I now have the privilege of uploading videos to YouTube that are longer than 15 minutes. I am guessing that I have passed a certain number of uploads and maintained a positive status with You Tube. So basically I have not uploaded any iphone videos of a Bruins broadcast or anything like that. I did recently post a series of videos on You Tube giving a basic overview of the OPT Model over the course of five videos. Visit my YouTube channel if you want to see them http://youtube.com/theericbeard. You probably notice that I have been investing my time outside of my blog lately I logged in last week to post and spent an hour fixing the typos in my last post. Sheesjh! What a stinker! My apologies for letting that go out. The content was good but what a mess! So that is fit for public consumption and worth a peak when you have time

More importantly is that I uploaded an entire DVD of mine to You Tube. It is finishing processing right now. The DVD is actually the prologue installment for my DVD series Secrets and Staples of Training the Athletic Shoulder. (of course available at http://athleticshoulder.com ) it is 54 minutes long and has some greta stuff in it if I do say so myself. Please watch it and let me know what you think! I am confident that you will find it helpful.

Thanks for reading!

Eric Beard
CEO A-Team
Corrective Exercise Specialist
AthleticShoulder.com
http://facebook.com/theericbeard
http://youtube.com/theericbeard

• September 14, 2009 -- Secrets of Training the Athletic Shoulder: Corner Activatons from AthleticShoulder.com (0)
• September 8, 2009 -- Corrective Exercise and Performance Enhancement for The Shoulder Complex Has Evolved (0)
• March 3, 2011 -- Shoulder Dysfunction and Contra-Lateral Sacroiliac Joint Health in a Tennis Player (0)
• November 5, 2009 -- Corrective Exercise for Carpal Tunnel Syndrome? (2)
• September 25, 2009 -- Teaching an NASM Personal Trainer Workshop in Atlanta Thinking about HFPN.com (0)
• January 22, 2012 -- Knock The Rust Off With Some Core Stability Work (0)
• January 19, 2012 -- Vertical Core Stability Training (0)
• January 12, 2012 -- Quick Tip to Improve Dorsiflexion (making your calve stretch more effective) (0)
• January 7, 2012 -- Can You Give Me Some Advice? (0)
• January 4, 2012 -- Does 30+30+30 Really Equal 90? (0)

The topic of dips comes up at workshops that I teach pretty frequently. They have been a staple of the body building, group exercise and body weight training scene for years. A simple take off on the parallel bars or rings in gymnastics.

So what’s the big deal about dips??? Well Google shoulder pain and there are over 11,100,000 hits. Too many shoulder problems! See the end of my post for more rationale on taking care with shoulder movements* I wish I learned more about biomechanics and corrective exercise before I did too many dips!

Optimal r.o.m. for humeral extension (sagital plane) is @45 degrees. Most people do not have optimal posture or r.o.m. Forcing the humerus past it’s natural end point will yield 2 negative results 1) excessive pressure of the humeral head into the anterior capsule of the gleno-humeral joint 2) tipping of the scapulae.

It is common that many people will have restrictions in the posterior and inferior capsules of their shoulder which forces the head of the humerus to migrate interiorly and superiorly respectively. Bones move away from tightness/restriction and create ligamentous and capsular laxity, joint instability and/or impingement while moving in the opposite directions. Forcing the head of the humerus anteriorly repeatedly, especially under load and with momentum with little focus on eccentric deceleration as most people who perform dips do, will wear out the anterior capsule of the shoulder. Once the passive stabilization of the joint is compromised (this is a permanent situation by the way) the active system (muscles and tendons) must become more active to protect the joint. This can have an impact from one joint throughout the entire kinetic chain. Take for instance the latissimus dorsi tightening up to make up for a stretched out joint capsule in the glenohueraml joint. The Lat originates in the thoraco lumbar fascia and has insertion points into the sacrum, illium, lumbar spine, thoracic spine and inferior angle of the scapulae. All of these joints can be negatively impacted by loss optimal force coupling around them which can in turn impact the femur and further down the kinetic chain leading to increases susceptibility of ankle sprains, patella femoral pain and low back pain. So the argument of I have been doing dips for years and my shoulders do not hurt is a tough one to make.

