Shoulder Treatment Part Two

Hi everyone! This week we continue to dive into the treatment portion of our shoulder series. In part one, we used the foam roller to target the large musculature below the shoulder. When tight and immobile those muscles (aka the lats, the pecs, the serratus…) can act like weights that pull down on your shoulder joint. Not only does this force the arm to work harder to get overhead, it also keeps the shoulder joint unstable and out of position. In that treatment post we also worked on the neck muscles that attach to the top of our shoulder blade (aka the levator and upper trap).

This week we’ll be moving closer to the shoulder to start restoring balance between the front and back of the shoulder. To that you’ll need a massage ball or tennis ball!

Here’s the breakdown:

  • Muscle mobilizations: 3 reps nice and easy of the pecs (3 arm positions) and 3 reps nice and easy of the back of the shoulder (two rotations and across the chest)
  • Stretches: 30 seconds x 2 of each (bicep and tricep)
  • Total time = 8 minutes

Shoulder Treatment Part One

Hi everyone! This week we are back to dive into the treatment portion of our shoulder series. Over the past month, we’ve talked about how the shoulder functions, what joints are responsible for moving it, and last but not least how the different layers of muscles are connected. The big take away should have been that the shoulder is the least stable joint of the body and that there are actually four joints responsible for moving are arm. What does that mean to you as an athlete?? That we need to keep those stabilizers healthy and mobile.

In this video we are going to be using the foam roller on those stabilizers (lats, serratus, pecs, triceps, and the big intersection that is our armpit). From there we’re going to shift to stretching out our neck. Yes, you read that right! In particular we want to loosen up the upper traps and levator.

Here’s the breakdown:

  • Foam roller: 1 minute of each (armpit, tricep, pecs)
  • Stretches: 30 seconds x 2 of each (levator, upper trap)
  • Total time = 5 minutes

shoulder massage pt 1 from Athletes Treating Athletes on Vimeo.

Superficial Back Arm Line

In our previous three posts, we talked about the two deeper muscle lines in the arms, as well as, the superficial chain in the front of the body. This week we’re going to introduce the last muscle/fascial chain- the superficial back arm. If you think of the deep lines as our stabilizers, the superficial lines are the real power behind reaching overhead, reaching out to the side, and pushing/pulling. It’s important to realize that these muscle chains/lines all work together. If the deeper lines are restricted/stuck, they will compromise the more superficial muscles and vice versa.

SBAL

In terms of function, this muscle chain is responsible for controlling the movement of our arm behind us, as well as, out to the side. To do that we need larger muscles which we get in the Trapezius and Deltoid. Both of these muscles feature multiple functional parts capable of moving the arm in multiple directions. This makes them powerful abductors. From the Deltoid, this arm line travels down the lateral septum (which separates the muscles in the front of the arm from the back of the arm). It then connects to the common extensor group (purple in the picture above). The extensor group originates on the lateral epicondyle and travels down the back of the forearm and hand to our fingertips.

Here’s a video to walk you through the muscles in this chain and to show you how to stretch them:

 

Superficial Front Arm Line

In our previous two posts, we talked about the deep arm lines. These muscle chains both included smaller muscles that were designed to help position our elbow and orient our hand. This week we’re going to build on those muscles by looking at the larger more superficial muscles that lay on top of them. If you think of the deep lines as our stabilizers, the superficial lines are the real power behind reaching overhead, pushing, and pulling.

The Superficial Front Arm Line

superficial_front

 

In terms of function, this muscle chain is responsible for controlling the movement of our arm out in front of us as well as to the side. To do that we need larger muscles which we get in the Pectoralis Major and the Latissimus Dorsi. While one muscle is found on the front of the body and the other on the back, both share a common attachment point on the inside front of the humerus. This makes them powerful adductors and internal rotators as they pull the arm back to our side. From that common connection on the humerus, this muscle chain then follows the intermuscular septum (green in picture above) down to the medial epicondyle where it attaches to the forearm flexors (aka the muscles responsible for flexing our wrists and fingers).

