The Shoulder Genie – Eric Cressey’s Seminar at Vigor Ground (Part 1)

If you magically found a Genie in a bottle and one of your wishes was to understand the shoulder and have the knowledge to best assess it, train it for optimal performance while getting rid of nagging pains in the process; then you’d ask the Genie to make Eric Cressey appear.

We didn’t have a Genie but a strategically planned trip to Seattle did the trick and Vigor Ground was fortunate to make him “appear” and drop serious knowledge on everything shoulder.

I’m not sure if he traveled like that

It was great to see 130+ professionals (we had to shut registration down early as it filled up so fast!), from trainers, strength coaches, chiropractors, physical therapists, manual therapists, come out to become better at their craft. The Northwest definitely has a lot of people that are thirsty for more knowledge and I’ll make sure we continue to bring the best of the best to Seattle.

I didn’t just write to tell you how awesome it was but rather what I learned, reinforced and the biggest insights that I feel will help you look at the shoulder in a different light, especially when it comes to assessing it, creating a great foundation for its optimal functioning and being able to see what is best for your (or your client’s) shoulder.

I learn well with bullet point or numbers; you know, little kid style.

That is why we’ll go with numbers (and pictures).

Some of the point will be general while others will be more specific. All of them will hopefully give you a better understanding of how to assess, program, and treat the shoulder.

Here we go...

#1. Imaging doesn’t tell us everything.

Even though imaging may be recommended with certain shoulder injuries, it doesn’t tell us everything. What it doesn’t tell us is:

• How the shoulder currently functions
• How the rest of the body interacts with the shoulder (and influences its position and function)
• What “subclinical” issues may also be present
• What it means for shoulder movement quality when there is soft tissue restrictions
• How lax the client is

Just looking at imaging can be far from the whole picture of what is actually going on.

This has a lot to do with the misinterpretation of the word “pathology.”

Inefficiency and pathology may be the same thing, especially when you look at the dictionary definition: “any deviation from a healthy, normal, or efficient condition.”

This is something that I personally dealt with when I had a serious back injury. I actually decided not to undergo MRI based on conversations with some really smart people (including Eric). Just because you have a disc hernia, slippage, doesn’t mean that is the cause of the pain (over 80% of people have one yet less than 30% are symptomatic with pain). If you address the other factors such as tissue quality, joint position, mobility, stability, strength, etc.

Here’s some studies from The Lancet2009;373 (9662), 463-472 that go in line with some of my thoughts:

“Lumbar imaging for low back pain without indications of serious underlying conditions does not improve clinical outcomes.”

Also...

“Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or sub-acute low back pain and without features suggesting a serious underlying condition.”

I’m referencing these findings because I dealt with a serious back injury and was pushed to do imaging instantly (which I declined) and also had a surgery “appointment” scheduled within weeks, which I did not go to as I opted for the rehab route.

There are many similarities with the shoulder and there should be more effort in addressing inefficiencies (both of the shoulder and other factors that influence its function) rather than just focusing on pathologies.

#2. Focus on correcting the inefficiency.

You can’t really go wrong with your focus being on correcting the inefficiency. When you do that then you will significantly reduce the likelihood of the tissues reaching threshold and creating the “pathologies.”

Starts of with a thorough assessment and understanding the populations(s) you work with and the specific norms for them. Also remember something I will drill in over and over again (as repetition will hopefully make you remember it better) – the site of the pain many times isn’t the source of the problem.

If you want to become very good at assessments and understand which way to go about correcting inefficiency I’d highly recommend the following resources:

• Assess and Correct
• Optimal Shoulder Performance
• Functional Stability Training – Core

#3. Understand the law of repetitive motion.

There is a formula for injury and thus also a formula to reverse the effects of damaging repetitive motion.

I = N x F/A x R

I = Injury
N = Number of repetitions
F = Force or tension of each repetition as a percent of maximum muscle strength
A = Amplitude of each repetition
R = Relaxation time between repetitions (lack of pressure or tension on the tissue)

In this equation the injury equals the number of repetitions multiplied by the frequency of those repetitions, divided by the amplitude of each repetition times the rest interval.

With a little understanding of the equation and the factors in it we can influence our lifestyle and training to stay under the injury threshold and that way get more results as we’re pain free and can be consistent with training.

I explain the law of repetitive motion a little more in depth in this 12 minute video I shot for you with some examples that should give you a better idea how to apply it now.

