Cross Fit – Is It Killing You??

Cross Fit Box jump
(Courtesy of Freedigitalphotos.net)

 

CROSS FIT 101

First of all, you need to understand the difference between aerobic and anaerobic exercise. Aerobic exercise requires oxygen, is low powered and lasts for greater than 15-20 minutes. Anaerobic exercise, like Cross Fit, does not require oxygen, is high powered and each exercise lasts less than 2 minutes.

The Positives: Recent studies have shown that anaerobic exercise is a vastly superior protocol for fat burning than it’s less intense aerobic counterpart. There is evidence that shows that anaerobic exercise is evenly matched to aerobic exercise with regard to cardiovascular benefits.  Check out the evidence in an article in the Journal of Strength and Conditioning. More evidence that comparable calorie burning effects can be achieved in half the time with anaerobic exercise.

The Negatives: Potential for INJURY! The article in the Journal of Strength and Conditioning also states that 16% of the participants dropped out due to “injury or overuse”. In addition, in 2011, the U.S. military, in conjunction with the American College of Sorts Medicine, advised soldiers to avoid CrossFit, citing “disproportionate musculo-skeletal injury risk.” You can read it HERE. In 2009, the US Military was encouraging training programs such as CrossFit. You can read it HERE. So what happened?

CrossFit goes out of its way to warn people that if they can’t maintain proper technique, they should back off. After all, the CrossFit mantra is “Mechanics, Consistency, Intensity”. Backing off , however, is a hard sell for many participants because workouts are viewed as a competition. The 2009 US Military study states that “Properly trained coaches are fundamentally important in both establishing an effective training program and developing proper movement mechanics in athletes.” It sounds like something, or someone, went wrong between 2009 and 2011.

So I guess the biggest question that you should ask (before joining a local Cross Fit gym) is WHO is running the classes and HOW they are trained. Make sure they at least have Level I or Level II Cross Fit training. A power lifting background is very helpful as power lifters are obsessive about proper form. Make sure you observe a class or two to witness how or if the instructor is scrutinizing and ensuring proper form. The proof is in the puddin’.

So BEWARE!!

Life is Sometimes “A Pain in the Neck!”

I think that most of you would agree that life is sometimes a “pain in the neck”!  The source of the pain is usually multi-factorial and may include such things as emotional stress, muscle weakness, history of trauma, arthritis, herniated discs, and/or poor posture, let alone the screaming child (or boss!)  thrown on top of that. Yikes!!  Of course, as many of you have experienced, there are many different physical therapy and medical approaches to treating neck pain.  So what does the research tell us about the most effective physical therapy treatments?  In 2002, a systematic analysis of studies (performed up to that date) showed that passive physical therapy modalities such as ultrasound, heat, electrical stimulation were ineffective in the treatment of chronic neck pain in the long term. Basically, only temporary relief.

Can 2 minutes a day of exercise decrease your neck pain?  How many of you experience neck or shoulder pain after using your computers? A study in Denmark evaluated 198 office workers with chronic neck and shoulder pain. The subjects were randomly assigned to either a non-exercising control group, a 2-minute exercise group, or a 12-minute exercise group. The exercise groups performed a lateral raise in the scapular plane to 90 degrees with elastic tubing. The exercises were performed 5 days per week for 10 weeks. After 10 weeks, both exercise groups significantly reduced their neck/shoulder pain and tenderness, and significantly increased their strength compared to the control group. The interesting thing about this study is that there were no differences between the 2 min and 12 min groups.  The conclusion is that only 2 minutes (to failure) of the prescribed exercise could control your neck pain.

A Finish researcher by the name of Jari Ylinen has performed many controlled studies on neck pain.  He is definitely the GO-TO guy for this research!  He notes that several studies have been performed that show an improvement in neck pain within 5-11 weeks of rehabilitation, but that the results usually disappear 2-3 months later. So what he did was demonstrate how YOU, the neck pain sufferer, could maintain the desired results over a 12 month period. One of his studies in 2003 compared 180 female office workers with chronic, non-specific neck pain.  They were randomized into two different strengthening groups, one consisting of 4-way isometric neck exercises with Tband at 80% effort, and a control group. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises 3 times a week and were educated in proper posture principles. At a 12 month follow-up, neck pain and disability decreased in both groups, yet maximal isometric neck strength had improved 69-110% in the isometric group, only 16-29% in the other strengthening group, and just 7-10% in the control group. Previous studies have shown either no or only temporary gains with active neck training and this study emphasizes the importance of performing your program at least 2x/wk for a solid year to achieve the described results.

