Welcome to Part 3 of our Shoulders Issues series.
Recruitment patterns; are you using your hips to do a bicep curl? Bodybuilding, what dysfunction in movements can cause.
Is your breathing getting in the way of your lifting? Importance of correct technique, including starting position.
On this episode, we also talk about the importance of breathing; chest vs. belly and how shoulder compensation can affect mobility downstream.
Send in your videos or stories, if you’d like feedback on any ‘shoulder’ issues that you may be having.
Yeah. So for example, they probably start training a bit later in life and they want to just build to become big. And then they start doing a lot of bicep curls to begin with. So a lot of people end up in our clinic, we see that they go, oh, I’ve got a shoulder issue. And we ask them what they do with themselves, not much. So what do you mean by not much? Oh, yeah, I do. I do a bit of gym training.
The thing about bodybuilding it’s not a bad thing. It’s just that like you mentioned the recruiting patterns are but all over the place. But what it is as well as that people tend to forget that they if they are, for example, if they’re seated, they still need to recruit from their glutes and your abs and stabilize themselves so that they are able to move that weight. If it’s not a heavy weight, that’s fine. But if it’s a heavy weight, then your biceps will not have the leverage that you think that you have. Unless you’ve been training for a very long time. By very long time, you are looking at at least a three to five year period of really good and concentrated effort of training.
Belly breathing, drawing the air deep into the diaphragm, the lower parts of your lungs. That’s how we learn in pilates. Chest breathing is when you take a breath, you can visually see your shoulders going up to your ears, your neck muscles getting nice and taut. If you just do that yourself, just bring your shoulders up to your ears and then try to reach overhead you won’t get very far, but you just keep them nice and relaxing. Go for do the movement. You can see how much further and more easily that is. So that’s just breathing and like Shermain touched on the starting positions.
Well, t spine mobility would be great if we can achieve it simply by lying on the foam roller for extended periods of time. If you look at the bony structure of the rib cage. It’s a pretty solid structure, lying on T spine for short for 5-10 minutes a day. That’s not good. I don’t think that’s going to do much in terms of being able to open up your chest. So I think you need to work on other layers like the fascia, the muscles, neuro.
Dr Shermain Wong is a seasoned chiropractor with particular expertise in Sports Medicine and a passion for the benefits of in ‘Active Release Technique™ (an advanced Soft Tissue Technique developed by Chiropractors). She is professionally trained in ART and has a Masters in Clinical Chiropractic from RMIT University. Dr Wong has provided chiropractic and movement rehabilitation services at international sporting competitions, and provided rehabilitation and training for professional dancers, professional football players and professional athletes.
She can be found at https://www.jurmainehealth.com.au/dr-shermain-wong/
Episode 004 : Shoulder Issues Part 3
Podcast brought to you by Jurmaine Health
This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We bring you topics on neuro psychology, neuro behavior, neuro musculoskeletal, neuro gastro, movement is well being, metabolism and microbiome, which are also some of the services that we provide. Today we'll be finishing off our short series by discussing sports or fitness related shoulder pain and other injuries. And joining me are Dr. Shermain Wong and our beloved physio Cera Lai.
It's been a long day today guys.
We are not as energetic as sometimes we are.
I do not agree.
We do want to go through a few topics with you today. Want to talk over some issues of recurring patterns, other actions such as overhead actions that can get you into trouble with your shoulders, and also even benchpress where some people don't even think that their shoulders are even involved.
We can start talking about overhead issues first and no overhead issues like CrossFit weightlifting.
At 45. Yes.
Golfing people who go overhead.
Yes. They said environmental-related.
If you�re lifting that's fair enough to let you get away with that as a fitness thing. Okay.
Yes and weekend warriors for AFL VFL kind of AFL footy.
Is that what is called AFL football. Football.
Football to me is soccer. Yeah. Great game.
Yep. So football as an AFL football.
Also the weekend bodybuilding. Yeah, the weekend bodybuilder.
Oh, the weekend bodybuilder.
Yeah. So for example, they probably start training a bit later in life and they want to just build to become big. And then they start doing a lot of bicep curls to begin with. So a lot of people end up in our clinic, we see that they go, oh, I've got a shoulder issue. And we ask them what they do with themselves, not much. So what do you mean by not much? Oh, yeah, I do. I do a bit of gym training and.
Five days a week.
