10 Most Common Problems: Rotator Cuff issue

                                                                Rotator Cuff Issues

The Rotator Cuff is a group of muscles and tendon tie-ins that are crucial for the proper functioning of the shoulder joint. These muscles sit around the scapula and shoulder joint. The muscles can be remembered by the acronym SITS. Supraspinatus, Infraspinatus, teres major/teres minor and subscapularis.  (see fig.)  Collectively, these muscles form a web of stability and are individually responsible for all the motions of the shoulder, our most mobile joint. The figure does not show the subscapularis which is the only rotator muscle located on the interior of the shoulder blade. It is responsible for internal rotation and adduction.  It is activated in the gym with exercises such as cable crossover and bench.  Not what I would classify as an underutilized muscle in the gym.

           

Dysfunction of the glenohumeral joint and more specifically the cavity separating the humerus (upper arm bone) and the scapula (shoulder blade) is the area that I will concentrate on in this article.  The most common problem I see is impingement of the shoulder joint causing inflammation or injury to the bursa and supraspinatus muscle. This is commonly an overuse injury caused by poor posture, muscular imbalances, general muscular weakness and over compensation of larger muscles of the anterior delt, pecs, upper back and cervical to thoracic spine area.

Other shoulder problems usually are a result of an injury that someone can point to as the cause of their acute pain. Impingement syndrome is usually a chronic problem that last months or even more than a year. It does not go away with rest. It must be corrected through clinical exercises and treatment plans.

By the time I see clients at TopShape Fitness Studio with shoulder issues, they can be quite severe. Clients have usually already been to physio more than once and have even had cortisone shots.  They may even have “Frozen Shoulder” (inability to move shoulder through any significant range of motion) and are in severe discomfort, dysfunction and stress.

Here is the good news. It can be fixed. In fact, a significant result can be shown within 2 weeks and full recovery in as little as 6 weeks. If you follow the plan!

Rotator Rehab Mistakes:

1. Common mistakes made by sufferers of rotator cuff, sprains, tears, tendonitis or bursitis make are to rest and wait for symptoms to subside.  Unfortunately when clients go to their family GP and complain that it hurts to do a certain movement, the doctor may advise not to move it. If you don’t move your shoulder through its proper range of motion you will lose that range of motion. Range of motion (ROM) rehab exercises are critical. The following videos show common range of motion warm-ups.

Here are some acute phase rehab exercises:

 (pendulum warmups)

 (warmup stick stretches)

2. Icing will stop the healing process momentarily. It feels good and it may help dull the pain but does not help in healing in any way. In fact, by stopping the inflammation process you are stopping the constant supply of blood that carries inflammatory cells to the injured area. This is critical in the healing process. You are also stopping the production of growth hormone and interrupting the lymphatic drainage process. The 1 way system that flushes swelling from the affected area. This is counterproductive. Please refer to our blog article on Icing for more information. At TopShape we haven’t used ice in rehabbing our athletes or regular clients since 2008. Since that time I have noticed a significant improvement in recoveries of various injuries.

3. Another mistake is to take non-steroid anti-inflammatory, NSAIDs, like advil. NSAIDs not only interfere with the essential process of inflammation, it interferes with the neurological training adaptation that needs to happen when healing during clinical exercise rehab.

4. Lift through it. Muscular imbalance plays a large roll.  An over dominance of anterior musculature, such as pecs and anterior delts and the lack of flexibility in these groups helped lead to the injury. To continue these movements in improper form is insanity. Many lifters even demonstrate incorrect form in their pull-ups, recruiting the pecs rather than the proper scapular movement. This is a main contributor to why women have such a difficult time with pull-ups. Not strength, but function.

So what’s the plan? First get a proper diagnosis. Here at the studio I do an injury movement test to confirm a doctor’s or physio’s diagnosis. Having a defined diagnosis, speeds up and helps me define an individualized treatment plan for the exact injury. This means you don’t have to do a lengthy generalized program.