Here’s a video to walk you through the muscles in this chain and to show you how to stretch them:

 

Deep Back Arm Line

In last week’s post we started digging into the functional arm chains by looking at the deep front line. This week we’re going to build on that by looking at it’s partner in the crime- the deep back line. An easy way to visualize the difference between the two is to lift your arm out to the side as show in the picture below. You want to make sure your hand is point down to the floor and that your elbow is pointing backwards. In this position, the deep front line is on the front and the deep back line is on the back.

The Deep Back Line

deepbackline

In terms of function, this muscle chain works in two ways. When the arm is moving freely out away from your body, it works to position the scapula and rotate the humerus while also working with the front line to determine how much elbow flexion/extension is needed.  In weight bearing (push up/plank) position, it provides stability from side to side. In total there are 8 individual muscles in this chain. Here’s a video to walk you through each and what they do. You will also find ways to stretch each one of them.

Remember! Don’t push through pain with the stretches. Just go until you feel a pull. If you’re bringing a lot of tightness in terms of posture, expect to feel these in a few different places! 🙂 20 to 30 second hold of each.

Arm Muscle Chains – Part One

In total, there are four distinct chains of muscles in the arm. What I mean by “chains” is that the muscles in each chain are linked together fascially. While standard anatomy lessons can lead you to think of the body as standalone muscles with specific origins, insertions and movements, the truth is that every muscle and organ in our body is wrapped in a fibrous web known as fascia. This web connecting our muscles is what allows us to function and move the way we do. Take lifting the arm overhead for example. It would be easy to think only in terms of the muscles we know: deltoids, biceps, triceps, pecs. The truth is that before you even move that arm you muscles along the trunk positioning and stabilizing the shoulder blade. Then as you lift the arm, your elbow and forearm are working to position the hand in the direction that you want. It’s a total arm effort!

With that concept in mind, we’re going to start going through the arm chains. Like I said above, there are four separate functional chains. Two of these chains are along the front of the body and two are along the back. In this post, we’re going to be talking about one of the front chains. More specifically, we’re going to start with the deeper layer of muscles.

The Deep Front Line

deepfront1

In terms of function, this muscle chain works in two ways. When the arm is moving freely out away from your body, it works to orient the hand. Meaning it determines how straight the elbow is and how much the forearm is rotated. In weight bearing (push up/plank) position, it provides stability from side to side. In total there are 10 individual muscles in this chain. Here’s a video to walk you through each and what they do. You will also find ways to stretch each one of them.

Remember! Don’t push through pain with the stretches. Just go until you feel a pull. If you’re bringing a lot of tightness in terms of posture, expect to feel these in a few different places! 🙂 20 to 30 second hold of each.

Trunk Mobility

STstabilzers

In our last post, we dove into the stabilizing muscles of the scapulothoracic joint (aka the joint that holds the shoulder blade against the ribcage). These four muscles (pictured above) play a huge role in setting up the scapula to be in position regardless of whether the arm is pushing, pulling, lifting, etc. However, just like every other muscle in the body, these muscles are only one part of the chain. In this post we’re going to be moving downstream a bit to talk about the muscles that influence the spine and it’s stability.

The legs are built for stability and our shoulders are built for mobility.

I know what you’re thinking… isn’t this series about the shoulders!? It is! 🙂 Hear me out though. True trunk mobility/stability is what sets you up for good posture and healthy shoulders. Remember, the shoulder is the least stable joint in the body. That means it requires muscular support and control to set up the thoracic spine, rib cage and shoulder blade so that everything is in position before you even move that arm. Ever think about the impact of a change to your lumbar spine on all of that? My guess is no…

Here’s a visual:

deepfrontline

Think of everything in this picture as an anchor that can pull your lumbar spine and pelvis out of position. This area is smack in the middle of your upper and lower body. Problems here will not only impact what’s going on upstream in your shoulders, arms and neck, but it will also impact how your hips and legs function as well. Remember all of those “S” curves in the spine? They are there to balance your upper body on your lower body and to help hold you upright. When you start changing those curves, bad things happen.

