 What’s up, everyone! Doc Jake here. In the spirit of Halloween, I wanted to take a moment to talk about some of the common “scary” comments my patients have heard from other providers, or seen on imaging, and why you shouldn’t be afraid at all. I know we’re all busy getting costumes and candy ready, so let’s jump right in: “Worst case of bone on bone I’ve ever seen!” If I’ve heard this once, I’ve heard it a thousand times. “The doctor said I’m bone on bone!” “Worst case of arthritis he has ever seen!” Most often your physician or other healthcare provider is referring to something called osteoarthritis (also called Degenerative Joint Disease or DJD) in situations like this, and guess what… it is totally normal to have arthritis! More and more studies are coming out that show many active adults have some form of DJD and that calling this a “disease” is incredibly misleading. While DJD cannot be reversed, it’s often not the main pain generator and can easily managed with education on symptoms, appropriately prescribed exercise, and just plain out staying active. Walking the dog, playing with your kids, gardening… all great examples of non-exercise based movement that keep your joints moving. As cheesy as it may sound, the old adage of “motion is lotion” is spot on and is the reason that “worst case of arthritis I’ve seen” shouldn’t get you weak in the knees. Torn Meniscus This one hits close to home. At the young age of 14, I actually had two knee surgeries. One to attempt to repair my meniscus and one to remove it once the repair failed. Looking back on it and relating my symptoms I was having to what the research is now showing, I had no business getting any of those surgeries and you most likely don’t need one either. Once again, a torn or frayed meniscus is a normal sign of aging and is often found on imaging with people who have NO knee pain at all. Even in an acute situation where a tear is found on an image after injuring your knee, as long as you don’t have a physical “block” in your knee, where that meniscus has essentially turned into a door stopper and impeds normal motion at the knee, you will be absolutely fine without surgery. In fact, research consistently shows that conservative treatment will have equal to (or better) results as surgery AND you won’t be setting yourself up for future complications associated with missing portions of your meniscus. Herniated Disc I’ll keep this one short. Simply put, in most situations, herniated discs do not require surgery. In fact, multiple studies have demonstrated that you can take 10 random people off the street with no back pain, give them an MRI, and an average of 7 out of 10 people’s images will come back with some variation of a herniated disc. In fact, “large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years” (Jacobs et al). Our bodies are incredibly resilient and will heal just fine with appropriate treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065612/ “You’ll never be able to do ‘X’ again.” This is the most frustrating thing for me and the rest of the staff here at Athletes’ Potential. We are constantly hearing people come in and say something like, “My doctor said I’ll never be able to deadlift again,” or, “My physical therapist said I shouldn’t do CrossFit.” This is absurd and is a fallacy you shouldn’t fall for. We constantly get people coming into our office and we are constantly getting them back to the activities they love. So, in review, there are a lot of scary phrases out there that, in reality, have no right to be scary. New research is being pumped out every day that our bodies are incredibly adaptable. If you’re in the Atlanta area and you’ve heard one of these phrases before, give us a call or fill out the contact request form by clicking the button below. We’d love nothing more than to help you get back to what you enjoy. Thanks for reading, Dr. Jacob, PT, DPT, CSCS
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 Tennis is a sport that demands an incredible amount of strength, stability, and performance out of one of the most unstable joints in the human body… the shoulder. Not only do you need to drive your shoulder through some truly incredible velocities with something like a serve, but you need to be able to control that power through finely tuned movements in multiple planes of motion with an almost endless list of types of swings. The demands on the shoulder are pervasive in tennis and because of this we have successfully treated endless amount of shoulder related injuries from the tennis players we see at Athletes’ Potential. However, through all these injuries that we’ve worked with, we have started noticing some trends in common strength deficiencies and biomechanical limitations that, when addressed, can have serious impacts on reducing injury risk and improving performance. Trend #1: Inadequate Shoulder External Rotation Range of Motion Arguably the most violent swing in tennis is the serve. To generate the amount of torque required for this swing, you need to have an appropriate amount of external rotation at your shoulders. The video below goes over a quick and easy drill to assess your shoulder external rotation. Essentially you should be able to lay on the ground and get the back of your wrist to the ground while keeping your low back pinned to the floor. Some common mistakes to avoid when doing this assessment include:
