A Guide to Shoulder Pain-Part 2

The corrective route vs the MWOD route

Everyone knows that I am a huge fan of both Kelly Starrett and Mike Robertson. I have been lucky enough to be able to work with both of them and I would say that they have each had huge influences on 90% of what I do every single day in the gym. I believe that their opposing viewpoints put anyone who is a big follower and believer of both in the minority.

I always drive the point home that the key to being able to fix your own as well as others, problems is to be able to understand the system as a whole and to be able to see how all of these really smart guys different ways of addressing the system can be utilized together.

I don’t think that anyone would argue the fact that pressing, bench pressing, pullups, and rowing variations are going to make you stronger and improve your performance more than half kneeling bottoms up presses. I think that it is easy to get caught up in the “corrective” exercise loop and forget that the ultimate goal is performance. You must always ensure that you are achieving a training effect.

On the flip side, I have seen numerous times people getting too caught up in MWOD and forgetting that it is not the only thing that you should be doing to prepare your body. I have even had to bring it up to my own coaches here after seeing some of our classes start to drift to that direction. How many people walk into the gym MWOD their shoulders, and then start warming up their press? If you have some real imbalances going on, this could be the recipe for a problem. Also, we will see some people who are stretching and stretching things that are already over stretched and weak. This may not cause an injury, but is almost certainly an exercise in futility.

That only points out the negative side of either of the two????

I don’t think so. I think that by pointing out the way that you could do either one wrong, you invariably point out the fact that you should be using the “opposing views” together.

If you mobilize something, you need to make sure that it is working the way that it is supposed to before you go and start throwing heavy loads on it. Think if it this way. If you use a MWOD and then gain more range of motion that you have ever had, how stable in that position can you possibly be?? We know that stability has much more to do with timing than the concentric strength of a muscle. How effective are the muscles of the cuff going to be at creating stability in a position that they have never been able to achieve before? How can the timing possibly be on point? Or… if your shitty breathing is causing you to go into a big anterior tilt with your shoulders and causing impingement when you go overhead, is just stretching going to fix that problem? or are you going to be able to achieve the position for a little while but eventually break down and revert back to the same thing that you were doing before.

If you are not currently in pain then I want to try to address all your problems and perfect your movement in the warm-up. I want to make sure and keep the focus on enhanced performance and not try to treat everyone who walks through the door like they are a patient. The game changes a bit if you are already in pain. Then you need to take out anything that is causing your pain and take a step back to improve movement in order for you to return to intense training with the capacity to make improvements. Unless you have a competition coming up, or are already in a competition, it is not going to kill you to not bench press for a couple weeks. Like I mentioned before, I took all overhead movements out of my main program for a month or two, focused on improving my movement quality, and hit a PR on press the very next time that I did a heavy one.

Warm-up Ideas

Here is a general protocol of what I would want to do with somebody who is not in pain, but like most everyone, has improvements on movement quality that need to be made, either to prevent an injury or to improve their current performance.

Monostructural movements– This is usually what we start our classes with, and pretty standard for anybody who walks through the door. It is pretty simple, just move around and get some blood flowing. Not really ground breaking.

SMR– Here is the first place that you get to stick the latest mwod into your routine and the first place where it is important to understand how to individualize your warm-ups to maximize effectiveness. As a general rule, if it is especially tender to the touch, smash it up. One important consideration here is that sometimes a muscle that is overstretched and weak will also feel tender to the touch. I haven’t really seen a definitive problem with rolling too much or rolling/smashing/flossing something that doesn’t need it other than the occasional internet article that says to “STOP FOAM ROLLING NOW” It seems to me that most wolf cries are either trying to get some attention or trying to sell a brand. Like Kellie says, find the point of restriction and then start looking both up and downstream.

Active– If you were really getting nasty with your SMR work then you should, at this point, already have a decent sweat going. Here we want to use big multi joint movements to continue to warm-up the major muscles we are about to start stretching and cranking on as well as slowly start increasing the demands on the CNS for muscular coordination (inter/intra) . Simple things like pushups, t pushups, pullups, body rows, air squats. Whatever. Doesn’t really matter that much. This part of the warm-up doesn’t really need to vary a whole lot for a group of people who aren’t in pain.

