Anti-Perspirant Integrity Test

My “Not-So-Baby” girl just turned four years old, so we decided to celebrate her pre-school status with a larger-than-life doll house.

While I was admiring my handiwork to assemble this monstrosity, I found myself marveling at Amelie’s determination to reach the tippy-top floor to put her Peppa Pig dolls in the attic.

This got me wondering: Why can’t many of us fully press our hands over our heads? Is it a fear of sweaty arm pits? We are in the midst of a DC summer, so I will not throw this theory out as a potential factor. Wait a minute…If this is the case, why do I also see this issue in the frigid, winter months? Is it a fear of exposing more of our bodies to the inclement weather?

Maybe, it is something far easier to explain: use it or lose it!  We stop trying to lift our arms over our heads, so we lose the ability to do so. Go ahead and try this test, I’ll be right here waiting (fully stretching my arms overhead):

Wall Flexion Test:

 

So how do we go from this:

My Muse:

To: “I can’t reach overhead, and I am moving all of the furniture to the bottom two floors of the doll house”?

 

10,000 Foot View:

People tend to fall into one (or more) of three camps – stiffness prevents overhead position, weakness prevents overhead position, pain prevents overhead position. Good news, we can treat all three, simultaneously! And, there is a ton of research that supports the utilization of overhead training in the presence of shoulder pain.

Many of my patients come in with pre-conceived notions that they should not be doing any resistance work over shoulder height. I find this puzzling, as many of the major muscles of the shoulder girdle work most effectively at progressive levels of shoulder elevation. For instance, the Serratus Anterior and Lower Trapezius muscles demonstrate improvements in activation with progressive levels of arm elevation^2-4 .  Additionally, the Overhead Press has been established as a movement that facilitates increased upward rotation and posterior tilt of the scapula, and reduced scapular internal rotation (all of these motions facilitate better reaching overhead)¹ .

What happens if I cannot get my arm fully overhead to effectively train these muscles? Train in the motion you possess! Numerous studies have shown the value of “partial range of motion” training, including a “training overflow” of 30 degrees beyond the training range^5-6. Just keep your eye on the prize, stretching ever closer towards that top floor of the dollhouse.

 

The Movements:

Broken record alert: A strong overhead game cannot be restored overnight – it will take MANY repetitions of purposeful movements, that are salient, specific, and build in intensity. ***As a dedicated reader of my previous blog posts, you may have noticed that I cut and paste this line from “Step Up Your Ground Game,” and replaced “ground game” with “overhead game.” I promise you that this is for the sake of reinforcement of principles, not the author’s laziness.

Principle of Movement – Mobility comes first! You cannot be strong in a position if you are too stiff to get there, in the first place. The following movements utilize weight/assistance to improve overhead mobility.

 

Pull Up Hold:

Haven’t hung from the monkey bars in a minute? Start with your feet on the ground. Let your body support the position and gently sink into the stretch.

 

Aspiring towards Amelie status? Pick up those feet and hold on for dear life! The longer you hold, the more time you spend working on your mobility (and strength, to boot!).

 

Dosage? Start with small sets (1-3 second holds) and progress in duration (20-30 seconds) as your tolerance improves.

 

Supine Pull Over:

Early stages of reaching overhead? Phone a friend for assistance!

Dosage? Start with small sets (20-30 second sets) and progress in duration (5:00 continuous) as your tolerance improves.⁷

 

How to progress? Sub out the dowel for some weights and repeat the process! 

Dosage? Treat it like a high rep strengthening exercise – sets of 12-20 reps.

Lat Pull Down: Doesn’t the top position look eerily similar to the top of a shoulder press?

Short on time and want to work on overhead mobility while building your back? Firstly, thank you for working on your back – even though you can’t easily see it in the mirror, a strong back is of huge importance. Secondly, here is the movement for you:

Dosage? Treat it like a high rep strengthening exercise – sets of 12-20 reps. Or, play up the tempo component, with sets of 6-8 reps with an 8-10 second eccentric. Not sure what I mean by tempo? I have a blog for that! Check out "A Not So Tempo-rary Training Tactic."

 

Principle of Movement # 2: Build strength and resilience in the range you possess. Start pressing on day one, within your good quality range of motion.

Towel Pull Apart: Early stages of reaching overhead? Phone a friend for assistance, part deux!

Dosage? Start with small sets (20-30 second sets) and progress in duration (5:00 continuous) as your tolerance improves.⁷

Sidelying Shoulder Press:

Dosage? Treat it like a high rep strengthening exercise – sets of 12-20 reps

 

Incline Press:

Dosage? Treat it like a high rep strengthening exercise – sets of 12-20 reps. Progress in weight and reduce the reps after one month.

 

Side Note – Pain is a big, hairy beast that is a separate blog unto its own. While slow, steady progression of these movements may help reduce your pain, you may need more guidance still. Suffice it to say, physical therapists thrive in the face of pain. If you have questions or concerns about pain limiting pressing overhead that cannot be addressed with these videos, schedule a consult with me and my friends at The Jackson Clinics!

 

https://thejacksonclinics.com/request-appointment/

 

The Overhead Movement Prescription:

1. Mobility is a dish best served daily. With this in mind, use the “20/20 Rule” – Every 20 minutes, step away from your work station and check the integrity of your antiperspirant (aka put your arms over your head) for 20 seconds.

2. Brush your teeth, brush your body – We brush our teeth at least twice daily to get rid of the gunk from our mouth. Why not do the same for the rest of our body, and undo the stiffness that we feel in our joints? Spend 3-5 minutes in the morning and evening exploring overhead positions.

3. Check your work – use the Wall Flexion Test after your movements and see which movements provide the biggest bang for their buck. Assess, don’t guess 😊

4. Check out my blog post, Balance the Shoulder, for specifics on exercise prescription for strength training purposes.

The Take Home:

There is a whole world of unused kitchen cabinets (and dollhouse attics) that are dying to be filled. Earn back the right to press overhead through restoration of mobility -> strength, and fill those cabinets!

 

References:
1. Ichihashi N, Ibuki S, Otsuka N, Takashima S, Matsumura A.Kinematic characteristics of the scapula and clavicle during military press exercise and shoulder flexion. J Shoulder Elbow Surg (2014) 23, 649-657.

2. Bäcker, H. C., Galle, S. E., Maniglio, M., & Rosenwasser, M. P. (2018). Biomechanics of posterior shoulder instability - current knowledge and literature review. World Journal of Orthopedics, 9(11), 245-254.

3. Bdaiwi, A. H., Mackenzie, T. A., Herrington, L., Horsley, I., & Cools, A. M. (2015). Acromiohumeral Distance During Neuromuscular Electrical Stimulation of the Lower Trapezius and Serratus Anterior Muscles in Healthy Participants. Journal of Athletic Training, 50(7), 713–718.

4. Ekstrom, R., Donatelli, R. and Soderberg, G., 2003. Surface Electromyographic Analysis of Exercises for the Trapezius and Serratus Anterior Muscles. Journal of Orthopaedic & Sports Physical Therapy, 33(5), pp.247-258.

5. George Davies - A Master Clinicians Approach to Advanced Concepts in Examination and Treatment of the Shoulder Complex – 2016.

6. Clark, RA, et al. The influence of variable ROM training on neuromuscular performance and control of external loads. JCSR. 25:704-711, 2011.

7. The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears Ofer Levy, MD, MCh(Orth), Hannan Mullett, FRCS(TR & Orth), Sarah Roberts, Bsc(Hons), Bed(Hons), MCSP, and Stephen Copeland, FRCS, Reading, United Kingdom - J Shoulder Elbow Surg 2008;17:863-870.