Squatter's Shoulder: The Cause & The Cure

 

Is Back Squatting Killing Your Shoulder Health?

by Dr John Rusin  

 https://www.t-nation.com/training/squatters-shoulder-the-cause-amp-the-cure

Here's what you need to know...

1. If the back squat is irritating your shoulders, it could be your workout split. Don't squat the day after heavy chest or shoulder work.
2. Try a different bar position. If you usually do low-bar squats, move the bar higher. Or try using a slightly wider grip.
3. Bad posture can cause shoulder pain. If your back and shoulders hunch forward under the bar, use a goblet squat to help you get a neutral spine.
4. A lack of shoulder mobility can cause pain during the squat. Mobility drills can help.

Squats and Shoulder Pain

The squat is a staple. It's foundational to many other lifts.

If you've experienced any increased shoulder pain from doing it, you're already be aware that squatting and shoulder health are related in some way.

How exactly are they connected? And how can we fix what's causing the pain?

Before checking yourself into physical therapy for the next three months and draining your bank account, evaluate your squat: the setup, variations you use, and your loading patterns.

Fixing Your Setup

Culprit #1:  Your Workout Split

First, don't squat heavy the day after a taxing shoulder or chest-heavy training session.

If you read any notable program that's been released since the inception of the barbell, they all follow this golden rule. Why?

As you damage active tissues during a press-heavy training day, those tissues will immediately start the rebuilding process. Rebuilding tissue involves localized edema formation (fluid retention) encompassing the active joints and tissues that have just been insulted secondary to training.

This will increase the tone of the muscles - mainly the internal rotators of the shoulder joint along with the other players of the press.

Even the smallest amount of fluid buildup in a region of the body will decrease the available area for tendons and muscles to smoothly move through. More space filled up by viscous fluid doesn't help us with mobility.

More tendon friction and less tissue mobility leads to you having a hard time optimally setting up your shoulders in a squat position.

If movement isn't coming from your shoulders, you damn well know it's going to come from somewhere else. This fact predisposes the shoulders, elbows, and spine to compensate in ways that could potentially lead to injury.

The Fix

Just hit legs before you press.

Culprit #2:  Bar Position

Do you squat with a high bar or low bar? Be aware of how various bar positions make your shoulders feel.

The low bar position requires more mobility of the shoulder. In geek-speak, this means that you'll have to achieve both an externally rotated gleno-humeral position and accentuated adducted humeral position when compared to the high bar alternative.

Related:  Squat Right For Your Type

The bar position has a huge influence on the positions of the rest of the kinematic chain, including torso angle, recruitment patterns around the muscles of the hip, along with chosen foot placements and tibial angles.

These variables are sometimes the origin of shoulder dysfunction.

The high bar position can be just as painful as the low bar, especially for those who've never deloaded the lift or played with the different positions of the squat setup.

The Fix

Alter bar placement. If the only variation you do is the low-bar squat, this may be your simplest, most powerful solution.

Before you jump on my back and say that bar position is sport specific, hold on one second. Your shoulder getting torn to shreds doesn't care about what sport you participate in.

Be smart and use intelligently programmed variations and modifications when warranted.

Culprit #3:  Hand Position

Do you use a wide or narrow grip? In terms of back squatting, the bar position and the grip really go hand in hand, pun intended.

Just as the low bar position requires an increased amount of mobility, the narrow-hand grip can also alter gross mechanics of the upper torso.

As your hands get more narrow on the bar, the shoulders must have the capacity to move into a highly adducted humeral position, one that places serious stress through the front of the shoulders from a near end range externally rotated position.

For some this can be a bad thing.

On the flip side, this hand position can also create some serious stability through the gleno-humeral and scapula-thoracic joints that can stabilize the spine better than the wide grip position.

The Fix

There's no magic ratio to tell you how wide your hands need to be to avoid pain. Find the middle ground between optimal shoulder and spine stability and comfortable shoulder positioning.

