Shoulder Pain with Pressing Exercises

Today’s Thursday Throwback is one of my most popular posts ever. This post gained traction quickly as it discusses the largest underlying factor in why so many athletes and lifters alike get shoulder pain while benching and doing other pressing exercises.

Since this post was first published over 3 years ago, I’ve continued to emphasize the importance of having some sort of screen to pre-qualify yourself (or your athletes) for specific exercises, and the necessity of having a system to make program changes if a specific exercise is not a good fit for an athlete. This is the system I use at Endeavor: Optimizing Movement

Enjoy the post and if you know anyone that has experienced shoulder pain while benching or doing push-ups, please share this with them!

Shoulder Pain with Pressing Exercises

Last week I got an email from my step sister saying that she’s been getting shoulder pain during bench pressing and dumbbell raising exercises. I had a similar conversation with a hockey parent a week before about one of his son’s teammates. In both cases, it’d be impossible for me to say with 100% confidence that I know exactly why they’re in pain and what they can do to fix it. As you know, non-traumatic pain tends to be multi-factorial and necessitates considerations to static and dynamic postures. In other words, how we hold ourselves throughout the day and how we move plays a large role in soft-tissue overload.

With that said, I’d bet my car (an estimated value of $137), that in both of these cases, the bench press is performed with a similar fault – the elbows are out too wide. Let’s walk through this:

It’s somewhat hard to tell from this picture, but my elbows are approaching 90 degrees off my side. In other words, my upper arm and the side of my rib cage form about a 90 degree angle. This puts a tremendous amount of stress on the anterior shoulder capsule at the bottom of the lift. It also increases the risk of having the glenohumeral head impinging on the structures superior to it.

Ligaments of the shoulder

The picture above illustrates the ligaments of the shoulder. As you approach the bottom of a bench press with your elbows flared out, it tends to put excessive stretch on the IGHL and MGHL ligaments displayed above and increases the chances of impinging the ligaments and tendons between the acromion and glenohumeral head (long head of biceps brachii tendon and subacromial bursa are two notables).

The same is true for push-ups, although there tend to be some other differences between bench pressing and doing push-ups. For instance, push-ups allow free movement of the scapulae, allowing the shoulder a bit more freedom than during bench pressing, which may delay the onset of pain from resulting from the elbows being out too wide. Of course, because your body isn’t supported by a bench during a push-up, it also means more freedom of movement for other joints; as a result, it’s common to see people with sagging hips, excessively arching backs and protruding chins (or what I call “bird neck syndrome” or BNS).

Brutal Push-Up…but decent display of BNS

In both exercises, the goal is to keep the elbows within 45 degrees off the side of the body and to retract the scapulae (squeeze the shoulder blades back and down) as you go down. Because the scapulae aren’t free to move during a bench press, it’s important to set up on the bench with your scapulae in the correct position, packed back and down, and to keep them there throughout the movement.

Bench Press with correct positioning

With push-ups, the shoulder blades aren’t wedged between your rib cage and the bench so they can move freely. When going down in a push-up, think of pulling your chest down to the floor and pulling your shoulder blades back and down along the way.

Push-Up with proper technique. Notice how the hands are beneath the shoulders, the elbows are within 45 degrees of the sides of the body and the chin is tucked back.

If you already have shoulder pain, it may be best to back off the pressing exercises for a week or two and focus more on rowing exercises, emphasizing pulling the shoulder blades back and down as you pull the weight toward your chest. If it’s not that bad, the floor press is a great exercise to reteach a proper pressing pattern while limiting the stress on the shoulder because of the decrease in range of motion.

Dumbbell Floor Press

With regards to push-ups, I think most of the problem comes from people assuming they can do push-ups on the ground right away. This stems back to an interesting paradox in youth training, where there is still the perception that lifting weights is dangerous but people are free to do as many push-ups as they want. In reality, I’ve come across very few athletes 14 and under that can do a single push-up the correct way on the floor. As with any exercise, it’s important to progress the loading as the individual develops the strength to perform it correctly. In this case, the overwhelming majority of people need to start performing push-ups on an inclined surface and focus on proper body positioning and proper movement (e.g. moving as a unit connected from ears to ankles, descending so that the lower chest is the first region to touch the ground or raised implement and keeping the elbows within 45 degrees of the side). As people progress in strength, you simply lower the implement closer and closer to the ground.

At Endeavor, we use the safety bars in our squat racks to accomplish this. This way it’s easy for us to objectively assess progress as each level is numbered. As the athlete gets stronger, they approach higher and higher numbers as the bar lowers closer to the ground.