Five days a week. And what do you do? I do a lot of bicep pulls and chest press and chest flies, tricep dips. Pulls, pull ups, and then they go oh, I've done all those things and my shoulder really hurts. Okay, well, yes, it will hurt. Because the upper body is not the only muscle region that you should be training incessantly. That's not what's happening. And if really they could, they probably cannot squat properly and then after they get back pain or neck pain, and then they become really stiff and unable to move and have they develop small little tears that will repair quickly enough. So we see a lot of that kind of cases. So for example, if you're doing bicep curls with your hips and you're swinging your hips, front and back, maybe that weight is a little bit too heavy for you and you need to kind of back down a little bit.
Or if you are gripping the barbells, dumbbells or whatever the hell you're using to try and do bicep curl with. Now it's meant to be an isolated exercise. Your biceps that work not your, not trying just to grip strength with this thing. Your body's not going to give you feedback on how strong your grip is. It's just going to end up with you having very tight hand muscles over your forearm muscles. And then you just may or may not end up with being woken up that night with nerve pain.
And tend to recruit muscles that don't seem to exist rather than having? Let's see how to put these in isolated exercise again. So one muscle they work about 30 in the shoulder, shoulder and neck, try and do that particular bicep curls, bicep curls, tricep dips or maybe not triceps dips. That's actually pretty accurate. Triceps extension, latpulls.
The thing about bodybuilding it's not a bad thing. It's just that like you mentioned the recruiting patterns are but all over the place. But what it is as well as that people tend to forget that they if they are, for example, if they're seated, they still need to recruit from their glutes and your abs and stabilize themselves so that they are able to move that weight. If it's not a heavy weight, that's fine. But if it's a heavy weight, then your biceps will not have the leverage that you think that you have. Unless you've been training for a very long time. By very long time, you are looking at at least a three to five year period of really good and concentrated effort of training.
And gradual build up. The guys who are going to build up really fast they are just going to fall just as fast too. So keep that in mind people and next sport is in the weightlifting categories or sport. What do you normally see Cera?
Anterior shoulder pain?
Pain with lockout. overhead.
So that's usually stemming from traps or just really poor recruitment, motor patterning, when going to move. No, just really just cheating your way through movement. Some people throw their body into a position and pray that their muscles and tendons will hold the weights in place. I guess there's also overuse as well. If you think about it in our daily lives, how often do we throw our hands overhead unless we are consciously doing something so you don't spend a lot of time overhead but you actually want to bear and bear load, heavy loads overhead without building that endurance and strength for that position. So that just like a road down to injury.
Yes, that is correct. with that in mind earlier on Cera was mentioning about shoulder this case is basically it's basically what that means is a shoulder rhythm or scapular rhythm, or rhythm dysfunction. What it is that the scapula were really in and of itself will become dysfunctional without having to react to musculature. When that happens, we're talking about musculature. It could mean or tissues, it could mean anything from the nerve. Anything from the neck, anything from the shoulder, anything from the pecs, anything into the thorax. And sometimes it's also the similar thing I mentioned before. In bodybuilding, it's that you're not using your glutes or thorax well enough and your shoulder has got do to the work. So when your shoulder has got to do all the work, and or you're not ready to be loading as heavy as you think that you're going to load, that's where the shoulder starts to become a bit of a challenge or that the shoulder will not be able to respond as well or as efficiently or as proficiently as you would like them to be. And that's one of those patterns that we see a lot in the snatch, and in the clean and jerk. When that happens we, what are we going to do? Do we fix it? Or do we fix or address the shoulder musculature? Do we change the recruitment patterns? What are we going to do as clinicians? What we try to do over time is that we would have to figure out what and how you are doing what you're doing. If we don't do that, then we are going to see the same recruitment patterns over and over again, the temporary fix of a shoulder issue and a person could be feeling really frustrated for a long time. Yeah, because the issue keeps coming back. That's true. So have any of your issues been hanging around, if you have it will be good for us to hear what kind of issues that you have been dealing with and how you have been training, that will be pretty awesome too, what do you think guys?
Especially yeah if what we're talking about. If you're getting stuck at something or keeps coming back in this case, sometimes you might be just going for a massage or something and they can't see it and they keep addressing the shoulder which was what you�re going for and you're getting no results, then talk to us or show us what pretty much show us what action you're feeling it and we'll see whether it's something else that may be contributing like we've talked about, where you might be it might actually be your neck that's causing the problem not the shoulder itself. So you pretty much getting your shoulder whacked or done whatever to and it's not going to give you any results will never get you anywhere. Unless the next release as well the actual culprit behind it were supplying that whole action or you might even be repositioned we might just reposition your neck when you do a lift and you might suddenly get into release. The sole reason if you're not using it happens all the time we see it all the time. We actually don't necessarily have to do something we just reposition someone in their actual action and they are like oh.
