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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As I was perusing the Internet, looking for “stuff’ to blog about I came across an article that appeared in a major market online newspaper written by a self professed “personal trainer and rehabilitation specialist“.

This “rehabilitation specialist wrote about these two exercise to do at home if you do not have equipment;

“Triceps dips: Sit on a bench or chair, placing palms flat with fingertips at the edge of the chair. Slide legs out straight in front of you, heels several feet forward. Lift buttocks off chair and dip toward the ground by bending the elbows, then raise yourself by extending the forearms and pushing yourself up.”-their text

Don’t think Arnold played much tennis….but can you see why he has bursitis in both shoulders now? At the bottom of each of these his poor little bursae sacks are screaming for help!

“Crunches: Do 100 to 250 crunches for five minutes (to increase difficulty, hold position at the top for five seconds on each crunch).”-their text

I like to call these “neck-ups” since most people just lift their neck up 30 times instead of using their abdominals and curling their trunk up. Then they tell me their neck is getting tired…or their low back hurts because they have not conditioned their core stabilizers to protect their spine…

Okay…where to start here…if you have been following my blog you would probably notice that crunches and training the “movement system of the core” is not what most people need to be doing, they need to address their stabilizers!

Reference this post; http://tinyurl.com/cop26y

and this post if you would like for more on core stabilizers; http://tinyurl.com/ch6d5h

What I would like to talk about today though is DIPS…http://tinyurl.com/d23nhc this post actually discusses upright rows, which can be thrown in the same category as dips as far as I am concerned.

Granted…these are probably the dips the author was referring too…

…not too much better for the anterior capsule of the shoulder…kind of looks like a “neck-up” huh?

Imagine people sitting around most of their day like this…

…the getting after some dips and crunches? How do you think this would feel for my tennis players??? I think it would feel like 8-12 weeks of physical therapy and some time on the “shelf” sitting out of crucial tournaments!

Maybe even some arthroscopic shoulder surgery…mm-mm..good!

I have a little write up on dips that I may post for you about dips…for now, most people’s posture and stability of the shoulder complex are so poor, that an exercise like dips brings them through a dangerous range of motion that can cause long term damage to the passive (ligaments and bursae) and active (muscles and tendons) systems of the shoulder complex. Is the short term “pump” and convenience worth it???? Please answer no:) I want to see you before surgery…not after:) It will cost you less money and enhance athletic longevity and performance that way!

I hope the “rehabilitation specialist” tries their hands at corrective exercise instead…

Corrective Exercise now vs. avoidable surgery later. Unavoidable surgery is another topic for another day:)

Thanks for reading!

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

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Impingement is right up there as well statistically…

Question; can we prevent overuse injuries in elite junior tennis players?

Or do we just rehab or surgically repair it all the time?

maybe we should be doing this BEFORE an injury instead of after…

Tennis elbow is also a common diagnosis for tennis players and also an overuse injury. Where does tennis elbow come from? The elbow? Interesting that one study indicated that 64% of those who were diagnosed with tennis elbow also had a shoulder injury….hmmmm.

According to Wikipedia;

Tennis elbow is a condition where the outer part of the elbow becomes painful and tender. It’s a condition that is commonly associated with playing tennis, though the injury can happen to almost anybody.^[1]

The condition is more formally known as lateral epicondylitis (“inflammation to the outside elbow bone”)^[2], lateral epicondylosis, or simply lateral elbow pain.

You could shoot yourself up with cortisone once every couple of months for a year like this guy did to treat his tennis elbow (obviously don’t do that unless you are a licensed professional)…

…or you could try and prevent it or treat it alternatively. Your choice.

Question; during which aspect of the game of tennis is one most likely to injure their shoulder?

a) backhand strokes
b) forehand strokes
c) serving
d) during dynamic flexibility drills in the warm-up

What is your answer?

Thanks for reading have to get ready for my next client, a fellow massage therapist who has shoulder pain!

Do you think I will perform an integrated assessment and prescribe corrective exercise for him?

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

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“In 2003, approximately 13.7 million people went to the doctor’s office for a shoulder problem, including 3.7 million visits for shoulder and upper arm sprains and strains.

Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. Injuries can also occur during everyday activities such washing walls, hanging curtains, and gardening.”

How about performing an over head serve like this?

So add poor technique to the list of potential causes of injury. In the rare case that someone has ideal posture, muscular balance, great neuromuscular control but they are learning how to serve overhead, or are just bad at it, injury may result as well.

