This week’s post is really a post of posts in that I have organized and summarized all of my shoulder and overhead performance articles into one. The goal here is to collate what we have so far in order to fix and improve shoulder mechanics as this is, in my opinion, the scourge of the modern athlete. Even in general orthopedic populations, total shoulder replacements are increasing faster than ever. We need to stop playing catch up: pain and a torn rotator cuff are lagging indicators!

But the real purpose of this post is to draw attention to this fact: not one single post on this site, so far regarding the shoulder, has directly addressed only the shoulder joint itself. This calls attention to the fact that, while I certainly think the shoulder joint itself does need to be addressed, correcting it without addressing all the other mechanics we’ve discussed so far will only serve to frustrate you and your athletes. Think of the shoulder joint as a transmitter, rather than a generator, of energy within the kinetic chain. The joint’s inherent stability and mobility demands set it up as a scapegoat for poor mechanics elsewhere in the system. Looking only at the dysfunctional shoulder as the source of the problem (i.e. myopically addressing rotator cuff function in an athlete with shoulder pain) is a fundamental error that will only serve to rob you of performance and time. You wouldn’t take Tylenol for a headache everyday for 5 years and not start to wonder what the heck is the cause, right? Yet people do this everyday for musculoskeletal pain! Recurrent shoulder problems? We need to start looking elsewhere first and often the shoulder dysfunction will resolve itself.

This is by no means an exhaustive list – 1st rib and head position/control are big too, but here’s what we’ve come up with so far (click the titles for the whole post and videos):

Wide Grip Bench Press is Hurting Your Power (and Shoulders): Using a narrower bench press grip, we can create torque through the shoulder system. This helps to achieve global extension via the lats and glutes and allows us to take advantage of the pectoralis’ considerable cross-sectional area for improved power. Furthermore, a wide grip (which I see WAY too often) puts the upper extremity at an anatomical disadvantage increasing the demands on the shoulder’s passive tissues (labrum, capsule, biceps tendon). Here’s the video

Improving Shoulder Position for Push-ups and Presses: Improper positioning of the scapula on the ribcage (and in turn the humerus on the scapula) can alter shoulder mechanics during push-ups and presses. By potentially restoring the position of this system, we can better elicit function of the shoulder and its active stabilizers. This is a mobility exercise I find great success with, try it out.  Here’s the video

Elbow and Shoulder Pain During Pressing/Pushing: Importance of Load Ordering on Pressing Mechanics: Properly loading the shoulder girdle rather than the elbows during pressing and push-ups is essential to improve power and decrease shoulder and elbow pain. As discussed with squats, the tissue loaded first in the movement is the one loaded maximally. By prioritizing motor control, we can use the shoulder’s active stability to generate powerful and consistent movement. Here’s the rest of the post

Improving the Overhead Squat – Cueing and Maintaining an Upright Torso: This post goes into how to maintain an upright torso using neuromuscular cueing of the upper kinetic chain. Cueing a proper torso position allows improved positioning of the shoulder complex, which can help improve stability throughout the entire movement. Here’s video 1. Here’s video 2.

Overhead Shoulder Dysfunction – Fix Your Spine Position First: Sacrificing spinal position for overhead stability via lumbar overextension is a common movement fault and one that must be corrected. Otherwise, no matter how hard you work on your rotator cuff, etc. the underling movement pattern is faulty and will return. Research is beginning to demonstrate that proximal control drives distal mobility, this is a good start. Here’s the video

Overhead Athletes and Pressers – Shoulder Mechanics and the Lats: Restrictive lats can seriously negate quality overhead position and potentially cause shoulder instability due to it’s anterior-inferior pull on the humerus. Furthermore, they extend the lumbar spine resulting in both poor overhead stability and lumbar overextension, neither of which are good. Here the video

Thoracic Spine Extension and Rotation – A Motor Control Fix for Shoulder Pain: Improving active control of thoracic spine extension-rotation is crucial for shoulder function as it allows for optimal scapulothoracic positioning resulting in better shoulder control. Improving this takes more than just a foam roll or lacrosse balls, we have to facilitate the appropriate motor pattern for optimal results, this post tells us how.  Here’s video 1 – assessing. Here’s video 2 – more assessing. Here’s video 3 – correcting.

Again, this is not an exhaustive list and we shouldn’t neglect the shoulder completely. But if we want performance improvements that stick we have to look at the shoulder as a system of systems. Again, don’t let the drag of orthodoxy get in the way of proper mechanics.

Thoughts on what we have so far? Post ’em.

– Seth

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