For those of you who have a tendency for finding short cuts, read on!  Ylinen in 2008 performed another study comparing the same active neck strength training exercises in the 2003 study to a control group that only performed neck stretches.  At a 12 month follow-up, he found NO statistical differences in neck pain or disability between the groups and only minor changes in strength and mobility. Why? The big difference in this study?  Patient compliance with the strength training decreased to only 1x per week!!  Sound famliar from my Pump You Up post?

So how do you put this all together into a neat package for the BEST  approach to neck pain?  Education is the key.  Number 1, evidence-based exercise will fail if you continue to assume poor posture. Number 2, you need to make time with the time you have. That means choosing the BEST exercises that can be done in a timely fashion and to continue your program 2 times per week. An interdisciplinary group of researchers and clinicians in 2009 reviewed the research to develop a ‘toolkit’ for clinicians to apply the best evidence for treating neck pain. The “Cervical Overview Group” created a clinical practice guideline that includes a therapeutic home exercise program for neck pain. You can view it HERE after signing up for free. In the next four videos, I would like to present 4 evidence-based exercises that incorporate isometric cervical strength training, scapular stabilization exercise, and functional retraining.  Do these and you will take control of your neck pain once and for all!

CERVICAL ISOMETRICS

SCAPTION

ROWS

“W” SQUATS

PUMP YOU UP!!

So how important is resistance training? I have had the privilege of working with one of my peers, a fellow PT, and strength and conditioning specialist, Mike Stare from Spectrum Fitness in Beverly, both professionally as well as personally. Mike helped to redirect MY fitness program while I was recovering from my knee injuries 1.5 years ago. Mike is on top of his game from a fitness training standpoint. He has devoted a lot of time and resources in developing an evidence-based approach to fitness and weight loss in ALL age groups. You can see this for yourself at his website. It is important for clients in a fitness program as well as our patients in physical therapy at OrthoWell to understand HOW to strengthen muscles.

The physiological principle of “overload” is what makes the difference between strength gains and stagnation. Resistance training is hard work! I tell my patients “If it’s easy, then you’re doing something wrong!” Is it true that people will lose 5-10% of muscle strength in every decade of life after the age of 40? Studies have shown that people can retain 100% of their muscle mass and strength from age 40 through their 80s with exercise! (Wrobelski, A. et al. The Phys and Sports Med, Sept 2011) You can read more on the Anti-Aging movement at Mike’s BLOG as well.

However, during exercise, you need to challenge your muscles physiologically. You need to provide a “load” that goes “over” your muscles comfort zone. In order for a muscle (including the heart) to increase strength, it must be gradually stressed by working against a load greater than it is used to. So how do you do this? There are many books and magazines such as Muscle Fitness that advocate all kinds of strategies for maximizing strength and muscle mass. Strength gains can be accomplished by performing a one-repetition maximum as well as via the typical 10 rep set approach. My approach, with the fine-tuning of Mike, is to instruct my patients in 2-3 sets of 8-12 repetitions per exercise. The most important factors to consider are the utilization of proper technique in order to isolate the specific muscle as well as to use the idea of the “loss of technical form” as your maximum output point. By the time you reach the 8-12th rep you should be tiring and on the verge of a loss of technical form. You should not work to fatigue as this will compromise your technique and become a safety concern. Regarding the frequency of strengthening exercise, studies show that strength gains are maximized at a frequency of 2-3x per week. The American College of Sport Medicine (ACSM) recommends working out a MINIMUM of 2x per week at an intensity that is equal to 70-85 percent of your one rep maximum (maximum weight you can use for one rep) for 8-10 reps and 1-3 sets. A program that comprises repetitions over 12 is considered endurance training. For cardiovascular benefits, the ASCM recommends exercising for a frequency of 3-5 times per week, at an intensity equal to 60-85 percent of your maximum heart rate for a time of 20-60 minutes. Research has shown that you’ll get the same beneficial results by exercising at 50-60% of your maximum heart rate that you would get exercising at an intensity 80% of your maximum heart rate.

At OrthoWell, as part of your physical therapy, we get you started on a strengthening program that targets your problem area. Finding the right practitioner to design a complete, individualized fitness program can be a very rewarding thing and Spectrum Fitness is definitely one of our choices. As Mike points out, “If there is one thing to do to improve the quality of life as we age, strength training would be it.”

For our athletes and runners, don’t forget that strength training has been PROVEN to enhance athletic performance. Read the following to get the facts!

