Got Shoulder Pain? Try this…

Over the past several weeks I have been trying to help one of our members, Kim, with her shoulder pain issues.  She is a fit and active 50 something, that rivals many 30 year olds I have seen.  However, she has had a cranky shoulder for some time now.  Without checking my notes, I’d say she has been complaining about shoulder pain for almost a year now.  Like many, she felt that if she stayed active and didn’t push it, the pain would go away and she’d be back to normal.

Well, that hasn’t happened and now the simplest of daily things like reaching for the milk in the back of the fringe can cause debilitating pain.  Normally I would not work with a person in pain until they have seen their Doctor, Physio or Chiro.  Pain during normal movement is the cue for us to refer out to get some sort of diagnosis or professional opinion.  However, there are many times when a person just doesn’t take our advice.

I hate seeing people in pain; particularly shoulder pain because it’s so common.  It actually frustrates me when I can’t help.  As a result I’ll reach out to my network of professionals to see if there is anything I can do that won’t get me in hot water and make their situation worse.  The situation with Kim was no different.  I had gone through a modified version of our Functional Movement Assessment with her (I just worked on her upper half) and based on her history, presentation, movement quality and results from common impingement tests I could isolate the mechanical break down that was more than likely a large contributor to her shoulder pain problem.  It’s referred to as Scapular Dyskinesis.

Kim’s shoulder blade does not move the way it should in order to make room for the head of her arm bone to rotate while she lifts her arm up and over her head or to the side.  The shoulder blade (scapula) forms the socket part of the ball and socket shoulder joint.  At the top of that socket is a bony process called the acromion.  There are some soft tissues that run through that space between the head of the arm bone and the acromion;  namely a bursa and the tendon of the supraspinatus muscle (one of the rotator cuff muscles) If the muscles that move the shoulder blade don’t do their job either at the right time or at all, the shoulder blade won’t rotate up and tip backwards to make room for the arm bone as it goes up and consequently, those soft tissues will get pinched.  This is referred to as subacromial impingement which is the most common type of shoulder impingement.  The image below illustrates the scenario.

I had just read a study that yielded impressive results from doing a modified version of a yoga based pose they called triangular forearm support.  You can read the study abstract here: https://journals.lww.com/topicsingeriatricrehabilitation/Abstract/2011/04000/Yoga_Based_Maneuver_Effectively_Treats_Rotator.10.aspx.  This intervention allows me to help without manually (me actually adjusting or manipulating) treating Kim, as that is beyond my scope.  It’s basically an isometric hold done with specific cuing.  If anything I thought it would activate one of the muscles responsible for articulating the shoulder blade which would create more space for her arm to move.  At best it would improve pain free range of motion and at worst, nothing would change.

Well, if I didn’t see it with my own eyes, I would not have believed how successful just two minutes and one exercise could be.  Kim’s range increased by at least 25 degrees and that extra 25 degrees was pain free!  Yes she experienced the pinch at her new end range but I’m excited to see how far we’ll get in a few weeks of supplemental work.  I’ll keep you posted with her results.  Checkout the video below and if you or anyone you know could benefit, come see me for an evaluation.

Your Movement Quality Self Assessment Checklist

Always Check Quality First.

Let’s Break the Rules.

The fitness industry is full of backwards information, questionable guidance, and less than ideal recommendations. We always hear things such as: You should be working out 3-5 times per week, you should be eating 100g of protein every day, and you should be sleeping 6-8 hours per night. The one key component that is missing from any of the aforementioned recommendations is the quality.

Most people attack their goals completely backwards. We must first address the quality of what it is that we’re doing and then begin to look at quantity. However, we often fixate on the quantity and not the quality. How many grams of protein, how many sets and reps, how many hours at the gym, or how many steps we’re taking are all measures of quantity, not quality. Don’t get me wrong, there is absolutely a time and place for numbers. However, when trying to accomplish fitness, exercise, health, or nutrition goals, quality must be put at the forefront of it all. Performing 3 sets of 10 squats that are not utilizing a full range of motion, causing your knees to ache, and hurting your low back….. Congratulations, you’ve accomplished your quantifiable 3 sets of 10. You’ve also concurrently reinforced a terrible movement pattern, have done more damage to your knees, and continued to aggravate your dodgy back. However, you may now drink your sugary protein drink knowing that you accomplished your 3 sets of 10 reps.

It’s a puzzling thing to me that people can be so fixated on the numbers that putting their body through pain is acceptable just so they finish their prescribed workout. This way of thinking only blurs the line between quality and quantity even further. By simply accomplishing your 3 sets of 10 reps, you assume that you had a high quality workout. The quality simply doesn’t matter at that point.

Let’s use protein as another example. Protein is the big buzz word of the fitness industry. Protein is king. This is not an article about protein, so we won’t get into specifics. Let’s use 100g as a nice round figure. Let’s assume that your daily recommended amount of protein was 100g/day. You can get protein from boneless/skinless chicken breast grilled on a BBQ at home or from chicken McNuggets from McDonalds. They are both protein sources. I think we can all agree that both should not be considered equal. When very little or no importance is placed on quality, there is no difference between grilled chicken breast and chicken McNuggets. However, we all know that there is a big difference between the two, and the difference is quality. For some strange reason, most of us can identify that there is a drastic quality difference between grilled chicken breast and chicken McNuggets yet we fail to see glaring deficiencies in the quality of our movement. Most people consider McDonalds to be unhealthy, and yes, it probably isn’t the best food to be consuming if you’re concerned about your cardiovascular and digestive health, but I would make the case that poor squatting technique and crunches are equally as detrimental to you musculoskeletal health.