The optimal hand positions vary from person to person, but test out a wider hand position if you've been experiencing pain.

Increase slowly and with caution. If you have the patience to test some new grips, you'll be rewarded with a squat that's not only pain-free but provides some pretty good thoracic stability as well.

Culprit #4:  Unracking The Bar

Even when your programming is sound and your bar height and hand placement is pristine, you still have to un-rack that bar and walk out of the rack like a pro to protect your shoulders.

I've seen everything from lunging the bar out of the rack to taking so many steps to get set that the chances of staying tight are slim to none. This is the final aspect of the setup, and it's the one in which I notice the most issues.

The Fix

A correct un-racking of the barbell out of the squat rack should look like a miniature version of the squat itself.

Foot placement, spinal stability, and pillar torque and tension should all be maintained before that bar leaves the rack.

Once you've gotten to that point, mini-squat that bar out of the rack. Think of it as a four-inch squat.

Keeping the entire torso stabilized, take one step back followed by a second step back by the opposite foot to get into position with no compensatory shifting.

Before you even squat with a barbell, master this part. Earn the right to use big boy training tools.

How to Fix Mobility & Mechanical Problems

Culprit #1:  Thoracic Spine Positioning

If your spine falls into a forward flexed position, it doesn't matter how great your shoulder mobility is, you're still at risk of shoulder issues.

Related:  6 Reasons You're Always Hurt

Before you get on the physical therapist's table, ask yourself this question:

Is your thoracic spine always kyphotic (hunched over), or is that position accentuated when you back squat?

The answer may save you a lot of time and energy looking for problems that don't actually exist.

The Fix

Break out your cell phone and have your gym bro video your next set of squats.

Then grab a dumbbell and hold it in a goblet position, using the same foot position, torso angle, and setup as you did on the barbell lift. Get a set of dumbbell goblet squats on video.

Does your spinal position look better during the goblet squat, or is it strikingly similar to the back squat?

If the goblet squat cleaned up your spinal positioning, your ability to get to a neutral spine under load is there. It's time to enhance your motor control using that implement.

Does the goblet squat still suck and look just as bad as the barbell? Move onto the next section.

Culprit #2:  Shoulder Mobility

Here's how to figure out if you have enough mobility to make it through a squat day without pain, or if you have to remediate your mobility just to squat another day.

This is a screen I picked up from Kelly Starrett. Place a dowel in your hands and position your elbows to 90 degrees while your upper arms are parallel with the ground.

From that starting position, externally rotate your shoulders back as far as you can get them without compensating from the spine or head. As soon as you reach end range of motion, start to depress the dowel slowly and under control.

Go down until you can no longer get it any lower. You'll come to a point where the dowel hits up against your back at a certain level.

Is the level of the dowel currently lower than your chosen bar position? If it is, move on for now. If not, time to fix your mobility.

The Fix

If you need to improve your thoracic position with the barbell on your back, a great tool for linking the external rotation of the shoulder with the extension of the thoracic spine is quadruped thoracic spine rotation.

The bottom position of the squat is the range most susceptible to thoracic rounding. So try the movement above.

If you're a mobility-limited lifter, some basic movement remediation can be achieved through dynamic stretching of the pectoralis group along with the internal rotators.

These are not static stretches, but rather strategic oscillating stretches that produce quick, transferable results.

Culprit #3:  Shoulder Packing

Mobility gets blamed for shoulder pain, lower back problems, and global warming. But not everything is a mobility problem.

Take a look at the stability of the shoulder if you passed the mobility tests above. Achieving a stable shoulder position is important. Here's what needs to happen:

First, gleno-humeral joint centration has to happen to place the ball of the humerus in a solid position in the glenoid fossa of the shoulder blade.

This position is found in terminal external rotation of the shoulder in addition to humeral extension and adduction. This is step one.