After the warm-up exercises like the ones above, we perform scapular stabilization exercises.

 Here are some exercises for the more chronic and dysfunction correction warm-ups

 (scapular retraction) and 

(lying dynaband extension)

Lastly some favorite posture correcting exercises. These are general correction exercises for the majority of dysfunction I see.  If you are a regular weight lifter than some shoulder accessory work is needed in your program. Add some of these to help balance anterior and posterior chain exercise

(rotator strengthening)

(scaptions)

(overhead scapular retractions)

 Try this program if you are suffering from shoulder dysfunction. It has helped me build functionally strong shoulders after years of dysfunction.

Mike Hayden

Yes Girls Can Do Pullups!

  My experience with thousands of clients over 20 years have taught me that there is really only 1 way to teach women to do proper pull-ups. The gravitron or other unweighting machines don't work. Using bands don't work. The only 2 things that work are, doing pullups and using exercises to strengthen the contributing muscles. Your traps, lats, rhomboids, serratus, rotators, biceps, delts and core have to be supper strong.

Follow this progression, adding these movements to your regular program and you will be well on your way to using your upper body to overcome your body weight.

The quest for the perfect female pull-up.
 Phase 1: passive hanging holds, allow proper activation of thoracic spin as well as much needed flexibility in this area. 4 weeks

Phase 2: Active hanging scapular retractions.  This is where you really get to strengthen and activate rotator cuff muscles as well as traps and rhomboids. 4 weeks

Phase 3: chin-up holds. Here is where you really get to test muscular endurance as well as build strength in the biceps, shoulder and core. You guessed it, 4 weeks.

Give this progression a try and up the weight on associated muscle groups during your regular training.  Please follow our blog and subscribe to our YouTube channel to help us out.
Thanks

Mike Hayden
topshape.ca

Functional Knee Strength for Runners

Basic points in this article:

• ·         It’s not the shoes, it’s you.
• ·         Over %85 of runners will get injured. How to prevent it.
• ·         Are you wogging?
• ·         Running culture bases its beliefs on non-scientific principles.
• ·         Strict vegan diets are dangerous for younger higher calorie burners.
• ·         Train like an anti-runner.
• ·         Lift! Heavy and often
• ·         Mobilization for common knee problems.

  I just finished my annual Ottawa Race Weekend 10K this past weekend.  Each year I get a little bit more disillusioned with the running world. There is more training information out there than ever before. Shoes and clothing technology, as well as electronic gear for runners of all sorts. So why are there still so many horribly unfit runners out there?

  Of course I know the answer and I’ll share it with you.  Instead of getting real technical with the bio-mechanics of running, I think part of the blame falls to running culture. Each year at the trade show booths at run weekend I see the same theme. When I walked in the past few years I am bombarded with ads and displays for circuit conditioning classes, yoga for runners, compression everything and vegan food and supplements of every type imaginable. It dawned on me that in almost every sport I can think of, training science is moving its athletes forward. Some took a long time to get going but it is generally happening. Running culture is moving backwards.

  I think many people run for the enjoyment it brings. However there are many who are running for the wrong reasons. They run for the hope of fat loss. They run to fight the process of aging. They run to stay strong. They run for their health. If you are running for any of these reasons other than enjoyment then you are making a mistake.  Read any article by the worlds most renowned anti-aging doctors and you will find if you want to age yourself fastest, follow a vegan diet and run long distances. If you are running for your health, then let’s do it the right way.

  During my 10k run and watching some of the other races on the weekend, I witnessed a lot of people that did not look like they were enjoying themselves. I saw knee and hip alignments that looked as if they would collapse at any moment.  I saw people that didn’t seem to have any core strength at all. I saw people with an imbalance in musculature and overly tight joints with limited mobility. I saw people who did not have their heart rates under any type of control and looked to the point of exhaustion.  Something has got to change.