We prioritize our cardiovascular health when we look at which foods to eat and which not to eat. However, I wish more people would prioritize their exercise in the same way. Begin to take the same approach to movement and exercise as you would to nutrition. Some exercises will benefit your health, and others simply will not. The underlying theme should always be the quality of the exercise. Do it with competence and then do it frequently.

I’ve put together a 3 step movement quality checklist. This checklist will only apply to you as long as you are performing fundamental movements as the basis of your training program. If machines are where you spend the bulk of your time, then you are not ready to begin applying this checklist to your movement. In that instance, you may consider seeking additional guidance to learn how to begin moving efficiently and properly. This checklist can be used to determine if your body is ready to lift weights or not. Some of you may be thinking to yourself – “well I lift weights all the time.” You would be right in saying that. I can assure you that you are more than likely setting yourself up for injury one day. Give this checklist a try and see how you do. If you can’t make it through all 3 steps, your body is not fundamentally sound.  The movement I would like you to perform for the checklist is a body weight squat. A very simple yet crucial movement for proper human performance.

Step 1 – Are you pain free while moving? If you experience pain while moving, your body is dysfunctional. There is no other way of saying it. Pain is the body’s red flag for when there is dysfunction. Most people don’t listen to the feedback that our bodies give us. The old “no pain, no gain” mantra of the past is no more. There are different forms of pain, however, when we’re speaking of movement, pain is not OK. It’s your body telling you there’s a problem and that you need to address it. Think of this as the alarm that goes off in your car when you leave your lights on. Before progressing to step 2, you must address any painful areas of your body first.

Step 2 – Are you performing a full range of motion? Step 2 is critical to movement. You must utilize your joints full range of motion. In my previous post about range of motion, I emphasize the importance of not limiting your body into a reduced range of motion for general health reasons. If you’re unfamiliar with that concept, please refer to my previous post here: (http://uxbridgefitness.com/range-of-motion.html). Assuming you are achieving a full range of motion with your movement properly, you’re then able to move on to step 3.

Step 3 – Can you perform the movement with integrity? The last step of the checklist is very simply; can you perform the movement with integrity? Here when I say integrity, I mean with 100% proper technique. A simple way to test this is to perform an exercise for 20 reps. If you can perform the movement with integrity for all 20 reps, then you can safely move beyond the checklist.

And that’s all there is to it. A quick and simple self assessment you can perform anywhere. Here we are primarily looking at quality. Do the movement pain free with full range of motion and then perform it with integrity. Do it with competence and then do it frequently.

About the Author:  Eric Noyes BHSc (Kin), CSEP-CPT

Eric is  Kinesiology Graduate from The University of Ontario and holds his Training Certification with the Canadian Society for Exercise Physiology.  He has been training general population and sport specific clients at Body Fit since 2013 and is currently the Lead Trainer.  He can be reached at eric@bodyfit.ca for advice and consultation.

Keeping Things in Balance

Balance training is something a lot of people overlook while they’re at the gym. It is a skill we take for granted until we realize that we’ve lost it. It isn’t until then that we actually appreciate how important balance is to activities of daily living.

As we get older, our balance diminishes. It’s not just you, it’s everybody. That’s just the way the body works. Balance can be viewed through the lens of – use it or lose it. Generally, as we get older, our need to work on balance activities becomes increasingly important.

As children, adolescents, and even young adults, we are training our balance fairly regularly because generally speaking, people are more active when they’re younger. Climbing trees, running through sand, swinging and playing sports are activities we perform early in our lives and generally stop doing them as we get older. From my experience, it seems to be the golden age of 25 years when humans start becoming less active. At that age, people are finishing school, working full time, holding a relationship, having children, owning a home and while doing all of that, usually they stop being active.

It’s at this point we begin to see a decline in a person’s balance. Tasks become just a bit trickier than what they once were. As we age, our balance continues to decline in a linear fashion.

Getting into older age (over 65 years), our ability to remain living on our own without assistance is partially determined by how well we can or cannot navigate our surroundings. If a person is at risk of injury while living in their home because they have less than acceptable balance, that person may have to live in an assisted living facility far sooner than an individual with markedly better balance.

Young people often ask about the importance of balance training. Think of it as an investment in your future. Investing the time to improve your balance when you’re younger, will yield a return on that investment as you age.

Balance Exercise Recommendations

The take-home point here is to make sure you work on your balance because it doesn’t just hang around forever for when you do need it. Use it now and use it often.

About the Author:  Eric Noyes BHSc (Kin), CSEP-CPT

Eric is  Kinesiology Graduate from The University of Ontario and holds his Training Certification with the Canadian Society for Exercise Physiology.  He has been training general population and sport specific clients at Body Fit since 2013 and is currently the Lead Trainer.  He can be reached at eric@bodyfit.ca for advice and consultation.