Tracy Fober http://ironmaven.blogspot.com wrote the following “the rehab bias against overhead movements and reduction of movements to only targeted rotator cuff stuff and scapular work that never allows the arm to elevate above 90-120. This is in spite of the fact that they want people to have "full ROM" and that in the real world, athletes fully flex and abduct and do combos of this all the time. “ Tracy this is something I have fought against for years. It is based on flawed research that just looked at the shoulder scapula relationship and failed to take into account the whole kinetic chain. I focus on the shoulder hip relationship that, is what is most important. Also impingement is not an overhead problem, to quote Gary Gray, “it is a getting to overhead problem.” Therefore we need to focus on how they get over head. Usually it related to weakness and lack of awareness in the trunk and tightness in the hips. There is no pain when the arm is overhead and no pain when the arm is at the side. The pain occurs just as the hand is raised past the shoulder. This should give us a huge clue that focusing on the rotator cuff is not the answer. Look at the mechanics of getting overhead, Stretch the lats and the pecs, not the shoulder. As far as exercises incline pull ups and push-ups, ring pull-ups and push-ups, front pull downs and crawling are the way to go. Some people eliminate bench press for the overhead athlete, I think straight bar bench press should be eliminated. Dumbbell bench is OK, but not a major focus. As an aside this is the third year I have worked with University of Michigan Women’s swimming and they have virtually eliminated shoulder problems. A big reason is that they have stopped working on the shoulder and focused on the linkage of the hip to shoulder. High volume of reps on the rings and med ball core is the answer.
2 Comments:
If you study biomechanics it becomes obvious the rotator cuff musculature works as force couples, designed to be a sort of "steering mechanism" for the humeral head. Training them to be primary movers is training them for another function.
All the focus on the scapula has given us clues into how the shoulder actually works.
Orthopedist Ben Kibler describes the scapula as a funnel that transmits forces from the rest of the body through the shoulder & hand. But, he cautions that sending the wrong info. into the funnel may cause what he refers to as "SICK" scapula syndrome.
If you have anything to do with shoulder rehab., you would be doing a disservice to your athletes if you did not study Kibler.
I love your idea of pull ups on the rings. It leaves the wrists, elbows, and shoulder free to rotate and lets the body find it's own comfortable position. Unfortunately, they've been removed from most high school gyms.
Why do you have to go back so far into the past to get great functional research? Case in point:
Hanavan, EP (1964). A mathematical model of the human body. , AD-608-463. Aerospace Medical Research Laboratories, Wright-Patterson Air Force Base.
Hanavan describes how work in the upper extremity segments can be transmitted to the trunk & spine via a large musculoskeletal surface.
In 1976, Jorgensen in BIOMECHANICS says that joint velocities above 1146 degrees per second are beyond the contractile velocity range of human skeletal muscle.
Understand the throwing shoulder's internal rotation velocities often reach 7000 deg. per second whenever you are considering the rotator cuff's function.
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