The Name of the Game is Progress

We have reached a milestone in the Alcorn household...Amelie is officially 1! Her first year has been truly incredible, as Amelie seems to be doing something completely new (and amazing) each day. It seems like only yesterday she was a tiny, little peanut that could not lift her disproportionately large head, and now we have progressed to this...

She is already a little rebel and has rejected the world of crawling, despite my lectures to her on the importance of closed chain activities to improve strength and control of the shoulder girdle.

On the heels of Balance the Shoulder (please check out my last post for details), I decided to follow in Amelie’s scootsteps and provide my progressions to the 6 foundation exercises in my shoulder program. The idea behind the next phase of the program is to progress in a step-wise fashion from pulling and pushing in a horizontal plane to a more vertical plane. Yes, you heard me correctly, I said pulling and pushing. We live in a world filled with pushing movements and we need to ensure that our patients are proficient in these movements. The Balance the Shoulder routine harped on pulling as the foundation of the program, and this continues to be the case, but what are we without progress?

10,000 Foot View - Adding levels to the pyramid of shoulder function through progression of  horizontal planes of motion -> vertical planes of motion. There is a tendency to see a breakdown in movement control of the shoulder/scapula as we progress above shoulder height so these progressions attempt to minimize the faults through a deliberate advancement from horizontal to vertical movements.

Disclaimer - these movements are meant to give you a sampling of the progressions towards better vertical pulling and pushing. They are not meant to be comprehensive in nature. 

The Movements – Horizontal to Vertical Pulling

1. Bent over row - Horizontal Pull to get the ball rolling (see video from last post)

 2. High to low row - Pulling from a position above shoulder height 

3. Pull-down - Pulling from a fully overhead position

4. Straight Arm Pull-down - Pulling from a fully overhead position with a longer lever arm

Horizontal to Vertical Pushing

1. Floor Chest Press - Pushing in the horizontal plane with a limited range of extension past the body (Note - this can be progressed to bench press to allow for a larger range of motion)

2. Land Mine Press - Pressing slightly above shoulder height

3. Land Mine Press with Lean - Achieves a greater range of motion overhead

4. Overhead Press - Pressing to a fully overhead position

The Prescription: Here is an example exercise prescription using principles from the American College of Sports Medicine’s Guidelines for Exercise Prescription¹.

1a) 2-3 x 10 Pull-down 

1b) 2-3 x 8 Front raise

2a) 2-3 x 10 Overhead Press

2b) 2-3 x 8 Shoulder extension

3a) 2-3 x 10 Floor chest press

3b) 2-3 x 8 Bent over row

4a) 2-3 x 10 Land Mine Press
4b) 2-3 x 8 Side-lying External Rotation

The Real World Application: This new crop of exercises can be added when there is proficiency with the foundation program and the patient demonstrates mobility and control above shoulder height. Remember, the basics are sexy (which is why I sprinkle the foundation movements throughout the program)! 

Onward and upward to stable overhead positions!

Resource:

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