Structural Balance of Shoulders

8/6/2019 Structural Balance of Shoulders

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ACHIEVING STRUCTURAL

BA L A NC E O F T H E SHOULDERS

RESEARCH



SESSION SUMMARY



RESEARCH



RESEARCH AREAS

Scapula position/stability

Shoulder strength

Shoulder flexibility

Other notes



SCAPULA POSITION/STABILITY



The rotator cuff and biceps are active 0.092

0.215 s prior to the initiation of the actual

movement and 0.1120.034 s prior to onset of deltoid and pectoralis major activity when

performing shoulder rotations (David 2000)

The infraspinatus, subscapularis, and latissimus

dorsi act as stabilizers during flexion; thesubscapularis acts as a stabilizer during external

rotation and the supraspinatus during extension.

(Kronberg 1990)



PROGRAM DESIGN

Exercise routines that emphasize the deltoidmusculature and neglect the rotator cuff may

create an imbalance of the deltoidrotator cuff force couple, leading to altered musclecoordination, restricted AROM, and impingementof the shoulder complex during arm elevation(Kolber 2009)

Increases in rotator cuff muscle forces tended toimprove stability whereas increases in deltoid orpectoralis major muscle forces tended to furtherdecrease stability (Labrioloa 2005)



The mid and posterior heads of deltoid should be

strengthened vigorously in anterior shoulder

instability...., because they provide more stabilitygenerating higher compressive force and lower

shear force... (lee 2002)



Scapula stability exercises and thoracic curve

correction should be done before rotator cuff

exercises (Kibler 1998)

Ideal scapula position yet to be determined but it

is not in its inner range of lower traps, and down

and back is not an appropriate command

(Mottram 1997)



IMBALANCES

Overhead athletes with impingement symptoms

demonstrated strength deficits and muscular

imbalance in the scapular muscles comparedwith uninjured athletes. (Cools 2005)

Significant difference in awareness of scapula

position between dominant and non-dominant

shoulders. (Boyar 2007)



SHOULDER STRENGTH



PULL:PUSH RATIO

Rugby players bench press to pull ups 1:1(Baker 2004)

Kayak paddlers bench press to pull ups females

- 1:1.47, & males 1:1.29 (McKean 2009)

Normal population pull:push ratio using

dynamometer 1:1.12 (Peebles 2003)



SHOULDER STRENGTH RATIOS

If use a key predictor exercise - 1RM Pull up = 100%(kayakers McKean 2009)

8 RM Shoulder press - Deltoid 18%

8 RM External rotation - External rotators 9%

8 RM Bent over trap 3 raise - Lower Traps 6%



BASED ON KEY PREDICTOR

EXERCISE

Muscle GroupMark McKean

(JSAMS-2009)

Same scores

presented for new

Predictor Ex

Predictor Exercise 1 RM PU (close grip) 1 RM BP (close grip)

Deltoid - 8RM 1 arm

Shoulder press18 29

External Rotators

8RM Ext Rot onknee

9 13

Lower Trapezius

8RM Bent over trap

raise

6 12



Suggested rotator cuff ratio of internal to

external strength is approx 1.3 to 1.6. (Codine

1997, Niederbracht 2008, Barlow 2002, Hughes1999)

Deltoid : External Rotators : Lower Traps

3 : 1.5 : 1 ratio of strength (McKean 2009)



Flexion:extension 1.26-2.22 (depending on

angle isometric measure taken 30-60-90 degrees

flexed - Hughes 1999)

Abduction:adduction 1.53-2.63 (depending on

angle isometric measure taken 30-60-90 degrees

abducted - Hughes 1999)

Both ratios above increased to a higher ratio with

age. i.e. Both extension and adduction

movements became proportionally weaker



OTHER RATIOSN O T A L L P U B L I S H E D



BASED ON DIFFERENT

PREDICTOR EXERCISES

Muscle

Group

Charles

oliquinDan Baker

Mark

McKean(JSAMS-2009)

Mark

McKean2010

Key PredictorExercise

1 RM BP(close grip)

1 RM BP(self selected

grip)

1 RM PU(close grip)

1 RM PU(close grip)

Deltoid - 8RM 1

arm Shoulder

press30% 17.5% 18% 21%

External

Rotators 8RMExt Rot on knee 9% - 9% 10%

Lower Trapezius

8RM Bent

over trap raise8% - 6% 8%

Triceps 8RM

Lying Tricep

extensions

40% 40% - 33%



STRENGTH SUMMARY

A few key issues to remember

Upper body structural balance not solely basedon numbers but also posture and movement