Related:  Lifter's Shoulder: The Cause & The Cure

Step two, use the soft tissues encompassing the joint itself to create spiral tension loading and torque to really wind up all available contractile and non-contractile tissue to hold that perfectly centrated joint in position.

The cue "pull the bar apart" has been used for years. This is what coaches are getting at with this coaching method.

The ability to get into a centrated position is largely dependent on mobility. If you can't achieve this position, see the above corrections for remediation of your mobility deficit.

If you're having difficulty finding torque through the shoulder complex, I have seen this to be a motor control issue that needs some re-patterning.

The Fix

Depending on how severe the motor control deficit is, there are a few drills you can go through to learn how to feel torque and generate some serious spiral tension loading through the shoulder joint.

Start off simple, generating torque from a supine position with the use of bands, then move into a quadruped position. If you graduate from all fours, the half kneeling and standing positions are used.

If and when you're ready to progress back to the barbell, this skill can be directly transferrable to the iron.

Culprit #4:  Soft Tissue/Joint Structure

If you've made it through to this point with no resolve, you've run out of self-sufficient options to remediate your squatter's shoulder.

Be sure that you haven't overlooked any aspects of the squat setup or internal movement mechanics above.

It's important to mention that this stage is where most people start. They want a complex diagnosis for an easy fix.

Your body is yours and yours alone. Take care of it until you've exhausted all conservative measures. Then get a professional evaluation.

The Fix

Seek a qualified sports performance physical therapist, chiropractor, or rehab professional.

Just because people sport a "Dr." in front of their name doesn't mean they're all equally qualified to evaluate, assess, and treat a strength athlete with specific training goals in mind.

These are few and far between, but if training is truly a passion and you plan on doing this the rest of your life, spending the extra effort vetting your rehab doc will pay off in the end.

Have a trusted professional in your back pocket to get better and be able to push harder in your training.

The 4 Most Useless Rehab Methods

 

Foam Rolling, Stretching, Taping, and Icing

by Dr John Rusin  

 https://www.t-nation.com/training/4-most-useless-rehab-methods

Here's what you need to know...

1. The foam roller may be the single biggest time waster in the fitness industry.
2. A majority of studies show that kinesio tape doesn't help with performance. And unless you're a specialist, it won't help much with injuries.
3. It's extremely difficult, if not impossible, to actually add length to a muscle by performing static stretching.
4. The first two letters of the RICE prescription (rest and ice) should be largely ignored.

Things That Can Bite You in the Ass

People who are trying to heal themselves using self-administered rehabilitation and regeneration techniques are often doing more harm than good.

With the mainstream popularity of things like foam rollers, stretching protocols, and even tape to enhance joint and body position, it's time to set the record straight.

Here, in order of descending stupidity, are the four most useless rehab methods that not only have limited carryover in performance and health, but can actually come back around to bite you in the ass.

#4  Foam Rolling

The foam roller may be the single biggest time waster in the fitness industry.

Soft tissue work including foam rolling, trigger point work, and even my hands-on self myofascial-release (SMR) techniques need to be focused and goal oriented processes. If you find yourself rolling the same muscles every single day, it's safe to say that your "practice" isn't yielding any notable results.

Related:  Do-It-Yourself Myofascial Release

Worse yet, flailing around on the foam roller with a smile on your face and carrying on a passionate conversation about Game of Thrones isn't the way it's done. Just the term itself, "foam rolling," has you set up for failure. It sounds soft, fluffy, and enjoyable.

It should be none of those when executed correctly.

You know who has the right idea with self-sufficient soft-tissue work? Mobility expert Kelly Starrett. He doesn't call this practice foam rolling. Instead it's referred to as "smashing" and he uses specific tools on select regions of the body.

Putting yourself into some serious pain in hopes of tissue deformation (and subsequent remodeling) and muscle tone reduction is what you need to create long lasting results.

Do This Instead

There's a few key things you can do to manage your soft tissues and enhance your health and performance. Prioritize your foam rolling on just a few targeted areas per day until these areas are resolved.