-A University of Alabama meta-analysis of the endurance training scientific literature revealed that 10 weeks of resistance training in trained distance runners improves running economy by 8-10%.  For the mathematicians in the crowd, that’s about 20-24 minutes off a four-hour marathon – and likely more if you’re not a well-trained endurance athlete in the first place.

-French researchers found that the addition of two weight-training sessions per week for 14 weeks significantly increased maximal strength and running economy while maintaining peak power in triathletes.  Meanwhile, the control group – which only did endurance training – gained no maximal strength or running economy, and their peak power actually decreased (who do you think would win that all-out sprint at the finish line?).  And, interestingly, the combined endurance with resistance training group saw greater increases in VO2max over the course of the intervention.

-Scientists at the Research Institute for Olympic Sports at the University of Jyvaskyla in Finland found that replacing 32% of regular endurance training volume with explosive resistance training for nine weeks improved 5km times, running economy, VO2max, maximal 20m speed, and performance on a 5-jump test.  With the exception of VO2max, none of these measures improved in the control group that just did endurance training.  How do you think they felt knowing that a good 1/3 of their entire training volume was largely unnecessary, and would have been better spent on other initiatives?

-University of Illinois researchers found that addition of three resistance training sessions for ten weeks improved short-term endurance performance by 11% and 13% during cycling and running, respectively.  Additionally, the researchers noted that “long-term cycling to exhaustion at 80% VO2max increased from 71 to 85 min after the addition of strength training”

Low Back Pain – Part 3 – BEST Evidence-Based Core Exercises!

So what are the BEST evidence-based Core exercises?  

Evidence from random controlled trials of people suffering from low back pain show that core stabilization exercises result in significant improvements in pain and function(5,7) . However, the most effective combination of which muscles to target and which stabilization methods to utilize are still debated(1-11).  One technique that has been suggested is abdominal hallowing or “drawing-in” your navel to activate the transversus abdominis (TrA) muscle.  This technique has been shown to increase the cross-sectional area of the TrA(10), however, many exercise scientists are now advocating a method called “abdominal bracing”(demonstrated in my last post) in which ALL the abdominal muscles are recruited instead of just one(11). It should be the goal of core exercises to activate as many torso muscles as possible in order to ensure spinal stability and to prepare our bodies for the dynamic and often complex movements that occur during our daily activities.  So what does the research say about which exercises activate which muscles the best?

Numerous studies have used EMG to determine the greatest electrical activity of torso muscles during various core stabilization exercises.  In Escamilla et al(3), they used surface or skin electrodes to compare exercises such as traditional crunches, sit-ups, reverse crunches, and hanging knee-ups using straps to exercises using an Ab Roller/ Power Wheel and a device called the Ab Revolutionizer. What they found was that the activation of the upper and lower rectus abdominis(the “washboard” muscle) as well as both the internal and external obliques was the greatest with Power Wheel roll-outs and hanging knee-ups with straps.  Because research indicates that the internal obliques are activated in the same manner(within 15%)  as the tranversus abdominis(3), we can assume that these results apply to the TrA as well. The activation was least with a traditional sit-up!   In Okubo et al(8), they used both surface electrodes and intramuscular fine-wire to compare curl-ups, side planks, front planks, bridges, and bird dogs.  What they found was that the TrA was activated the greatest during front planks with opposite arm and leg raise and that multifidus activation was greatest with bridging.  Although core stabilization exercises should be performed in multiple planes of motion, these two studies highlight the enhanced activation that occurs during “face down” exercises such as front planks and roll outs.

The functional progression of exercises as well as training in all planes of motion are important aspects of OrthoWell’s core stabilization program. Our program will uncover your weaknesses and maximize your strength by progressing through successive levels of difficulty in all directions of movement ie anterior, posterior, lateral, and rotatory. Optimal development of the “local” system ie your functional neutral position and bracing technique(my last post) should occur before attempting to train the “global” or big muscle system.  Unfortunately, most people over-train the global system and need to be re-educated. So be patient as we take you by the “core” and steer you in the BEST, evidence-based direction.

The following videos are examples of some of our functional progressions for each plane of motion(sorry for the  occasional “sideways” view).  I demonstrate a particular exercise and then follow with an exercise of progressive difficulty. Functional progression is very individualized and requires skilled observation to determine competency.  Many thanks to two of my peers, Mike Reinold,PT and Eric Cressey for being very helpful in this regard.

