Monday, July 4, 2011

Learning About the Shoulder From Two Smart Dudes

 I recently finished watching the DVD set "Optimal Shoulder Performance: From Rehabilitation to High Performance" by Eric Cressey and Mike Reinold.  This is a fantastic resource that would be beneficial for coaches, trainers, or anyone suffering from shoulder problems.  For those who don’t know, Mike Reinold is the Head Athletic Trainer and Assistant Director of Medical Services for the Boston Red Sox and works with some of the most expensive shoulders in baseball.  Eric Cressey is a strength coach and also has a ton of experience working with shoulders.  Both guys are crazy smart, but they are able to present great information in an easy to understand way in this DVD set.

You can check out the home page for more information about the DVD at:
Today, I want to provide you with some of the notes I took while watching the DVD.  Let me say that there is a lot more awesome info in the DVD than what I am listing here, but these were some of the major points that I took away. 
-Total glenohumeral (GH) motion is important (180 degrees is ideal).  Difference in internal rotation (IR) and external rotation (ER) between sides is not as important.  If one shoulder has 110 degrees of ER and 70 of IR, while the other has 90 degrees of ER and 90 degrees of IR, this is okay.  Even though IR and ER differs between the two shoulders, they both have equal total motion, and it is 180 degrees, which is good.
Now, if you have one shoulder that 110 degrees of ER and 70 degrees of IR, while the other shoulder has 90 degrees of ER and 60 degrees of IR, then this is a problem.  You would want to fix this by increasing the 60 degrees of IR on the latter shoulder.

-Do not stretch aggressively into IR (should feel a gentle stretch on back of shoulder).  When stretching into IR (such as in the sleeper stretch) make sure to pin the shoulder blade back so that you stretch the muscles between the shoulder and scapula vs. muscles between the scapula and spine.  Reinold says the stretch should be a 2-3 on a 1-10 scale in terms of aggressiveness.
-Cuff injuries usually happen over time.  This means that if you have or have had a cuff injury then you need to look at asymmetries, limitations, etc. to determine the underlying reason you injured it - it most likely did not result from one incident.
-If you abduct the arm and have irritation at:
      >170 degrees then most likely it is an acromioclavicular (AC) joint problem or subacromial
      ~45-120 degrees then most likely you have cuff tear or cuff inflammation
-If pain is present with ER, then it is most likely a capsular or labrum issue.  If pain is present with IR, then it is most likely a cuff issue.
-In general, the top two muscles to strengthen if someone has poor shoulder health are the infraspinatus and the lower trapezius.  The DVD provides good examples of how to do this.

-If the scapula is not in a good resting position (due to poor thoracic spine position, rib cage position, etc.) then it will be difficult to strengthen peri-scapular muscles optimally.  
-The subacromial space is bigger if scapula is retracted.  This is significant because a small subacromial space can pinch or tear any tissue that passes through it.
-Do not train the cuff to failure.  Reinold had a good blog post on this recently: CLICK HERE TO READ
-Cuff endurance is very important.

-The main function of the rotator cuff is to stabilize the humerus in the glenoid via compression.  A great way to train this function of the cuff is through rhythmic stabilization exercises, which basically involve applying perturbations to a person's arm.  Below are some examples of these:

Cressey says he usually focuses one day around external rotation and/or internal rotation strength and the other around the exercises described and shown above.  This way he trains all the functions of the cuff.
-Scapular push-ups are a good exercise, but they are advanced.  You have to be in a good neutral spine position for them to be effective.  Elevating the feet makes the exercise more effective at activating serratus anterior.
-When measuring IR and ER, put the humerus in the scapular plane. 
-When measuring IR, put enough pressure on the humerus to get to the end range of the person’s rotation.
-But, when measuring IR and ER, do not put pressure on the anterior part of the humeral head.
-When measuring IR, place the fingertips on the superior border of the scapula and the thumb on the coracoid process.  This will allow you to feel when motion starts to come from the scapula and not solely from the glenohumeral joint.

The DVD also provides a detailed assessment protocol to determine common shoulder problems.  It then lists out corrective strategies for these common shoulder problems and things to avoid if you suffer from them.

Overall, this was a great DVD set and I highly recommend it.  Here is the link again if you are interested:

Have a great week everyone!!  Oh and I almost forgot- Happy 4th of July!!!


  1. Hi,

    I am currently in shoulder rehab for a grade 3 AC joint separation and really appreciate your insight on shoulder rehab/training.

    I as well purchased "optima shoulder performance" and have to agree with you completly! Easy to understand, well presented and very thourough...

    I have one question remaining though on rhythmic stabilization:

    Do you think once I get out of rehab I can replace the therapeut with a "shaking stick" like this:

    or won't this do the job?



  2. Sebastian- Sorry it has taken me a while to get back to you. To answer your question, I would say that the shaking stick you linked to could probably be a decent tool if it gives you the right amount of "shaking force." What I mean by this is that you want to make sure you are stabilizing your arm/resisting the shaking by using your cuff and are not using other muscles such as your pec to stabilize. If the pressure is too much, then you will most likely recruit other muscles to stabilize. This is why it is better to have someone else provide the perturbations because you can give them feedback as to whether the pressure is too much or too little. Hope this helps! Good luck with your rehab!