Big, superficial muscles like the quads and lats can be worked very well with the roller, so don't throw the tube away quite yet.

If you think foam rolling is going to enhance your athletic performance, the research doesn't support you.

What multiple studies do show, though, is the ability for self-myofascial release to significantly alleviate muscle soreness and increase muscle flexibility for short periods and potentially long-term periods when used on specific areas for more than two weeks.

In other words, the roller can potentially expedite the recovery process.

When dealing with pinpointed soft tissue restrictions and dysfunction, there's nothing better than getting your hands dirty and literally working on yourself.

Your fingertips provide a much smaller surface area that match the size of small structures (like the rotator cuff tendons) while also allowing a sensory-rich environment for you to explore your body.

The more you learn and discover in terms of muscles and structure, the better you can apply that knowledge to your training by enhancing a mind muscle connection.

But if this sounds like too much concentrated effort, just keep flailing around on the roller with nothing to show for it. My recommendation will still be here when you come to your senses.

#3  Kinesio Tape

Since when has wrapping yourself up like a brightly-colored mummy become a prerequisite for being an athlete?

Though kinesiotape has been in use in the therapy industry for a while now, everything went into overdrive after the 2008 Beijing Summer Olympic Games.

You probably remember seeing the Americans kick some major ass on the beach volleyball sand, where both the men and women teams were noticeably covered in that mysterious tape.

The initial hypothesis was that the tape was administered to cover up Misty May Treanor's tramp stamp to keep relations civil with communist China. This hypothesis was quickly debunked and replaced with a statement from the American team saying that the tape was a therapeutic aid for pain and dysfunction.

But was it really? Since that time, there have been countless research articles published looking into the efficacy of kinesio tape for both pain modulation and performance enhancement.

Unfortunately, a majority of studies show that the tape is of no more help to an athlete's performance than any other faddist trend we've seen sputter through the industry.

White athletic tape has been around for almost 100 years, but too bad it didn't sport a logo. Johnson and Johnson really missed out on that mega-opportunity.

The thought is that tape can be strategically placed over the skin in areas that can either inhibit or facilitate muscular tone, thus enhancing joint positions and the production of muscular force.

There are rehab experts out there that swear K-tape is the most game-changing tool they've used for enhancing the performances of their athletes, but the chances of it working when an amateur with no experience administrates the tape is about as likely as an ice cube's chance in hell.

Do This Instead

If you're going to go down that rabbit hole just because those jacked and conditioned athletes throwing around absurd weights in the CrossFit Games are showing more Rock Tape logos than they are skin, at least do it right.

Look, there's a reason why certified practitioners and movement specialists get certified in this stuff. There's indeed a science and skill set to properly administrating a theoretically sound K-tape treatment.

Go see one of those people. They paid thousands of dollars to be a certified tape specialists and may actually know what they're doing.

That said, you can tape yourself up using nothing but plain athletic tape. It's not a cure-all, but the treatment can be useful in some circumstances.

#2  Stretching

Do you have tight hamstrings? You must start stretching! Lower back pain and discomfort? I bet you aren't stretching! Sustained an injury to your hips or spine? Better do yoga!

These are the kind of insane misconceptions about stretching I deal with on a daily basis with my clients, some of whom, I may add, are world-class athletes pushing the limits of physical achievement.

If world-class athletes and well-informed clients who have a passion for wellness are this confused about stretching, the layperson must be monumentally screwed when it comes to the subject.

What we have to ask is, what exactly does static stretching do to the human body, and does it have a place in athletic performance and reducing injury rates?

It's important to mention that physiologically speaking, it's extremely difficult, if not impossible, to actually add length to a contractile tissue such as a muscle.

What's essentially happening with any type of mobilization of an area is the relaxation of that muscle and the reduction of its tone, which are largely neuromuscular properties, not mechanical.

