Monday, December 22, 2008

The Shoulder Series - Part V: Secondary Compensations


Image courtesy of Lauren Keswick at www.medicalartstudio.com

Just one look at the lattice work of soft tissue and bone that makes up the shoulder and its neighbors, and it's little wonder that damage or injury in one area can lead to a ripple effect in others nearby.

Many of you have heard the orthopedic saying - "If you injure the neck, the shoulder suffers too; and if you injure the shoulder, the neck suffers, too." Well, that's just the tip of the iceberg...

Let me give you a few examples of how a problem elsewhere in the system can manifest as a "shoulder" issue. Looking at the shoulder anatomy image above, it's not too hard to see how these situations might arise.

1. Neck: Some sort of soft tissue trauma occurs with the neck, whether from a car accident, a fall, or a stiff jab to the face. Even a bunch of swings done improperly such that the shoulder is raised to try to pull the bell upward will cause strain to the neck muscles! The soft tissue will recover from the strain/sprain and knit more easily when it's in a shortened position. However, that means that the shoulder will be drawn up closer to the neck. This can lead to what Gray Cook refers to as "stabilizers acting as prime movers and prime movers acting as stabilizers." As the neck tries to regain its stability, it recruits the shoulder into helping with extra stability. That, in turn, forces the muscles of the shoulder and arm to work harder to create "ordinary" arm & hand movements.

2. Elbow: Just as Gray Cook and Brett Jones used the tagline that "The hip is a bad neighbor", so too can we argue that the elbow is that way too. Movement pattern issues in the elbow can manifest either as wrist or shoulder pain. As regards the shoulder, if the elbow doesn't have its usual ranges of motion in an unfettered manner, the nervous system will recruit other muscles nearby to create the movement that's been compromised.

3. Thoracic Spine: The T-spine is a source of mobility for the shoulder. No two ways about it. If the muscles that move your T-spine start to exhibit the length-tension imbalances that are usually part & parcel of a sedentary lifestyle (office worker, long distance driver, etc.), then you're going to lose ranges of motion when you try to do overhead work with your arm. If you just try to lift your arm straight overhead without moving your T-spine in the slightest, you'll notice that you've probably maxed out at something like 20-30 degrees away from vertical. If you remove the limitations in the T-spine and do the same ROM test, you'll notice that ROM improves towards the vertical if not achieving it!

All of the above mechanisms create patterns of compensation. And compensation's like fire. It spreads and spreads until everything that can be burned is burnt out.

What's the long & short of this as relates to the RKC's HARD STYLE kettlebell training? Simple...

1. Mobility is a pre-requisite to stability. If you're going to do strength work, make sure you have unfettered ranges of motion. If you don't, then work on achieving them.

2. If you're injured, you can still train around your injury, but you have to make VERY sure not to feed any compensations.

3. NEVER push yourself past the limits of your form. If you lose form on one rep, put the bell down. If you've not lost form so badly that you can still regain perfect form on the next rep, go ahead & continue. If you do 2 reps with poor form, put the bell down.

People immediately get defensive when I say to "put the bell down", but that doesn't mean that you have to go and check yourself into an ER or give up your beloved way of training. Rather, it means that you need to cease the exercise you were doing when you lost form, and change your activity temporarily.

- If you were doing Swings, then go to the Turkish Get-Up.
- If your hands are too tired to even grip the bell, then go for a jog.
- If your legs are too shot to hold you up, then do the cobra stretch.

There are always options in intelligent training. So please go back and re-read all of the installments of the shoulder series and think about how the neck, upper back, hand, or shoulder discomfort that you or one of your clients/patients might have could be avoided or addressed.

2 comments:

SG Human Performance said...

Extremely well said Mark. I am a firm believer that anyone who has shoulder problems needs to have a shoulder mobility test performed as well as an assessment on t-spine mobility. I have had so many patients and clients that cannot retract the shoulders properly due to a lack of t-spine extension (scapular winging is a result). Usually a session on the foam roller or two tennis balls taped together helps to free the t-spine extension up and then they are able to retract and not wing so badly. Keep up the good work Mark.

Dr. Mark Cheng said...

Thank you for your kind words, Mr. Snow.

Perhaps one of the biggest insights I've gotten from Gray Cook's FMS system is that asymmetries can take MANY forms. Generally, we're looking for gross left-right asymmetries, but medial-lateral or anterior-posterior length-tension imbalances can really do a number on someone's quality of life.

That little insight has helped make all the difference in the lives of many patients & clients.

There's actually a really good exercise in Tai-Chi that talks about this. Maybe one of these days, I'll make a Youtube video explaining it in detail. :)