Upper Body Structural Balance

Upper Body Structural Balance : 

Mark McKean Upper Body Structural Balance RESEARCH

Session Summary : 

Session Summary This session will cover Shoulder strength & flexibility research The relative ratios for shoulder strength & flexibility. Key issues for program design

Research : 

Research

Research Areas : 

Research Areas Scapula position/stability Shoulder strength Shoulder flexibility Other notes

Scapula position/stability : 

Scapula position/stability

Muscles Involved : 

Muscles Involved Trapezius and serratus anterior most important stabilisers acting on scapula thoracic joint (Mottram 1997) The external rotator musculature functions in a synchronous pattern, with the deltoids creating a force couple necessary for normal, unrestricted motion (Kolber 2009). The deltoid provides dynamic stability with the arm in the scapular plane and only decreased the stability of the shoulder with the arm in the coronal plane. (Lee 2002)

Slide 7: 

The rotator cuff and biceps are active 0.092–0.215 s prior to the initiation of the actual movement and 0.112–0.034 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; the subscapularis acts as a stabilizer during external rotation and the supraspinatus during extension. (Kronberg 1990)

Program Design : 

Program Design Exercise routines that emphasize the deltoid musculature and neglect the rotator cuff may create an imbalance of the deltoid–rotator cuff force couple, leading to altered muscle coordination, restricted AROM, and impingement of the shoulder complex during arm elevation (Kolber 2009) Increases in rotator cuff muscle forces tended to improve stability whereas increases in deltoid or pectoralis major muscle forces tended to further decrease stability (Labrioloa 2005)

Slide 9: 

The mid and posterior heads of deltoid should be strengthened vigorously in anterior shoulder instability...., because they provide more stability generating higher compressive force and lower shear force... (lee 2002)

Slide 10: 

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 : 

Imbalances Overhead athletes with impingement symptoms demonstrated strength deficits and muscular imbalance in the scapular muscles compared with uninjured athletes. (Cools 2005) Significant difference in awareness of scapula position between dominant and non-dominant shoulders. (Boyar 2007)

Shoulder strength : 

Shoulder strength

Pull:Push Ratio : 

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 : 

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%

Slide 15: 

Suggested rotator cuff ratio of internal to external strength is approx 1.3 to 1.6. (Codine 1997, Niederbracht 2008, Barlow 2002, Hughes 1999) Deltoid : External Rotators : Lower Traps 3 : 1.5 : 1 ratio of strength (McKean 2009)

Slide 16: 

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 RatiosNot published : 

Other RatiosNot published

Based on key predictor exercise : 

Based on key predictor exercise

based on Different predictor exercises : 

based on Different predictor exercises

Strength Summary : 

Strength Summary A few key issues to remember Upper body structural balance not solely based on 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 try and keep Traps and Rotators relatively strong for improved shoulder stability

Shoulder flexibility : 

Shoulder flexibility

ranges of movement about the shoulder : 

ranges of movement about the shoulder Based on position of assessment done at 900 abduction

Other Notes : 

Other Notes

Slide 24: 

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 exercise capacity 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)

Slide 25: 

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 : 

Changes in Shoulder Posture

Slide 27: 

2007

Slide 28: 

2010

Slide 29: 

April 2008

Slide 31: 

Oct 2008

Key issues for program design : 

Key issues for program design

Posture : 

Posture Ensure thoracic curve close to ideal before you address shoulder related strength problems Must reinforce correct thoracic curve at all times for all upper body exercises Need to negate the associated and exaggerated movement of thoracic hyperextension when pulling

Pattern : 

Pattern Control 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. Trying to go too heavy, too quickly, too dynamic, too early before good patterns established

Proprioception : 

Proprioception Teach client to “feel” the exercise, the movement, the stress, and the response of the body Unstable surface training often applied too quickly before client can “feel” a posture or pattern and once complicated by increased proprioceptive demand, loses “control” of the pattern and is unable to develop proper force output

Pushing Exercise Progressions : 

Pushing Exercise Progressions Chest press pw Chest press pl BB chest press DB chest press Change grip Change angle Change angle Use 1 arm Change grip Change grip/line Use 1 arm Change grip

Sample progression : 

Sample progression Chest press pin weight Chest press plate loaded – horizontal grip Seated chest press pin weight Chest press plate loaded – vertical grip Chest press plate loaded – alternate push BB chest press – close grip BB incline chest press BB incline chest press mid grip – high bar DB chest press – neutral grip DB incline chest press – horizontal grip DB chest press – alternate arms DB chest press 1 arm

Pulling Exercise Progressions : 

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 : 

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 : 

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 full Push-pull Normal exercises

Sample progression : 

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 : 

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 : 

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 slower eccentric Aim for proper strength ratios and good ROM

Program samples : 

Program samples

Mark McKean : 

Mark McKean Post Doctoral Research Fellow Australian Institute of Fitness Research University of Sunshine Coast mmckean@usc.edu.au