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The shoulder is a very dynamic region. To put it to the test on the daily, either through sports, such as swimming and tennis, or through workouts, means that you have an awareness of how dynamic it really can be. In this complex, there's a lot of range of motion and even more potential for strength/power output so there’s plenty that can go wrong! This short write-up is a summary of a concept that you can start learning today to help your shoulder complex function more efficiently and effectively. Learn these coordination cues and then start to look out for other opportunities where you can connect your core to your fingertips!  Every shoulder action is anchored to the core. From the fingertips all the way through to the lumbar spine, every push and pull, throw and press… ALL involve the core. The more aware and coordinated you are with this, the more efficient your shoulder motions can be. This heightened coordination also improves force distribution throughout the entire chain of movement, therefore decreasing chances of wear-and-tear on a specific tissue such as the rotator cuff. Two simple drills I like to do to help identify how much the core can affect the shoulder complex is the plank in both passive and active positions and then compare those positions to a functional test, such as pushing a car.   The plank with passive shoulders and relaxed core is disconnected from the lumbar spine and your power output will suffer. Using this coordination pattern while pushing a heavy object, such as a car that has run out of gas, would surely be weak as it does not fully take advantage of your core strength during the push! Let's compare that to an effective plank with an active core.   The power output of this position is clearly higher! By using the musculature from the core initially to stabilize my center of mass, my shoulder complex can successfully attach to this foundation and press much more effectively. Next time you’re in the gym or you are playing your sport, try to see if you can find other actions that you can connect from your core to your fingertips. You’ll be surprised at how much more effective your swimming stroke, tennis serve, or pullups can be with an active core. Give these approaches a try and let us know what you think! Thanks for reading,
Marcus Rein, PT, DPT, CF-L1
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The shoulder complex is just that… complex! It is a series of incredibly mobile regions stacked on top of each other in such a way that if there is a significant issue in any one of these regions, the whole thing doesn’t work well. What I want to do with this blog post is give you QUICK and EASY assessments you can do on your shoulder to discover what it can do and what it should be able to do!
 This quick and easy assessment gives us an idea of how well your shoulder can go overhead (flexion) and how well it can go behind you (extension). If you’re having difficulty with either of these movements, make note of which is the most challenging and let's move on to the next test.
  Lying down with a towel under your elbow, see how much range you have going backward and forward with your wrist. In total, you should have about 160 to 170 degrees of total motion with the shoulder staying pinned on the table (see how the second image has the patient pinning their shoulder to the table so it doesn’t come up). Typically we see the back of the wrist touching the table when going back and the front side of the wrist nearly getting to the table, for a normal range of motion. If you’re having difficulty with either of these, take note and let's move on to the last assessment.
    Being able to use your shoulder overhead is challenging without the correct musculature in place and ready for action. The “Reach, Roll, Lift” assessment really tests your shoulder’s ability to have good range of motion, as well as good muscle activation to pull your hand off the ground. First, crouch down, then slide your palm across the ground overhead; roll your thumb upward to the sky while keeping your outside of the hand on the ground; finally, pull your thumb and arm to the sky, keeping your arm straight. If this is not possible, make note, and let's move on. After you’ve done these three assessments, you may have found you are lacking certain fundamental movements of your shoulder that are required for healthy functioning of your upper body. At Athletes’ Potential, we specialize in working with correcting these issues regularly and getting our patients back to the activities they love, fast, and without the need for injections or surgery. If you discovered that you are unable to perform any of these three assessments, feel free to reach out to us and schedule a treatment today! Thanks for reading,
Dr. Marcus Rein, PT, DPT, CF-L2 Shoulder pain when going overhead? Watch Dr. Marcus walk us through a shoulder assessment so you can get better understanding of how your shoulder should move. Don't forget, there a few cues to make sure you're keeping yourself honest.