Also, repetitive and excessive tipping of the scapulae can alter Length Tension Relationships and Neuromuscular Efficiency around the shoulder complex, head and cervical spine, traumatize the rotator cuff tendons (mostly infraspinatus and supraspinatus in this scenario), aggravate bursae sacs and increase cervical extension yielding increased pressure on the cervical discs. Know anyone with tight necks? Headaches? Over-active levator scpulae?

This…

Plus this…

Will lead to this…

Do to the seated posture and “upper cross syndrome” apparent in most clients personal training clients and gym goers today, the above scenario will contribute to their preexisting imbalances and accelerate wear and tear on components of the passive system. Ligaments wear out like the rubber on the bottom of your sneakers…it’s just a question of when they wear down? 30?40? 85? or in the grave???

This is a high risk exercise option for the triceps, pectoral complex or shoulder complex. These muscles can be targeted with much safer alternatives with minimized risk regardless of the patient, client or athletes goals..

if someone MUST “dip”…1) the Life Fitness Signature Series Tricep machine looks and feels like a seated dip machine, but does not allow the user’s humerus to extend past 45 degrees it is very comfortable and fills the need most people are looking for.

2) Sitting on a bench with your hands on two dumbbells at tour side for lower trap activation can be pretty helpful. Having trouble loading my picture of this one.

3) other than that..shallow range of motion dips that do not let the humerus extend more than 45 degrees are a better option than what is seen in most gym, classes or health clubs.

I know they FEEL GOOD sometimes and can be good for the ego…but there is life after ego and plenty of exercises to blast away at those muscles with a much lower risk of trauma.

There is more to talk about of course…but I think that is enough for now.

What do you think?

A typical Corrective Exercise program for someone who has been trashing themselves with dips might look something like this;

I wanted to add some more in, but Murphy my lab wanted out of his crate and my 5 year old was itching to play…sorry, he is tough to turn down:)

Thanks for reading!

Eric Beard

Athletic Performance Enhancement Specialist

Corrective Exercise Specialist

theericbeard.blogspot.com

www.ericbeard.com

Shoulder pain and dysfunction rank among the most common of peripheral joint complaints (1)(2)(5)(9)(11). Incidence has been estimated to be between ten and 25 per 1000 patients (1)(2)(11). Pain, injury and instability can be either the cause or the effect of shoulder joint dysfunction (1)(5)(6)(7)(8). The two most frequent diagnoses for patients presenting with shoulder pain are impingement and rotator cuff tendonitis (1)(2)(6)(7)(9)(11). Approximately 48% of patients who have presented with shoulder pain have been diagnosed with impingement syndrome in Dutch general practice (6). Bankart lesions, bursitis, dislocations, separations, rotator cuff disease, osteoarthritis and rotator cuff tears are other common diagnoses (1)(2)(5)(6)(7)(8)(9)(11). In order to select the appropriate treatment, the appropriate diagnosis must be made first (6)(7)(8)(11). Treatments range from palliative to curative and may include over-the-counter medications, manual therapy, therapeutic exercise and surgery (1)(2)(3)(4)(5)(6)(7)(9)(10)(11).

References:

1) Bang, Michael and Deyle, Gail. (2000). Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome. Journal of Orthopaedic & Sports Physical Therapy, Volume 30 (3), pp. 126-137.

2) Bergman, MScGert J.D. Winters, PhD, C. Jan. Groenier, MsC, H. Klass. Betty. Pool. Meyboom-de Jong, PhD, MD, Betty. Postema, PhD, MD, Klass and van de Heijen, PhD, Geert J.M.G. (2004) Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain. Annals of Internal Medicine, 141, pp. 432-439.

3) Eccles, Nyjon K.,M.R.C.P., Ph.D. (2005). A Critical Review of Randomized Controlled Trials of Static Magnets for Pain Relief. The Journal of Alternative and Complimentary Medicine, Volume 11, Number 3, pp. 495-509.

4) Fabbriciani, C. Milano, G. Demontis, A. Fadda, S. Ziranu, F. Mulas, PD. (2004). Arthroscopic Versus Open Treatment of Bankart Lesion of the Shoulder: A Prospective Randomized Study. Arthroscopy, May-June; Volume 20, pp. 456-62.

