Bench Pressing and Shoulder Pain Solutions Part 2

If you just joined in the conversation here, be sure to read the post from yesterday below

Trainer Mike T Nelson Testimonial: Shoulder Pain While Doing a Bench Press Gone!

The Solution

Note, this is what worked in this case for exercise and this does not automatically mean it will work for you since everyone is individual.   This not medical advice and if you have a medical issue, talk to your doc.  It if it painful, don’t do it!

Hopefully that will keep my attorney happy, so here we go.

Shoulder Issue, Check My Hip?

The body is a huge X.  I know it goes not look like one, but trust me on this one.
As you step with your right foot, the impact force is transmitted up the back of the leg, past the right knee, into the right hip where it then moves over to the LEFT side of the body (around the SI joint), up the left scapula where it starts to split into 1) left upper trap and left side of the face and 2) left shoulder and on out to the left elbow and eventually the left wrist/hand.

The formal name for this it the “Back Force Transmission Line” and I first learned of this from Dr. Cobb of Z-Health.

It makes sense that the force would have to shift to the opposite side in order to keep the body balanced in gait (walking movement).  Look at what you do with your opposite shoulder/arm when you run!    Hopefully you will see some opposite motion going on there.   If all the force were to stay on the right side when you plant your right foot, it would be very difficult!

Don’t believe me?  Test it!   Run how you would normally run and now try these 2 drills
1) Run without moving your arms.    Get a buddy to do this and video it.
2) Run by moving your arms in the WRONG directions.  Humans are so hard wired to walk that this is VERY hard to do.   If you can do it easily, that is not a good sign.

Efficiency Is Key

The body is so amazingly designed I love it.  Looking a bit deeper, we see that the tendons, fascia and soft tissue are designed to absorb and return force; thus making movement much more efficient.

We Are All One

Many of you are familiar with Thomas Meyer’s “Anatomy Trains” and the idea of biotensegrity from Dr. Stephen Levin at http://www.biotensegrity.com/ If so, you are on the right track.

Cadavers To the Rescue!

The body is highly highly connected.  If you ever get the chance to do any cadaver work I highly highly recommend it.  When you start, you will see nice clean lines and everything looks very clean.  This is because at the lower level cadaver work, someone else has already prosected (cut, chop, cut cut, chop)  the cadaver for you!   This is not bad, as there are tons of things to be learned from this method since having undergrads hacking away on cadavers is not only expensive, but impractical.

Note: I am not implying any disrespect to those that have donated their bodies to science for use as a cadaver model, just trying to not use too many techy words so people can understand what is involved in the process.

As you do more advanced cadaver work (and the lab fee goes up to over a grand just for one class; still working on paying back many lab fees myself yet), you will soon find fat and fascia EVERYWHERE.  Trust me, you want to pick a lean cadaver if you can.  Seriously.

Perhaps you got to see the bodies exhibit, which is amazing too!

So we now that the body is all connected, and it appears that the primary path is the back force transmission line.

Serape Effect: More Evidence

The serape effect is primarily referred to as a crisscrossed connection between the lower and upper body, most commonly (maybe not so commonly as I am a big geek) used in discussing the connection from the shoulder to the opposite hip (glute).   It was first mentioned by Logan, G., & McKinney, W. 1970 (1), so there are some evidence from multiple sources for a connection between the shoulder and the opposite hip.

Cross Body Connection Here?  Yes!

No, not here!

Enter the Nervous System

So far we have made the case for the mechanical structure of the body and how it is all connected from your little toe to your pinky finger.
The nervous system is entwined in the picture too since it is actually controlling and sensing movement of the entire body.

Cross-Body Nervous System Connection?

Great question!   There does appear to be a nervous system connection that works “cross-body”.  Again, this probably goes back to a gait (walking) type motion.

In an experiment done by Kline TL et al. (3),  in stroke patients they showed quote, “rectus femoris in the impaired leg was active during finger flexion of the impaired hand in the stroke survivors and all four tested muscles in the impaired arm were active during extension of the legs ”

Note, this was done in stroke patients and in a similar study done by Ellis MD et al. used non stroke patients (um, normal people) they did not show a pattern in them (4).

Any Evidence In Non Stroke Patients?

In a very cool study from  Huang HJ,  et al. (6) published recently stated,  “We found increased muscle activation in passive lower limbs during active upper limb effort compared with passive upper limb effort. Likewise, increased muscle activation in passive upper limbs occurred during active lower limb effort compared with passive lower limb effort, suggesting a bidirectional effect”

English Please

While these neurologically intact (read = normal) people did an upper body movement, they saw increased muscle activation in a NON MOVING lower limb.    Back to our running example, try to move your arms in the wrong direction and it is really really hard.  It looks like our wiring is set to faciliate moving the opposite limb!

Can We Alter It?