I was talking to a client of mine who is a certified High Performance Coach through the United States Tennis Association, excellent tennis pro and all around good guy, Tim Smith, about the shoulder complex and how it relates to tennis. In his years of experience as a player, coach with the New England Academy of Tennis and Director of the Junior Program at Longwood Country Club in Brookline, MA Tim has seen plenty! The topic that day was internal rotation of the shoulder, or lack of it, and how that impacts the follow through on the overhead serve. Just like I have talked about before, this can cause unwanted movement of the scapulae leading to impingement in the glenohumeral joint amongst other maladies. of course I brought up Maria Sharapova, who I have written about a few times and Tim mentioned seeing that same compensation in many players. We then reviewed some soft tissue techniques and stretches that are critical for tennis players to do on a regular basis to keep the shoulder healthy.

Soft tissue work like this;

or this…

Stretches such as the sleeper stretch…

Or if you have access to a SHARQ…

There are many people that need help with corrective exercise and refining their tennis game. We want to get to them before they get hurt! An ounce of prevention…

Tim is doing some great stuff with video work comparing his players execution to that or pros, much like I do with the overhead and single leg squat. I enjoy my conversations with him and look to improving our ability to help our clients and athletes move better, play better and play longer!

Currently editing my DVD “Secrets and Staples of Training the tennis Shoulder”! Looks great so far! Over two and a half hours of content! Hope to have it ready by April first!

Thanks for reading!

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

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Read the text…”An Introduction to Core Stability”…an introduction??? how is standing on the ball an introduction? Maybe this wins style points and get a consumer to purchase something, but this is the message that many coaches and trainer have been fighting against for years. Quality before quantity! Master the simple then move to the complex! Ask any computer programmer ad they will agree that “Junk in equals junk out!” the same with the human body. If we learn sloppy habits trying to perform a task that is too far outside of our current abilities then we will merely create faulty and sloppy movement patterns to try and replicate the the task.

Exercise must be taught in progression, especially in core training. You would not see a tennis pro teaching an overhead serve in the first lesson to a true novice would you? Their brain would be scrambled! They might simply start with which grip to use and what the white lines on the court mean, right?

I came across this system that rates speech tasks in order of complexity from www.unl.edu;

“A Continuum of Linguistically Simple to Complex Speech Tasks.

(The CALMS Rating is the number to the right of the category if a high frequency of
stuttering appears at that level of linguistic complexity)

A. Automatic Speech: (5)
1. Count from 1-10
2. Say the days of the week.

B. Short Phrases: (5)
(Ask the child to repeat the phrase from a model or read the phrase)
1. “It’s a nice day.”
2. “I see a dog and a cat.”
3. “Sam bought Bobby a puppy for his birthday.”

C. Picture Description: (4) Show the child a picture that depicts some type of action and say to
the child, “Tell what’s going on in this picture.”

D. Picture Sequence: (4) Show the child a series of pictures from a script. Tell the story and
then with the pictures in front of the child, have the child retell the story he/she just
heard.

E. Ego-Centered Topic Discussion: (3) Have the child talk about his/her most recent birthday
party or a vacation/event he/she experienced personally.

F. De-Centered Topic Discussion: (2) Ask the child to describe in detail the content of a
familiar movie or a television show they have seen or a game (e.g., board or video
games) he/she has played recently.

G. Relational Topic Discussion: (1) In this task, ask the child to describe how one plays a
particular sport or activity that the child his familiar with. The clinician could say for
example, “Let’s say that I have never seen a (football, basketball, baseball, soccer) game.
Explain to me the object of the game, things about the game, how teams score points and
how a team wins or loses.”

H. Complex Oral Discourse: (1) Pick a topic the child would not have very much knowledge
of but has experienced in the real world (e.g., different types of clouds or how are clouds
formed- www.wildwildweather.com). Read a short explanation of the phenomenon and
then have the child retell the information they just heard.”

Correlate that to core training…the first task may be to have a client or athlete learn how to find a neutral position in their lumbo-pelvic hip complex (LPHC) and then perform the drawing in maneuver correctly, which most people struggle with due to muscular imbalances and years of sitting. Next exercises like floor bridges to have clients/athletes keep neutral in their LPHC while they use their glutes to move their hip joint.

Maybe I progress to a challenge in a different plane of motion with a “side ios-abs”…

Then maybe get fancy with a balance toy if you MUST use one, perhaps holding a push up position on BOSU ball…

These progressions take weeks for most people to get through if not 2 months or more at times!

