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Surgeon says this exercise cures 99% of shoulder pain

 

By Kirik Jenness  

If you train in combat sports, at some point, your shoulders hurt. It drives some people from the gym entirely.

However, an orthopedic surgeon, John M. Kirsch, M.D., has an exercise protocol that he says eliminates 99% of shoulder pain. It’s not just non surgical, it’s free.

The theory is, we descended from apes but no longer use our bodies like apes do, so there is an obvious solution – Go Ape. Dr. Kirsch spoke with Rick Ansorge about it, for NewsMax Health.

“Man is the fifth great ape,” said Dr. Kirsch. “The others are the gorilla, chimpanzee, orangutan, and gibbon, all of which still swing from trees or brachiate.

“When we came down from the trees about 3,000,000 years ago, we stopped brachiating. But we still have the shoulders of an ape that’s supposed to brachiate.”

To treat and prevent such injuries, he has developed a simple protocol that simulates brachiating. It requires two elements: hanging or partial hanging from a pull-up bar and performing light weightlifting with dumbbells.

“It cures 99 percent of shoulder pain,” says Dr. Kirsch.

He outlines the protocol in the fourth edition of his popular book: “Shoulder Pain? The Solution and Prevention.” Unlike conventional treatments such as physical therapy and surgery, Dr. Kirsch’s method is almost cost-free. “All you need is a branch on a tree and a brick,” he says. “You hang from the branch and lift the brick.”

As with any exercise program, it’s important to start gradually, especially if you are out of shape. “If you can’t do a complete hang with your feet off the floor, do a partial hang and keep your feet on a stool or on the floor, and gradually put pressure on the shoulder,” he says.

The protocol can be painful at first. “Paradoxically, the pain experienced while hanging from a bar will not injure the shoulder, but must be accepted” so the exercise can reshape the space in the shoulder, strengthen the shoulder muscles, and reduce pain. In some patients, it has erased chronic shoulder pain in as little as two weeks. In others, it has taken as long as a year and a half.

Dr. Kirsch’s first patient was himself. In the early 1980s, he developed an impingement in both shoulders. The notion that simulated brachiating could help occurred to him when he noticed that his children could easily swing across monkey bars while he had difficulty reaching the second rung.

“It was just intuition,” he says. “But I decided if I were to hang from a bar I could squeeze the fluids out of the swollen tissues and reshape the arched bone that compresses the rotator cuff. After a little over a year, I completely relieved the pain in my shoulders.”

In 2004, Dr. Kirsch performed a series of CT scans to study the mechanics of the hanging exercise in the shoulders of live subjects. He later founded the Kirsch Institute for Shoulder Research in Stevens Point, Wis.

If you have shoulder pain, Dr. Kirsch recommends that you first see a doctor to get an X-ray to rule out unlikely causes such as cancer or an infection. If the pain results from a common rotator cuff tendinitis, he recommends gradually working up to three, 30-second bar hangs per day and performing the weightlifting exercises as described in the book with dumbbells as weighing one pound or more.

“I lift 10 pounds, 150 times each day with each arm, all the way up as high as I can lift it, up and down and up and down,” he says.

According to Dr. Kirsch, about 80 percent of Americans will experience shoulder pain at some point in their lives, with annual direct costs such as treatment and indirect costs such as lost productivity exceeding $300 billion.

“All of that can be eliminated by following this simple little protocol,” he says.

H/T BJJEE

THE PATH TO MASSIVE TRAPS | THE ONE NEGLECTED EXERCISE YOU NEED

 

The Path to Massive Traps

The One Neglected Exercise You Need

Get Trapped

Even if you are not where you want to be yet, by pounding iron in the gym, your sweat and effort will eventually pay off with a thick chest, arms that will give your shirt stretch marks, and carved mass across your middle back. When it comes to the back, usually it is the latissimus muscle that garners most of the training attention from bodybuilders. As a result, the trapezius muscle often receives indirect work from other back exercises, but little direct work. To avoid imbalance in your back symmetry, this muscle needs some direct work.