Some laws are not meant to be broken. This is one of them!

#4. The BIGGER picture – looking at multiple shoulder health factors.

As trainers we overlook (sometimes it’s just that you “don’t know what you don’t know” – my solution for this is to make it a priority that you do know) how many things influence shoulder health.

I strongly advise you have a great, trusted referral network of physical and manual therapists that you are on the same page on, so you can refer out when necessary. With that said here are 12 factors that influence shoulder health and quite a number we can address with a great training program and coaching that is catered to the specific client.

• Overuse
• Rotator Cuff Weakness
• Scapular Stability
• Poor Glenohumeral ROM
• Soft Tissue Restrictions
• Poor Thoracic Mobility
• Type 3 Acromion
• Poor Exercise Technique
• Poor Cervical Spine Function
• Opposite Hip/Ankle Restrictions
• Poor Structural Balance in Programming
• Faulty Breathing Patterns

Looking at all of the above is the way to go as then we can truly assess what may be creating issues and/or what to address for optimal function.

#5. Look at the shoulder in 3D.

Most people just look at front to back shoulder balance and don’t have a second thought about top to bottom balance.
Do you have enough scapula upward rotation? Are your lats very tight or is it your traps that are overactive? How about your rib cage position?

This is one of the reasons that some shoulder issues go unsolved, as they are not being looked at from all angles.

#6. Work proximal to distal with shoulder programs.

Looking directly at the shoulder when we haven’t checked the positioning of the spine makes the assessment of the shoulder ineffective.

Start with creating core control to keep the spine in neutral, along with thoracic rotation if you can see anterior rib flare (it will most likely be on the left side in shoulder flexion) or posterior rib hump (this will most likely be on the right side and you can check it during the toe touch). It would look like this in an assessment:

Left anterior rib flare; right posterior rib hump

Once you have the person in the neutral position at the spine and rib cage then you can assess the shoulder and figure out how their scapular stabilizers and rotator cuff function.

#7. Stiff lats means (there should be) a stiff core.

For healthy shoulders there needs to be good (good meaning the rib cage is neutral alignment) anterior core stiffness during shoulder flexion. If you have stiff lats, then you need to have good anterior core control/stiffness during shoulder flexion so that it can overpower the lats while putting your arms overhead and being to able to maintain stable core. If your lats are also short then you need both anterior core control as well as some serious soft tissue work on your lats (you might want to work on the triceps while you’re at it too).

With that said, you should most likely do these two things:

1. Improve your anterior core stiffness. Just remember that it may have to be worked on from the ground up. So start from the ground and work your way up. Here is how you would progress it:

Prone/Supine --> Quadruped --> Half/Tall Kneeling Vertical

A great drill to start with in the prone supine category is the “dead bug”:

2. Improve soft-tissue quality of your lats, triceps, inferior capsule, etc. (manual therapy such as ART, Graston, or something like dry needling is best BUT you should make sure you do your foam roll/lacrosse ball, etc. daily).

#8. “Where do you feel it”?

Clients tend to do what we tell them most of the time (at least while we’re coaching them) even if things don’t feel right or feel “funny.” They don’t know any better whether that is what they should feel and many times won’t ask you for fear of it being a dumb question.

With that said, a great question to always ask is “where do you feel this?” If they feel it in the right places and are asymptomatic (no pain), it’s most likely good form. You also want to be able to get feedback on what they feel such as pinching, tightness, unstable, stretching, sore, etc. and not just whether there is pain or no pain. This helps you make adjustments as you are coaching the client.

#9. Should you press overhead or not?

If you cannot pass a back to wall shoulder flexion test with flying colors then there are certain things you shouldn’t be doing:

• Pressing
• Snatching
• Anything overhead for that matter

Here is the back to wall shoulder flexion test explained by Eric:

In this situation I like to get clients doing half and tall kneeling core trainer presses as they train the shoulders as well as being able to train the core in regression (remember the progressions for core training I wrote in point #7).

Once again I have to split this up into two parts since Eric was dropping so much knowledge I couldn’t put it into just one article (or it would be reeeaaalllll long).

If you can take just some of these lessons and start applying them to yourself and/or to the clients you train, you’ll improve shoulder performance.

Key word – apply!

Get to work and be on the look out for part 2 with another ten lessons from Eric Cressey’s Shoulder Seminar.