Dynamic- The first place that we want to stick some dynamic movement into the warm-up is before we get into our stretching/lengthening work. Simple things like arm circles, leg swings, but kicks, high knees, med ball throws (depending on how you are using them) etc. The point here is to continue to warm the muscle as well as provide a lower intensity stretch before you get into the serious lengthening stuff. The biggest problem I see people making here is the fact that they aimlessly swing their arms and legs around and pay no attention to ensuring that they are maintaining good positions. If you are doing arm circles and you are arching the shit out of your back then you are taking the stretch that we are trying to get in the shoulder away and cheating to achieve the ROM out of your low back.

Joint Mobility/Lengthening– this is the portion of the warmup that, in order to be efficient and effective, must be individualized. In the last post I talked about the common problems that I saw in our gym, or in videos that people send to me. This is where you have to look to correct your specific problems. If your t spine is overly kyphotic or is just immobile then you should spend your time working on that. If your problem is a lack of internal rotation in your shoulders then you need to spend this time fixing that. One point that I like to make about this is that you should start axial to peripheral. Meaning that if your tspine is the real problem, then spend most of your time focusing on what you need to do to fix that before you start spending much time worrying with your trap/1st rib problem or your internal rotation. You should fix one before you worry too much about the other. You can’t prevent the earthquake 100 miles from the epicenter…. actually, I guess you can’t prevent earthquakes, but you know what I mean.

Activation– now is when I want to stick in some more of what would be the corrective type stuff. We have just gained all this ROM and now we want to make sure that our bodies know how to use it properly. Sometimes I think that people can over think and complicate the whole idea of these “corrective” movements. (I use the term corrective loosely. If you are doing any lift/movement correctly then they should all be corrective) Also, this is a place where you must be very individualized on what you are doing. We can make some generalizations, but for the most part it is about examining your lifts and finding what isn’t working the way that is is supposed to. This is where you can address those weaknesses. One important note on this is that we are activating the muscle, not fatiguing it. You shouldn’t be doing 5 sets of 10 band pull aparts or anything crazy like that. Focus on the movement, do it a few times and ensure that you aren’t compensating to achieve it, placing the emphasis on the muscle or muscles that are supposed to be doing the work. Once they are working, that movement did it’s job.

I like to classify these activation exercises in two categories. The first includes that band pull aparts and things like that, the second is more to establish the timing and rhythm in smaller muscle groups that allow you to complete bigger more complex movements correctly, and since we know that timing is the key to proper stabilization we can see the importance of these movements. This category could include the PNF movements along with a ton of other dynamic stability movements/drills aimed at creating “glenohumeral congruency” (stole that term from Eric Cressey, sounds legit). Since this article is getting so long and Waylon is always bitching at me about keeping things brief, I am not gonna get to in detail with this stuff right now.

Sometimes, when I am reading Eric Cressey I feel like he is playing horse with exercises… Maybe that is just because he is smarter than me, but he is probably smarter than alot of you as well. I feel like there is a pretty simple progression that we can move through with this stuff that will get you into the correct positions quickly, without your head exploding.

Shoulders have a huge range of movements, but for this purpose I want to simply classify things as either push/pull or vertical/horizontal. That gives us 4 types of movements. I am going to focus on the vertical, because that is typically what gives people the most problems

Quadruped vertical pulls

Half kneeling horizontal pulls

Half kneeling vertical pulls

Tall kneeling horizontal pulls

Tall kneeling vertical pulls

Standing horizontal pulls

Standing vertical pulls

Neutral grip pullups

Pullups

The idea would be to place yourself, or your athlete/client in the first position. Assess weather or not they have good thoracic extension, good upward rotation of the scapulae, able to maintain an externally rotated shoulder while in full shoulder extension. Basically, just see if they are doing it right… then progress through each of the movements. When you find the one that causes you to start screwing up, go back to the one before that and add it in for a couple of days/weeks, then start back through the progressions.

Since this seems to be quickly becoming a 47 part series I will stop there for the day and pick back up with some more shoulder thoughts with a part three soon.

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