Dr. Gonzales Podcast Interview: 10 Off-Season Shoulder Health Tips

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Recently had the opportunity to sit down and talk shop with Dr. Sebastian Gonzales on his very own podcast called Performance Place. 

You can listen to it by clicking this link below.

Episode 60: Ten Off-Season Shoulder Health Tips w/Nancy Newell

    Please listen to the whole thing and share with a friend dealing with an issue like the ones we are talking about. We get into some really cool rehab and treatment methods you can try today.

    Share with friends and don't forget to thank the host, Dr. Gonzales, by reviewing our session on iTunes and subscribing. The podcast has some really interesting sports-related topics coming that I think you would really enjoy... especially if you are active and want to stay that way even into your later years.

    Softball: Superior Biceps Pain and What to Do

    Purpose: To give actionable takeaways to help softball players resolve nagging biceps pain

    Superior Biceps pain is one of the top instigators that cause pitchers to lose playing time. Often times this pain can be disguised as anterior shoulder pain. A 2009 study by Shanley, found a 45% incidence (11/24) of time-loss injuries in a single season among softball pitchers. Of the time-loss, injuries were to the shoulder and elbow. Including bicipital and rotator cuff tendinitis and strain—both examples of repetitive load and abrasive wear and tear. 

    Short head - Green Long head - Red

    Short head - Green

    Long head - Red

    But first, A mini anatomy lesson.

    The biceps brachii breaks off into a two-headed muscle near the top of the shoulder. These two heads are known as the short and the long heads of the biceps tendon.

    Short head originates on the coracoid process of the shoulder blade

    Long head originates on the supraglenoid tubercle. In lay man’s terms, this tendon runs up through a shallow groove located in the front of the shoulder.

    Note to the reader* This tendon is also very superficial. Meaning there is not a whole lot of muscle in front of it to protect the tendon from abrasive wear and tear.

    Here are 4 more than likely reasons you are experiencing superior biceps pain and what to do about it.

    Poor Technique

    When an athlete expresses an annoyance that she's been experiencing with her shoulder the first thing I do is ask her 2 questions.

    1. What exercise bugs your shoulder the most?

    Note to the reader* Don’t be surprised if this is an upper body push/pull movement like a push-up or a row variation.

    2. Would you mind showing me a few reps?

     In many cases, the glaring cause of this pain is due to a flaw in technique that she’s been unknowingly doing for many months. 

    Action Steps:

    1)    If particular exercises is causing you pain, don’t do it.

    2)    If you’re in pain while doing these exercises simply ask a coach to take a look at your technique. Here is a quick technique tutorial for the 1-arm cable row.

     

     

    Improve Core Stability/Core Strength

    Core stability is the ability of the muscles surrounding your trunk to “own” positions. Many of these movements involve your limbs moving around a fixed core.  

    Here is a quick example:

     

     

    Why do we need to improve this?

    Rib cage position is often affected by the core. When the core lacks optimal stability the rib cage can become flexed forward. Now, the shoulder blades are fixed to your rib cage. When the rib cage is flexed forward this causes the shoulder blades to tilt anteriorly off the rib cage pushing the humerus forward in the shoulder joint. Over time, if athletes stay in the position the humerus will start rubbing against the long head of the biceps tendon that could lead to issues down the road.

    Take a quick look at these two photos: What do you see? Which one is more likely to have anterior shoulder discomfort? 

    In photo A, I am in a  good athletic position. I have my core braced and my lats engaged. As you can see there is no forward glide occurring.

    In photo B, My core and lats are not engaged causing my shoulder blades to pop off my rib cage. This unstable position pushes the head of the humerus forward into the long head of the biceps. 

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    Actions Steps:

    1)    Use core stability drills in your warm-up as well as in your training to enhance stability and get your shoulder blades moving along your rib cage.

    2)    Learn what a good athletic position looks like and feels like. 

     

    Little or Too Much Rotator Cuff Work

    little or too much rotator cuff work before a competition can actually be a bad thing. We have to remember that the rotor cuff is a group of SMALL muscles. These little guys will fatigue much faster with high volume direct arm care work. In result, they won’t be able to help stabilize the humerus when you need it the most in the circle.

    If you’re an overhead athlete it’s a pretty smart idea to perform some variation of a low-level arm care drills prior to competition, practice, or strength training sessions to activate the rotator cuff. For most athletes, I recommend picking 3-4 “cuff” exercises and performing one set of 8 reps.

    *Note to the reader: Quality reps are a must! I find all too often people have good intentions when performing arm care but many athletes are just grinding away at the anterior aspect of their shoulder. Check out this video to see common J-Band mistakes.

     

    Trigger Points

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    A trigger point is an area of connective tissue or muscle that becomes painful when compressed. These trigger points also have referral pain patterns. For example, if you have a trigger point located in the pec major the pain could radiate up to the front of your shoulder. 