You can tell the guys who have clocked many hours at the gym pounding their trapezius. A few are genetic freaks who have trapezius mounds that seem to rise from the top of their shoulders to almost touch their ears. These guys seem to have taken a cue from the Hulk, the comic book green mammoth who was illustrated with huge, monstrous traps that overshadowed his clavicle and buried his neck. 

Perhaps you don’t want quite the extreme size of that green fellow, but if you choose to target this area, your trapezius can thicken toward Hulk-like portions— and this will make you a standout far beyond the average bodybuilder. Barbell shrugs behind the back provide an alternative to dumbbell and machine shrugs, and allow you to home in on your upper and middle trapezius muscle fibers.

 

Anatomical Activation by Shrugs

The trapezius has several parts, but it is primarily the superior (upper) fibers of this muscle that are activated by barbell shrugs behind the back. The superior trapezius begins along the base of the skull and the seventh cervical (neck) vertebrae. The fibers angle downward to attach on the lateral part of the clavicle (collarbone) and along the scapula (shoulder blade). The superior fibers lift the scapula and shoulder structures toward the ears (shrugging), and this is the portion of the muscle that is targeted by barbell shrugs.

The middle one-third of the trapezius muscle stretches from the upper thoracic spine, laterally to the posterior side of the scapula and clavicle. These fibers “squeeze” the two scapula bones toward the midline of the body (adduction of scapula). While the middle trapezius is affected very little if the barbell is in front of your body, placing it behind your back forces these fibers to pull the scapula together. The most inferior (lowest) parts of the trapezius muscle extend from an inferior medial position at the lower thoracic vertebrae, and attach to the scapula from below. The function of the inferior fibers of the trapezius is to forcefully depress (lower) the scapula. 

Guide To Barbell Shrugs Behind the Back

Step 1. Place a barbell behind your thighs. Your hands and your feet should be spaced about shoulder-width apart. Take an overhand grip (palms facing the floor) on the bar, and stand with your knees slightly bent. You can also take the bar off of a power rack.

Step 2. Allow your elbows to straighten almost completely. You may want to consider using wrist straps to prevent grip failure during the heaviest sets, but they are not needed for the lighter warm-up sets.

Step 3. Raise your shoulders and both scapulae simultaneously, as high as possible. Your shoulders will come up and back during the lift. Try to squeeze the scapulae together as you are coming up. Although it will be nearly impossible, attempt to touch your ears with the superior part of your trapezius. Bend your neck just a little forward as the weights come up.

Step 4. Hold the top position for two seconds. 

Step 5. Continue to squeeze the scapulae together as the weight is lowered about two-thirds of the way down to the starting position, and then let the scapulae slide forward as the shoulders are moved downward. Do not let the weight drop haphazardly, but control the weight on the way down.

Step 6. You are not quite done with the first repetition. At the bottom, let the barbell pull the scapulae and clavicles downward toward the floor even further, so that you are able to feel a good stretch across the superior trapezius muscle. This stretch between reps will fight off any cramping in your scapular muscles.

Step 7. After a two- or three-second stretch, repeat the movement and start the barbell moving upward as before.

Step 8. Exhale as the weight is lifted upward, and inhale as the weight comes down.

Any version of the shrug will activate the superior trapezius as you lift the shoulders upward. However, with the barbell behind your back, you are forced to squeeze the shoulders together (scapular adduction) as you lift upward, and this strongly recruits the medial fibers of the trapezius muscle. The inferior fibers of the trapezius muscle are not activated very strongly in this movement; however, they do see some work as they eccentrically (during the lengthening portion) resist lowering the bar in each rep. Try to get as much of a range of motion as possible in each rep.

Merely thinking about acquiring trapezius mass will not get the job done. However, the trapezius muscle is one that responds very well to regular hard and persistent work. Barbell shrugs behind your back will transform a thin and narrow trapezius and shoulder frame to a new thickness and power with Hulk-like proportions. Look at a most-muscular pose of Mr. Olympia, Phil Heath, and ask yourself if traps are important to a bodybuilder. The thick traps that explode above his clavicles quickly tell you that he has not neglected training the trapezius, and this makes his back look great from any angle.