Where would you put standing on a stability ball? Even better using your adductors like vice grips to stand on a stability ball? If we use the system I shared above, that would be more like letter “T” or so…

I might not have been much help today, perhaps just more of a rant, but take your time and progress your clients/athletes/yourselves slowly…ask your self, what will happen if they/I do an exercise with poor form for 20 years? Will my cartilage or disks be better off? or worse off? If you are not sure, then ask a corrective exercise specialist for an integrated assessment and an individualized program to help you out.

Thanks for reading!

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

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What about an integrated assessment by a corrective exercise specialist to find the root of the problem?

Ask.com says;

“Treatment involves resting the shoulder and avoiding activities that cause pain. Ice packs applied to the shoulder and nonsteroidal anti-inflammatory drugs will help reduce inflammation and pain.

Physical therapy to strengthen the muscles of the rotator cuff should be started. If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain and inflammation enough to allow effective therapy.

If the rotator cuff has sustained a complete tear, or if the symptoms persist despite conservative therapy, surgery may be necessary. Arthroscopic surgery can remove bone spurs and inflamed tissue around the shoulder.

Small tears can be treated with arthroscopic surgery. Newer techniques allow even large tears to be repaired arthroscopically, although some large tears require open surgery to repair the torn tendon.”

Sure this is just from a website, but this protocol is probably pretty standard treatment for rotator cuff tendinitis. This is a relatively common injury for tennis players, who make up a great deal of my practice.

Impingement is a fairly common injury as well…

…with significant tears of the rotator cuff being less frequent with my clientele.

What really needs to be addressed is the alignment and function of the thoracic spine and scapulae

These two areas seem to be omitted from many rehabilitation protocols. This is a shame b/c addressing the inflammation at the rotator cuff will help with the symptom, but rarely the cause. the same thing with biceps tendinitis that elicits anterior shoulder pain. The thoracic spine must rotate and the scapulae mus be lined up long before the rotator cuff is strengthened. This just leads to repeated dysfunction at the shoulder joint or elsewhere through the kinetic chain.

Remember to have a corrective exercise specialist perform an integrated assessment which in turn will help to create a program that promotes athletic longevity, injury prevention and enhanced athletic performance!

Have to turn in, have an awesome workshop to deliver in Pittssburg the next two days and I have to be up early!

Thanks for reading!

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

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I am not so sure about either of those. I honestly have no first hand information to go from, but based on my experience I would say that no one looked at how here body moves as a whole, like during an overhead squat test.

Restrictions in joints down in the big toe and ankle can lead to upper extremity dysfunction. Maybe her primary area of concern is not her shoulder??? In this example, the athlete can not keep their feet straight ahead during their squat, this could mean tightness in their calves (amongst other tings), this will have a significant impact on her low back and the low back is most definitely connected to the shoulder via the latissimus dorsi. The human body is a wonderfully interconnected organism and the kinetic chain principle states that we are only as strong as our weakest link. Sometimes the weak link is somewhere other than where the pain is. an integrated approach will help to determine if that is the case.

I hope that they looked at the internal rotation in her shoulder as well. This picture demonstrates poor technique performing this assessment, but you get the gist. There should be 70 degrees of internal rotation at the glenohumeral joint from this position. The picture shows about 58 degrees, but with compensations at the shoulder.

If we look at what is happening at Maria’s shoulder dynamically, it appears that her shoulder is not internally rotating sufficiently during her follow through. That is a precursor to impingement syndrome, tennis elbow and rotator cuff tendinitis at the least, and other undetected issues throughout the kinetic chain at the worst. It is causing her shoulder blade to elevate and tilt forward and her trunk to lean too much to the side as well.

I hope they are not just doing massage, electrical stimulation and rotator cuff strengthening on her. There is much more that she, and most other tennis players and athletes in general need.

Soooo the next time your or one of your athlete’s shoulder hurts, or even better….BEFORE there is an injury, find a corrective exercise specialist or licensed health care professional that is truly proficient at completing an integrated assessment. An assessment that look at how the body moves as a single unit, that can help to pin point segments that are impacting the entire kinetic chain. this can save hours or pain and rehabilitation, keep players on the court and in Maria’s case…save hundreds of thousands of dollars. From there specific;

1) soft tissue work/manual therapy
2) flexibility techniques
3) joint mobilizations
4) activation techniques
5) coordination/total body strengthening techniques

…can be applied in a systematic manner.

Thanks for reading and remember to look at the big picture but pay attention to the small details!!

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

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That is the dollar$28 million question.

“The surgery went exactly as we planned,” said Marc Philippon, who performed the 80-minute procedure at Vail Valley Surgery Center in Colorado.