    Action Steps:

    1. Perform soft tissue on the muscles surrounding the shoulder (avoid the neck). Many of these muscles have referral pain patterns that go directly to the front of the shoulder.

    2. See a certified manual therapist. They will be able to help located the trigger points faster and show you how to correctly perform soft tissue work on sensitive areas.  

    Grit Gym Podcast Interview - (Video)

    Recently had the opportunity to sit down and talk shop with Grit Gym owner and operator Adam Rees.

    What did we talk about? 

    • Similarities and differences between male and female strength training 
    • Why adults should use med ball training more frequently 
    • Learn a little more about me and how I ended up working at Cressey Sports Performance 
     

    Softball: 4 Simple Solutions to Help Improve Tight Lats

    Main Takeaway: Strength coaches should assess before assuming that every athlete that walks through their door has the ability to work overhead safely. Learn how to detect and manage those athletes who have tight lats. 

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    As a whole, college strength coaches have migrated away from performing individualized assessments. In result, coaches tend to miss contraindications that wind up hurting players due to poor exercise selection for specific individuals. 

    It's no secret that a vast majority of college strength coaches use the Olympic lifts and overhead work to help build strength and power. However, there are times when some overhead athletes such as softball players don't have the adequate active nor passive shoulder flexion to perform work overhead. In my mind you need to EARN the right to work overhead. A lack of shoulder flexion combined with overhead work will almost always result in compensation patterns that end up injuring lower backs, shoulders and chewing up medial elbows overtime.  

    How to Detect Lat Stiffness? 

    To detect lat stiffness use these 2 simple tests. 

    Test 1: Standing Shoulder Flexion (active) 

    Good standing shoulder flexion: They can get full shoulder flexion without compensation and with good scapulohumeral rhythm. 

    Poor standing shoulder flexion: The individual lacks full shoulder flexion with or without compensating


    Test 2: Supine Shoulder Flexion (passive) 

    Good supine shoulder flexion: The individual is able to get both of their arms down to the assessment table without compensating. 

    Poor supine shoulder flexion: The individual is unable to get both of their arms down to the table. 

    Check out this quick video to see if your athlete has tight lats. 
     

     

     

    How can I manage tight lats? 

    Action Step 1: Manual Therapy on the Latissimus dors and Teres Major

    Seeing an experienced manual therapist at least (1-2x/week) and performing soft tissue work on yourself every day could be the difference maker in gaining full shoulder flexion back. 

    When would I choose this option?  
    Use this option if both test 1 and test 2 are poor 

    Action Step 2: Breath and Stretch

    A simple way to lengthen the lat is by adding more warm-up drills that place the lat on stretch. Here are some drills to consider. 

    When would I choose this option? 
    Choose this option if test 2 is poor. 


    Action Step 3: Create good anterior core stiffness

    By stiffness, I mean the ability to move your limbs (arms and legs) around a braced core. Performing simple anterior and rotary core drills such as these ones below will improve core control and give you more time away from being in a gross extension pattern. 

    Note** have no clue what a extension based pattern looks like? Click this awesome article Tony Gentilcore wrote about it to learn more.

    When would I choose this option?  
    Use this option if test 1 is poor. Actually, use these drills EVERY DAY with your athletes. As a strength coach, you can't go wrong with having a rock solid core. 


    Action Step 4: Improve Scapular Upward Rotation

    Tight lats could be a long-term result of an athlete locking their shoulder blades down and back while training. This gross habit is not ideal for softball players because it limits shoulder flexion (like a lot). Pitchers specifically NEED to work on exercises that promote the scapula moving along the rib cage such as these ones below. 


    When would I choose this option? 

    If you're working with an overhead athlete you should always be programming movements that get the shoulder blade and humerus to work as a team. 

    Check Those Lats! 

    As a strength coach, taking the time to perform a short assessment (<10mins) on your athlete can help you as a coach make more informed exercise selections that will keep your players stronger and healthier. 
     

    Bench Press Do’s and Don’ts for Athletes

    Today's guest post comes from the co-owner of The Strength House and former Cressey Sports Performance coach Tony Bonvechio. Tony is THE guy when it comes to anything bench pressing related and today you'll see why. Enjoy! - Mama Nance

    The barbell bench press may be the most popular exercise in most gyms, but it gets a bad rap among many strength and conditioning coaches. They say it’s not “functional” and has no carryover to sports. I respectfully disagree for the most part, and believe that the bench press can help many athletes get stronger, faster and more powerful.

    Nancy wrote an awesome article last week about why softball players should avoid the bench press and I agree with it 100 percent. Throwing athletes like baseball and softball players should stick with non-barbell bench press variations. But it got me thinking about which athletes SHOULD bench press and what mistakes they make while performing the exercise.