Now that we got that straight, here's the deal. Static stretching of a tissue over a 45-second period has been shown to increase muscular flexibility that may even last more than 24-hours in certain muscle groups.

That increased range of motion may be a double-edged sword, especially when executed right before an athletic event or workout.

If you're stretching with the intent of reducing likelihood of sustaining an injury during athletic participation, the verdict is still out. What we do know is stretching can reduce muscular force and power output in certain muscle groups, which can potentially decrease the level of performance.

Not exactly what you were thinking when you went down to touch your toes, is it?

Do This Instead

Static stretching done for long durations has its place in a select population of people who are literally so tonic (shortened and tightened) that administering a stretch is the only way to prevent serious and debilitating contractures.

For the rest of us, the use of dynamic stretching and oscillating protocols can get the job done without adding to the traditional problems posed by stretching.

Dynamic warm-ups are nothing new by now, and should be programmed before every type of exercise, training, or athletic event to increase local blood flow to active tissues, lubricate joints, increase core temperature, and prime the neural system.

As for adding functional length to problematic tissues, the use of oscillations – moving in and out of near end-range of motion – for specific tissues can lead to marked improvements in the tone of tissues without overstressing the musculotendinous junctions that notoriously take the brunt of a static stretch hit.

Simply put the muscle you're targeting into an end-range stretched position. Move back and forth, in and out of an end-range stretch, nice and easy with an oscillating motion.

This stretch on, stretch off range-of-motion may only be an inch or two, but it will be far easier on the tendons and non-contractile tissues.

Do this back and fourth like a pumping motion, attempting to get just a little more range of motion through those tissues each time. Stick to 60-120 seconds per tissue to start with and work your way up to 5 minutes at a time if you can stomach the tension.

Think it's too simple to work? Try it out for yourself.

#1  Icing

In 1978, The Sports Medicine Book, authored by Dr. Gabe Mirkin,introduced the concept of RICE – rest, ice, compression, elevation – for the treatment of athletic injuries. It makes sense to ice down an injury as soon as possible to limit swelling and maintain function, right?

Not quite.

In 2014, Dr. Mirkin went on record debunking his own work pertaining to the ice portion of the RICE acronym for acute musculoskeletal injury management. It takes a special man to admit that countless research articles and reviews had disproved his life's work, but we're all glad he did.

Not only did the use of cryo-therapy not aid in the healing process, it actually delayed the healing process altogether.

Related:  The Shocking Truth About Inflammation

And while he was at it, Dr. Mirkin also shed some light on his recommendation for complete rest after sustaining an injury. "With minor injuries, you can usually begin rehabilitation the next day," said Mirkin.

Hey, if the guy who literally wrote the book on injury management is saying don't restrict movement or ice an acutely injured area, we damn well better listen!

Do This Instead

It's a good thing there were a few more letters in the RICE acronym that stood the test of time.

Compression and elevation of acutely injured areas are still highly effective and should be prioritized after sustaining a low to moderate-level injury. Along the same lines, you might want to experiment with VooDoo Floss.

But as far as rest and ice (R and I), it's best to rethink those letters.

Позвоночник, проводник наших эмоций

Остов нашего тела состоит из 24 позвонков. Эта удивительная структура поддерживает скелет в вертикальном положении и одновременно обеспечивает надежную защиту нашей центральной нервной системы. Каждый нервный импульс, сознательный или бессознательный, эмоциональный или механический, через позвоночник поступает в мозг или же из него, будто по сверхскоростной магистрали. К сожалению, мы часто недооцениваем значение этой сложной системы — как для нашего здоровья, так и для душевного равновесия.