If you want to run, then train your body to be an anti-runner. By this, I mean do the training off the road that will keep you on the road and keep your tissue and joint health optimal.  Especially for those 35 and older.

  You need to strength train. Not cardio condition or yoga strength or body pump or circuit classes with light weights or even running on a treadmill in the water. Really strength train to build real muscle mass and burn real fat. Many runners fall into that "skinny fat" category. They have very poor structural posture, poor muscle tone and high body fat percentages.  Resistance training at least 3 X per week with a minimum 60% of your 1 RM will force your body to adapt to build muscle and strengthen connective tissues. What am I talking about?  See a professional at TopShape Fitness or follow my blog and Facebook.

For now here are some great exercises for glute strength. Try these 2x per week  Glute and core strength are essential for a strong running posture.

https://www.youtube.com/watch?v=fLbJ9RJqrYo

  You need to perform deep tissue work and range of motion work for structural imbalances and poor flexibility in the hip, back, knee and ankle joints. Your problem is you are WEAK.

Using barefoot shoes, minimalist shoes, support soles, rockers and compression socks is not your issue. Shoe technology and athletic wear has come a long way since 1981. What has also come a long way is the increase in running injuries. Over 85% of runners will suffer from a joint or connective tissue injury.  With so much information, why? It is because most North American’s WOG. They walk jog. It’s the same comparison I make to my clients all the time. Put a picture of a sprinter and a marathoner beside each other and find me the person who wants to look like the marathoner.  It is all bio-mechanics. Stop jogging and learn to sprint slower.

   Shorten the stride and up cadence. Studies have shown that cadences of 85-90 steps/minute can reduce injury. See the photos left.  Notice the runner on the left with the longer stride length. Her heel strikes the ground first way in front of her body. This stops her momentum dead and reverses that kinetic energy right back towards the knee. She has to expend a lot of energy to overcome and push forward on each step. This repetitive joint pounding will eventually lead to dysfunction.

Courtesy Skye Pellerin 2016

Notice our young runner on the right. Kids are my favorite because they haven’t been taught to run improperly. They run naturally in a sprinters form… correctly. She will spend more time in the air and less on the ground. Her foot strikes in line with the body or even slightly behind as her body lean will be forward at the moment of strike. She strikes the ground with the ball of the foot not her heel. Her energy is pushed out the back with her high heel kick and is returned through her hip hinging motion allowing the knee to return in front high so that her foot can strike under her again. Stop WOGGING, jogging, almost walking. You spend too much time on the hard surfaces in a poor posture. Run like you did as a kid.

Constantly  focus on joint mobilization. Don’t just get out and start running. Perform dynamic range of motion exercises before each run.  See my link to my you tube channel here.

  Mobilize your IT band after runs. The IT band commonly collects and strains the outside of the knee and puts pressure on the lateral tendon. This forces the knee to strike the ground in a dysfunctional pattern. It is one of the leading causes to runners becoming injured. Other problems follow soon after. Foam rolling followed by static stretching after a run will make your knees and hips bullet proof.

  

 “I also now consider strict vegan diets to be potentially deficient for teenagers who burn a lot of calories each day and whose growing bones and bodies still require a full spectrum of nutrients. This may be true for adults, as well, if they follow a vegan diet strictly for a year or two or more.”  Chet Day

  Lastly, it would take too long to get into why vegan diets are not healthier. I respect people who eat this way for ethical reasons. My closest run partner is vegan and I have many vegan clients. Simply, if your goal is to get stronger and leaner and maintain an optimal body fat percentage, then eating a complete protein source as well as eating enough saturated fat is essential. Vegan protein is not a complete protein source.

Dr. Donaldson includes a list of all major sources of B12 in a vegan diet and observes, "We see then that dietary vegan sources of vitamin B12 are very sparse since plant foods do not contain vitamin B12 in appreciable amounts." He concludes that all vegans must take a B12 supplement.

Or eat eggs. 

Thank-you, that is all.

Mike Hayden

topshape.ca