Incline Push-Up

In a team off-ice training setting (especially with younger teams), this can be tough. In these situations, I’m more apt to use our jump boxes, which are set at heights of 24, 18, and 12 inches. Using these, I can start everyone at the top box and progress them lower on an individual basis as they demonstrate sufficient strength. If someone mastered the 18″ box, but isn’t quite ready for the 12″, you can just lengthen the negative or “going down” phase of every rep to make it a bit tougher.

Pressing movements are an essential part of any person’s training program. Unfortunately, they’re also one of the most common causes of upper body pain. Making the simple corrections discussed above will help make you stronger than ever, while keeping you pain free!

To your success,

Kevin Neeld
OptimizingMovement.com
UltimateHockeyTraining.com
HockeyTransformation.com

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This may be why you’re not playing…

A few years ago I had a really interesting conversation with one of our D1 hockey players at Endeavor.

It was his first Summer with us so I didn’t know much about him, but the report I got was that his coaches felt he was extremely skilled, but too fat, slow, and lazy to contribute a significant role on their team.

After spending some time with him, he wasn’t really fat at all (~12% body fat), he WAS definitely slow, and I think “lazy” wasn’t as true a descriptor as “laid back”.

He also prided himself on playing “smart” and not being one of those players that just ran around all over the ice.

This is a tough combination of qualities to overcome as a player.

Here’s the thing…if you’re 12% body fat, but you’re one of the fastest players one your team, you’re less likely to be perceived as “over fat” and even less likely to be perceived as lazy. If you’re fat and slow, but one of those players that brings an intense, focused look to every practice (e.g. not a laid back, joking personality), you won’t be interpreted as lazy either. Players that constantly move their feet and “run around all over the ice” may not be making the best use of their energy, but they certainly won’t be thought of as lazy.

But if you have a slightly higher body fat than the team average (most colleges look for <10%), you’re not fast, and you have a laid back personality, it’s hard to interpret you as anything except lazy, even if that’s not actually the case.

The reality is that players at every level bring different strengths and weaknesses to the team, based largely on their developed skill sets and genetic make up. And while I firmly believe every player can (and should) get faster, not every player on a team can be the fastest. This, however, rarely limits a player’s playing time on a team. In combination with the perception of him being lazy, though, will certainly send the wrong message to the coach and is likely to limit playing opportunities.

The reason I’m telling this story is because I think it’s important for players to understand how they may be perceived by their coaches (and even their teammates), even if…or especially if it’s not how they perceive themselves.

As I’ve talked about in the past (See: Play the Underdog), body language matters. So does how you respond to your coach’s feedback.

With this in mind, here are three common things youth players do, how these actions are likely to be interpreted by the coach, and how you can make subtle adjustments to improve the coach’s perception of your character. .

1) Action: Rolling your eyes while tilting your head back

Interpretation: I have no interest in your feedback and would rather continue doing things my way then even listen to what you’re telling me, let alone try your suggestion. Simply, I’m not coachable.

One of the few times I’d suggest not following Iron Man’s lead (Image from: EvilEnglish.net)

Better Action: Look the coach in the eye and just listen.

2) Action: Saying “I know!” or “I can’t…”

Interpretation 1: I’m quick to speak, but slow to listen. I think I already know what you’re telling me, despite my actions showing the opposite.

Interpretation 2: I’d rather give up then go through the uncomfortable process of improving.

Better Action: Look the coach int he eye and listen. When he/she is finished speaking, say “I’ll try that. Thank you.”

3) Sitting down/slouching at every opportunity

Interpretation: I’m tired and not ready to go.

Better Action in a training setting: Walk around and help spot/encourage teammates and clean up weights/equipment.

Better Action in game setting: Stand up, but if you must sit, stay engaged with the game. Anytime the coach looks your way, you want to look like you’re ready to go.

Wrap Up

These are very basic ideas, but making the subtle adjustments suggested above will make a huge impact on how your perceived by your coaches and teammates (For more tips on being a great teammate, click here: 10 Qualities of GREAT Teammates). A lot of this comes down to the two simple habits of being respectful and being engaged.

One of the greatest compliments someone can pay an athlete is to say that he/she is very “coachable”. Following the tips above will help you be just that. The best part is that it’s 100% within your control. Decide to be coachable and it’ll have a positive impact not only on the rest of your athletic career, but the rest of your life as you transition into the “real world” and have bosses instead of coaches, and coworkers instead of teammates.

