B2R Shoulder Stability Project. The Prehab
Prehabilitation tends to be an overlooked part of training programmes. It is often seen as boring and as such does not get done.
However we believe not being physically prepared or conditioned and potentially resulting in unnecessary injuries is more boring. For these reasons rehabilitation is built into the start and end of each session.
There are details you need to understand when you perform these drills. Details, if ignored, will mean the difference in;
Effectively preparing us for the very demanding sessions that follow, or not.
Slowly building the resilience and capacity of our connective tissues, or not.
See the Envelope of Function (EoF) link above for a brief overview of this clinical pathway we call ‘sensitive to robust’. If we can start rehabilitation programmes the other side of the metaphorical bridge, that is exactly where we start people. The simple preparation drills in this course are popular ones we use.
The warm ups (unless otherwise stated) will have a guided general activity to raise your heart rate. This is not a jump rope course however so it is not required or mandatory, you could replace this with an activity of your choice. For a comprehensive jump rope programme, sign up to The Phoenix Movement.
Jump rope is a personal favourite I use for a general heart raiser. Warm up is an often overlooked section of our training, an opportunity to insert some rhythm training, or problem solving.
Something we consistently have to coach in the more traditional banded or stick activities is the approach. Whether we are performing bent arm, straight arm or some combination of both we should be entering and setting up in an athletic stance. The athletic stance is one where you are set in a position that you can both react and produce force. From this position you could deadlift, you could squat, you could overhead press, you could jump for max height or turn and run. From this position you give yourself the chance to get the most of these specific drills to prepare and condition your wrists, elbows and shoulders.
“All prep work should be done from an athletic stance, one where we can produce force”
When we understand how we approach these drills, there is no time wasting, there is no part of the session just going through the motions. By subtly changing variables like number of sets, tension on the band, where we hold the stick and so on, preparation becomes highly metabolic conditioning - using the same drill.
Prehabilitation. In this bent arm dowel drill (elbow), we perform 50 full rotations holding the stick. The closer we hold the stick to the end, the greater the lever arm and challenge to wrist rotation. This can be very easily progressed with a longer stick, or a heavier one.
Elbow prehabilitation. You do not need to watch the full video, however notice the setup and intent through the entire set of movements.
With all of the sequences prescribed, the goal is to be able to complete a round without taking rest. Once we understand the approach, and the set up for how we stress the joint in question including how to progress / regress tension, we can adapt the tension through the sets for when we develop fatigue and cannot manage that tension, or we change to a movement that is mechanically weaker and will require re-distributing band / stick tension to perform with good form.
Banded rotator cuff sets. These sets will involve both internal and external rotation in varying positions. Internal rotation (unless significantly injured) will, due to our muscle mass distribution always be a lot stronger than external rotation. We need to learn to use these open ended bands efficiently to redistribute appropriate tension for the movement. Signs of too much tension will be accessory movements in the torso or hips, avoid this, if the movement is external rotation of the shoulder, that is all that should be happening.
USEFUL LINK
Scapula movement orientation. This will be a review if you have read any of the other articles. If you struggle with any of the movements under load or against resistance, then training them during your banded sets is essential as you can reduce or increase the resistance very easily, stepping back into the bands for example.
This banded scapula routine is an easily scalable (band tension, hold further apart) primer for; elevation - depression and protraction-retraction. In all of these drills we strive to set up in athletic stance or in our handstand set up for force transmission - see video for hollow body.
A tour of the hollow body position, including anterior / posterior pelvic tilt and rib cage position for training our ‘corset’. These positions must be understood from the outset as they will run through our preparatory training as well as all bodyweight training.
Banded chest and shoulders prep. This drill requires you to observe the movements before attempting them and then replicating. In this drill, we should be familiar with scapular orientation, which should, for the large part track the direction of our hand pull. For example in a maltese pull (one part of this sequence) we are pulling the bands from behind to in front, which should be accompanied by protraction and a straight arm throughout (no elbow bend). A victorian pull moves the opposite direction and so we should be retracting. Understanding these enable us to figure out where our strong athletic stance should be.
Shoulder dislocate. An unfortunate name (especially for someone like me, who has suffered multiple shoulder dislocations!) but an extremely effective drill for shoulder health, if done regularly and accurately.
Hanging daily will be our main attack on shoulder mobility, and also as a preparatory exercise for sessions. This drill for example is a task for all the above whilst simultaneously exploring scapula movement variability.
Prescribed mobility will not be an ‘obvious’ feature of the programme, our training and preparatory methods will be training the full range of our shoulder; which will impact our mobility. Hanging daily will rebuild our shoulders. We have navigated the landscape for stretches / exercises worth including and kept it minimal. One exercise we have included for improving ongoing shoulder mobility is the dislocate. Details for training the dislocate accurately:
Correct approach; athletic stance.
Set your torso for tension; PPT / hollow body - DO NOT LOOSE THIS POSITION
Grip the stick (firmly) in chosen grip (Overhand shown above)
Elbows are locked the entire set.
Scapular is active in the direction of the stick; depression, protraction, elevation, retraction, depression - repeat.
Slightly flex the upper spine (between shoulder blades) and maintain ribcage down (Hollow body).
Simply changing the grip will dramatically alter an accurate dislocate for you.
Adhering to all of the above will ensure the drill is biasing the shoulder and not the spine. You will know you are doing these correct when a single rep is right on your threshold and is moderately intense. There are several ways to progress. If we can maintain all the above technical points, we can move our hands 1 finger closer together and repeat, striving to work our hands towards shoulder width potentially.
If we can safely manage a shoulder dislocate with 20% of our body weight on a dowel, we can explore skin the cat variations for shoulder mobility.
Weighting a dislocate with a small plate is a second way to strengthen through range. This will be a very different challenge, especially if your tendency is more towards being ‘flexible’ than strong. If we can perform weighted dislocates for 3-5 reps with 20% of your body weight, it opens up ‘skin the cat’ training for our shoulder mobility. Ensure you can achieve these pre requisites to safely train mobility this way.
There is not going to be hundreds of preparation drills; the ones we have chosen have been chosen because they work, if done consistently over time. Get to grips with these simple drills and reap the rewards. This is our clinical opinion.
Luke R. Davies,
#B2Rhealth
“We have navigated the landscape of stretches to hone in on what we believe are the most effective. We’ve kept it minimal, but what we’ve chosen has to be done.”