5) Gursel, Kurtai Yesim. Ulus, Yasemin. Biligic, Ayse. Dincer, Gulay and van de Heijen, Geert

JMG . (2004). Adding Ultrasound in the Management of Soft Tissue Disorders of the Shoulder: A Randomized Placebo-Controlled Trial. Physical Therapy, Volume 84, pp. 336-343.

6) Johansson, Kajsa M. Adolfson, Lars E. and Foldevi, Mats OM. (2005). Effects of Acupuncture Versus Ultrasound in Patients With Impingement Syndrome: Randomized Clinical Trial. Physical Therapy, Volume 85, pp.490-501.

7) McClure, W. Philip. Bialker, Jason. Neff, Nancy. Williams, Gerald. and Karduna, Andrew. (2004). Shoulder Function and 3-Dimentional Kinematics in People With Shoulder Impingement Syndrome Before and After a 6-Week Exercise Program. Physical Therapy, Volume 84, pp. 832-848.

Park, Hying Bin, MD, Yokota, Atsushi, MD, PhD, Gill, Harpreet, MD. Rassi, George, El, MD and McFarland, Edward, MD. (2005). Diagnosis Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome. Journal of Bone and Joint Surgery. Volume 87-A, Number 7, July, pp. 1446-1455.

9) Razavi, Mahanaz and Akuten, Kvaters. (2002). Effects of Acupuncture and Placebo TENS in Addition to Exercise in Treatment of Rotator Cuff Tendonitis. Clinical Rehabilitation, 2004, Volume 18, pp. 872-878.

10) Sperling, John W., MD, Cofield, Robert, MD and Schleck, Cathy, BS. (2004). Rotator Cuff Repair in Patients Fifty Years of Age and Younger. The Journal of Bone and Joint Surgery, Volume 86-A, Number 10, October pp. 2212-2215.

11) van den Dolder, Paul A. and Roberts, David L. (2003). A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Australian Journal of Physiotherapy. Volume 49, pp. 183-188.

12) Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes J Strength Cond Res. 2008 Jan; 22(1):140-5. J Strength Cond Res. 2008

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Ahh...the wonderful complexity of the human body! The principles of human movement are relatively basic, but the organism and how it works is fantastically unique and complicated at times.

The sport does not matter, the activity does not matter, we must simply be able to move in a coordinated manner with joint alignment and muscular balance. Pretty easy, right?

Take a look at Rafael Nadal during his overhead serve

Or a volleyball serve

Even our feline friends

Just kidding:)

The mechanics are pretty similar a the shoulder trying to get the arm into position to serve. You need rhythm, Scapulohumeral Rhythm!

A key muscle in the movement that is almost always weak and out of balance is the serratus anterior.

According to Kendall and McCreary, when the origin is fixed, the SA abducts the scapula, rotates the inferior angle of the scpulae laterally and the glenoid cavity cranially and holds the medial border of the scapulae firmly against the ribcage. The SA will also protract and slightly elevate the scapulae as well. If the insertion is fixed (by the rhomboids) the SA may act in forced inspiration. The SA will also prevent scapular winging.

So…as the humerus move, usually in 2:1 ratio the scapulae, the SA “sucks” or holds the scapulae to the ribcage as in glides through movements.

Often there is a muscular imbalance present with the pec minor leading the way to inhibit the serratus.

Levator scapula, teres major, latissiums dorsi, pec major should be looked at as well to name a few. In some cases the rhomboids can lock the scapulae in downward rotation and be overactive as well.

When a weak/under-active SA is present, and the SA cannot resist the pull of the deltoid during humeral abduction, scapular winging occurs. Winging can occur during static posture as well as during other movements. This can be a result of or cause shortening of the rhomboids since the rhomboids are antagonists of the SA. Once the force couple at the shoulder joint becomes dysfunctional altered recruitment strategies will present. Over-activity of the levator scap and pectoralis-minor are common imbalances. This can lead to impingement syndrome at the gleno-humeral joint once the scapulae has protracted. The biceps tendon in the Sagital plane and the infraspinatus tendon in the frontal plane will be at risk for impingement syndrome typically.

Aggravation of the bursae sacs may occur as well

To treat this situation with corrective exercise, I would of course begin with an integrated assessment. Then I would apply the corrective exercise continuum. I would maintain the protocol of; inhibit, lengthen, activate, integrate.