To your success,

Kevin Neeld
HockeyTransformation.com
OptimizingMovement.com
UltimateHockeyTraining.com

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“Kevin Neeld is one of the top 5-6 strength and conditioning coaches in the ice hockey world.”
– Mike Boyle, Head S&C Coach, US Women’s Olympic Team

“…if you want to be the best, Kevin is the one you have to train with”
– Brijesh Patel, Head S&C Coach, Quinnipiac University

Sports Nutrition Tip: Slow and Steady Wins the Race

Today I have another awesome sports nutrition tip from Brian St. Pierre, who authored the Nutrition Guide for my new program Ultimate Hockey Transformation. Enjoy! – KN

Tip #2: Slow and Steady Wins the Race

Have you ever missed out on accomplishing a goal or task because you were overwhelmed? Maybe you had too much information to sort through or tried to do too much at once.

If so, I’d like to share a powerful principle with you – one that can increase your chances of success.

And not just a little. If you apply the principles discussed here, your chances will skyrocket from less than 35% to greater than 80%.

That’s the difference between: “maybe this will work” and “this is totally gonna happen.”

The principle I want to share today is one that I use very comprehensively with my own clients.

And the principle is called: habit based coaching. So, what is habit-based coaching?

Well, it’s the commitment to a single, but immensely important idea: Focusing on less helps you achieve more.

What it all comes down to is this. In a world full of distracting “technologies”, “novelties”, “cutting edge resources”, and “gadgets”, one thing ALWAYS rules: the application of basic habits.

Research and experience with thousands of clients – “regular” folks, high school athletes, and professional athletes alike – has taught me that this is the best approach.

The key is to go slow and steady for long-lasting success.

Select only one habit at a time. You can choose any habit you want, whatever you think will have the biggest impact on your life. Or follow the monthly tips that will follow this one. Simply choose one habit per month (at most every 2 weeks).
Write this habit down. Put it on post it notes, or use iPhone reminders to help you do it each day.
Tell people you are doing this habit. This helps to provide social support, and social accountability.
Track your consistency daily. It’s not about perfection, simply progress over the long haul. You won’t get it 100% right every single day, and that is okay. Just aim to get better day by day, with the occasional hiccup, until you have that habit down pat.
Only then do you move on to your next habit.

Image Credit: OneSocialMedia.com

I know this may sound slow, or even boring. It is definitely more exciting to make big sweeping changes.

But here’s the thing – those big sweeping changes rarely last. There is too much change all at once, and nothing sticks. Instead, by just making one change at a time, you allow for that new habit to simply become what you do everyday.

Then, and only then, you add on a new habit. Before you know it, you will have radically changed the way you eat and think, will be fitter, healthier and performing at a higher level, and doing so in a sustainable manner.

So remember, slow and steady wins the race. Practice one new habit at a time, and you will change your life.

-Brian St. Pierre, MS, RD, CSCS, CISSN, PN1

P.S. For more information on how to get a copy of Brian’s incredible hockey nutrition resource, click here: Ultimate Hockey Transformation

Brian is a Registered Dietitian and received his Bachelor’s in Human Nutrition and Dietetics from the University of Maine, where he also received his Master’s in Food Science and Human Nutrition. He is a Certified Sports Nutritionist as well as a Certified Strength and Conditioning Specialist.

Brian worked for three years at Cressey Performance as the head Sports Nutritionist and as a Strength and Conditioning Coach, working with hundreds of athletes and recreational exercisers of all types. During this time, he also authored the High Performance Handbook Nutrition Guide, Show and Go Nutrition Guide, Ultimate Hockey Nutrition and dozens of articles for publication.

Nowadays, he works closely with Dr. John Berardi as a full-time coach and a nutrition educator at Precision Nutrition. In particular, working closely with our elite athletes and fitness professionals. As part of the Precision Nutrition mission, he helps to deliver life-changing, research-driven nutrition coaching for everyone.

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Year-round age-specific hockey training programs complete with a comprehensive instructional video database!

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“Kevin Neeld is one of the top 5-6 strength and conditioning coaches in the ice hockey world.”
– Mike Boyle, Head S&C Coach, US Women’s Olympic Team

“…if you want to be the best, Kevin is the one you have to train with”
– Brijesh Patel, Head S&C Coach, Quinnipiac University

The Myth of Core Stability

Today’s Thursday Throwback takes us back to 2010, when a controversial article questioning the benefits of “core stability” training was published. The post discusses what core stability really means, and the most effective progression we’ve found to not only minimize injury risk, but also to improve performance in athletic settings.

We still use variations of the exercises presented in the videos below. They’re incredibly challenging, which our guys really enjoy. Give them a shot the next time you’re in the gym with a partner.