Aim to achieve a steady and progressive change

in loads across all lifts

Every sport has a different ratio outcome but tryand keep Traps and Rotators relatively strong for

improved shoulder stability



SHOULDER FLEXIBILITY



RANGES OF MOVEMENT

ABOUT THE SHOULDER

Population IR ER Year Author

Tennis 440 890 2004Schmidt-

Wiethoff

Baseball 400 1030 2000 Donatelli

Kayak 430 880 2009 McKean

Normal 610 850 2004Schmidt-

Wiethoff

Ideal 700 900 2005 Kendall

Based on position of assessment done at

900 abduction



OTHER NOTES



Push pull movements/stabilising showed postural

adjustments were initiated shortly before all focal

movements (Cordo 1990)

Isometric strength was significantly lower for the Scapula

Protracted position compared with the Scapula Neutral

position and Scapula retracted position (Smith 2002)

By increasing the eccentric external total exercisecapacity without a subsequent increase in the concentric

internal total exercise capacity, it potentially decreases

shoulder rotator muscle imbalances and the risk for

shoulder injuries (Niederbracht 2008)



Bodybuilders showed an overall loss of shoulder

rotation ROM (1660 vs. 1880) and a significantly

decreased internal rotation ROM (-110)compared with the control group, and were

significantly weaker in lower trapezius strength

when expressed as a percentage of body weight.

(Barlow 2002)



CHANGES IN SHOULDER POSTURE



2007



2010



2008



2009



KE Y I SS UE S F OR PROGR AM D ES IG N



POSTURE

Ensure thoracic curve close to ideal before youaddress shoulder related strength problems

Must reinforce correct thoracic curve at all timesfor all upper body exercises

Need to negate the associated and exaggeratedmovement of thoracic hyperextension when

pulling

Check ROM for select postures e.g. Does ROM atshoulder allow them to press vertically if thoracicposture is increased



PATTERN

Control/ROM must occur before strength

Practice makes permanent not always perfect

Simplify pattern until it can be controlled and

perfected

Poor movement patterns are the main cause of

most muscle balance related issues i.e. Tryingto go too heavy, too quickly, too dynamic, too

early before good patterns established



PROPRIOCEPTION

Teach client to feel the exercise, the

movement, the stress, and the response of the

body

Unstable surface training is often applied too

quickly before client can feel a posture or

pattern.