If you're still struggling with this movement or experiencing pain or discomfort, give us a call. 470-355-2106 or email us at info@athletespotential.com. We want to help you!  So, let’s talk about the shoulder: It is a very dynamic joint with little surface area between the humeral head and the glenoid fossa. The analogy we often use is a golf ball on a golf tee. There’s a reason why you hear more about shoulder dislocations than hip. We have numerous muscle attachments and ligaments that surround the joint itself. These can be broken down into active (muscles/tendons) and passive stabilizers (ligaments). When we are going through different movements at the shoulder (whether that’s an overhead press, push up, clean, etc.), if we do not have the requisite range of motion, coordination or strength, then our passive stabilizers take on a lot of that stress. As I’ve said before, every single tissue (muscle, tendon, ligament, bone, etc.) in our body has a certain capacity and threshold. Stress is how we build those thresholds up. Stress is also how we break those down. When those thresholds are surpassed significantly or repeatedly, pain and injuries start to pop up. The dosage is the difference in having the poison or the antidote (- quote from someone smarter than me). Now, how can we create more buffer room or bandwidth to withstand these stressors? Smart and well thought-out training. Sure. But, what about creating more freedom and control at the shoulder joint? Then, those tissues are less prone to getting overstressed and everyone is doing their jobs. Today, our focus will be on the overhead archetype – which is an expression of shoulder flexion and external rotation. This can be anything related to pressing, reaching overhead, hanging, or throwing overhead. I see people in the clinic every day that have pain with these movements and when we break these positions and joints down, we tend to see a limitation in one or both flexion and external rotation. Next, we’ll go through a test that you can utilize to see how your overhead position checks out. Wall Test: Common faults we see related to this are:
Try to avoid these mistakes and see where your true baseline overhead position is. After the techniques provided below, come back to this test and re-test the movement. Can you go further? How does the quality of getting there feel? Next, we’ll look at some strategies to improve the mobility aspect of the shoulder joint. Subscapularis Mobilizations: Shoulder Overhead Opener: When discussing the shoulder joint, I would be remiss not to mention the thoracic spine. The shoulder blade and thoracic spine/ribcage are very intimately related which directly impacts shoulder mechanics and position. Next, we’ll go through some techniques to address the thoracic spine. T-Spine Mobilization: Half-Kneeling Wall T-Spine Rotation with Lift Off: Lastly, we will cover my favorite component in the performance process which is the strength and control of the shoulder joint for the overhead position. Supine Eccentric Shoulder Flexion – Dowel or Single Arm with Plate: Dowel Shoulder Flexion PAILS/RAILS: Chaos Overhead Band Carry: Now, you may be thinking, "These are great exercises, but how do I implement them?" Try them as movement prep prior to an overhead workout, accessory work on upper body days or even on recovery days. Do you have to do all of them? Nope. Find the ones that you feel had the best impact on you via the test-retest on the Wall Test and start implementing them in consistently. An active approach tends to work better in the long term compared to the passive approaches and exercises. You’ll be surprised how quickly your overhead position will improve and your overall shoulder health.
