. Now to the point.

In May, 2009, I was fed up with my back squat being interferred with by a "stupid" shoulder problem. So, I found a great PT (Joe Grant, Warren, VT) and we went to work. His main comment on assessing me went something like this: "Holy Crap! I've (almost) never seen someone that trap dominant". In other words, thanks to lots of heavy pulling (especially rack pulls), my traps were doing all the raising (literal lifting) of my scapular shelf and I wasn't getting any raise out of upward rotation of the scaps. Now, you can get height at the shoulder in two ways: either shrug (duh) or rotate your scaps so they "face the heavens". I was doing all of the former.

So, my PT prescribed some exercises. Here are the two "raises" that were most useful:

(1) DB in right hand, standing tall, shoulders pushed away from my ears, palm facing forward (supine position): do a "front raise" but move from the hip across in front of your LEFT eye/ear and continue up ... as long as you don't get into a shrug. Lower and repeat. Eventually, I did this in a staggered stance (right leg slightly back) which emphasized the cross-body movement a bit.

(2) DB in right hand, slightly bent forward and rotated right shoulder towards left hip, palm to the back: basically do the cocking motion for a volleyball spike but keep it in slightly tilted plane ... when you get to the top, reach back but also allow your body to open up (don't isolate). As you get the feel for your serratus anterior, make sure it is locking your scap to the ribs as you reach back.

A comment on raise (1). Thing about the action of the SA: it anchors the scaps to the ribs. If you reach across your body (particularly with your palm like a mirror coming up to your face), you almost have to staple the scaps to the ribs to make it happen. Bingo! Hello, Mr. SA, pleased to meet you! Raise (2) is more of a "make the whole body open up so you don't overstress your rear delts and friends" when you reach behind you.

I consider raise (1) my money exercise to wake up my SA. I do it almost every workout. When I "forget" it ... I pay. My setup for my squat now includes actively raising my chest (includes upward scap rotation), shrugging my shoulders DOWN, and then reinforcing the upward rotation. All of a sudden, I have tons of room for my arms AND I'm not hyperextending in the rear delt compartment.

3 other exercises that were surprisingly helpful:
(1) Full body version of raise (2) progressing to one foot. Right hand starts near your left foot. Open up and reach back behind you to your right-rear corner. Make sure everything contributes to opening-closing. If you do it very forcefully, you might want to review your judo forward rolls.

(2) Full body reach up. While standing, dip low and then reach up as if you are trying to do a layup. Focus on the shoulder mechanics in raise (1) and using all your muscle to extend up and absorb the force of coming back down.

(3) Kung fu power punch (sorry folks, this are my mental images ). Standing in about a 45 degree stance: coil back on your right leg with your right hand chambered at your hip. Twist your feet, rotate your hips, shoulders, and extend your right arm forward (a knife hand or cupping hand works well, palm facing your left) ... and keep extending and extending and extending. Possibly try to take the base of your hand (the side under the pinkie) and show it to a person in front of you [that last bit I found helpful to get more SA involved].

In all three of these "stupid human tricks" as my PT names them for some of his clients, the goal is to look like an athlete. When I was learning them, an older lady on a bike in the office said: "He looks like a Greek statue". Let me assure you, it was not b/c of my physique!!! It was b/c of the full extension/movement of my whole body.

A few other notes that I learned on my journey:

(1) If you are compensating for lack of scapular mobility with overuse of your posterior delts and friends, then doing more posterior delt/upper back work may make your shoulder worse! Seriously! I look at it like this: my humerus should be in line with my scap. If the humerus goes back significantly further than my scap, there is going to be a "pinch" in the area of the delt.

(2) Pushup-pluses are good ... if you know how to work your SA. If you don't, you are just grooving the wrong pattern. If you are in the position of re-educating your SA, then make sure you have a mind-body connection to your SA and make sure you can feel it before going pushup-plus crazy. Don't be ashamed to do pushup-pluses from your knees.

(3) Raised feet pushups can activate the SA more (if you are using the right movements ... if you pike up and shrug your shoulders, guess what ... you lose).

(4) I found that pushups with either my hands (fingers) pointing to 10 and 2 o'clock (or even 6 o'clock on both like a reverse grip bench press) made feeling my SA easier. Using a medicine ball with the fingers at 9 and 3 o'clock has the benefits of being unstable (more muscle activation with less weight) AND the great benefit of requiring some compression (i.e., pulling the arms to the chest ... and the scaps to the ribs).

I didn't pursue it alot, but raised feet, medicine ball pushups definitely bring out the SA.

(5) Be careful of pull ups and friends. If you do a "chest heavy" pull up (i.e., at the top squeeze, you pull your shoulders together with your pecs to get the last inch), you might be making things worse. If so, make sure that your are opening your chest at the top (i.e., pulling your shoulder blades together for the top squeeze).

My PT also recommended DB presses from seated and incline. He wanted me using the "reverse bench press" grip orientation and taking them in front of the opposite eye. These were low weights. Again the cross-body action forces the SA to get in on the act.

Hope your find one or two useful pieces of advice in here.

Best,
Mark

A few additions for the Prehab sticky thread:

I also incorporated serious stretching of the upper traps and the pecs.

My preferred trap stretch was right ear to right shoulder, pull with right hand, depress left shoulder. I also held a 45 lb plate in the left hand. Eventually, I moved it to a contract-relax format: I went to a "gentle tightness" and forcefully executed an isometric of the left ear to the left shoulder (obviously, no movement). The goal here is to reduce the tone of the traps.

My preferred pec stretch is a bit hard to describe: I utilize one of the machines (a lat pull down) in a very odd manner. Here's an attempt: One arm over head (making sure to raise with the serratus and not shrug the trap), palm forward and drive the forearm into an obstacle (a bar at head height plus a foot or two would work): now, sink your hips, twist your feet and hips away from the arm, and let the shoulder girdle float back behind the neck. If you get a tingly sensation in your forearms and fingers, you might be doing it right. Tightness in the pecs can cause constriction of blood and nerves underneath the insertion into the shoulder (thoracic outlet syndrome). In this case, it is an indicator of a "good stretch". Also, I'm thinking a lot more "up" than "back". "Back" comes from the hips and the twist. Thinking "up" with the arm keeps it open.

Last edited by Mark Fenner : 01-27-2010 at 07:38 AM. Reason: Typos
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