Starting to see why this is important? Even if you aren’t stuck behind a desk or in the car for hours each day, you know you’re already bringing tired legs to the table as an endurance athlete. Keeping this middle section healthy and mobile is the key to success for us. That’s why I wanted to take a minute to go over some strategies for loosening up those hips and backs, before moving onto the rib cage and arm itself.

In the video you’ll find the following stretches:

  • Hip flexor (progression is 1/2 kneeling/lunge, 1/2 kneeling with side bend, standing lunge with foot twisted out, standing lunge with foot twisted in, standing lunge with foot up on chair/couch/etc).
  • Adductors (progression is side lunge, side lunge with elbow to push knee out). Be sure to get both sides.
  • From this side lunge position you can also switch to a front lunge to better target the front of the hip.
  • External rotators (start with something slightly taller than knee height and build in height; ** remember to stand up straight and don’t let your hips drop. press knee down!)
  • Just like all of our stretches: hold for 20 seconds and repeat for reps versus longer holds. Frequency will always give you faster results, not pushing into pain. 🙂

Scapulothoracic Joint: Muscles

In last week’s post we talked about what/where the Scapulothoracic (scapulocostal) Joint is and more specifically how it moves. The big take away should have been that the ST joint is where the shoulder blade slides over the rib cage. It has this function so that we can position the shoulder blade and stabilize it so that the arm has a strong foundation to move from. In this post we’re going to be digging into the muscles responsible for these movements.

Before we do that, however, let’s talk about the basic set up. By now you’ve heard me say “it’s all connected” a billion times so it should come as no surprise that I’m going to say it again here. When it comes to the shoulder blade, there are layers of muscles pulling it in every direction. In this post, we’re going to focus on the big four that help stabilize the scapula and provide the postural stability we need for the arm to function. In this regard, the arms are no different than the legs. The muscles are connected fascially and function in chains. If part of the chain is pulled out of position or restricted in it’s mobility/strength, it will impact the rest of the chain.

STstabilzers (1)

 

For the scapula stabilizers, an easy way to visualize them is as a big “x”. These muscles work in two pairs and provide scapular movement in opposite directions. Imbalances in these pairs will result in one muscle getting pulled out of position, impacting both muscles in the pair and their ability to function. The first pair is made up of the rhomboids and serratus anterior (green arrows). The second pair is made up of the pec minor and lower trap (purple arrows).

Muscle pair one:

#1 Rhomboids

rhombo2

  • The rhomboids lie between the spine and the shoulder blade. They originate along the spinous processes of vertebrae C7-T5 and attach to the medial border of the scapula (from the spine to the inferior angle).
  • Technically there are two rhomboids on each side (the minor and major). Together these muscles work to retract (adduct/pull the shoulder blade in towards the spine, elevate and rotate the scapula down).
  • The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#2 Serratus Anterior

serratus

  • The serratus anterior is 100% an overlooked muscle. Think armpit muscle! It starts on the underside of the shoulder blade and then wraps around the rib cage in a fan like shape attaching to the first nine ribs.
  • It is responsible for protracting the shoulder blade. It also helps with upward rotation, as well as, elevation and depression (the upper muscle fibers pull the scapula up and the lower muscle fibers pull it down).
  • Another fun fact about the serratus is that restrictions in this muscle can make it difficult to retract the shoulder blade and open up the chest for a deep breath. Ever had a “side stitch” while running? This is the culprit behind it.
  • The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

Muscle pair two:

#1: Lower Trapezius

lower-trap

 

  • The lower portion of the large trapezius muscle is part of the second stabilizing pair of muscles for the ST joint. You can see in the picture above just how big the Trapezius muscle is as a whole. The lower portion is what we’re focusing on here. These fibers attach from the spine of the scapula to the spinous processes of T4-T12.
  • The lower trap helps position the shoulder blade by pulling it down (depression), rotating it upwards, and pulling it in towards the spine (retraction/adduction).
  • The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