Maybe you are not ready to challenge Phil on the Mr. Olympia stage yet. Nevertheless, if you are serious about adding some hulking mass to your trapezius, barbell shrugs behind your back will get the job done— and will add towering trapezius mass that cannot be easily camouflaged in clothes.

References:

Arlotta M, Lovasco G, McLean L. Selective recruitment of the lower fibers of the trapezius muscle. J Electromyogr Kinesiol, 21: 2011. Available online ahead of press at: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T89-51N7CBP-3-N&_cdi=5081&_user=768492&_pii=S1050641110001793&_origin=search&_zone=rslt_list_item&_coverDate=12%2F08%2F2010&_sk=999999999&wchp=dGLzVzz-zSkzV&md5=2d09b9102847547679e15dc129dd5dc1&ie=/sdarticle.pdf.

Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther, 33:247-58; 2003.

Johnson GR, Pandyan AD. The activity in the three regions of the trapezius under controlled loading conditions--an experimental and modelling study. Clin Biomech (Bristol, Avon); 20:155-61; 2005.

Moore KL and AF Dalley. Clinically Oriented Anatomy, Fourth Edition. Baltimore, Lippincott Williams & Williams, Kelly PJ, Editor, 1999, pp. 467-468, 691-693.

Nielsen PK, Andersen LL, Olsen HB, Rosendal L, Sjogaard G, Sogaard K. Effect of physical training on pain sensitivity and trapezius muscle morphology. Muscle Nerve, 41:836-44; 2010.

 

Written by Stephen E. Alway, Ph.D., FACSM

 

 

 

Develop a Thick Chest with Machine Pullovers

Rarely has a human come along with a barrel-like chest that captured more unbelievable depth than the chest that belonged to Mr. Universe, Reg Park. The side chest shot that belonged to Park was mind-blowing, and in fact huge enough to capture the imagination of a young Arnold Schwarzenegger, who developed a pretty decent side chest shot himself. If you have come to realize that your chest is not as large as you want, it is probably a great time to find an exercise that will cause your chest to explode with size from the inside out. Exercises like machine pullovers can begin a transformation in your chest structure that will seemingly erupt with an explosion of growth. Not only will machine pullovers challenge your chest structure, but the muscles packing over your back and chest will be forced to thicken and grow.

The rib cage protects everything important in your chest, but it also supports the muscles that make your torso look great. The portion of the rib that attaches to the sternum (breast bone) is not bone, but costal cartilage (“cartilage of the ribs”). This costal cartilage provides the elasticity to the chest, and allows the ribs of young adults to “give” rather than fracture under a blow or compression. This elasticity permits some stretching in the costal cartilages (e.g., by training)— thereby increasing the diameter of the rib cage. The costal cartilage will harden by approximately age 25, so expansion of the rib cage via stretching the costal cartilages becomes almost impossible for people older than that.

 There are three layers of intercostal muscles, and they lie between adjacent ribs. From deepest to most superficial, they are the innermost, internal and external intercostal muscles. The innermost and internal intercostal muscles lie deep to and at right angles to the external intercostal muscles. All three muscles of this group are active during inspiration (taking in a deep breath) and expiration (exhaling that breath). If the intercostal muscles are developed to their maximum, the size of the rib cage is markedly increased during inspiration.

 

The serratus anterior is a large muscle that overlays the lateral parts of the rib cage and the lateral part of the intercostal muscles. The fibers of the serratus anterior muscle attach to the first eight ribs, and run posteriorly along the lateral side of the thorax. The other end is attached along the medial border of the scapula (shoulder blade). This muscle pulls the scapula forward (protraction) and holds it against the thoracic wall.

