Improving Shoulder Mobility

At the beginning of every season, we will do a Functional Movement Screen (F.M.S.) with each member of our team.  It has become a part of the whole overall testing and assessment process.  The process of using the F.M.S. has evolved as I have learned new strategies and techniques from season to season to help us incorporate corrective exercises into our program.  During the first few seasons that we implemented the F.M.S., we simply screened our team and then implemented our in-season program.  Now, we are taking a much more individualized corrective exercise approach as I felt that we needed to incorporate some corrective exercises to help the players with F.M.S. issues and prevent players from having problems.

We have seen some trends in the scoring the F.M.S. over the past 5 years.  The hurdle step pattern has been one that has shown some asymmetries.  Mike Boyle has written and talked about this pattern and his hockey players for a few years now.  We have definitely benefited and implemented some of his ideas and progressions.

Another part of the F.M.S. where we will see some asymmetries is the Shoulder Mobility Screen.  Every season, we will have some shoulder mobility asymmetries with some of our players.  Many times, these players may be new players acquired by our team through trades or through free agency.  With these players, it is not uncommon to hear them describe having a previous injury which may have been a separated shoulder, an AC sprain, or a dislocation/partial dislocation earlier in their career.  They may have undergone surgery to correct one of the previously mentioned injuries or they may have rehabbed it without surgery.  Either way, the injury has caused them to lose some mobility and/or stability in the shoulder joint and in the thoracic spine.  Therefore, we may have some differences in right versus left side in our shoulder mobility screen.

The Thoracic Spine is an area that we are continuing to learn more about.  Many hockey players display some thoracic kyphosis and will also show signs of Janda’s Upper Crossed Syndrome.  Tight pectoralis major and pectoralis minors, combined with weak upper back muscles are common.   There are many factors that may of lead to these imbalances such as prolonged sitting, improper training programs, or simply playing the game of hockey.  Along with previous injuries, these imbalances are another reason why we may see some asymmetries in the shoulder mobility screen.

Something that I have learned from listening to and reading Gray Cook’s materials is that one of the biggest predictors for injury is previous injury.  The most important aspect of our jobs as strength and conditioning coaches is injury prevention and recovery about which you can learn more here on the products and tools we use to do it.  It is important to try to ensure that a previous injury will not become a current injury.  Making corrections in faulty patterns by correcting tightness and/or weakness is beneficial to preventing further injuries.

With the shoulder mobility assessment and its corrective strategies, I’ve realized that making progress will not happen overnight.  These are not exercises that can be done once or twice and then forgotten about.  We have found that using the corrective strategies that have worked for us usually have to be done on a daily basis.

How do we incorporate the corrective exercises?  With a long schedule consisting of many practices and games, players will develop their own routines to help them prepare on a daily basis.  We will simply have the players who have exhibited asymmetries on the Shoulder Mobility screen add some of the corrective exercises into their daily pre-practice and/or pre-game routines.  As a result, we have seen small increases in shoulder mobility as we go along.  It is not uncommon to hear our players say that their shoulders feel better.

Here is a sequence of exercises that we do with our players.  Each part of the sequence needs to be done in order and no parts can be missed.  The proper order needs to be followed to allow us the greatest chance of success.

Soft Tissue Work- We will use many different methods to address thoracic spine mobility including the foam roller, the Stick, and 2 tennis balls taped together.  We will address the posterior shoulder girdle, the upper back, the pectorals, and the lateral aspect of the rib cage.  Sue Falsone, Physical Therapist from Athlete’s Performance, gave an outstanding presentation at last summer’s Perform Better Functional Training Summit that covered the Thoracic spine.  She discussed several methods of increasing mobility in the t-spine.  We have successfully borrowed and implemented some of her ideas from her talk.

One thing I remember learning from a Gary Gray course that I took 7 years ago was that he said “Use the other 2 planes of to help get more motion in the less mobile plane.” In the case of the thoracic spine, increasing mobility in the sagittal and frontal planes will help with gaining mobility in the transverse plane, while increasing mobility in the transverse and frontal planes will help with gaining mobility in the saggital plane.  We will look to increase mobility in all 3 planes of motion using the easiest and most efficient methods.  We will also work on flexibility for muscles that can become shortened and tight including the Pectorals Major and Minor, latisimus dorsi, and subscapularis.

Here are some of the exercises and progressions that we have used to help us gain more mobility and stability in the thoracic spine and glenohumeral joint:

Standing T-Spine Rotation- This exercise is borrowed from Michol Dalcourt.  I really like this one because we are standing.
 

Quadruped T-Spine Rotation- This is another exercise that we have used to help prevent the lumbar spine from moving so that the rotation is primarily at the t-spine level.

 

Standing Wall Slides- This is the easier progression of the wall slide.  The back of the head, shoulder blades, and butt are touching the wall.  We are simply keeping them against the wall as we slide our arms up the wall until our hands and elbows can no longer stay in contact.  A much more difficult version of this exercise is also standing, but in addition to the head, shoulder blades, and butt, we try to keep the lower back flat as well.

Seated Wall Slides- this is a more difficult version of the standing wall slide as we are now in a position where the lower back is flat against the wall which will allow for a more kyphotic thoracic spine to take place.  This will put the athlete in a position where the anterior muscles need more length and the scapula retractors more strength to get the shoulder blades to touch the wall.

Integration-  
 
One of the aspects of the F.M.S. that I like is that asymmetries in one of the screens can result in an issue in another screen.  For example, with an athlete with shoulder mobility 1’s and 2’s, it is common to see a 1 or a 2 in the Deep Squat assessment. We will try to correct the Deep Squat after we have seen some positive results from our Shoulder Mobility exercises.   Sometimes by just working on shoulder mobility, we have seen positive changes in the deep squat.   If we still have some issues with thoracic spine extension, we will incorporate this:

Toe Touch Squat With Alternating Arm Reach- 
 

With hockey being a collision sport, injuries to the shoulder joint are not 100% avoidable.  However, if we can make positive changes by helping our players feel better, I am all for it.