I hope you’ve been doing your homework up to this point regarding practicing the content of the first two videos on how to re-position your shoulders in order to place in an “optimal loading zone” so that any impingements you may possess won’t be aggravated by the resistance that you’re using in your exercises or body enhancement program. In parts 1 and 2 we established a new recruitment pattern for your scapula to use (back and down position) in order for your shoulders to reposition themselves and relieve the stress on your rotator cuff tendons caused by a faulty posture dysfunction such as ” forward-rounded shoulders”.
If your homework has been successful and your case is really no more than a simple impingement caused by faulty posture, then correcting your “scapular dyskinesis” (faulty movement pattern and stability pattern) this work should’ve made a world of difference. You would’ve noticed right away that your shoulder pain would’ve decreased by 70 to 80% while lifting your arm overhead. And, likely any other movements when your arm was at the shoulder level. Perhaps you were so excited by this “pain-relieving phenomenon” that you decided to try this for a week or so before you decided to get serious and really apply your new “scapular set” and shoulder repositioning. Once you’ve been experiencing pain-free movement for what seems like a long time, perhaps you contemplated what it might be like to resume some of the old exercises that you were doing before the pain set in?
How did those push-ups turn out?? What about pressing those dumbbells over your head??? Were you wondering what would happen if you tried to do a supine bench press with either dumbbells or a bar??/ Hmm, as it turns out, this is the main subject of my post today! Here is what you need to be able to do before practicing exercises in this post today?
- Understand and demonstrate the concept and application of a “scapular set”.
- You have overcome any flexibility limitations that your front chain possessed (pecs and fascia) in order to free up your ability to direct your scapulae in the “back and down” position.
- You have worked through the main movement that has been repeatedly been causing you pain by using the scapular set. And you have been doing this for at least 1 to 2 weeks successfully.
- You feel you are ready to take on the next challenge for your shoulder and finally add some resistance or load to your movement patterns. That said, you are also prepared to use your new movement pattern to reposition your shoulder in order alleviate any of those old irritations or painful movements. You are currently nodding your head in the “yes” direction because you’ve been doing this for well over 2 to 3 weeks! Cool! Let’s work through these progressions with you!
The entire upper-body is involved in this posture! From the mid-back and up! Scapula are forward and rounded (or protracted and anteriorly-forwardly tilted) which automatically places the g-h joint in a very compromised position. Again, this compromise is trying to move your arm up and overhead along with certain movements or exercises. As discussed previously, the space under the acromion (part of the scapula bone) where the rotator-cuff tendons will likely brush-up against or traverse under will be further crowded or compromised. This will likely place many shoulders into a more severe impingement position (see image below) where it is just a matter of time before many repetitions have occurred until a painful arc occurs while lifting the arm overhead, executing a lift from the bench press, or pressing overhead that set of dumbbells. Some patients of mine have even complained while reaching up into their cupboard to retrieve their favourite coffee cup??
So, hopefully you have successfully navigated through the first few progressions that I presented in the first two video series. If you are now successfully raising your arm with the once painful-arc that existed before with a notable improvement in your pain, or impingement, then chances are you are on the right track, and the “scapular-set” is relieving the irritation that your rehabilitated “forward-rounded” shoulder was causing.
So in Part 3 here, in order to move forward with the progressions in this section, you need to at least successfully lift the weight of your arm and shoulder while using the scapular set and moving through the once “painful-arc, or “range of motion” now with out any pain, and without any weights or loads. Once this is the norm for you,(practicing for about a week or so) you can then start to introduce these newly calibrated movements to some resistance or loads. Obviously, the loads or resistance shouldn’t intimidate you or make you feel like you can’t maintain your scapular set. I will review three exercises that will cover different movements that will likely occur in your exercise regimes.
We will demonstrate the movements by illustrating the “unloaded set”, and then the “loaded set”, and perhaps a intermediate exercise that will help you get from the unloaded to the loaded exercise.
Unloaded Overhead reach/press:
- From the deep-W position, initiate your scapular-set.
- As you begin to elevate your arm(s), always have a sense of what your scapula is doing: Example: elevate your arms 2 inches, then adjust your scapular set accordingly to match the position of your gh joint.
- At the length of your overhead reach, focus on the “lock out”. Reach about one inch further towards the ceiling by shrugging your shoulder up towards your ears slightly.
- Continue these adjustments as you fully elevate your arms overhead. If you start to feel your old impingement, even slightly, then adjust your scapula to the “back and down” position, lower the arm below the pain threshold range of motion, then re-elevate the arm with a more pronounced scapular set, and see if this alleviates your pain. You may not have had positioned your scapular set enough to open up the joint space where the rotator cuff tendons traverse and likely get irritated. So, we’ll call this a reset, and allow you to refine your scapular set to really demonstrate that where you place your gh joint does matter to the quality of your pain-free movements.
- See the images below for this progression:
Loaded Overhead presses:
- Assume the same “deep-w” position as in the unloaded set.
- Choose a load that you are confident with and one that isn’t tool heavy that may confuse your movement strategies.
- For your first loaded set, elevate your arms in the “deep-w” position, with a scapular set. Choose a deliberately lighter weight then what you used to train with and practice with this weight for your first two or three overhead lifts.
- Once you have successfully completed 2 to 3 sessions with load for your overhead presses, then increase your weight another 5-7% of your current weight and practice the same scapular strategy and positioning.
- Again, it is also recommended that you perform your loaded overhead presses in front of a mirror so that you can see and receive immediate feedback as to how your positioning your upper back, and the dumbbells along with this.
- If you don’t feel any familiar irritations from the shoulder, then increase your loads for this lift 5 % every week or so, until you are comfortable with your performance and strength values.
Most people when executing a push-up are mainly concerned about ascending up from the bottom position. This phase of the exercise mainly focuses on the concentric phase of the lift, which is contracting the pecs, deltoids, triceps and abdominal muscles. This is your proverbial “pump” right??? Truth be told, perform enough of these pumps in a week with your gh and scapular in a forward- rounded position, and you could be exercising your way right into an impingement.
The key points to maintaining a scapular set while performing a push up are:
- Keep the top of shoulders level on the up and down phase of the movements. (no shoulder hiking up towards the ears)
- Pinch your shoulders blades in towards your spine before pushing up, and then do the same before lowering your body down.
- Maintain an active “chin-tuck” to reduce any strain to the base your skull and your sub-occipital region on your neck.
- Squeeze your glutes dramatically as if you were “crushing your underwear” within your gym shorts
Re-positioning your scapulae during the push-up has been shown to reduce the friction moments or irritations within the shoulder joints, and also reduce the compression force that is imposed on your rotator cuff tendons. (Mike Reihold- Optimal Shoulder Performance-Home DVD course- 2009)
The images below illustrate the scapular position in both the bottom , mid-way, and top positions in the push-up movement as well as including all the relevant points above..
If you feel like you are unable to control or stabilize your scapular set during any phase of the push-up, then it is recommended to decrease the load or effort you are using for the push-up, which is elevating your push-up/off point, this being the floor. Using something raised and sturdy like an portable exercise bench and risers is a marvelous adaptation and adjustment to the bodyweight’s load in the push-up movement. This weight shift will allow you to perform the push-up with more control and better alignment.