 The latissimus dorsi and teres major musclesare strongly activated by machine pullovers. These muscles addimportant width to the upper back. The latissimusextends from the lower (inferior) thoracic vertebrae and the iliac crest of the hip to the upper (superior) portion of the humerus bone of the upper arm, near the shoulder. The teres major muscle begins on the inferior angle of the scapula (shoulder blade), but it attaches high, into the same region of the humerus bone of the arm as the latissimus dorsi. Together, the latissimus dorsi and teres major muscles extend the humerus from a flexed position (i.e., with the arm forward). These muscles are more completely activated with the arms at mid-chest level, or in work directly overhead. They are strongly activated with the arms abducted (wide apart) and therefore, machine pullovers are perfectly suited to activate the upper-back muscles.

The clavicular head of the pectoralis major lies along the anterior lower surface of the clavicle (collar bone). The sternocostal head of the pectoralis major begins along the manubrium (top portion of the sternum), the upper-six costal cartilages and the tendinous-like portion of the superior part of the external oblique muscle (a lateral muscle of the abdominal wall). Both heads converge on a groove near the head of the humerus. Both sternocostal and clavicular heads help to extend the humerus by moving the upper arm downward during the last one-half of the pullover.

  

Machine Pullovers

1. Adjust the seat height so that your feet are flat on the floor, with knees bent to about 90 degrees. Some pullover machines have safety belts that will keep your hips on the seat.

2. Press your elbows into the pads. Take a breath, and then exhale as you press your elbows forward and downward in a controlled and deliberate fashion. Press your elbows down as far as you can. Do not try to do the exercise explosively, because your shoulder joints can be unduly stressed if you try to explode downward from a stretched position.

3. Inhale deeply as you slowly return your arms to the starting position. However, do not hit the weight stack on the bottom plates.

4. Hold the stretched position at the top for at least one full second, and then move into the next repetition downward. Rest only after you have completed a set of 8 to 12 reps.

  

You should always do some shoulder stretching before beginning this exercise— even if it is your final exercise. Injury-free shoulders will allow you to have the greatest range of motion on machine pullovers. This exercise activates the serratus anterior as the arms are being lowered, and when the scapula is protracted. The intercostal fibers and costal cartilages will be maximally stretched by the deep inspiration. The pectoralis major, the latissimus dorsi and teres major muscles are activated in this exercise particularly during the last downward part, and also when resisting the upward movement of the machine as the scapula is retracted (shoulder blades come closer together). Therefore, this is a great exercise to finish your chest or back workout. 

 Don’t be afraid of piling on the resistance in machine pullovers. A few months of consistent effort with good resistance will activate the beginnings of your chest explosion, so that you will be on your way to the largest barrel possible.

References

Agur, AMR and MJ Lee. “Grants Atlas of Anatomy.” Tenth Edition. Philadelphia. Lippincott Williams & Wilkins 1999, pp. 442-453.

Bull ML, Freitas V, Vitti M and Rosa GJ. Electromyographic validation of the trapezius and serratus anterior muscles in rowing exercises with middle and closed grip. Electromyogr Clin Neurophysiol, 43: 4-8, 2003.

Cannon DT, Grout SL, May CA, Strom SD, Wyckoff KG, Cipriani DJ and Buono MJ. Recruitment of the serratus anterior as an accessory muscle of ventilation during graded exercise. J Physiol Sci, 57: 127-131, 2007.

Cappello M and De Troyer A. On the respiratory function of the ribs. J Appl Physiol, 92: 1642-1646, 2002.

Moore KL and AF Dalley II. Clinically Oriented Anatomy. Fourth Edition. Baltimore, Lippincott Williams & Williams, 1999, pp. 690-697.

Schachter AK, McHugh MP, Tyler TF, Kreminic IJ, Orishimo KF, Johnson C, Ben-Avi S and Nicholas SJ. Electromyographic activity of selected scapular stabilizers during glenohumeral internal and external rotation contractions. J Shoulder Elbow Surg, 19: 884-890, 2010.

Uhl TL, Muir TA and Lawson L. Electromyographical assessment of passive, active assistive, and active shoulder rehabilitation exercises. PM R, 2: 132-141, 2010.