Anterior Core Stabilization Exercises

Anterior/Posterior Core Stabilization Exercises

Posterior Core Stabilization Exercises

Lateral Core Stabilization Exercises

Rotatory Core Stabilization Exercises

1.  Allison GT, Mo4444rris SL, Lay B. Feedforward responses of transversus abdominis are directionally specific and act asymmetrically: Implications for core stability theories. JOSPT. 2008; 38: 228-237.

2. Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. JOSPT. 2007; 37: 754-762.

3. Escamilla RF, Babb E, Dewitt R. Electromyographic analysis of traditional and nontraditional abdominal exercises: Implications for rehabilitation and training. Physical Therapy. 2006; 86: 656-671.

4. Faries MD, Greenwood M. Core Training: Stabilizing the Confusion. Strength and Conditioning Journal. 2007; 29: 10-25.

5. Hall L, Tsao H, MacDonald D. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. Journal of Electromyography and Kinesiology. 2007; 19:763-773.

6. Hides J, Stanton W, McMahon S. Effect of stabilization training of multifidus muscle cross-sectional area among young elite cricketers with low back pain. JOSPT. 2008; 38: 101-108.

7. Hodges P, Kaigle A, Holm S. Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: In Vivo porcine studies. SPINE. 2003; 28: 2594-2601.

8. Okubo Y, Kaneoka K, Imai A. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. JOSPT. 2010; 40: 743-750.

9. Stanford M. Effectiveness of specific lumbar stabilization exercises: A single case study. Journal of Manual and Manipulation Therapy. 2002; 10: 40-46.

10. Critchley, D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing. Physiother. Res.Int. 7:65–75. 2002.

11. Kavic, N., S. Grenier,  S.M. McGill. Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine. 29:1254–1265. 2004a.

 

Low Back Pain -Part 2- Getting Down To The “CORE”

Getting down to the CORE!!

What is your Core?

It is defined as the center or “core” of your body.  It is the “powerhouse” around which all limb movement is performed. It consists of 29 pairs of muscles as well as boney, ligamentous, and discs structures that support the lumbo-pelvic-hip complex in order to stabilize the spine, pelvis, and kinetic chain during functional movements.  In short, it’s pretty important!

 What is the function of the Core?

The core functions to provide both stability and mobility.  It can generate forces in order to complete a sit-up as well as provide spinal stability as you reach your arms overhead.  The muscles that are most important in providing core stability can be divided into two groups:  the primary stabilizers and the secondary stabilizers.  The primary stabilizers are the transversus abdominis in the deep abdominal region and the multifidus muscles which are deep in your back and attach directly to each vertebrae in the spine.  The secondary stabilizers are the obliques in the front, the quadratus lumborum & lumbar paraspinals in the back, the pelvic floor muscles at the bottom, and the diaphragm at the top.

So what does the research say about the Core muscles?

Current research has promoted the transversus abdominis (TrA) and the multifidus as the primary stabilizers of the spine.(1,4,6,8,9)  The TrA is the deepest of the abdominal muscles and, when contracted, it increases tension of the thoraco-lumbar fascia, it increases intra-abdominal pressure, and increases spinal stiffness in order to resist the forces that act upon the spine(4,7) The multifidi span from 1 to 3 vertebral levels and attach one vertebrae directly to another.  As a result, they provide the largest contribution to inter-segmental stability.(4,9) The TrA and multifidus have been found to activate prior to limb movement in order to prepare and stabilize the spine(1,4,9) and it has been shown that the EMG activity of the TrA may be delayed in patients suffering with chronic low back pain (LBP).(7)  The TrA is activated regardless of the direction of trunk or limb movement(4) and this is the reason why performing spinal stabilization exercises in multiple planes of motion can be so effective. A significant reduction in the cross-sectional area ie atrophy of the multifidi as well as poor motor control of the TrA has been associated with patients with acute or chronic LBP.(6.9) Patients with LBP who did not receive exercises specific for the multifidi continued to have atrophy of the multifidi even after 6 weeks of being painfree as compared to the increases in multifidi cross-sectional area in those that performed the exercises.(6,9)  In other words, just because your pain is gone does not mean that your muscles are functionally recovered.  One of our primary objectives in physical therapy is to prevent FUTURE episodes of LBP!  So how do we do it?

How do we test the Core?

Unfortunately, there is not a research-proven, valid testing regimen for core stability.  However, Shirley Sahrmann has proposed a test called the Sahrmann Core Stability Test which is the most common test of function.  It involves the use of a pressure cuff placed under the lumbar spine to measure one’s ability to maintain pelvic neutral while performing five exercises of progressive difficulty.  The chart is included below.

