Structural Balance of Shoulders
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Transcript of Structural Balance of Shoulders
8/6/2019 Structural Balance of Shoulders
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ACHIEVING STRUCTURAL
BA L A NC E O F T H E SHOULDERS
RESEARCH
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SESSION SUMMARY
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RESEARCH
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RESEARCH AREAS
Scapula position/stability
Shoulder strength
Shoulder flexibility
Other notes
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SCAPULA POSITION/STABILITY
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The rotator cuff and biceps are active 0.092
0.215 s prior to the initiation of the actual
movement and 0.1120.034 s prior to onset of deltoid and pectoralis major activity when
performing shoulder rotations (David 2000)
The infraspinatus, subscapularis, and latissimus
dorsi act as stabilizers during flexion; thesubscapularis acts as a stabilizer during external
rotation and the supraspinatus during extension.
(Kronberg 1990)
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PROGRAM DESIGN
Exercise routines that emphasize the deltoidmusculature and neglect the rotator cuff may
create an imbalance of the deltoidrotator cuff force couple, leading to altered musclecoordination, restricted AROM, and impingementof the shoulder complex during arm elevation(Kolber 2009)
Increases in rotator cuff muscle forces tended toimprove stability whereas increases in deltoid orpectoralis major muscle forces tended to furtherdecrease stability (Labrioloa 2005)
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The mid and posterior heads of deltoid should be
strengthened vigorously in anterior shoulder
instability...., because they provide more stabilitygenerating higher compressive force and lower
shear force... (lee 2002)
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Scapula stability exercises and thoracic curve
correction should be done before rotator cuff
exercises (Kibler 1998)
Ideal scapula position yet to be determined but it
is not in its inner range of lower traps, and down
and back is not an appropriate command
(Mottram 1997)
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IMBALANCES
Overhead athletes with impingement symptoms
demonstrated strength deficits and muscular
imbalance in the scapular muscles comparedwith uninjured athletes. (Cools 2005)
Significant difference in awareness of scapula
position between dominant and non-dominant
shoulders. (Boyar 2007)
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SHOULDER STRENGTH
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PULL:PUSH RATIO
Rugby players bench press to pull ups 1:1(Baker 2004)
Kayak paddlers bench press to pull ups females
- 1:1.47, & males 1:1.29 (McKean 2009)
Normal population pull:push ratio using
dynamometer 1:1.12 (Peebles 2003)
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SHOULDER STRENGTH RATIOS
If use a key predictor exercise - 1RM Pull up = 100%(kayakers McKean 2009)
8 RM Shoulder press - Deltoid 18%
8 RM External rotation - External rotators 9%
8 RM Bent over trap 3 raise - Lower Traps 6%
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BASED ON KEY PREDICTOR
EXERCISE
Muscle GroupMark McKean
(JSAMS-2009)
Same scores
presented for new
Predictor Ex
Predictor Exercise 1 RM PU (close grip) 1 RM BP (close grip)
Deltoid - 8RM 1 arm
Shoulder press18 29
External Rotators
8RM Ext Rot onknee
9 13
Lower Trapezius
8RM Bent over trap
raise
6 12
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Suggested rotator cuff ratio of internal to
external strength is approx 1.3 to 1.6. (Codine
1997, Niederbracht 2008, Barlow 2002, Hughes1999)
Deltoid : External Rotators : Lower Traps
3 : 1.5 : 1 ratio of strength (McKean 2009)
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Flexion:extension 1.26-2.22 (depending on
angle isometric measure taken 30-60-90 degrees
flexed - Hughes 1999)
Abduction:adduction 1.53-2.63 (depending on
angle isometric measure taken 30-60-90 degrees
abducted - Hughes 1999)
Both ratios above increased to a higher ratio with
age. i.e. Both extension and adduction
movements became proportionally weaker
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OTHER RATIOSN O T A L L P U B L I S H E D
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BASED ON DIFFERENT
PREDICTOR EXERCISES
Muscle
Group
Charles
oliquinDan Baker
Mark
McKean(JSAMS-2009)
Mark
McKean2010
Key PredictorExercise
1 RM BP(close grip)
1 RM BP(self selected
grip)
1 RM PU(close grip)
1 RM PU(close grip)
Deltoid - 8RM 1
arm Shoulder
press30% 17.5% 18% 21%
External
Rotators 8RMExt Rot on knee 9% - 9% 10%
Lower Trapezius
8RM Bent
over trap raise8% - 6% 8%
Triceps 8RM
Lying Tricep
extensions
40% 40% - 33%
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STRENGTH SUMMARY
A few key issues to remember
Upper body structural balance not solely basedon numbers but also posture and movement
Aim to achieve a steady and progressive change
in loads across all lifts
Every sport has a different ratio outcome but tryand keep Traps and Rotators relatively strong for
improved shoulder stability
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SHOULDER FLEXIBILITY
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RANGES OF MOVEMENT
ABOUT THE SHOULDER
Population IR ER Year Author
Tennis 440 890 2004Schmidt-
Wiethoff
Baseball 400 1030 2000 Donatelli
Kayak 430 880 2009 McKean
Normal 610 850 2004Schmidt-
Wiethoff
Ideal 700 900 2005 Kendall
Based on position of assessment done at
900 abduction
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OTHER NOTES
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Push pull movements/stabilising showed postural
adjustments were initiated shortly before all focal
movements (Cordo 1990)
Isometric strength was significantly lower for the Scapula
Protracted position compared with the Scapula Neutral
position and Scapula retracted position (Smith 2002)
By increasing the eccentric external total exercisecapacity without a subsequent increase in the concentric
internal total exercise capacity, it potentially decreases
shoulder rotator muscle imbalances and the risk for
shoulder injuries (Niederbracht 2008)
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Bodybuilders showed an overall loss of shoulder
rotation ROM (1660 vs. 1880) and a significantly
decreased internal rotation ROM (-110)compared with the control group, and were
significantly weaker in lower trapezius strength
when expressed as a percentage of body weight.