If you can’t bring your wrist to the ground, or you have pain when you do or feel like you really have to fight to get there, then try some of my favorite drills to improve shoulder external range of motion. Drill #1: Front Rack Opener Drill #2: Lat Stretch Drill #3: Upper Back Mobilization Trend #2: Upper Back Strength In order to have a strong, effective swing you need to have a strong back. This may seem a little counter-intuitive, but let me explain. Your body is innately intelligent and it’s not going to let you produce more force than it feels it can control. Therefore, to have a better swing, you need to have a strong back to be able to eccentrically control your arm as you go through the swinging motion. Some of my absolute favorite exercises to make sure you have a strong upper back are listed below. Exercise #1: Deadlifts Exercise #2: Pendlay Row Exercise #3: W, Y, Negative Trend #3: Lack of Rotational Core Strength Your power in your swing comes from having a strong core. If you don’t have a strong core, then you have no foundation to deliver a strong swing, and if you are trying to have a strong swing without a solid foundation, well, you’re begging for an injury. Check out my favorite exercise to improve rotational core strength. Exercise #1: Med Ball Rotational Throws Exercise #2: Deadbug Pallof Press Exercise #3: Landmine Twists If you’re a tennis player struggling with shoulder pain (and yes, even elbow pain) or are looking to improve your performance, these drills are a great place to start. They are the three main problem areas that we find ourselves addressing with the tennis athletes who come to us for help. However, If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS What if you could experience less anxiety and less stress without a pill forcing your body to calm down? What if you could exercise your heart, lungs, muscles and bones without having to step foot in an LA Fitness? Seems too good to be true... but have you tried HIKING?  To some, hiking may seem like a pointless wandering through the woods, but for many folks the benefits are numerous and welcomed. Mental Health Hiking, or even a stroll through a nature setting, has been shown to decrease anxiety and lower risks of depression. A Stanford study showed that “neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.” That means that annoying repetitive voice in your head telling you that you don’t have enough time in the day can be quieted, maybe even silenced! In the technology-driven world we live in, quiet and empty time is almost non-existent. By taking a walk through a nearby park during lunch or finding some trails on the weekend, you may notice mood enhancement and more productivity when working! Another mental health booster—try taking a friend with you sometime. Personal interactions, without large groups and distractions or cell phones in our faces can help build meaningful relationships that are valuable for mental health. Do you train really hard during the week? Take a hike on your off day/rest day as a way to keep the blood flowing and body moving while also allowing it an exercise input that is not 100% intense the whole time. Your body will thank you! Physical Health Hiking also provides a unique challenge that we don’t see often- an uneven surface. Unless we are still playing some sports as adults, like soccer or lacrosse, we tend to exercise on and spend our days on flat, hard surfaces. Navigating uneven ground challenges our foot and ankle stability, single leg control, and balance, unlike conventional fitness routines. You can search for hikes according to distance and challenge at websites or apps like “All Trails.” I suggest trying some longer and easier hikes as part of recovery from tough fitness routines or as an easy mental release. These trails usually have less obstacles so there is less focus demand for watching your step. Of course, they are not as demanding on the heart and muscles, but that may be desired for an off day! Depending on your fitness level, you can also try to push it to more challenging terrain with obstacles and steeper incline. This will get your heart pumping and lungs working hard!  As we get in our weekly routines of work, gym, dinner, repeat, I think we tend to forget to use our fitness. We are exercising to keep the heart and lungs healthy, manage a healthy body composition and release stress or worry but also to be able to continue being active throughout our lifetimes. So get out and find a nature-filled area to hike or a park to walk through! Your mental and physical health depend on it!
Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS  Shoulder volume. This is the first thing that comes to mind with I have the opportunity to work with youth swimmers. A typical club or high school swim team will average around 40,000 to 60,000 yards in a week of practice and the average athlete will have a stroke count of about 12 to 15 strokes per 25 yards, giving you a range of 19,200 to 36,000 strokes per week...that’s a TON of volume on the shoulders! With such a high demand on swimmers’ shoulders, injuries are incredibly common, so common in fact experts coined the term “swimmer’s shoulder” as an umbrella diagnosis. That being said though there are a number of steps you can take to prevent injury, the most crucial of which being to improve your movement efficiency. Movement efficiency is key to not just preventing injury, put to improving performance. Think of it this way. Performing 36,000 strokes a week with poor mechanics is like trying to drive a Ferrari with the handbrake on; sure, you’ll still be able to move and potentially pretty damn fast, but you’re going to leave a ton of performance on the table, in addition to breaking down way quicker and more often. In order to know to know where a deficiency is happening, you must break down each stroke into its component parts. For the sake of this article, we will focus on freestyle. Each freestyle stroke can be broken down into five main phases:
When looking over all the different component phases that make up a freestyle swimming stroke, something becomes abundantly clear… internal rotation is crucial. From the catch phase all the way through the recovery phase, internal rotation is necessary in order to perform the freestyle stroke effectively and efficiently. That’s why you’re always hearing your coaches scream out cues like: “Keep a high elbow;" “Drag your fingers;” and “Point your elbow to the ceiling.” All are various cues for internal rotation.  The problem is though, we see a ton of swimmers who are missing adequate internal rotation. When you’re missing internal rotation and you try to go into a “hang position” (see picture above) you will compensate by dipping your shoulder forward. This is a big problem because when you dip your shoulder forward you’re putting your rotator cuff in a weakened position, putting unneeded stress on your biceps tendon and labrum, and decreasing your power output. Add all that together and multiply it 36,000 strokes you're doing in an average week and it becomes easy to see why this is a recipe for disaster. So how do you know if you’re missing internal rotation and what can you do if you are? Well, check out the video below to assess your shoulder range of motion and see if you hit the minimum of 70 degrees of internal rotation we like to see our athletes to hit. If you don’t have the needed range or it is a struggle to get there, check out the following two videos for a couple of our favorite ways to improve your shoulder rotation. (Internal Rotation Self-Assessment) (Internal Rotation Superfriend Stretch) (Banded Internal Rotation Stretch)
Lacking internal rotation is one of the main reasons why we see swimmers, especially youth swimmers, in our clinic in Decatur, GA. However, the shoulder is an incredibly complex joint and there could be a number of reasons in addition to a lack of internal rotation causing pain in a swimmer’s shoulders. If you’re still struggling with shoulder pain or noticing a decrease in performance after working on your shoulder internal rotation you live we’d love to help. Simply give us a call at 470-355-2106 or fill out the contact request form below and we’d be happy to contact you. Thanks for reading, -Dr. Jake, PT, DPT, CSCS Breathing. Seemingly, the most innate skillset you have as a human being. So innate that it’s used as a benchmark for being a healthy newborn and your first time taking in a breath happens within 10 seconds of entering the world. Fast forward to adulthood and you’re breathing an average of 12 to 20 times per minute without a single thought. With all that practice, we must be pretty good at it; right? Not exactly. Stress, lifestyle choices, and mechanics all play a huge role in how we breathe, and all breath is not created equal. Just like any skill, practice makes perfect, and I routinely see the opposite. I constantly see people who can only breathe into their chest, who don’t know how to take appropriate deep breaths, and who have no control over their diaphragm. This is a problem for many reasons and let me tell you why. First and foremost, deep breathing has profound effects on your autonomic nervous system. Your autonomic nervous system includes your sympathetic and parasympathetic nervous systems which control your fight-or-flight responses and your rest-and-digest responses, respectively. In the world we live in, it’s easy to feel the weight of stress - stress from your job, driving in traffic, relationships, finances, etc. Here’s the crazy part though: our brain can’t decipher between the stress of being chased by a bear and the stress of being behind for an important work deadline. To the brain, stress is stress and breathing short, shallow breaths is one of the main ways our brain interprets stress. All this to say that shallow breathing is both a cause of increased stress and a symptom of increased stress responses, creating a vicious negative feedback loop leading people to live in a chronically stressed state of mind. No bueno. Not only are there serious cardiac, mental, and metabolic diseases linked to chronic stress, but chronic stress can also put you at a higher risk of injury AND slow down your rate of recovery from current injuries. Here’s the good news though: Something as simple as taking longer, deeper breaths using your diaphragm has been demonstrated time and time again to not only prevent the effects of chronic stress, but also significantly decrease non-specific mechanical low back pain. But don’t take my word for it:
Training your diaphragm is relatively easy. Below I’ve listed my three favorite drills to do so. While doing these drills, I’ll often have my patients perform something called an “apnea breathing” pattern, which is designed to slow down your breathing, increase your parasympathetic nervous system, and decrease your levels of chronic stress.