 

Written by Stephen E. Alway, Ph.D., FACSM

 

 

Blast Chest & Back with Straight-Arm Dumbbell Pullovers

Lifting heavy dumbbells for upper body training may seem like a throwback to the pioneer days of bodybuilding. However, upper body mass building lies less in chrome machines and more in grit and determination to grind through the heavy resistances of free weights. Machines have their place of course, but some of the muscle stimulation patterns of free weights are rather hard to duplicate with chromed machines. If you are stuck in the machine age and are not interested or motivated enough to explore hard training with free weights, or if you are already satisfied with your upper body width and thickness, then there is little need to read further. However, if you have the guts to face a hard challenge and try new things to achieve your goals of possessing an untouchable upper body, then straight-arm dumbbell pullovers are for you.

  

Muscle Structure and Function

Straight-arm dumbbell pullovers will lock in your latissimus and pectoralis muscles¹ and the smaller serratus anterior muscles, which highlight the chest and lats from the front for an overall upper body blitzing approach to widen the chest and thicken the back and shoulders. The fibers of the latissimus dorsi muscle extend from the lower thoracic vertebrae and the iliac crest of the hip, and the fibers come together at the upper portion of the humerus bone of the upper arm near the shoulder.² The latissimus dorsi muscle extends the humerus by pulling the upper arm backward. In addition, it adducts the humerus bone by bringing the arm towards the center of the body. When the arms come directly over the head as in straight-arm dumbbell pullovers, the middle and lower parts of the latissimus are activated most effectively. 

The pectoralis major muscle of the chest is also activated as the dumbbell is being moved from over the head to the chest in pullovers.¹ The pectoralis major runs from the clavicle, manubrium (the top portion of the sternum), the upper costal cartilages, and the upperparts of the external oblique muscle to the head of the humerus bone of the upper arm near the shoulder joint.² The pectoralis major adducts the humerus (draws the arm towards the midline of the body). The serratus anterior muscle attaches to the lateral side of the ribs.^2,3 Its fibers anchor on the first eight ribs and then run posteriorly along the lateral side of the thorax. The other end is attached along the medial border of the scapula (shoulder blade).¹ It pulls the scapula forward (protraction) and holds it against the thoracic wall, which is important during pushing and throwing movements.^4,5,6   

The abdominal muscles stabilize the upper body during pullovers. The rectus abdominis runs from the pelvis to the base of the sternum.² The external oblique runs from the fifth through the 12^th ribs, down to the pubic and the iliac bones of the pelvis. When both left and right sides of the external oblique muscles and the rectus abdominis shorten, they flex the trunk so the head moves towards the feet.²

 

Dumbbell Pullovers: Execution

1. Place a dumbbell on its end at one edge of a flat bench. Lie 90 degrees to the long axis of the flat bench. Your shoulders and upper back should contact the bench, and your feet should be placed flat on the floor. Your neck and head should be just off of the bench. 

2. Grasp one end of the dumbbell with your palms facing the ceiling, so that you form a diamond between the thumbs and fingers of each hand (one hand completes one-half of the diamond). Position the inside plates of one end of a dumbbell against the palms of your hands, so the shaft of the dumbbell sits in the “diamond” created by your hands. Lift the dumbbell over the chest; this is your starting and finishing position.

3. Straighten the elbow joints, then slowly lower the dumbbell from a position that is over your chest, to an arc that moves backwards over your head and then behind your neck. Drop your hips towards the floor as the weight goes over your head to increase the stretch of your rib cage.

4. Stop the descent of the dumbbell when your upper arm forms a straight line through the shoulder to the armpit. Keep the elbows locked as you lower the weight. 

5. In the lowest position, your triceps should be in the same plane as your nose. From this position, slowly raise the weight in an arc back over your chest to the starting position. 

6. You should inhale forcefully while you are lowering the dumbbell behind your head and towards the floor.⁷ Forcefully exhale near the top of the movement, when the weight is over the chest.⁷

Ensure that the motion of the dumbbells is slow and controlled to minimize the stress of the delicate rotator cuff muscles of the shoulder. Similarly ensure that you finish with the weight over your chest and never lower the weight on the floor behind your head because this will place excessive stress on your rotator cuff muscles.

