Save Our Shoulders S.O.S.

- Dr. Matthew DiLallo DC, MA, CSCS

The “shoulder joint" is often used to refer to the glenohumeral joint which is the articulation between the humerus (upper arm) and glenoid fossa (cavity) of the scapula. The shoulder is designed for maximum mobility to allow the broad spectrum of upper body movements to occur. Unfortunately, this mobility comes at the expense of stability. In fact, the shoulder is often compared to a golf ball resting on a tee, as the surface area of the humeral head is three to four times that of the glenoid cavity. Besides the shallow depth of the cavity, glenohumeral instability may also emerge due to laxity in the supporting ligaments and weaknesses in the surrounding musculature. With such a high potential for instability, it's easy to see how the bones and soft tissues of the shoulder region are some of the most often injured parts of the body.

Assessing "True" Range of Motion

We need proximal stability to have distal mobility. This means that we need stability through the trunk to make full use of the range of motion available in joints such as the hips and shoulders. A reflexive core that activates at the correct time and with the appropriate intensity is the prerequisite to having arms and legs that function well. It doesn’t matter how much force you can generate with your extremities if your trunk is not in the position to oppose and transmit that force. It also doesn’t matter how rigid you can make your core if the intensity of the contraction is not appropriate or is not timed properly, based on the specific movement being performed. This simple self-assessment is a great way to see if you are able to express true full range of motion in the shoulder.


Trunk Activation and Breathing

How do we make sure we can engage and coordinate the proper activation of the core musculature? The answer is through breathing. Breathing is one of the very first things we do when we enter this world and one of the last things we do before we leave, hence one could argue that breathing correctly is one of the most vital things to our health and wellbeing. Believe it or not most of us are breathing incorrectly. Below, Dr. DiLallo discusses the importance of breathing and demonstrates one of our favorite drills we use to reinforce proper breathing and bracing mechanics.

Increasing the Difficulty

After we understand how to properly engage the abdomen we can then start to challenge our ability to hold that neutral rib cage to pelvis relationship in a variety of ways. One of the most-simple yet effective ways is to simply start to raise the arms up overhead like we saw in the previous video. We can make this even more challenging by starting to add a little load to the equation as seen below. This can be an effective regression for an individual that struggles to maintain proper positioning during overhead movements. The heavier the implement in one's hands the more difficult the movement becomes. Key points: 1) keep rib cage tucked 2) maintain neutral spine 3) keep pressure with the feet in the wall to help drive lumbopelvic stabilization 4) as we lower the implement overhead continue to “reach” through the hands.

Tall Kneeling and Half Kneeling Positions

Two of our favorite ways to work on the coordination and development of the trunk musculature is via the half kneeling and tall kneeling positions. The half-kneeling position loads one hip in a flexed position while the other stays relatively neutral. For a move that is deceivingly simple to the eye, true mastery of this position yields huge benefits in performance and long term health of the spine, hips and lower body in general. Below is one of the many ways we can utilize the half kneeling position while working on shoulder stability and motor control.

The tall kneeling position challenges hip extension and tends to translate better to bilateral movements like squatting, deadlifting, etc. Below we have Dr. DiLallo demonstrating the Tall Kneeling Anti-Extension exercise. This exercise a great movement that drives a lot of engagement of the anterior trunk, musculature while challenging your ability to lift an object overhead.

Finding the Weak Link in the Chain

These two positions serve as a great diagnostic tool that we utilize often in our office. For example, if you’re not really good on your feet, with one of these standing postures but you look awesome on your knees, then, there is a bigger issue going on below your knee than above your knee. If we see you hide it when you’re standing and we see it exposed when you’re kneeling, then we tend to think a hip/trunk stability issue. A good way to test this is to take the same exercise, in this case we are going to use the Kettlebell Bottoms-Up Press, and perform it in both the standing and half kneeling positions (without the band). You should notice a difference between the two positions and that feedback is an invaluable tool as to determining where the true root of your dysfunction lies.

If you have any pain or discomfort with the movements we discussed, we recommend that you see a trained professional to properly diagnose and treat your dysfunction. If you are in the South Florida area feel free to contact our office at 561-402-4701 with any questions or concerns that you may have.


References:

1.Smith, L.K., Weiss, E.L., & Lehmkuhl, L.D. Brunnstrom's Clinical Kinesiology: 5th Edition. F.A. Davis Company, 1996.

2.Anderson, M.K., Hall, S.J., & Martin, M. Sports Injury Management: 2nd Edition. Lippincott Williams & Wilkins, 2000.

3.R.T., & Thompson, C.W. Manual of Structural Kinesiology. McGraw Hill, 2001.

4.Moore, K.L., & Agur, A.M.R. Essential Clinical Anatomy: 2nd Edition. Lippincott Williams & Wilkins, 2002.


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