Philippon said Rodriguez will need a more extensive operation after the season, but said the three-time American League most valuable player will be ready for spring training in 2010.

Rodriguez suffered from a torn labrum, cartilage that lines the hip socket to stabilize and cushion the joint. Philippon said he found a small impingement in the cartilage.

What also caught my eye was this quote from Yankees first baseman Mark Teixeira

“Any athlete knows injuries are part of the game. It’s not how you got injured, it’s how you respond. I think Alex is going to be great. It’s more important for him to be healthy during the stretch run and during our playoff push.”

This is probably a standard response when talking about an injured teammate, but to me it is critical to figure out what caused the tear in the labrum! If the cause is not discovered, than this symptom of hip dysfunction with return or rear it’s head elsewhere. This is an outdated paradigm. It is now the age of prevention not reaction! Truth be told, I am a Red Sox fan
and have no personal interest in seeing him return to the line up and tear up the American League East. Professionally however…I think there could be great deal learned about identifying dysfunction and movement impairments BEFORE they lead to injuries so significant that surgical intervention is warranted. That is what an integrated assessment and corrective exercise is all about. A-Rod is a physical specimen and puts his time in in the gym, steroids or not, he trains more than most. He looks great superficially, but do all his joints move like they should? The hip joint should rotate internally 45 degrees when one is lying on their back (supine) and their hip is flexed to 90 degrees.

If not…take another look at A-Rod taking a cut here…

…if his either hip joint is not internally rotating properly, then there will be a significant amount of pressure on the labrum and other structures. Most of the athletes that I check have significantly limited internal hip rotation and over time can lead to injuries just like A-Rods. Even my tennis players need to be aware of this!

So maybe someone should have checked to make sure that;

1) all his joints were moving correctly (flexibility and joint mobilization techniques can help with this)
2) his smaller muscles could control and protect the joints from the forces generated by the larger muscles (activation and isolated strengthening can help with this)
3) and that his nervous system was able to coordinate these factors together

Well that’s is the time I have for now…more on integrated assessments and corrective exercise another time.

Thanks for reading!

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

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and Shirley Sarhmann.

The feel of the blog was that total body movements were the best thing to do. He did not say this, but this is what I read between the lines. I wholeheartedly agree that that is the goal, but I also believe that often times you must start with an local areas of dysfunction before dressing global movement.

One of the quotes the author shared was from Sharmann’s fantastic text “Diagnosis and Treatment of Movement Impairments Syndromes” a must for any health, fitness, performance or rehabilitation professional.

“There are numerous ways in which slight subtleties in the movement
patterns contribute to specific muscle weaknesses. The
relationship between altered movement patterns and specific muscle
weaknesses requires that rehabilitation addresses the changes to
the movement pattern; the performance of strengthening exercises
alone will not likely affect the timing and manner of recruitment
during functional performance.” Shirley Sahrmann 2002

This is true…don’t just strengthen, you must address all aspects of dysfunction like;

1) shortened muscles that won’t lengthen
2) restricted muscles that can’t can’t lengthen
3) weak muscles that don’t “turn on” or shorten
4) then go after the total body movements and global function

Kind of like back in school when there were 2 or 3 kids that were struggling on a certain lesson, if the teacher did not help those 2 or 3 students, either in class, before or after somehow, then they would continue to fall behind on related topics potentially for the rest of their academic careers. That’s why tutors or coaches can be so helpful! You want the entire class to stay on schedule, but the short term fast pace will may leave some students behind may lead to those students acting out or disrupting the class at a later date because they are lost. No child left behind approach or no muscle or joint left behind@ In the end it will catch up to the entire system. This leads to injury often times away from the source of dysfunction.

I cover this process in my video “Secrets and Staples of Training the Tennis Shoulder” which is being edited as I type and should be ready before the end of the month!

Be careful not to get caught in the “functional training trap”. Make sure the entire class is up to speed! Use your corrective exercise specialist as a coach or tutor!

Thanks for reading!

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

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Here is a generic picture of Irish Steppers, not my daughter in action:)

This is the middle event in a great family weekend. Last night I brought my daughter to a Father/Daughter dance for the Girl Scouts. That….was…..AWESOME!!!! 70 Dads and 70 Girl Scouts all dressed up dancing and having fun. It was a night I will never forget:)

Tomorrow we close the weekend out with a birthday party for my youngest son who is turning 3 this month. We are having it at the Sports Club where I work. We will be in the kids club for the food and festivities and in the gym for games and an inflatable  bouncy house.

Well back to the movie and family fun time!

Hope you are enjoying your weekend.

Thanks for reading!

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

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