Sometimes it could be as simple or as complex. I don't know how it goes as breathing patterns, what do you normally see Cera?
A majority of us have a tendency to be chest breathers. I'm sure people are quite familiar with belly breathing and chest breathing.
What the difference?
One is you're actually actively using your diaphragm.
That's belly breathing.
Belly breathing, drawing the air deep into the diaphragm, the lower parts of your lungs. That's how we learn in pilates. Chest breathing is when you take a breath, you can visually see your shoulders going up to your ears, your neck muscles getting nice and taut. If you just do that yourself, just bring your shoulders up to your ears and then try to reach overhead you won't get very far, but you just keep them nice and relaxing. Go for do the movement. You can see how much further and more easily that is. So that's just breathing and like Shermain touched on the starting positions.
That can easily change how a movement is being performed. And how you feel. I think going by feel is the perfect feedback one can use to determine how they're moving. Yeah.
What happens if they can�t feel it?
They can't feel their position is like for example, some of them can get their hands behind the ears. What are we going to do then in an overhead activity for example, some of the common things I found is like they would do thoracic stretching.
Aha, like t t, spine mobility.
Yeah t spine mobility. What are your thoughts around that?
Well, t spine mobility would be great if we can achieve it simply by lying on the foam roller for extended periods of time. If you look at the bony structure of the rib cage. It's a pretty solid structure, lying on T spine for short for 5-10 minutes a day. That's not good. I don't think that's going to do much in terms of being able to open up your chest. So I think you need to work on other layers like the fascia, the muscles, neuro.
They're all yes, your attention and.
Sometimes it goes into the rectus abdominus, too. Yeah, if a person is holding too much tension in the over bracing, yeah, in the thorax, and their rectus abdominus locks down, what you're going to see is that your shoulder has got to also move significantly more and that creates the instability and then someone tells you that oh, you need more stability. Please check out our previous podcast.
About our pet peeves with mobility instability.
And then you keep working on stability, then you're so stable, that there's no motion downstream, you can�t sit into squat and standing over your extension really. And then we start having more and more patterns of compensation.
I think that we can go further. So it cannot only be the rectus, it can be the hips, you know, limited ankle mobility, and then the shoulder having to compensate for the overhead position.
So all you guys out there before you start training, you might want to know if you are squatting well overhead. So just squat and then raise your hands overhead. And if you can get into those positions and.
Without your shoes without weight.
Yes, without shoes without weight and in a narrow squatting position. That'd be perfect.
Yeah, I bet we could. So part of my work is to look at a lot of movement patterns for weightlifters for dancers for CrossFit as well. Yeah, a huge range of people from athletes to non athletes. And when that happens, so that means we have got to calibrate that part quickly. So if you're interested, send us a video on our Instagram. And we would try to case study that through for you, and we'll be quite happy to do that. So if you are a weightlifter, perfect if you're a crossfitter, excellent even, if you're a golfer or runner, we are quite happy to do it for you and what are the other sports we are complaining about all the time that we see. There's some that we go through.
Talking about benching.
Benching? Yes. Benching was our other one. But benching was it's a little bit like a catch 22 position because sometimes you're talking about Kendall power lifters who are benching over�
That's my pet peeve with that is you will.
You worked at powerlifting events before.
That was terrible.
And what happened there.
That was terrible. I was just waiting for a back to go, legitimately walking around going alright, I just cannot watch this anymore. I was watching people bench with their backs going into extreme Vs in reverse in extension. When I was looking, this can�t be normal, this can�t be normal. I could have sworn that you're supposed to keep you back on all these things, probably.
Not really. Because.
No, I'm not talking about this is where I didn't care about powerlifting I am here for a good benchpress or like I could swear to do this properly.
To keep yourself safe.
This is never gonna work for you. And then you get them coming. Oh my god, my back hurts. How about you just lean forward? Touch your toes. I swear it will give you a lot of relief.
Geez. Yeah, I know. I know guys. Thank you. It was predominantly because of the fact that you are arching your back like in a position when it should not be going. Yeah. Unless you're pretty much doing gymnastics, ballet or anything of the sort where you've got a very mobile spine, in your case where you've got a stiff spine, it's not a position that it should be going in unless you would like an actual fracture or an actual disc to go.