 

How do we perform spinal stabilization exercises?

In physical therapy, we utilize the concept of a neutral spine while performing spinal stabilization exercises.  Every joint has what we call a  “resting” or “open-packed position”. It is the position of a joint when the joint spacing is maximized and the resistance from boney or ligamentous structures is the least. These are the fundamentals of Orthopedic Manual Therapy.  In the following video, we will review the concept of the Functional Neutral Position as well describe how to activate the transverses abdominus and multifidi muscles in mutiple positions.

 

 

NEXT POST:

So what are the BEST evidence-based, core stabilization exercises? 

 

1.  Allison GT, Morris SL, Lay B. Feedforward responses of transversus abdominis are directionally specific and act asymmetrically: Implications for core stability theories. JOSPT. 2008; 38: 228-237.

2. Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. JOSPT. 2007; 37: 754-762.

3. Escamilla RF, Babb E, Dewitt R. Electromyographic analysis of traditional and nontraditional abdominal exercises: Implications for rehabilitation and training. Physical Therapy. 2006; 86: 656-671.

4. Faries MD, Greenwood M. Core Training: Stabilizing the Confusion. Strength and Conditioning Journal. 2007; 29: 10-25.

5. Hall L, Tsao H, MacDonald D. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. Journal of Electromyography and Kinesiology. 2007; 19:763-773.

6. Hides J, Stanton W, McMahon S. Effect of stabilization training of multifidus muscle cross-sectional area among young elite cricketers with low back pain. JOSPT. 2008; 38: 101-108.

7. Hodges P, Kaigle A, Holm S. Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: In Vivo porcine studies. SPINE. 2003; 28: 2594-2601.

8. Okubo Y, Kaneoka K, Imai A. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. JOSPT. 2010; 40: 743-750.

9. Stanford M. Effectiveness of specific lumbar stabilization exercises: A single case study. Journal of Manual and Manipulation Therapy. 2002; 10: 40-46.

 

What are the BEST shoulder exercises?

Everything we do at OrthoWell is evidence-based!  Maximizing results in minimal time depends on the expertise of the clinician. As our knowledge of biomechanics and muscle function improves, more of an emphasis is placed on scientifically based rehabilitation protocols.  This is particularly true regarding the shoulder and scapulothoracic complex.  In the February 2009 volume of JOSPT, Mike Reinold, the Boston Red Sox team physical therapist, presented a thorough analysis of the shoulder and scapular stabilization exercise literature.  One of the most effective exercises for each muscle will be presented.


Supraspinatus
*Full Can Exercise
*Enhances scapular position>
*Decreased deltoid compared to empty can
*Minimizes superior humeral translation

Infraspinatus/Teres Minor
*Side-lying ER
*Minimal capsular strain
*25% increased EMG using towel roll
*Highest EMG for infraspinatus

Subscapularis
*IR at 90 deg abd
*Position of shoulder stability
*Enhanced scapular postion
*Less pectoralis activity than 0 deg abd

Serratus Anterior
*Push-up with plus
*Easy position to resist protraction
*High EMG activity
*Also activates subscapularis

Lower Trapezius
*Prone full can at 135 deg abd
*Full can = horiz abd with ER(thumbs up)
*High EMG activity
*Also activates infraspinatus, teres minor, Mid traps, supraspinatus

Middle Trapezius
*Prone Full Can at 90 deg abd
*High EMG activity
*Also activates infraspinatus, teres minor, Mid traps, supraspinatus

Rhomboids
*Prone Row
*Below 90 deg abduction
*High EMG activity
*Good ratio of upper, mid, low traps

Combo Exercise
*Bilateral T-band ER
*25% increased EMG ER’s with towel roll
*Good ratio upper:lower traps per McCabe
*Emphasize scapula retraction and post tilting

In addition, it is clinically imperative to ensure proper technique during all therapeutic exercises especially as you progress to other exercises such as plyometrics, closed chain UE exercises, and sport- specific exercise training. Proper exercise TECHNIQUE and proper exercise CHOICE is required to effectively treat the muscular imbalances seen in most shoulder pathologies.

The importance of closed-chain exercise.