Enjoy!

The Myth of Core Stability

Few people would argue that core training is an integral part of an athletic development training program. Aesthetic benefits aside, core training is widely accepted as improving:

Lumbar stability and therefore reducing risk and/or symptoms of low back pain
Force transfer between the lower and upper body, which improves power in just about every athletic movement (kicking a soccer ball, swinging a bat, lacrosse and hockey shooting, fighting off defenders in every contact sport)
Stability of the pelvis to allow for more efficient lower body movements, such as rapidly changing direction

Because of the core’s importance in both maximizing performance and minimizing injury risk, core stabilization concepts are one of the underlying foundations of all of our training programs at Endeavor. If you’ve been following my site for a while you know that I do my best to actively seek out new information to better design programs to help our athletes. Last week I came across a draft of an article from Eyal Lederman, a professor in London, titled “The Myth of Core Stability.” I’m always intrigued by articles that argue against the norm as these are usually the most eye opening.

Lederman argued that the evidence in support of core stability training to back pain is pretty limited. He notes that strength may not be the issue since some of the major core muscles are minimally active during activities of daily living. As a quick background, muscles become “active” when the body sends an electrical signal to the muscle to contract. For study purposes, the signal is often “normalized” to a maximal value for that muscle (MVC). When we talk about these “maximal” values, we need to keep in mind that maximum activation is highly dependent upon the length of the muscle and direction of the movement, but I won’t bore you with all the underlying neuroscience.

The article cites research demonstrating that walking necessitates average values of:

2% MVC from the rectus abdominis (the six pack muscle)
5% MVC from the external obliques

Further research is cited painting the picture that normal activities (even some with external loads added) require minimal trunk muscle activity (between 1-5% MVC).

The underlying tone of the article was that core stability training is foolish and scientifically unsupported. I bring up this article because many times these things work their way to your eyes and ears through the media with headlines like “Core Training Is Not Important” as some staff writer attempts to create an interesting story with out-of-context research. Within an athletic context, there are a few things worth keeping in mind:

The article cites trunk activity during walking and standing, not hockey-relevant movements like skating, changing directions, shooting, taking hits, etc.
The article is put within the frame of solving back pain, not optimizing performance
The article largely ignores evidence of active people with back pain resolving symptoms by putting a greater focus on improving their posture and core stability
Like many academics, this article systematically (although using flawed logic) dismisses many commonly held beliefs about core training, but fails to offer any alternative

At Endeavor Sports Performance, our core training system functions to integrate appropriate mobility and stability of the pelvis and spine into athletic movements. We follow a basic progression of:

Reinforce core stability in static positions (front planks, side planks, glute bridges, anti-rotation belly press isoholds, etc.)
Increase challenge to static core stability by adding a dynamic component (chop and lift variations, plank and bridge “marches”, rollouts, tight rotations, 2-Way Bunkie side planks, dynamic anti-rotation belly press’, etc.)
Maximize unexpected dynamic stiffness through perturbation training (Split stance belly press with perturbation, overhead stability ball perturbation, squat with overhead stability ball perturbation, split squat with overhead stability ball perturbation, stability ball front plank with perturbation, side plank with perturbation, etc.)

While I think most people are at least loosely familiar with the first two steps of this progression, few athletes have been exposed to perturbation training. I strongly believe this type of training will drastically increase in popularity over the next several years. Check out videos of a couple of the more advanced progressions of perturbation training below. Have you ever seen anything like this?

Split Squat IsoHold with Overhead Stability Ball Perturbation

Stability Ball Front Plank with Perturbation

Colby Cohen and Jeff Buvinow do a great demonstrating these exercises. The goal is to not move at all or, more realistically, to minimize the displacement and return to “neutral” as quickly as possible. It’s hard to tell from the video, but I’m really “cranking” on them pretty hard. We progress to more vigorous perturbations, but ultimately we want to challenge their stability in multiple directions. In the first video, I’m randomly alternating amongst pushing, pulling, and rotating the ball in a variety of directions. In the second video, I’m somewhat randomly alternating between rotating the hips, rotating the shoulder, and laterally deviating the hips and shoulders. By creating a random variety of stresses, the athlete learns to reflexively generate stiffness.

To your success,

Kevin Neeld
OptimizingMovement.com
UltimateHockeyTraining.com
HockeyTransformation.com

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“…one of the best DVDs I’ve ever watched”
“A must for anyone interested in coaching and performance!”