В ПРЯМОМ СМЫСЛЕ СЛОВА

Мы инстинктивно чувствуем, как глубоко связана осанка с нашими переживаниями. Когда негативные эмоции «тяжелым грузом ложатся на плечи» или неудача «сбивает с ног», мы подавлены, сутулимся, чувствуя напряжение в области шеи и верхней части спины. Неожиданная удача, напротив, заставляет нас «воспарить», расправить спину, а удовлетворение собой позволяет «шагать по жизни с высоко поднятой головой». Сильный стресс может вызвать не просто напряжение, но и боль в спине. Врачи пришли к выводу, что душевная боль каким-то образом передается телу, но механизмы этого феномена еще не до конца понятны. «Болезненные ощущения в области спины, которые возникают в результате стресса, так называемые психогенные боли, не имеют отчетливойнейро-ортопедической причины, — объясняет врач-невролог Наталья Щербакова. — Стресс может явиться причиной тонического напряжения мышц спины в любом отделе позвоночника, провоцируя болевой синдром. Возможно, механизм формирования такой реакции кроется в опыте запечатления „болевого поведения“ близких, которые окружали человека в детстве, или в опыте собственной боли, перенесенной когда-то».

Он служит основой нашего тела во всех смыслах этого слова — не просто помогая нам держаться на ногах, но и не давая упасть духом.

СВЯЗУЮЩЕЕ ЗВЕНО

Позвоночник также является великолепной амортизирующей системой: межпозвоночные диски поглощают толчки, идущие от коленей, бедер и всех суставов. Это своего рода «подушки безопасности», защищающие от повреждений во время ударов. Практически все мышцы живота и грудной клетки соединены с позвоночником. Кроме поверхностной мускулатуры, которая помогает нам двигаться в пространстве и поднимать тяжести, есть еще глубоко расположенная внутренняя мускулатура — она поддерживает наши внутренние органы, помогает сопротивляться силе тяжести и держаться в вертикальном положении. Вся эта система необыкновенно устойчива и способна выдерживать очень большие нагрузки. Наибольшей проблемой является то, что мы нагружаем ее крайне неравномерно и неразумно. Мы много времени проводим сидя, в результате на 40% увеличивается давление на нижнюю часть спины. Кроме того, одни мышцы постоянно находятся в напряжении, а другие используются совершенно неэффективно. «Нарушение микроциркуляции приводит к дистрофическим процессам в позвоночнике, — продолжает Наталья Щербакова. — Из-за этого страдают окружающие его нервы, нарушаются связи вегетативной нервной системы, что, в свою очередь, может привести к тому, что возникнут проблемы в периферическихорганах-мишенях». Так, сдавленный нерв, идущий к печени, не может эффективно посылать сигналы, и это сказывается на работе самого органа. Плохое пищеварение может быть вызвано ущемлением нерва в основании черепа и т. д. Таким образом нарушения в работекакого-нибудь органа могут повести нас по длинной цепочке врачей, тогда как корень зла — проблемы с позвоночником.

О ЧЕМ ГОВОРИТ ВАША СПИНА?

Боль в плечах

Это обычное следствие долгого сидения за компьютером или за рулем машины связано с напряжением мышц и приводит к сдавленности позвоночника в области шеи.

Как облегчить положение. Сделайте глубокий вздох, приподнимите грудную клетку и отведите плечи назад, повторите это движение несколько раз.

Напряжение в средней части спины

Напряженность мышц в этой области ограничивает иннервацию внутренних органов и может повлиять на работу надпочечников, мочевого пузыря или почек. Иногда ощущение напряжения, наоборот, может быть вызвано функциональными нарушениями в мочеполовой системе.

Как облегчить положение. Дышите животом, это поможет уменьшить мышечное напряжение и стресс. Посетите врача, чтобы исключить вероятность того, что причина — во внутренних органах.

Боли в нижней части спины

Они могут быть вызваны напряжением внутренних мышц, когда человек долго сидит. Большинство из нас слегка «сползает» при долгом сидении, изгибая позвоночник и еще больше перегружая его.

Как облегчить положение. Попробуйте сидеть на фитболе, мяче большого диаметра, — для удержания равновесия на нем требуется постоянно держать спину прямой. Еще один вариант — подобрать ортопедические подушки для стула.