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TPT
12-06-2009, 05:48 PM
many bodybuilders have symptoms of upper extremtiy pathology including posterior shoulder tightness.

take a read.



Addressing Posterior Shoulder Tightness in the Athletic Population (http://forums.rxmuscle.com/nsca-scj/Fulltext/2009/12000/Addressing_Posterior_Shoulder_Tightness_in_the.9.a spx)

Corrao, Melissa; Kolber, Morey J; Wilson, Stanley H
Strength & Conditioning Journal. 31(6):61-65, December 2009.
doi: 10.1519/SSC.0b013e3181c2a828

Abstract:SUMMARY: POSTERIOR SHOULDER TIGHTNESS (PST) IS A COMMON IMPAIRMENT IMPLICATED IN THE ETIOLOGY OF SHOULDER PAIN. INDIVIDUALS PARTICIPATING IN ATHLETICS HAVE A PREDILECTION FOR PST, THUS INTERVENTIONS TO MITIGATE SUCH TIGHTNESS SHOULD BE INCORPORATED INTO TRAINING PROGRAMS. THIS COLUMN PRESENTS EXERCISES TO ADDRESS PST APPLICABLE TO THE ASYMPTOMATIC AND INJURED POPULATION.
(C) 2009 National Strength and Conditioning Association

INTRODUCTION

Shoulder disorders affect up to 67% of the population at some point in their lifetime (6 (http://forums.rxmuscle.com/#P42)). Although the etiology of shoulder pain is multifactorial, specific impairments such as inadequate mobility have been associated with more common disorders. Posterior shoulder tightness (PST), in particular, has been implicated in the etiology of numerous shoulder disorders such as impingement syndrome and labral tears (3,8,11,12 (http://forums.rxmuscle.com/#P39)). From a biomechanical perspective, PST has been directly linked to abnormal humeral head translation, which may lead to the aforementioned shoulder disorders (3 (http://forums.rxmuscle.com/#P39)). PST has been associated with limited shoulder mobility including flexion, internal rotation, and horizontal adduction (2,3,12 (http://forums.rxmuscle.com/#P38)). Researchers have suggested that overhead athletes (2,8 (http://forums.rxmuscle.com/#P38)) and weight-training participants (4 (http://forums.rxmuscle.com/#P40)) have a tendency to develop PST, thus efforts have been made to identify efficacious stretching methods to improve mobility of the posterior shoulder structures (5,7 (http://forums.rxmuscle.com/#P41)).
The purpose of this column is to provide evidence-based recommendations for the prescription of posterior shoulder stretching, applicable to both the asymptomatic and injured population. A discussion of the anatomical/biomechanical implications arising from, and leading to, PST will be presented to substantiate our recommendations.

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ANATOMICAL AND BIOMECHANICAL CONSIDERATIONS

A brief but necessary discussion of the posterior shoulder anatomy is required to gain an understanding of the mobility impairments that may arise from PST as well as the recommendations set forth for improving mobility.
The shoulder complex comprises the glenohumeral, acromioclavicular, and sternoclavicular joint along with the scapulothoracic articulation. Shoulder mobility is primarily determined by glenohumeral joint configuration, scapulothoracic mobility, flexibility of soft tissues, such as the shoulder capsule and muscles, and synchrony of the shoulder complex musculature (14 (http://forums.rxmuscle.com/#P50)). Restricted mobility of the posterior shoulder structures, in particular, has been implicated as a causative and perpetuating factor for shoulder dysfunction (12,14 (http://forums.rxmuscle.com/#P48)). PST and the ensuing mobility impairments of flexion, internal rotation (when arm is abducted to 90) (Figure 1 (http://javascript<b></b>:void(0);)), and horizontal adduction (Figure 2 (http://javascript<b></b>:void(0);)) are generally associated with flexibility of the posterior glenohumeral joint capsule (Figure 3a (http://javascript<b></b>:void(0);)), posterior based rotator cuff musculature as illustrated in Figure 3b (http://javascript<b></b>:void(0);) (infraspinatus and teres minor), and to a lesser extent the posterior deltoid. The posterior capsule, however, has received much focus in research investigations and therefore will be the focus of our discussion.
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Figure 1
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Figure 2
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Figure 3
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A restricted posterior capsule has been proposed as a primary mechanism responsible for a loss of internal rotation (when the arm is abducted to 90) and horizontal adduction (4,5,7,8,10-13 (http://forums.rxmuscle.com/#P40)). Myers et al. (8 (http://forums.rxmuscle.com/#P44)), in an investigation of throwing athletes, reported limited internal rotation and horizontal adduction reflecting PST. Similarly, Barlow et al. (1 (http://forums.rxmuscle.com/#P37)) reported internal rotation limitations in bodybuilders when compared with a control group, suggesting a relationship between bodybuilding and a loss of internal rotation. Kolber et al. (4 (http://forums.rxmuscle.com/#P40)), in an investigation of weight-training participants, reported limited internal rotation and horizontal adduction when compared with a control group and attributed this to PST. Plausible explanations for PST in the athletic and weight-training population include (a) eccentric resistive forces during the deceleration phase of throwing place stress on the posterior capsule and posterior rotator cuff musculature, thus leading to tightness (2,9 (http://forums.rxmuscle.com/#P38)); (b) soft-tissue hyperlaxity anteriorly, leading to anterior translation of the humeral head opposite the posterior capsule resulting in stiffness (3,15 (http://forums.rxmuscle.com/#P39)); and (c) the relative infrequency of end-range internal rotation and horizontal adduction movements (4 (http://forums.rxmuscle.com/#P40)). While the mechanisms thought to be responsible for PST are unlikely to change, routine stretching of the posterior shoulder structures may serve to mitigate such tightness and prevent future problems attributed to PST. Exercises designed to improve PST are being recommended from an injury perspective only, as insufficient evidence exists to imply an improvement in performance.