Yeah, now and I walked out of there going, please don't put me there again.
Okay. Oh, yeah, that was an experience. That�s an interesting experience.
I got told that it's the legal cheat. That is now their legal cheat. I had an Australian a former Australian champion come up to me, come up to me again for the same thing back pain after having lifted with said arch. Bottom has to be on the bench and the shoulders have and the upper back has to be on the bench. So this is where he kicks in. He said, "Can you treat my back because it hurts?" Did you see what you're doing? And I said to him, I could have sworn it was always like, is it not supposed to be flat it always used to be but this is the easier way, if you arch your back it means you don't have to lift as high.
So this is their way of having a legal cheat.
So they don't have to the power does not have to actually be there in the shoulders to do the lift. All it has to be is a timing on your body for pretty much bouncing on your vertebrae.
Maybe bouncing on your clavicles.
Oh, either way is bad.
Just watching it. Oh, that's it. That's a clinician talking you see it's like oh my eyeballs really hurt watching you do that. My entire body just does not respond to this, this excruciating position that you place yourself in. So.
We all see the deadlift. You'd be looking at it going but one more leaf then you're gonna blow a hamstring and then two seconds later they've dropped away, hamstring blown away.
Yes back to shoulders guys, and so you can see why we are really very squeamish by nature and that's a very good reason for being squeamish back to bench press I quite like the Thompson pad. Have you seen one of those Thompson pads? It's a bench for lifters for power lifters and it's a huge, is a larger with pair. So what it is it actually keeps the shoulder stable. And so what happens is so that when you are doing your bench press, your shoulders do not retract backwards as beyond the smaller benches themselves. What that means is that your it stabilizes your shoulder as well, and it allows you more recruitment patterns throughout the entire body to allow that weight range to go through. So I like that Thompson pad. If people like to train with it, that would be much better. Also the slingshot I think I like the slingshots because it trains the body to have better recruitment potential. This is not like advertising because they are not paying us to do anything like that. But I like those accessories to help people to do that along so if you do train bench, please use that. Also bracing you need to really breathe really well. Breathe really well into your abdominals to do the bench press instead of just not breathing or breathing into the neck.
That's when I have trouble with that.
I'm gonna say there's no point trying to breathe into your neck and into your shoulders. If you require your shoulders to be doing the action. It's something that without having to actually do my work or do much thinking you pretty much can take out some force or some stresses from your shoulders. To give them relief, is that simple that you can put all your energy into actually doing a lift. If you use the right muscles, instead of using your neck and your shoulders to breathe.
The next sport I want to talk about apart from bodybuilding is AFL. Shoulder issues in collision sport, shoulder issues. So collision sport shoulder issues what I find is that, it's largely from collision really, and wrong or inadequate or imprecise strengthening, conditioning, programming for those kind of sports. So it's important for example, for AFL VFL to do a lot of pushing or pulling. And the perception is that you've got to do a lot of push ups. Push ups are not bad in general, but still, because not forgetting that you're still running a lot. So when that happens and there's a lot of pulling, pushing in various positions, I prefer, I would prefer to see more people using cables for training as compared to cables for training. More planes of motion. Yeah. So that is much more important if you're using a lot of dumbbells that is going to create hypertonicity in which means tight muscles really, in your pecs, and you don't, you're not really training in different planes to strengthen your proprioceptive formation in those planes in those regions. So that's one sport I think that they would, it's going to be much better for them to train with cables and to train with kettlebells.
The other thing that we see with the VFL the AFL for shoulder injuries and some common one, as I say, I've caught it a few times when it's come when players have been coming back from post shoulder reconstruction or post shoulder, massive shoulder surgeries. They rush them.
So don't rush them. You look at the operation go alright, this player should be out for about, oh, at least probably half a year and then suddenly three months later, they going back to playing. Probably gonna do that. I feel like this is being rushed. And then within that first game, that's it they're out again. Mm hmm. So it was either was with one contact or they've just put a shoulder out like that. Not even landed we're talking about literally was just put their hand up for a mark and gone. Oh, needs to come off. Shoulders gone. Again.
No amount of sports team is going to take you back together. Yeah.
You look at it sometimes and you're like, Oh, please don't just don't.
Tape player. Yes. Duct tape player.
And speaking of duct taping players, well we don't really do that right?
Yes you do.