    For athletes who play sports like football, hockey, rugby, basketball, etc., here are some do’s and don’ts to make sure you get the most out of the bench press.

    Do: Bench Like a Powerlifter

    Don’t: Bench Like a Bodybuilder

    Ever hear the old cliché, “There’s no right or wrong way to do it”? In this case, there’s definitely a right and wrong way to bench press if athletic performance is the goal. Athletes should adopt a powerlifting-style bench press, which means:

    •  Upper back arched
    •  Shoulder blades retracted and pulled down and back
    • Elbows tucked tight to the sides
    • Legs in a position to contribute to the lift
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    This is how powerlifters bench in order to move maximal weight, but it’s also the safest position for the shoulders because it keeps the “ball” in the “socket” to limit strain on the pecs and biceps tendons. Plus, this turns the bench into a full-body lift, which has more carryover to sport-specific situations such as blocking or pushing away an opponent while standing or running.

    Some coaching cues that I love for learning how to bench like this:

    • Put your shoulder blades in your back pockets
    • Squeeze the bar like you’re trying to melt it in your hands
    • How would you try to push a broken-down car? Elbows in or elbows out?

    The typical bodybuilding bench press (elbows flared, no leg drive) puts more strain on the shoulders and doesn’t do much to enhance any sport-specific situation.

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    Notice how far away the elbows are from my sides in this picture. Could I block a blitzing linebacker in this position? Could I throw a good chest pass this way? The answer is clear and I’m much better off benching like a powerlifter if I want to train for strength that carries over to the field.

    Do: Focus on bar speed

    Don’t: Grind all the time

     Speed kills when it comes to sports. Very few things happen slowly on the field, and if you don’t want to get left in the dust, you’d better learn to move the bar quickly in the weight room.

    Don’t make the mistake of doing too many “grinder” sets where the bar moves slowly. Bar speed slows down either because the weight is too heavy (i.e. going for a 1-rep max) or the muscles are too fatigued (i.e. doing “burnout” sets).

    That said, most of your sets should be done with a weight that you can move quickly and a low enough number of reps that the last rep looks just like the first rep. Some good rules to follow:

    • Use 50-80 percent of your 1RM
    • Do sets of 2-5 reps
    • Keep rest periods long enough that you’re fully recovered
    • Always move the bar as fast as possible

    That last point is crucial. Imagine trying to throw the bar through the ceiling every time you press it. Slow and controlled reps won’t get you anywhere when an opponent is trying to knock you on your butt.

    Beginner athletes show practice this with “straight weight” (just the bar and plates), but as athletes get stronger, they can add chains or bands to the bar to help learn to move the bar quickly. Usually, bench press reps are harder as you first press off the chest and get easier toward lockout, but bands and chains reverse this because they de-load at the bottom and get heavier at the top. This teaches athletes to accelerate through the entire movement.

     
     

     

    Do: Pick the right variation for your sport/body

    Don’t: Rely on the barbell all the time

    As mentioned, barbell benching isn’t the best choice for throwing athletes. And even athletes who can benefit from the barbell (football, rugby, etc.) should mix in other pressing exercises from time to time to stay balanced and prevent overuse injuries. Finally, some body types and injury histories just don’t match up with the barbell bench press.

    Here are some quick tips for picking the right pressing exercises for your sport and body type:

    Tip 1. Pick the right bar

    The type of bar you use will determine the stress on your shoulders. A straight barbell places the most stress, while a neutral grip bar (palms facing each other) is less stressful, and dumbbells are even more shoulder-friendly.

    Tip 2. Pick the right angle

     You don’t always have to press on a regular flat bench. Adjusting the angle, whether it’s incline, decline or a floor press, can make for a better fit for some athletes. For example, the floor press limits the range of motion, making it easier on the shoulders while still keeping most of the strength-building benefits.

     
     

     

    Tip 3. Mix in “reaching” presses

     The barbell bench press locks your shoulder blades in place, which is great for getting really strong. But shoulder blades are meant to move, especially when throwing or rotating. Make sure to include plenty of pressing movements that let the shoulder blades “reach”, such as push-ups and landmine presses.

     
     

     

    Tip 4. If it hurts, don’t do it

     If you perform an exercise with perfect technique and it hurts or doesn’t feel right, skip it and do a different exercise. No single movement is so important for any sport that you MUST do it no matter what.

    Hot Off the Press

     For more bench press tips like this, check out my new book, Bench Like A Beast. It includes a 10-week training program and over 70 in-depth exercise tutorials. Pick up your copy at benchlikeabeast.com.

    About the Author

    Tony Bonvechio is the co-owner of The Strength House in Worcester, MA. Previously, he served as a coach at Cressey Sports Performance and a personal trainer in Providence, RI. A former college baseball player turned powerlifter, he earned his Master’s degree in exercise science at Adelphi University. You can read more from at Bonvecstrength.com