Once complicated by increased proprioceptive

demand, a client loses control of the pattern

and is unable to develop proper force output



PUSHING EXERCISE

PROGRESSIONS

Chest press pw

Chest press pl

BB chest press

DB chest press Change grip

Change angle

Change angle

Use 1 armChange grip

Change grip/line

Use 1 arm

Change grip



SAMPLE PROGRESSION

Chest ress i eight

Chest ress late l a e horizontal gri

Seate chest ress in eight

Chest ress late loa e vertical gri

Chest ress late loa e alternate sh

BB chest ress close gri

BB incline chest ress

BBin

clin

e ch

est ress igri high ar

B chest ress ne tralgri

B incline chest ress ho

rizon

tal gri

B chest ress alternatear s

B chest ress 1 ar



PULLING EXERCISE

PROGRESSIONS

Lat pulldown RG

Lat pulldown CG

Assisted pull ups

Pull ups Change angle

Single arm DB row

BB row

Change support

Seated row Use 1 arm



SAMPLE PROGRESSION

Lat pulldown RG

Lat pulldown CG

Lat pulldown sup grip

Assisted chin ups rg

Assisted chin ups sup grip

Pullups eccentrics

Pull ups - RG

Seated row cg

Seated row neutral grip

DB prone row

Seated row 1 arm

1 arm DB row kneeling

1 arm DB row standing

bent over

BB standing bent over

row cg, low bar

BB standing bent over

row rg/mg, mid bar



STABILITY EXERCISE

PROGRESSIONS

Thoracic posture

Scapula rhythm

Scapula - humerus

ROM control deltoids

Shoulder rotation

Stability-mobility

Int/ext rotators

Scapula setting Traps/subscap/serratus

Initial Strength ex Partial to fullPush-pull

Normal exercises



SAMPLE PROGRESSION

Straight arm wall sags and press

Wall/floor angles up and down

Bent over trap 3 raise

Shoulder rotations scap controlled limited ROM

Side arm scaption raises - partial to match control

Single arm DB scaption press - partials to match ROM control

Chest press/lat pulldown/seated row partials to match

ROM control



PROGRAM MANAGEMENT

Develop awareness of posture and ROM client

can control

Assess ROM, strength ratios either via real

testing or subjective assessment depending on

stage of client

Progress clients according to ability and regress

when required



SUGGESTED PROGRESSIONS

0 - 6 months

8-15 reps

2-4 sets

Up to 70% efforts

Slower tempos to develop

control eg 4020

Aim for control of shoulder

movements and stability as

a priority

6-18 months

6-15 reps

3-5 sets

Up to 90% efforts

Tempos can range up to

2010 still keeping slowereccentric

Aim for proper strength

ratios and good ROM



PROGRAM SAMPLES



Ex No Exercise Tips Tempo Warm ups Work sets

DAY 1 R L R L R L R L R L R L R L R L Rest

Dynamic Stability

A1 Chest press Close grip 3020 6 12 12 12 60

A2 Bent over raises Seated bent over 2020 6 8 8 8 60

B1 Split Squats DB 2020 6 8 8 8 60

B2 Single leg DB deadlift Balance ± DB to floor 2020 6 8 8 8 60

C1 Tricep pressdown Cable 3020 12 12 12 60

Core Work

DAY 2

Dynamic Stability

A1 Lat Pulldowns Close grip front 3020 6 12 12 12 60

A2 DB shoulder press 1 arm - Standing 3020 6 8 8 8 60

B1 DB lunge and reach 1 DB to opposite side 2020 4 8 8 8 60

B2 Reverse hyperextension Hold under bench 2020 4 8 8 8 60

C1 DB curls Seated 3020 12 12 12 60

Core Work



Ex No Exercise Tips Tempo Warm ups Work sets Rest

cycleDAY 1 R L R L R L R L R L R L R L R L

A1 Pull Ups Close grip 4010 4 4 4 4 4 90

A2 DB Shoulder press 1 arm, no back support 3010 2 8 8 8 60

B1 Hang Deadlift To knees slow 4020 4 6 6 6 6 90

B2 Reverse Hyperextension Bent over bench 3020 6 8 8 8 8 60

C1 External shoulder rot Rest elbow knee 10 sec 2 2 2 2 60

DAY 2

A1Bench press

Close grip, feet down 30104 6 6 6 6

90

A2 Seated row Elbow - shoulder level 4020 4 6 6 6 6 90

B1 Lunge and reach DB to forward toes 2020 6 6 6 6 6 90

B2 DB good morning Standing ± 1 leg 3010 4 6 6 6 6 60

C1 Bent over trap 3 raise standing 4020 4 8 8 8 8 60



Sit with good trunk posture and rotateunder resistance from chord. 2 x 15 ea

side, heaviest tension possible

Lift legs up behind you tillstraight 2 x 12-20. Start with 1

leg and then progress to 2

Bridge and lift ± hold 4-6 x eachleg for 6-10 sec. Start with no lift

and progress to lift and hold

Seated leg lift ± lift leg off floor keeping back arched and hold 10

x 10 sec. Each leg

Peterson step ups let leg move forwardand down so back foot moves onto toesand then push heel down to step back

and up. 2 x 12-15

Single leg half squats againstwall ± lower to 1/3 or ½ way

down and hold 2-5 sec and push back up

Lower legs slowly to the floor oneat a time and lie over rolled towel.

2 x 12 ea

Stand on 1 leg with eyes closedand swing other leg around and

out to different directions etc andtry and maintain balance 30 sec

each 2 x



Ex No Exercise Tips Tempo Warm ups Work sets

DAY 1 R L R L R L R L R L R L R L R L Rest

A1 Bench press Close grip 2010 6 8 8 6 6 90

A2 Lat pulldowns 2010 6 8 8 6 6 90

B1 Squats Partials 3010 6 8 8 8 8 8 90

C1 Bent over raise barbell 2010 6 12 12 8 8 60

C2 Alternate DB curls standing 3010 4 8 8 8 8 60

DAY 2

A1 Seated DB shoulder press Neutral grip 2010 6 8 8 6 6 90

A2 Seated Row Neutral grip 2010 6 8 8 6 6 90

B1 Hang deadlifts BB to knees 3010 6 8 8 8 8 8 90

C1 Tricep cable pressdowns Use rope grip on cables 3010 6 8 8 8 8 60

D1 High to low cable rotation Swap sides each rep 1010 4 12 12 8 8 60



Shrugs bent over ±6 x 10 sec Bent over trap 3 raise ± 15 x High cable pull ± 50 x

Shoulder rotations ± 30 x Single arm press with rotation ± 30 x Roll one leg over and hold 2-3 min

Suck and tuck hip and lean over 30s Lie over front leg and knee 30 s Lower chest towards floor 45 s



MARK MCKEAN PHD

Post Doctoral Research FelloAustralian Institute of Fitness Research

University of Sunshine Coast

[email protected] u.au

Structural Balance of Shoulders

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