Yes. So the other one is the Jiu Jitsu guys. Jiu Jitsu guys do you see a lot of shoulder issues with them?
Of shoulder not so much maybe I see more neck where they've had their neck crank themselves.
From the guarding, shoulder it's definitely I don�t have very much. No, I had elbow. Yes. And from arm bars. And yeah, and from that. Yeah, that's pretty more from hands stuff.
No. All right, believe it or not. Yeah, you think so. But no, or if we have just missed them. But no, I am fairly confident that I haven't seen too many shoulder issues I've had as I said, we've talked about in the previous podcast again, where we're talking about nerve pain in the hands. That is from the gripping especially if they are doing work and then it doesn't necessarily have to be just from the hands can go all the way up into our in and around the shoulder and the nerve bundles there. But for the shoulder dysfunction itself culprit whether it's the shoulder joint, or the scapulohumeral rhythm, that's usually okay.
How about climbers? Who?
Okay, I know that there�s lots of dislocated shoulders.
Yes because climbing is also a lower limb sport, but a lot of times people would use.
Power their ways.
Power their ways. They think that we are having evolved from our.
You know, I'm really strong. It's 100% true. I legitimately totally mate, what happened to the glutes.
I'm sorry. I recall climbing the elite sport not an arm sport.
But also, I guess I used to climb so you do put your bodies in weird positions just to get set up. So.
That's fair enough. If you put them into weird moves you do need the arms.
Like bouldering yeah as compared to climbing? Yes.
Quite a bit. If you're go and straight up a wall, doing rock climbing, you've got a straight up a wall and you didn't really pull in. You're using your arms to do it. That's yeah, that's never gonna get you anywhere.
How about volleyball?
Ah, we'll say fingers and wrist.
How many sports are you involved in?
It's just oh.
Mostly the ankles, knees, fingers and wrists. Okay.
Oh, yeah. All right, that may come in another podcast maybe.
Iron Man. And yes. We worked in Hawaii the Iron Man championships and several Australian Ironmen events. And we have seen quite a number of interesting shoulder cases.
Yeah, people that are sweaty you had, must have been going out with the intention to drown, because the first leg of Ironman is the swim. It's 5 ks isn�t it?
Oh, yeah. And I look at them, they'd say, I can't, I'm having difficulty with my shoulder. Okay, let's have a look at the range of motion. Let's see how much, let's have a look at what you can do with your shoulder can you get them to raise their arms above their head from the front so that they're bringing up straight up and then get to about halfway so legitimately the hand stop or both hands stop in front of them smack bang parallel with their shoulder, perpendicular to the shoulders and it's like that's as far as I got. So you know you got to swim, you know you're swimming right? Yeah. What are you planning on doing doggy paddle?
Did you ask them that?
Yes I did. I was a bit harsh I'm sorry.
I was never very encouraging when it came to breastroke.
Are you going to breaststroke through your competition?
I was like mate I'm concerned for you because literally you are like a little T rex, you cannot move your arms, you can't actually do that.
They wouldn't get full range. It was that as far as they were swimming so that yeah, they were chopping into it, but they weren't. It was majority of the time again. It was nowhere near the actual shoulder joint itself, so you've worked predominantly on their lats and then get full range of things. So yeah, you can swim, maybe go out and swim or go at least get a few massages done through here. Where is here usually? I said the lats. oh yes the �. yes it was like it was it could be anything really? Yeah, of course it could. It was the fact that majority of the time they weren't getting themselves treated. It was until five minutes before the event are called, can you look at begin with my shoulders? Well, and then you look at it.
I highly don't recommend this.
That is a bit concerning. And no, it's not.
One, like, everything they do is �. it's over used and not getting themselves released in the same �
Fashion. Yeah, that's correct. And they weren�t getting treated. So with Ironman, Ironmen, people who like Iron Man sport and Iron Women sport, yeah, iron women sport.
It's for you guys. I think that it's really important to not just doing your ab work, not just during swimming, you need to really condition yourself in different sets of movement patterns. If not, then your shoulder, we're talking about shoulder case now. So your shoulder cases will almost always recover all the time.
So and if that happens, then you will not be able to enjoy your sport and your productivity levels will probably drop as well. So with that, I think that we have had enough for shoulder this time around maybe next time we'll just go downstream and go into the elbows and hands. Yes, we are. Well now we are okay.
We can. Oh yeah, we will surprise you next episode.
And thank you for listening. If you have a video that you want us to see, send it to us.
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