(Barlow 2002)
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CHANGES IN SHOULDER POSTURE
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2007
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2010
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2008
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2009
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KE Y I SS UE S F OR PROGR AM D ES IG N
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POSTURE
Ensure thoracic curve close to ideal before youaddress shoulder related strength problems
Must reinforce correct thoracic curve at all timesfor all upper body exercises
Need to negate the associated and exaggeratedmovement of thoracic hyperextension when
pulling
Check ROM for select postures e.g. Does ROM atshoulder allow them to press vertically if thoracicposture is increased
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PATTERN
Control/ROM must occur before strength
Practice makes permanent not always perfect
Simplify pattern until it can be controlled and
perfected
Poor movement patterns are the main cause of
most muscle balance related issues i.e. Tryingto go too heavy, too quickly, too dynamic, too
early before good patterns established
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PROPRIOCEPTION
Teach client to feel the exercise, the
movement, the stress, and the response of the
body
Unstable surface training is often applied too
quickly before client can feel a posture or
pattern.
Once complicated by increased proprioceptive
demand, a client loses control of the pattern
and is unable to develop proper force output
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PUSHING EXERCISE
PROGRESSIONS
Chest press pw
Chest press pl
BB chest press
DB chest press Change grip
Change angle
Change angle
Use 1 armChange grip
Change grip/line
Use 1 arm
Change grip
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SAMPLE PROGRESSION
Chest ress i eight
Chest ress late l a e horizontal gri
Seate chest ress in eight
Chest ress late loa e vertical gri
Chest ress late loa e alternate sh
BB chest ress close gri
BB incline chest ress
BBin
clin
e ch
est ress igri high ar
B chest ress ne tralgri
B incline chest ress ho
rizon
tal gri
B chest ress alternatear s
B chest ress 1 ar
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PULLING EXERCISE
PROGRESSIONS
Lat pulldown RG
Lat pulldown CG
Assisted pull ups
Pull ups Change angle
Single arm DB row
BB row
Change support
Seated row Use 1 arm
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SAMPLE PROGRESSION
Lat pulldown RG
Lat pulldown CG
Lat pulldown sup grip
Assisted chin ups rg
Assisted chin ups sup grip
Pullups eccentrics
Pull ups - RG
Seated row cg
Seated row neutral grip
DB prone row
Seated row 1 arm
1 arm DB row kneeling
1 arm DB row standing
bent over
BB standing bent over
row cg, low bar
BB standing bent over
row rg/mg, mid bar
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STABILITY EXERCISE
PROGRESSIONS
Thoracic posture
Scapula rhythm
Scapula - humerus
ROM control deltoids
Shoulder rotation
Stability-mobility
Int/ext rotators
Scapula setting Traps/subscap/serratus
Initial Strength ex Partial to fullPush-pull
Normal exercises
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SAMPLE PROGRESSION
Straight arm wall sags and press
Wall/floor angles up and down
Bent over trap 3 raise
Shoulder rotations scap controlled limited ROM
Side arm scaption raises - partial to match control
Single arm DB scaption press - partials to match ROM control
Chest press/lat pulldown/seated row partials to match
ROM control
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PROGRAM MANAGEMENT
Develop awareness of posture and ROM client
can control
Assess ROM, strength ratios either via real
testing or subjective assessment depending on
stage of client
Progress clients according to ability and regress
when required