In review, taking deep, long breaths could be an effective treatment option for you if you’re dealing with low back pain and, at a minimum, will help your live a healthier life. However, diaphragmatic breathing is just a piece of the ever elusive puzzle. If you’re dealing with low back pain, reach out with any questions. We design and implement programs to help people just like you, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to get out of pain and return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS Running has been around for a long, long time… you could even make the argument that it’s been around since the beginning of time. It’s a fundamental movement that humans perform and officially became a sport all the way back in 776 B.C. when a foot face was the FIRST ever event in the FIRST Olympic games. Then, fast forward to 490 B.C when Pheidippides ran roughly 25 miles to deliver news of a victory against the Persians at the Battle of Marathon, which gave way to the marathon race being added to the first-ever international Olympics in Athens, Greece (which only 9 out 25 athletes finished!). This entire blog post could be on the history of running. It’s an integral part of being human. So we should be pretty good at it; right? Well… not really. Running related injuries are some of the most common injuries that we see in the clinic. When you look at the literature, anywhere from 36% to 57% of the running population will experience an injury every year and upwards of 75% of all running injuries can be related to overuse. That’s a lot of people who are getting injured every year. Too many. We see a lot of those people every day at Athletes’ Potential, which has allowed us to pick up on something - something that is criminally absent from running programs: Strength Training. This. Is. Huge. No matter how you try to look at it, the lack of strength training in the running community is astonishing and unwarranted. Time and time again research is proving the injury reducing and performance boosting benefits of strength training for runners, yet I still hear things like, “I don’t want to get bulky,” or, “it will slow me down,” or, “I’ll get too stiff.” All of these are based on archaic midsets and need to be changed. Nowhere in the literature are these thoughts supported and, in fact, it finds the exact opposite.
However, all that being said, strength training has to be specific to the performance goals of runners. You shouldn’t go out and try to do the exact same training program as a bodybuilder if your goal is to be able to run a marathon. Movements that are going to improve single leg loading and train in multiple planes of motion is the name of the game for runners. Below are some of my favorite exercises to do just that. Bulgarian Split Squats Single Leg Romanian Deadlifts Step Ups with Knee Drive Finish Lateral Lunges Hollow Rock Step Downs Band Resisted Side Steps If you’re dealing with an injury and looking to boost your performance as a runner, reach out with any questions. We design and implement programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS  What’s up, everyone. One of the many treatment options that we offer at Athletes’ Potential is something called Personalized Blood Flow Restriction Training (PBFRT). This is something I remember being blown away about while in physical therapy school and seeing the results that research was showing. To put it simply, it’s one of the best evidence supported treatment options out there and we are thrilled to be able to offer it to the Decatur and greater Atlanta area. There are a ton of awesome benefits with PBFRT, but first let’s take a look at what exactly BFR is. PBFRT is the brief and intermittent use of a tourniquet in order to restrict the amount of blood flow from coming into your limb (arterial flow) while performing low-load resistance training. The way PBFRT works is it reduces the amount of oxygenated blood reaching a working muscle in order to trick your body into thinking it’s working at a higher intensity than it actually is. By using this form of engineered suffering, you’re able to use extremely light resistance and still get the same increases in size and strength as lifting at higher intensities with heavy weight! Exactly how this happens is laid out below:
Essentially, PBFRT is a true biohack that allows people to work at loads that are non-stressful on the tissue but still get improved size and strength. A true game-changer in the world of strength and conditioning. But just like everything else in the world of sports medicine, PBFRT has to be used appropriately and with the right population. Otherwise, you could risk wasting your time and resources. So, who exactly would benefit? Below are three of the most common scenarios that people see the best results. Post-Injury/Surgery: Muscle breakdown (atrophy) after a surgery or injury happens incredibly fast. For example, when you’re injured or you’re not allowed to put any weight through one of your limbs, in as little as two weeks that limb goes into a state of anabolic resistance and protein synthesis shuts down leading to a 30% loss of muscle mass in that limb! This is obviously extremely problematic and slows down recovery from an injury dramatically. However, with PBFRT we now have the ability to combat that significant muscle loss because we are able to use low intensity and weight levels that are safe and tolerable to the patient and get the same increases in muscle size and strength as lifting at 65% of your one rep max or higher. A great example of just how beneficial PBFRT can be for patients rehabbing from injury comes from Dr. Zach Long who was working with an elite level olympic lifter after tearing his ACL. With this type of injury, more than 65% of patients demonstrate quadricep weakness even a year out from surgery. However, Dr. Long’s patient’s surgical leg became one inch larger than his healthy leg in just three months time after his surgery! Sport Performance: PBFRT has shown numerous benefits to enhancing sports performance, but perhaps the most documented is the ability for athletes to maintain muscle size and strength without the dip in performance caused by muscle soreness. This is possible because there is no muscle tissue breakdown associated with PBFRT since the intensity is kept so low.
PBFRT has also been shown to have a profound effect on your aerobic capacity as well by increasing your VO2 max and capillary beds.
Recovery: Imagine this. You’re training for an upcoming triathlon and are starting to feel a little banged up from the volume pulling, or you’re gassed trying to prepare for a CrossFit competition, or maybe you’re midseason in soccer and have been trying to push through some nagging issues. Now, imagine during your recovery day you rode for just 15 minutes, at a pace well below a typical recovery ride pace, and we’re able to give your tendons that increased HGH we mentioned above, all while boosting your VO2 max AND letting your tissue continue to recover. Sounds pretty cool; right? We have people do that all the time here in the clinic and we are consistently seeing people hit PR’s and feel good doing it. Rehab, Performance, Recovery. That covers a vast majority of the population, and that’s on purpose. The research (over 600 published studies) is incredible and the results we are getting wiht people speak for themselves. However, as the old adage goes, “If all you have is a hammer, everything looks like a nail.” Personalized blood flow restriction training isn’t for everyone, and that’s okay. At Athletes’ Potential we firmly believe we have the most skilled doctors of physical therapy who can use a vast array of treatment options to help you reach your injury or performance goals. Whether you are training through a nagging injury or looking to improve your performance, we would love to help you achieve your goals. Give us a call at 470-355-2106 or fill out the contact request form below and we will be happy to contact you. Thanks for reading, Dr. Jake, DPT, CSCS It’s baaaaack. The largest fitness competition on Earth, the CrossFit Open, is finally here. Maybe you’ve trained all year for this, maybe you’re still new to CrossFit and are curious about all the excitement. Maybe you’re a seasoned vet, maybe this is your first Open you’ve ever participated in. Regardless of your CrossFit background, your fitness will be tested, your mental toughness will be challenged, and you will certainly have a blast working through these workouts with your crew at your local CrossFit affiliate. That being said though, this is typically a time where we start seeing an uptick in the people we see coming in for CrossFit related injuries. Having an athletic background, where I had to personally sit out multiple seasons due to injuries, I speak from experience when I tell you there is nothing worse than working all year towards a goal/competition/test and not being able to perform at an optimal level, if at all, because of an injury. And, look, I get it. There is inherently an increased risk of injury when you're pushing yourself in a competitive environment. However, there are some very important things you can do to minimize this risk and allow you to perform your best. Let’s take a look at the three easy things you can do: #1 Don’t Be Reckless This is huge and something I see year after year. If you’re a CrossFit coach, or even just an observant CrossFit athlete, I’m sure you’ve seen what I’m about to explain...You’ve worked all year to create movement patterns that are both safe and effective. You know the importance of good, quality movement. However, throw in the element of an international competition and it seems like all these lessons about technique go out the window. For example, last year’s first Open workout (18.1) consisted of three movements: toe-to-bar, dumbbell clean and jerks and rowing. Can you guess what type of injury we saw coming into our clinic after this workout? If you said back pain, you’re correct. But why? Well, with this workout people were trying to perform as many rounds as possible for 20 minutes. To get better scores people weren’t maintaining core control for a solid hollow position with their toes-to-bar, they stopped getting full hip and knee extension for optimal power production during the drive portion of the clean and jerks, and/or they started to over-extend during the rowing component. All of these create situations that are destined to increase stress on your low back. Keep in mind that this was just the first workout! Now you’re either completely unable to participate in the other workouts or will not be performing at an optimal level because you’re trying to grind through an injury. #2: Protect Your Sleep There are four main pillars of health care that we look at with every patient who walks in the door at Athletes’ Potential: Movement, Stress, Sleep, and Nutrition. Sleep is easily on of the biggest problems that we see out of these pillars. And check this out: Sleep affects everything you do and everything you do is positively affected by quality sleep. Good, quality sleep literally improves everything: every marker on a blood panel, weight management, sport performance and recovery, productivity, and numerous types of disease management. The list goes on and on, yet the percentage of sleep deprived Americans, particularly in Urban areas, continues to rise at an alarming rate. In fact, the U.S Centers for Disease Control and Prevention reports that more than 30% of Americans are sleep deprived getting fewer than 6 hours of sleep per night. If you’re not getting enough sleep, you’re not giving your body a chance to recover. If you’re not recovering appropriately, then you're leaving yourself at risk for injury and decreased performance. So, bottom line: create an optimal sleeping environment, protect your night time routine, and get some good, quality sleep. For more info on how to optimize your sleep, check out this article we wrote. #3: Maintain Perspective This comes full circle with tip #1. For those of you trying to make it on to Regionals, those extra few reps I mentioned could be the difference in making the cut vs staying home. However, for the vast majority of athletes competing in the CrossFit Open this is not reality. You all have careers, kids you need to take care of, and numerous other responsibilities that you need to keep rocking with once you leave the gym. Is bouncing off the top of your head to get an extra rep or two really going to mean that much if by doing so now you can’t look over your shoulder while driving? (yes, this is a real scenario that we’ve worked on at our clinic...I’m looking at you 17.4). Or is that two position jump on the leaderboard really all the important if now you can’t bend over to pick up your kids?
CrossFit is meant to be a competitive, fun, and challenging way to make all aspects of life outside the gym a little easier. This time of year is huge for all CrossFit athletes and it is truly impressive to see the physical accomplishments and PR’s that happen every single year in the Open. However, the Open isn’t an excuse to throw all safety out the window, but it isn’t something you should be afraid of either. Following these three easy tips will ensure that you have a great time, reduce your risk of injury, and maybe even hit a PR or two. Thanks for reading, Dr Jake, DPT, CSCS, CF-L1 Coming at you with the the final part of our two-part series for ensuring healthy shoulders while improving your pull-ups. In this part we’re talking about how to develop appropriate strength in the appropriate areas. For those of you who missed it, part one is super important and I highly recommend reading that before moving on with part two. For those of you who are caught up, let’s get after it. Part II: Strength In any training program, it’s important to make sure your movements are balanced and that your shoulders are working in multiple directions (ex: vertical pulling, horizontal pushing, horizontal pulling, etc). The pull-up is an excellent example of a vertical pull strengthening exercise. With most pulling exercises, your body is primarily moving through two movements: elbow flexion and shoulder extension. This means your primary shoulder extension (latissimus dorsi, teres minor, post delt) and primary elbow flexion (biceps brachii, and brachialis and brachioradialis) muscle groups need to work synergistically to perform this movement appropriately. Unfortunately this synergistic relationship isn’t normally the case. More often than not I find that people way over utilize elbow flexion and underutilize shoulder extension. When this happens bad things happen and those bad things