If you’re dealing with an injury, 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. Cheers, Dr. Ravi Patel, PT, DPT, 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 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 Pain on the outside of the elbow is classically called “tennis elbow” or tendinitis. Although, people who don’t play tennis can also have this pain from grip-heavy or repetitive activity. There are also many structures that can cause this same pain, outside of the usual tendinitis. Tendinitis is thought to be caused by increased inflammation due repetitive stress in the area and micro-tears to the muscle. It is acute, meaning it just happened. However, many folks that we see have had symptoms for months (sometimes years!!) and so the process is different and chronic. We call this tendinosis. There is no longer acute inflammation or swelling, rather long term changes to the tissues in that area from improper healing and continuous repetitive trauma. The area that is irritated to cause the pain at the outside of the elbow is called the extensor tendon. That is, the common tendon where all of the smaller forearm muscles that extend the wrist, join at the elbow. Often times, players who are playing frequently throughout the week without proper mobility and recovery plans will present with this issue. Over-gripping the racket is also another major cause. If the muscles and therefore the tendon or irritated, a great place to start for self-care would be to perform the forearm release (seen below). Doing this for two minutes, 1-2x/day, can have a positive impact on the pain you feel.  So while many tennis players have pain at their elbow, only a fraction will actually have “tendinitis”. Another tissue that is often the culprit is the nervous tissue. Nerves course throughout our entire body for muscle function, sensation, etc. Irritation of the nerve, from repetitive activities or rubbing against another structure can send pain signals to the same area. However, treating the muscle in this case will not clear up the symptoms. The major nerve that runs by the outside of the elbow is called the radial nerve. Muscles nearby are commonly overused in tennis and can be the cause of the symptoms. Irritation of this nerve can also begin at the neck, but that is a discussion for another time! I often see players who are changing their grip or adding more top spin to their balls tend to have more issues with nerve irritation.  The best way to address the radial nerve irritation is a radial nerve glide (see video below). Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation! Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation! While both of these strategies above are a great way to decrease your pain, the best way to keep it from happening again is to address the shoulder. Shoulder weakness changes how your arm (elbow and wrist) move through space. With tennis players, overhead strokes and serving can be particularly irritating if proper shoulder position, strength and control are not achieved. Does your back look like this? Notice how the inside edges of her shoulder blade are prominent? Not ideal. That demonstrates weakness in muscles that are essential for overhead movement.  You can begin to address this weakness and shoulder position with a simple and effective exercise called the single arm punch out. It strengthens a muscle called the serratus anterior to help normalize scapular position. Try 2 sets of 15 reps per side, 3x/week. This is a great warm up on the court or at the gym! Summary:
Thanks for reading, Dr. Jackie, PT, DPT  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 12-15 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 move and potentially even move pretty damn fast, but you’re going to leave a ton of performance on the table and you’re going to break 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”, “point your elbow to the the ceiling”, all those 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 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 Elbow pain can be one of the most irritating and inconvenient issues. I once had a patient say that the most painful part of his day was just cutting butter for his toast in the morning. Classically, we tend to blame the tissues at the joint—wrist extensors/flexors. Sure, the common insertion for these muscles becomes inflamed, but what causes that? I like to view the elbow similarly to the knee; it is a joint that is pushed and pulled on either side by very complex joints. The shoulders will largely influence the biomechanics of your elbow and the amount of torque that passes through the joint. Although somewhat simplified, we could group you as either tight and immobile or mobile and bendy. Each characteristic has its own pros and cons, but the cons are where pain manifests. With decreased shoulder mobility and/or control, the elbow will take the brunt of the force when lifting weights or swinging a racquet. Shoulder stabilization and control are important for correct biomechanics of the shoulder girdle and upper extremity. Lack of control upstream, allows more movement downstream at the elbow. The repetitive, small insults at the elbow joint will eventually result in elbow pain.  Hammering away at the soft tissue around the elbow is often where athletes start when self-treating. Don’t get me wrong, a little forearm smash with a lacrosse ball or barbell is great. But if it does not improve your problems, move on! In this case, we are going to check out the shoulder. Less mobile folks: To decrease the torque at the elbow, it would be ideal to improve both the external rotation (front rack) and flexion (overhead position) or your shoulder. Tight lats can often be the cause of the restrictions. Try these two mobility pieces:
  More mobile folks: Shoulder stabilization is going to be the key for you. A simple way to start on this is kettlebell carries, all variations! Here are two simple, yet effective stabilization drills:
  As always, do a movement screen/ form check first. Get a coach or super friend to watch you move and see if they notice any faults. Racquet sport athletes—if you constantly have elbow pain, check your grip size. Grips too small or too large can cause elbow issues as well. If you are a desk jockey, check out your work station and the ergonomics!
Try these mobility exercises and tips out. If you continue to have issues, come see us at Athletes’ Potential. We see elbow pain often and are able to effectively treat it with an evaluation! Keep devoting time to making your body work and feel better. Thanks, Dr. Jackie, PT, DPT, OCS, CSCS |
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