#2 Pectoralis Minor

pecminor

 

  • Remember all of the times your parents yelled at you to stop slouching? 🙂 The Pec Minor is one of the muscles you are stiffening up by doing so. While the larger Pec Major gets more press, this little muscle underneath it can cause A LOT of problems when it gets stuck in a short position.
  • The pec minor attaches to that little bony knob on the front of the scapula (the coracoid process), as well as, ribs 3-5. It’s responsible for pulling the scapula forward (abducting/protracting), rotating it down and depressing it. It also helps pull the ribs up to assist with breathing.
  • The video below will go over how to find/palpate this muscle, as well as, how to stretch it.

Video: How to find and stretch these muscles

Click here to return to part one: Intro to the ST joint

Click here to continue to part three (coming soon)

Build Leg Strength for Downhill Running

So many of the runners I work with initially identify one of the areas they want to improve as being running downhill, both from a technique stand-point and from the perspective of building strength in their legs to meet the demands of a hilly run course.
You may well be able to relate: running downhill can be really tough on particularly the knees and the quadricep muscles. Poor technique makes this worse – the most common mistake being slamming your heels into the ground ahead of you, with an extended knee to decelerate your momentum moving down the hill.
 The exercise described in the video above has two major benefits when it comes to running downhill. It helps to teach you the runner to land with a softly flexing knee, and helps to build eccentric strength in the quadricep muscles that control knee flexion.
 Give it a go. Let me know how you get on…
Best of luck with your running!

Scapulothoracic Joint: Part One

ST_joint

To kick off our shoulder series we’re going to be talking about the scapulothoracic joint (ST joint). Some of you may also know this joint as the scapulocostal joint. Either way, we are talking about where the shoulder blade (purple in the picture above) connects and moves over the underlying ribcage (red). The reason I want to start off our shoulder series here is that this piece of the puzzle is often overlooked by athletes. While it’s easy to focus on the shoulder joint as the source of your injury, the first part of the evaluation should always be to look at the shoulder blade and how it moves.

The reason for looking at the ST joint is simple: it’s sole purpose is to help position the shoulder blade so that the head of the humerus remains in full contact for maximum stability and efficiency. Let’s look at the picture below to show you what I mean:

glenoid

 

The groove in the scapula where the humerus attaches is called the glenoid fossa. It’s the purple part of the picture above (where the humerus has been removed). This groove is curved so that it is a ball and socket joint. The “ball” of the humerus (aka the humeral head) is then able to move in that groove, giving you all of the different movements you see at the shoulder.

The ST joint functions to position the glenoid for optimal contact between the humeral head and the scapula. It does this through muscles that are able to pull the shoulder blade in different directions. These directions include:

  • up (elevation)
  • down (depression)
  • in towards the spine (adduction/retraction)
  • out away from the spine (abduction/protraction)
  • upward rotation (meaning the most lateral tip rotates up)
  • downward rotation (meaning the most lateral tip rotates down)

Now these movements may not seem that important by themselves, but they are hugely important when you think about the impact they have on the shoulder joint itself (glenohumeral joint). If your shoulder blade gets stuck and becomes unable to move, the arm will be forced to pick up the slack. The real problem with this is that the glenoid we’ve been talking about will be out of position and the bigger stabilizing muslces will be unable to maintain full contact with the humeral head. This is the start of impingement syndromes! If that continues, the humeral head can start pinching and fraying rotator cuff tendons and the bursa. It can also cause increased bone to bone contact which is always good for creating bone spurs and can even tear the cartilage/labrum.

Bottom line: healthy, mobile joints have SPACE. Tight, unstable joints do not. So if you’re someone who’s been diagnosed with spurs or has a rotator cuff tear or just has pain anytime you work with your arms overhead, you should be working to restore that space!

Just like we did with the foot, we’re going to be working our way through the different layers of muscles. This means we’ll talk about how to evaluate these areas and what to do for them self treatment wise.

Continue to part two (coming soon)