usually end up manifesting themselves as pain along the front of the shoulder. As you can tell in the picture above, the long of of your biceps tendon crosses the shoulder joint and when you rely too much on elbow flexion with pulling based exercises, you can end up agitating that tendon, which leads to shoulder pain. I see the aforementioned situation happen all the time in athletes who do a lot of kipping pull-ups vs strict pull-ups, specifically in those who don’t have the requisite strength to perform consecutive strict pull-ups but are repping out 15+ kipping pull-ups at a time. Now I’m not saying kipping pull-ups are bad or that you shouldn’t do them, but kipping pull-ups should be an expression of strength, not a way to avoid a weakness. To ensure you’re not overusing your biceps while doing the pull-up you want to have strong, engaged lats (latissimus dorsi). To make sure this is the case, check out our top 3 exercises below for improving shoulder lat strength and control. Drill #1: Active Hangs This drill is an all time favorite of mine for a couple of reasons. First, it allows you to feel how your lats should be contracting while you are going a pull up. Second, it allows you to strengthen your shoulders in a vulnerable/weak position. You’re only as strong as your weakest link and being strong in a weak position is a great way to prevent injuries. Drill #2: Lat Pull Over This one is a great example of “killing two birds with one stone” because not only are you able to improve lat strength with this drill, but because of the long eccentric phase (muscle contracting while lengthening) of this drill, it’s also a great way to improve shoulder mobility. Drill #3: Single Arm Banded Lat Pull Downs Breaking up a bilateral movement (using both arms) into a unilateral movement (using one arm) is a highly underutilized training modality that allows to balance out weaknesses. Plus, as an added bonus, you’re able to perform a vertical pulling drill at a slightly different angle which, as we talked about above, is how you train for healthy shoulders. If you have shoulder pain while doing pull-ups, or want to prevent pain from coming, this two-part post is a great place to start. Ensuring appropriate mobility and then building appropriate strength is a common occurrence in the rehab world. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading, Dr. Jacob, PT, DPT, CSCS Whether you’ve never stepped into a gym or are a diehard fitness enthusiast, chances are you’ve attempted a pull-up. That’s a good thing! It’s hard to argue an exercise that is more foundational to upper body strength than the pull-up. That being said, for how much I love this exercise and think it is something everyone should be doing (or at least a type of modification), I treat patients all the time in the clinic with shoulder pain related to the pull-up. Whether it be mobility issues, strength, or poor technique, there are a number of reasons why your shoulder can hurt during or after pull-ups and this article is the first of a two-part series that will teach you how to keep hitting your pull-ups pain-free! Part 1: Mobility First and foremost, let’s take a look at what exactly is happening at the shoulder joint while doing a pull-up. When you raise your arms over your head to get in the starting position for this exercise, your shoulder joint has to do a combination of two movements: flexion and external rotation. If you're limited in any of these two ranges of motion your body will make compensations to get your arm in position, which will eventually set you up for a higher risk of injury. Think of it this way: If your car tires are out of alignment, nothing will happen right away, but eventually there is going to be uneven tread wear and you’ll end up blowing a tire sooner than later. The same can be said for your shoulder if you're lacking requisite mobility with either shoulder flexion or external rotation. The videos below are great ways to test if you have enough shoulder range of motion, as well a favorite drill of ours to improve any range that needs work. 1. Flexion  (Shoulder Flexion Self-Assessment (Performed by Norcal Strength and Conditioning)
(Banded Overhead Opener)
(Thoracic Spine Opener)
2. External Rotation  (Shoulder External Rotation Self-Assessment - Performed by Michael Carroll)
(Chest Opener)
(Front Rack Opener)
To recap, if you have shoulder pain while doing pull-ups, or want to prevent pain from coming, the first place to start is to make sure you have enough shoulder flexion and external rotation to perform the exercise without compensation. Be on the lookout for Part II of this blog post which will dive into the common mechanical flaws and strength imbalances that can lead to shoulder problems with the pull-up. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading,
Dr. Jacob, PT, DPT, CSCS |
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