Closed chain exercises for the lower extremities (exercise with you feet contacting the floor) should be an integral part of your rehabilitation program.  They are important in terms of regaining dynamic stability and improving neuromuscular control.  Co-contraction of the muscles on all sides of a joint occurs only thru closed chain or weight bearing activities.  An effective program for a patient with an ACL tear of the knee should include exercises such as squats, lunges, and step-ups.  A patient recovering from an ankle sprain should perform balance board activities.  In terms of patello-femoral dysfunction or pain in the region of your kneecap, the literature describes a strong link between hip weakness (especially the hip abductors and external rotators) and P-F pain.  Open chain exercises such as straight leg raises should be performed in every plane of motion.  Closed chain exercises should incorporate multi-planar strengthening as well.  The following exercises include hip abductor resistance during a functional squat exercise and hip adductor resistance during a lunge.  Creativity is the key to devising a more functional and sport specific program.

At OrthoWell/WalkWell, we use evidence-based and creative strategies to get you better- FASTER!  The following testimonial is from a recent “graduate”.

“I’ve had major ankle issues for over 15 years and have seen several PT’s and specialists but saw no progress until I came to WalkWell.  After only 10 visits, I have made more progress than in the 15 years combined.  The individual attention and rehab is without peer.  And on the 8th day, God created WalkWell!” – Tom Lynch, Ipswich, MA

CLOSED CHAIN CREATIVITY

Closed chain exercises for the lower extremities should be an integral part of your rehabilitation program. They are important in terms of regaining dynamic stability and improving neuromuscular control. Co-contraction of the muscles on all sides of a joint occurs only thru closed chain or weight bearing activities. An effective program for a patient with an ACL tear of the knee should include exercises such as squats, lunges, and step-ups. A patient recovering from an ankle sprain should perform balance board activities. In terms of patello-femoral dysfunction or pain in the region of your kneecap, the literature describes a strong link between hip weakness (especially the hip abductors and external rotators) and P-F pain. Open chain exercises such as straight leg raises should be performed in every plane of motion. Closed chain exercises should incorporate multi-planar strengthening as well. The following exercises include hip abductor resistance during a functional squat exercise and hip adductor resistance during a lunge. Creativity is the key to devising a more functional and sport specific program.

At OrthoWell/WalkWell, we use evidence-based and creative strategies to get our patients better- FASTER!   The following testimonial is from a recent “graduate”.

“I’ve had major ankle issues for over 15 years and have seen several PT’s and specialists but saw no progress until I came to WalkWell. After only 10 visits, I have made more progress than in the 15 years combined. The individual attention and rehab is without peer. And on the 8th day, God created WalkWell!” – Tom Lynch, Ipswich, MA

Shoulder Exercises: The Evidence

Everything we do at OrthoWell is evidence-based! Maximizing results in minimal time depends on the expertise of the clinician. As our knowledge of biomechanics and muscle function improves, more of an emphasis is placed on scientifically based rehabilitation protocols. This is particularly true regarding the shoulder and scapulothoracic complex. In the February 2009 volume of JOSPT, Mike Reinold, the Boston Red Sox team physical therapist, presented a thorough analysis of the shoulder and scapular stabilization exercise literature. One of the most effective exercises for each muscle will be presented.


Supraspinatus
*Full Can Exercise
*Enhances scapular position>
*Decreased deltoid compared to empty can
*Minimizes superior humeral translation

Infraspinatus/Teres Minor
*Side-lying ER
*Minimal capsular strain
*25% increased EMG using towel roll
*Highest EMG for infraspinatus

Subscapularis
*IR at 90 deg abd
*Position of shoulder stability
*Enhanced scapular postion
*Less pectoralis activity than 0 deg abd

Serratus Anterior
*Push-up with plus
*Easy position to resist protraction
*High EMG activity
*Also activates subscapularis

Lower Trapezius
*Prone full can at 135 deg abd
*Full can = horiz abd with ER(thumbs up)
*High EMG activity
*Also activates infraspinatus, teres minor, Mid traps, supraspinatus

Middle Trapezius
*Prone Full Can at 90 deg abd
*High EMG activity
*Also activates infraspinatus, teres minor, Mid traps, supraspinatus

Rhomboids
*Prone Row
*Below 90 deg abduction
*High EMG activity
*Good ratio of upper, mid, low traps

Combo Exercise
*Bilateral T-band ER
*25% increased EMG ER’s with towel roll
*Good ratio upper:lower traps per McCabe
*Emphasize scapula retraction and post tilting

In addition, it is clinically imperative to ensure proper technique during all therapeutic exercises especially as your patient is progressed to plyometrics, closed chain UE exercises, and sport- specific exercise training. Proper exercise TECHNIQUE and proper exercise CHOICE is required to effectively treat the muscular imbalances seen in most shoulder pathologies.