The serratus anterior muscles are activated as the arms are being lowered, because the scapula is protracted during this phase. The lower fibers of the pectoralis major and the latissimus dorsi muscles are hammered as well during the upward trajectory of the dumbbell. Even the rectus abdominis and oblique muscles of the abdomen are recruited during the upward movement of the dumbbell. The costal cartilages that attach the ribs to the sternum are stretched as the dumbbells are lowered and this stretch is increased as the hips are lowered. You will quickly find that old school straight-arm dumbbell pullovers will make a huge impact on achieving unprecedented torso depth and chest circumference for a superior upper body.

References:

1. Marchetti PH, Uchida MC: Effects of the pullover exercise on the pectoralis major and latissimus dorsi muscles as evaluated by EMG. J Appl Biomech 2011;27:380-384.

2. Moore, K.L. and A.F. Dalley II. Clinically oriented Anatomy. Fourth Edition. Baltimore, Lippincott Williams & Williams, 1999; pp. 690-697.

3. Agur, AMR and MJ Lee. “Grant’s Atlas of Anatomy.” Tenth Edition. Philadelphia. Lippincott Williams & Wilkins 1999; pp. 442-453.

4. Ha SM, Kwon OY, Cynn HS et al: Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. Phys Ther Sport 2012;13:227-232.

5. Chelly MS, Hermassi S, Shephard RJ: Relationships between power and strength of the upper and lower limb muscles and throwing velocity in male handball players. J Strength Cond Res 2010;24:1480-1487.

6. Andersen CH, Zebis MK, Saervoll C et al: Scapular muscle activity from selected strengthening exercises performed at low and high intensities. J Strength Cond Res 2012;26:2408-2416.

7. Caruana-Montaldo B; Gleeson K; Zwillich C: The control of breathing in clinical practice. Chest 2000; 117: 205-25.

TRIGGER POINT THERAPY - THORACIC OUTLET SYNDROME

 

Thoracic outlet syndrome (TOS) is a frequently overlooked peripheral nerve compression or tension event that is often difficult to diagnose - but can respond surprisingly fast to trigger point therapy.

TOS occurs when nerves and/or blood vessels become compressed in their passageway through the thoracic outlet which sits between your collarbone and first rib. The thoracic outlet is surrounded by bone, muscle and other tissues. Movement or enlargement of these tissues near the thoracic outlet as a result of conditions such as cervical rib, tumours in the chest, muscle enlargement and weight gain, may lead to TOS. These conditions may cause the collarbone to slip putting pressure on the blood vessels and nerves that sit underneath it leading to TOS.

TOS is one of a group of conditions that cause pain into the arm hand and fingers. Not everyone is too aware of TOS and it's not unusual for clients to work their way through a number of visits to doctors and therapists by the time they receive a confirmed TOS diagnosis.

The symptoms of TOS can be really disturbing and cause much anxiety (which doesn’t help). There are generally two types of TOS – one is an unmistakable blockage pressure (organic) to the nerves or blood supply and the other is a functional or temporary pressure issue. This functional group tends to respond very well to trigger point self-help techniques. That’s because functional TOS results from a combination of poor rib mechanics and tight muscles (especially the Scalenes and Pectoralis Minor) that cause pressure on the neurovascular structures (sometimes called a myogenic plexopathy).

TOS and Trigger Point Therapy

Trigger points can develop in muscles for a number of reasons especially overuse. When present they cause the host muscle to be shorter, tighter and tenser and they also add to the cycle of increased input to the peripheral and central nervous system. With TOS, the results of trigger point therapy can be startlingly fast; will almost always provide relief; and accelerate well being.

As is usually the case with trigger point therapy, the hands-on treatment is likely to be most effective when combined with correct stretching and strengthening exercises. When treating TOS, these typically include neck stretching, ulnar glides, upper trapezius and pectoralis stretching, back mobilisation, and rhomboid strengthening. Self treatment with pressure tools can also be very effective. See examples below:

Self Help - Subclavius

Self Help - Infraspinatus

Self Help - Infraspinatus 

Self Help - Pectoralis Minor