Click here for more information >> Optimizing Movement

Is your corrective approach leading to injury

When I was growing up playing hockey, at least once every season I’d have some sort of left groin or hip flexor issue.

None were ever significant enough to keep me off the ice, but they were always enough that I was constantly “aware of it”, which is not where you want your focus going while you’re playing.

I always wondered if there was something I was doing, or not doing, that was causing these injuries.

Now that I’ve made the transition from player to S&C coach, I’m thankful for my long list of injuries as they’ve motivated me to learn more about functional anatomy, biomechanics, and a number of other injury risk factors.

Naturally, one of the major goals of every program I write is to reduce my athletes’ risk of injury. As a result, it’s important to understand what factors may predispose an athlete to injuries in the first place, and then make decisions about what I have the ability to influence.

With the increasing popularity of PRI and FMS courses over the last several years, a lot of attention is being paid to the potential for faulty movement patterns to contribute to breakdown. This is obviously an area I subscribe to, as I’ve taken FMS Level 1&2, the SFMA course, and spent over 100 hours in PRI courses, in addition to becoming PRT-credentialed a couple years ago.

With that said, purely postural/biomechanical approaches to injury risk have been appropriately questioned in the research, as these are really just one piece of the puzzle. In an effort to perfect movement, coaches may be inadvertently increasing their athletes’ risk of injury.

Identifying Injury Risk Factors

The most effective approach to injury risk reduction is to attack it from all angles. While this topic can get pretty complex, I generally think of risk factors as falling into these major buckets:

Postural/Biomechanical: Determines length/tension relationships, how mechanical stress is distributed during movement, and movement efficiency in general
Neuromuscular Abilities: Force production, rate of force development, and timing of force production
Conditioning/Fitness: The ability to repeat the sport-specific movement demands at a consistently high level and recover appropriately, both in a short-term perspective following a work bout, and at the conclusion of a training session/practice/game
Stress Tolerance: The resiliency of the body to the accumulation of stressors from within and outside the training/sports paradigm. This also determines the individual’s adaptation capacity at any given period of time
Accumulated Fatigue: Related to stress tolerance; influences all of the above factors

Each of these areas is an important contributor to injury risk and needs to be considered in a training program.

When Corrective Exercise Goes Wrong

A couple years ago, I remember hearing people talk about how some personal trainers and strength coaches were taking some of these movement-based courses and basically not letting their clients/athletes do anything except corrective work until they met some standard. At the time, as I would now, I remember thinking “people actually do that?”

As time has gone by, I realize this is more common than I would have ever thought.

If you come back to the list above, focusing on movement capacity to the exclusion of other qualities will only improve that one injury risk factor. An argument can be made (that I’d agree with) that improving movement quality can improve stress tolerance by reducing unnecessary tension/tone resulting from a compensatory attempt to produce the desired movement, but not to the same degree that also addressing fitness/conditioning and accumulated fatigue would.

Probably the biggest oversight in an overly “corrective” approach is that the athletes actually detrain. Having slow, weak, and poorly conditioned athletes that move well doesn’t only neglect many key areas of injury prevention, it makes them worse at their sport.

A Better System

Even in the presence of movement limitations, athletes need to train to improve, or at least maintain, their performance capacities. The key here is to pick exercises and methods that are best suited for the athletes based on their current movement abilities. This is one of the major topics I discussed in in my DVD Optimizing Movement, as having a system for what to do in the presence of specific movement limitations makes it easy to individualize training, even in a group or team setting.

Assessing factors that influence movement, and demonstrating how to use them to drive your training approach

It’s important to recognize that slow, weak, poorly conditioned, stressed out, and/or tired athletes are all at a greater risk for injury. With this in mind, training programs should be designed to develop physical capacities using individual-specific exercises/methods while also improving notable movement limitations, with coaches monitoring stress and accumulated fatigue to make any necessary adjustments to training loads or recovery strategies on an ongoing basis.

Wrap Up

Looking back on my own injuries, I can remember that some happened when I just didn’t feel right (possibly an alignment issue), some were the result of overuse, and others were simply because I was too weak.

As strength and conditioning coaches, our job is to deliver highly trained, injury resistant athletes to our coaches. As more emphasis is placed on assessments and corrective work, it’s important to not lose site of the importance of continuing to develop the speed, power, strength, and conditioning of our athletes, while also monitoring fatigue. Ultimately, a more comprehensive approach will not only improve their durability, but also their performance.

To your success,

Kevin Neeld
OptimizingMovement.com
UltimateHockeyTraining.com

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“…one of the best DVDs I’ve ever watched”
“A must for anyone interested in coaching and performance!”