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SUGGESTED PROGRESSIONS
0 - 6 months
8-15 reps
2-4 sets
Up to 70% efforts
Slower tempos to develop
control eg 4020
Aim for control of shoulder
movements and stability as
a priority
6-18 months
6-15 reps
3-5 sets
Up to 90% efforts
Tempos can range up to
2010 still keeping slowereccentric
Aim for proper strength
ratios and good ROM
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PROGRAM SAMPLES
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Ex No Exercise Tips Tempo Warm ups Work sets
DAY 1 R L R L R L R L R L R L R L R L Rest
Dynamic Stability
A1 Chest press Close grip 3020 6 12 12 12 60
A2 Bent over raises Seated bent over 2020 6 8 8 8 60
B1 Split Squats DB 2020 6 8 8 8 60
B2 Single leg DB deadlift Balance ± DB to floor 2020 6 8 8 8 60
C1 Tricep pressdown Cable 3020 12 12 12 60
Core Work
DAY 2
Dynamic Stability
A1 Lat Pulldowns Close grip front 3020 6 12 12 12 60
A2 DB shoulder press 1 arm - Standing 3020 6 8 8 8 60
B1 DB lunge and reach 1 DB to opposite side 2020 4 8 8 8 60
B2 Reverse hyperextension Hold under bench 2020 4 8 8 8 60
C1 DB curls Seated 3020 12 12 12 60
Core Work
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Ex No Exercise Tips Tempo Warm ups Work sets Rest
cycleDAY 1 R L R L R L R L R L R L R L R L
A1 Pull Ups Close grip 4010 4 4 4 4 4 90
A2 DB Shoulder press 1 arm, no back support 3010 2 8 8 8 60
B1 Hang Deadlift To knees slow 4020 4 6 6 6 6 90
B2 Reverse Hyperextension Bent over bench 3020 6 8 8 8 8 60
C1 External shoulder rot Rest elbow knee 10 sec 2 2 2 2 60
DAY 2
A1Bench press
Close grip, feet down 30104 6 6 6 6
90
A2 Seated row Elbow - shoulder level 4020 4 6 6 6 6 90
B1 Lunge and reach DB to forward toes 2020 6 6 6 6 6 90
B2 DB good morning Standing ± 1 leg 3010 4 6 6 6 6 60
C1 Bent over trap 3 raise standing 4020 4 8 8 8 8 60
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Sit with good trunk posture and rotateunder resistance from chord. 2 x 15 ea
side, heaviest tension possible
Lift legs up behind you tillstraight 2 x 12-20. Start with 1
leg and then progress to 2
Bridge and lift ± hold 4-6 x eachleg for 6-10 sec. Start with no lift
and progress to lift and hold
Seated leg lift ± lift leg off floor keeping back arched and hold 10
x 10 sec. Each leg
Peterson step ups let leg move forwardand down so back foot moves onto toesand then push heel down to step back
and up. 2 x 12-15
Single leg half squats againstwall ± lower to 1/3 or ½ way
down and hold 2-5 sec and push back up
Lower legs slowly to the floor oneat a time and lie over rolled towel.
2 x 12 ea
Stand on 1 leg with eyes closedand swing other leg around and
out to different directions etc andtry and maintain balance 30 sec
each 2 x
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Ex No Exercise Tips Tempo Warm ups Work sets
DAY 1 R L R L R L R L R L R L R L R L Rest
A1 Bench press Close grip 2010 6 8 8 6 6 90
A2 Lat pulldowns 2010 6 8 8 6 6 90
B1 Squats Partials 3010 6 8 8 8 8 8 90
C1 Bent over raise barbell 2010 6 12 12 8 8 60
C2 Alternate DB curls standing 3010 4 8 8 8 8 60
DAY 2
A1 Seated DB shoulder press Neutral grip 2010 6 8 8 6 6 90
A2 Seated Row Neutral grip 2010 6 8 8 6 6 90
B1 Hang deadlifts BB to knees 3010 6 8 8 8 8 8 90
C1 Tricep cable pressdowns Use rope grip on cables 3010 6 8 8 8 8 60
D1 High to low cable rotation Swap sides each rep 1010 4 12 12 8 8 60
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Shrugs bent over ±6 x 10 sec Bent over trap 3 raise ± 15 x High cable pull ± 50 x
Shoulder rotations ± 30 x Single arm press with rotation ± 30 x Roll one leg over and hold 2-3 min
Suck and tuck hip and lean over 30s Lie over front leg and knee 30 s Lower chest towards floor 45 s
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MARK MCKEAN PHD
Post Doctoral Research FelloAustralian Institute of Fitness Research
University of Sunshine Coast
[email protected] u.au