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POSTERIOR SHOULDER FLEXIBILITY EXERCISES

Numerous exercises have been advocated to improve PST (2,7,9 (http://forums.rxmuscle.com/#P38)). Movements of the shoulder complex, which are often prescribed to stretch the posterior structures such as horizontal adduction (cross-arm stretch), may be less effective as a result of compensatory movement from the scapulothoracic articulation if the scapula is not stabilized. During horizontal adduction, the posterior shoulder tissues are engaged; however, the freely moving scapula will often compensate and limit effectiveness of the stretch to isolate the posterior shoulder structures. Similarly, during internal rotation, the scapula may tip forward, thus limiting the effectiveness of the movement's ability to engage the posterior shoulder structures. Effective stretching exercises must both use movements that engage the posterior shoulder structures and provide stabilization of the scapula to prevent compensation.
The sleeper and cross-arm stretches have been recommended to decrease PST. Both stretches have been found efficacious (5,7 (http://forums.rxmuscle.com/#P41)) and are relatively simple to perform. Moreover, these exercises may be performed in both injured and asymptomatic individuals.

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SLEEPER STRETCH

With the sleeper stretch, the body is in the side-lying position. Participants lie on the side to be stretched with their arm in a 90 abducted position (Figure 4a (http://javascript<b></b>:void(0);)) and elbow flexed to 90. Once in position, the opposite arm is used to push (proximal to the wrist) the stretched arm toward the table into internal rotation (Figure 4b (http://javascript<b></b>:void(0);)). The scapula is stabilized as a result of the individual lying on the side to be stretched.
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Figure 4
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SIDE-LYING CROSS-ARM STRETCH

With the side-lying cross-arm stretch, the individual lies on the side to be stretched (to stabilize the scapula) with arm in a 90 abducted position (Figure 5a (http://javascript<b></b>:void(0);)). Once in position, the opposite arm is used to pull the arm (proximal to the elbow) across the chest (Figure 5b (http://javascript<b></b>:void(0);)).
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Figure 5
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STANDING CROSS-ARM STRETCH

The standing cross-arm stretch is provided as an alternative to the side-lying cross-arm stretch. The standing cross-arm stretch is performed with the individual leaning into a wall with the side to be stretched in direct contact at the posterolateral shoulder/scapula for stabilization (Figure 6a (http://javascript<b></b>:void(0);)). Once in position, the opposite arm is used to pull the arm (proximal to the elbow) across the chest, while the scapula remains in contact with the wall (Figure 6b (http://javascript<b></b>:void(0);)).
http://images.journals.lww.com/nsca-scj/LargeThumb.00126548-200912000-00009.FF6.jpeg (http://javascript<b></b>:void(0);)
Figure 6
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Flexibility exercises should be designed with the sole purpose of improving flexibility; therefore, we recommend them to be performed on a daily basis. The stretching exercises recommended should be held for 30 seconds and 3 to 5 successive repetitions, similar to the duration and frequency used in the studies that have identified efficacy of the stretches (5,7 (http://forums.rxmuscle.com/#P41)). Generally, stretches should be performed when the individual has warmed up; however, no evidence exists to imply whether a specific time of the day would be more efficacious. In regard to the intensity of each stretch, we advise participants to bring each stretch to a point of mild discomfort and hold. If the discomfort level increases during the stretch, we ask that they release the position to a steady level. Participants are advised that the strain felt during the stretch should resolve immediately on completion. In cases where the strain persists, participants are advised to reduce the intensity in future sessions and follow-up with a health care professional. Generally, individuals engaged in a stretching program should see acute improvements in mobility. When PST is improved, one would recognize an increase in internal rotation and horizontal adduction mobility.

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CONCLUSION

PST has been identified in the literature as an impairment that is both predictive of and associated with shoulder disorders. Given the propensity for overhead athletes and weight-training participants to develop PST, exercise techniques designed to address flexibility of the posterior shoulder structures may serve as preventive tools for maintaining normal mobility. Although many athletes and recreational fitness participants engage in stretching, the posterior shoulder structures may often be overlooked or ineffectively addressed. The stretching exercises recommended are designed to isolate the posterior structures while preventing compensatory scapular movements. Moreover, these exercises have been found efficacious in the literature. Rehabilitation professionals and strength and conditioning specialists must be cognizant of proper exercise form when prescribing posterior shoulder stretching to isolate the desired structures, thus are encouraged to consider our recommendations Last, individuals with previously diagnosed shoulder disorders may perform these exercises provided they do not cause pain or discomfort at the conclusion of the stretch.

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REFERENCES

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Cogrick2
08-27-2010, 10:08 AM
TPT, this looks valuable. Do you have a link that allows viewing the figures? I did not find one when I searched.

tmno
07-05-2011, 11:40 AM
very interesting, it was a good read.. thanks for posting