Balance the Shoulder

When it comes to curiosity, nothing fills my cup quite like a good nerd-out session on the shoulder. I try to casually throw it into conversations with my colleagues and blurt out random shoulder factoids to passersby on the street, much like Amelie does with her favorite word, “dada.”

Slight digression – Amelie’s first word was “dada.” Hooray me! Reality check - Amelie’s word for everything in her environment is “dada.” Insert Debbie Downer theme music now.

Okay, back to the point of today’s message. The months of April-July, 2018, are like a perpetual Christmas/Hanukah/insert favorite holiday here, because I get the privilege of talking about the shoulder to captive audiences! My good friend and codependent shoulder partner in crime, Dr. Mike Kecman, and I will be teaching the Jackson Clinics Upper Extremity Series, speaking at the INOVA Sports Medicine Symposium 2018, and teaching a lecture on the upper extremity athlete to George Washington University’s PT school. In the spirit of all things curiosity about the upper extremity, and building on the momentum of these courses, I wanted to give you all a glimpse at how I treat the shoulder (Caveat – adjustments are made based on a formal assessment. This is not intended to be formal medical advice. Caveat # 2 - The Jackson Clinics PTs offer Free Movement Screens and accepts most insurancesJ). On with the show!

This post will focus on the foundational movements to start you on a path of optimizing shoulder health. Coming in for an ankle sprain? Great, you get the balance the shoulder routine (in addition to your ankle specific exercises, of course)! This routine heavily focuses on pulling movements to counteract all of the pushing movements that people tend to gravitate towards in the gym. How many times have you asked someone about their gym routine and they rattle off 12 upper extremity movements that target pushing/front of the shoulder? Bench press, incline press, decline press, push-ups, shoulder press, curls. What happened to the pulls?!

Are the muscles on the backs of our torsos suffering from the old adage: out of sight, out of mind? We can’t see these glorious pulling/back muscles so we forget about them? With this post I attempt to end an epidemic – Paltry Pulling Disease.

The Movements – Balance the Shoulder: The beauty of these movements lies in their simplicity. Anyone can do them (see caveats above) and you can make them challenging for any patient/athlete with minor tweaks to the volume. The goal is to get them to realize that the basics are sexy!

1. Shoulder Extensions: Pulling movement that targets the back and bottom of the shoulder.

   

2. T’s: Pulling movement that targets the back of the shoulder

3. Y’s: Pulling movement that targets the back and bottom of the shoulder

4. Bent-Over Row (DB): Pulling movement that targets the back of the shoulder

5. Sidelying External Rotation: Pulling movement that targets the back of the shoulder

6. Front Raises (Shoulder Flexion): Targets the front and top of the shoulder

The Prescription: Let’s rely on some help from the American College of Sports Medicine (ACSM) in this arena. The ACSM is a paragon of strength training and they derived these recommendations based on a compilation of > 300 references on the subject1. No sense in reinventing the wheel. The basics are sexy!

1. 1-3 sets - 1 set for untrained populations, multiple sets for trained populations
2. 10 repetitions per set - maximizes increases in strength, endurance, power
3. Establish 10 repetition maximum for each movement and working weight should be 60-80% of this number - You can also use a rating of perceived exertion of 6-8 on a scale of 0-10. ²
4. Utilize superset format – alternate between two exercises. These should target dissimilar movement patterns to allow for a rest period between sets. For example:

1a) 2-3 x 10 barbell hip thrusters

1b) 2-3 x 10 bent over row

2a) 2-3 x 10 stationary lunges

2b) 2-3 x 10 shoulder extensions

5. Rest intervals 60 seconds³ – this is built into the superset format. You are resting the shoulder while you perform an exercise for the legs or a different movement pattern.
6. Frequency: 2-3 x week – If you are working at an intensity of 60-80% maximum for each exercise, you will need a day of recovery between working days.
7. Duration: minimum of 6 weeks – change the volume every 6 weeks. After 6 weeks, the body will need a new stimulus to continue to adapt. One example is to switch to sets of 8 repetitions with a focus on heavier weight after you have some proficiency with the movements.

The Real World Application: If you are new to strength training, these 6 exercises can be your starting point. They primarily focus on movements that reverse the dreaded slouched position we see in every office, metro, and even gym (I’m looking at you, Mr. “nose in my phone while I use the elliptical”).

If you are a savvy lifting veteran you use these 6 movements as an active rest for your foundational lifts, as described in the superset portion of the blog.

The Tie-Back to Previous Blog Post: In my inaugural blog post (Please read if you haven’t done so. Go ahead and scroll down to the bottom of the blog post page. It’s only 3 articles so it won’t take long and I will still be here when you get back, I promise), I discussed Gray Cook’s concept of the pyramid of removing weak links and the foundation of the pyramid being movement⁴.  The foundation of treating the injured/weak/underperforming shoulder is moving it into a stable position no matter the movement. The Balance the Shoulder routine creates stable positions in movements close to the body, reaching out away, reaching overhead, and reaching through rotation. Whatever your ailing movement, we’ve got an exercise for that!

Much more of this to come in future articles, but until then, let’s put the back in the forefront of our training priorities!

Resources:

1. ACSM. Progression models in resistance training for healthy adults. MSSE. 41(3):687-708, 2009.

2. Colado, JC, et al. Concurrent validation of the OMNI-resistance exercise scale of perceived exertion with theraband resistance bands. JSCR. 26:3018-3024, 2012.

3. Bunn J – Exercise Physiology in the PT Setting (2016) – The Jackson Clinics Residency Education

4. Cook, G. Athletic Body in Balance: Optimal Movement Skills and Conditioning for Performance. 2003.
5. Davies, G - A Master Clinician's Approach to Advanced Concepts in Examination and Treatment of the Shoulder Complex - 2016  *** Special Thanks to George Davies for the inspiration behind the Balance the Shoulder. His course was a truly inspiring course that I would recommend to anyone!