Here are some activation exercises.

“Push Ups with a plus” using most versions of a push up have p/c/a finish/complete each repetition at top of movement with protraction. I find having p/c/a use modified positions (on the wall from the knees) to be helpful (based on fitness level) so they do no have to manage their entire body weight at first. This technique during pressing movements has been helpful as well to engage the SA.

“Dynamic Hugs” or modified cable/tubing fly is another great way to engage the SA.

From a standing (or possibly seated) position, have p/c/a perform horizontal abduction (fly) with a slight bend in the elbows until hands touch, return slowly to staring position, repeat.

“Bench dips” have p/c/a keep elbows extended and active move from scapular elevation to depression with appropriate loads.

I have a few other favorites as well including alligator breathing to activate the diaphragm and "serratus push ups".

Integration would be the last step. Remember our body works as a functional unit and was must install and reinforce proper movement patterns/neuromuscular efficiency.



Squat to rows, squat to scaptions, step up to PNF, lunge to overhead press and kettlebell work can be great when done well.

There is more to this scenario, but hopefully we can get some more people to focus on serratus anterior from here on in.

So get your tennis players, baseball pitchers, volleyball players, house painters, plumbers, electricians and more an integrated assessment and some corrective exercise to help their rhythm!

Thanks for reading!

Eric Beard

Athletic Performance Enhancement Specialist

Corrective Exercise Specialist

theericbeard.blogspot.com

www.ericbeard.com

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Does this look and feel familiar? Even for those of us who move our body for a portion of the work day must get stuck with the inevitable paper and or computer work. My student athletes are subjected to these postures for 6 plus hours a day at school, never mind meals, transportation to and from school, doing homework and “down time” playing video games or watching TV.

Imagine what happens to the length of their muscles, strength of their muscles, joint movement and coordination? Not good! We know that the human body is an amazingly adaptive organism and it will adapt to whatever stimulus we provide to it repeatedly. The S.A.I.D. Principle (Specific Adaptation to Imposed Demand) tidily explains this. Couple this with repetitive movements and pattern overload and our athletes are on a sure path for an injury or at least sub-optimal performance.

This picture demonstrates a very important force couple that produces upward rotation of the scapulae and eccentrically decelerates downward rotation of the scapulae. These muscles are often weak and the downward rotators of the scapulae; levator scapulae, rhomboids, latissimus dorsi/teres major are often overactive and lack extensibility. The rounded shoulder/chair borne posture above can lead to this imbalance which puts the shoulder (and other aspects of the kinetic chain) under greater than stress. Remember, an “injury” occurs when tissue experiences greater force(s) than it can accommodate. It won’t take long for this imbalance to lead to rotator cuff tendinitis, headaches, low back pain or elbow pain. If the scapulae is misaligned then the glenohumeral joint will not articulate properly. With throwing athletes, over-head athletes and tennis players the internal rotation of the humerus on their follow through is critical for shoulder health. If the can not rotate internally (ideally 70 degrees from a 90 degree horizontally abducted position) then there will be significant forces placed on the ulna collateral ligament. Hello tennis elbow if this happens too often! That’s how too much sitting can lead to elbow pain:)

Corrective Exercise and Manual Therapy can go a long way to restore optimal human movement and eliminate the symptoms of these imbalances.

As I mentioned yesterday, I filmed the first half of my video last Sunday (tentatively titled Secrets and Staples of Training the Tennis Shoulder) and look to finish next Sunday. I noticed that the camera man was getting into the presentation. He started to move his shoulder around, palpate muscles and mimic assessments as I talked about them. I could almost hear him say “hhmmmm..” and “oh yeah…” as he was noticing some imbalances and limited ranges of motion. He appeared to have some issues that may have not been cleaned up completely and were still effecting his quality of movement. I hope that he applies some of the things I talked about!

Here is a link to a blog post that I made in January. It has a short video that goes over some self care techniques to help keep the shoulder joint moving correctly.

http://tinyurl.com/b4yf5o

Thanks for reading and have a great day!

Eric Beard
Athletic Performance Enhancement Specialist
Corrective Exercise Specialist
theericbeard.blogspot.com
www.ericbeard.com

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