Cortis C et al. (5) showed that interlimb coordination was better in soccer players, quote,  ”Regardless of age, soccer players always showed better performances (handgrip: 383 +/- 140 N; CMJ: 28.3 +/- 8.7 cm; IP: 55.2 +/- 12.9 s; and AP: 31.8 +/- 25.0 s) than sedentary individuals (handgrip: 313 +/- 124 N; CMJ: 21.0 +/- 9.4 cm; IP: 46.7 +/- 20.2 s, and AP: 21.1 +/- 23.9 s).  ”

While this is not the exact same thing, it is similar and appears to be trainable.  I know I am reaching a bit with these data here, but there is not one perfect study to directly point to any of this yet.  I think in the next 2-3 years (so someone is doing it right now) we will have a more exact study.

Enough With the Science!  Solution!

Back to our friend Dave and his bench rising from the dead from painful with the bar to 270 lbs in one session.

Note: If you have any medical issues, see your doctor.  I am not claiming to cure or fix anything that you have currently going on.  Don’t move through pain and see a professional!

For the sake of entertainment, here is the process I used for Dave to get his shoulder pain reduced.

My goal was to get him to bench heavy again in a short period of time.  It just so happens that when you get someone to move better, many many times (with acute pain) there pain levels drop dramatically.  As my buddy Frankie says “the body really cares most about FUNCTION – what can you do.”

Step 1

Find out what movement is painful.

This may take a bit of work, but you want to isolate the painful movement.  In Dave’s case, it was primarily left arm external rotation with his elbow bent.

Step 2

Do the EXACT opposite motion with the opposite joint

The opposite joint to the left shoulder is the RIGHT hip.  Heck, they even look scary similar as both are a ball and socket joint.

We know that LEFT arm EXTERNAL rotation with his elbow bent created the pain.
What is the exact opposite of that movement?

Do you have it?

Are you sure?

Correct!  Right hip internal rotation with a straight (not bent) knee (knee is the opposite to the elbow).

Step 3

Perform a joint mobility drill in the new position

So with his right hip internally rotated, knee straight, laying down, we had him create a circle at the hip joint (joint mobility) very slow, with no pain.  He did 3-5 reps in each (clockwise and counter clockwise) directions.

Step 4

Walk around for about 20 seconds, retest the painful motion

Any difference?

If they stare at you like a 2 headed purple space alien, you are on the right track.  Then yell at them “Never doubt my VooDoo”  That always helps!

I learned this method from Dr. Cobb initially in R Phase, so thanks again!

I Left Something Out

Come on back tomorrow for part 3 as we are still missing something.

Can anyone guess what it is?

The hint is in the first part of the article.    What other exercise do you think we had Dave do for his homework?  No, you can’t ask Dave directly (nice try).

Put your guesses in the comments below, and the winner gets a free 30 minute phone consult with me (valued at about $50).

Comments must be posted by tomororw Friday March 12 at midnight CST to be eligible. You may only enter once, but you can leave multiple comments and the latest comment you left will be used for your answer.  I will do my best to scan my spam folder too, but I can’t promise that if your comment ends up in there that I will find it (getting over 100 spams a day now).  Once comments are in, I will post the answer and the final installment of part 3 (so Sat AM).

Summary

Today we went on a tour of the body to show that it is all connected by both mechanical links (muscles, soft tissue, tendons, etc) and the nervous system.     We provided data to explain how it all works together, gave some demos for you to test it yourself, and provided you a possible solution to try on your own.

Your homework is

1) If you have an issue, try it out first and see if it works for you.   Do this on your own risk and if you have an issue, go see a doc!

2) Figure out what component we did not address yet and place your comment below.  Closest one get a free 30 minute phone consult from me.

I am excited to see how gets it!  Don’t worry, even if you did Z-Health training, you can still enter below too for the missing component.  In the event of a tie, the first one posted (by time stamp) gets it.

Rock on!
Mike T Nelson

REFERENCES

1) Logan, G., & McKinney, W. 1970. The serape effect. In Anatomic Kinesiology (2nd Ed., pp. 154-561). New York: William C. Brown, Co.

2) Publications for Biotensegrity at http://www.biotensegrity.com/index.php

3) Kline TL, Schmit BD, Kamper DG. Exaggerated interlimb neural coupling following stroke. Brain. 2007 Jan;130(Pt 1):159-69.

4) Ellis MD, Acosta AM, Yao J, Dewald JP. Position-dependent torque coupling and associated muscle activation in the hemiparetic upper extremity. Exp Brain Res. 2007 Feb;176(4):594-602.

5)  Cortis C, Tessitore A, Perroni F, Lupo C, Pesce C, Ammendolia A, Capranica L.    Interlimb coordination, strength, and power in soccer players across the lifespan.  J Strength Cond Res. 2009 Dec;23(9):2458-66.

6) Huang HJ, Ferris DP.  Upper and lower limb muscle activation is bidirectionally and ipsilaterally coupled.  Med Sci Sports Exerc. 2009 Sep;41(9):1778-89.

PS

Get those answers in the comment section now before the clock his midnight on tomorrow (Friday, March 11) for a chance to win a free 30 min phone consult with yours truly!

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