Jessica Bento, Physical Therapist (Co-Creator of DVRT Restoration Certification, Shoulder & Pelvic Control Courses)
Shoulder issues were one of the most common issues I would see patients in the clinic with. The amount of shoulder issues could almost rival those with low back issues, it seemed so frequent. At the time as a young physical therapist I did the pretty standard shoulder exercises. Band external rotations, wall slides, Y, T, and I’s, the pretty typical stuff that you would see by even many therapists today!
Why change though? Why did I look for something better for my patients if the program I had them on was working. The simple answer is because it didn’t. A lot of the people that get better simply did so from healing over time, or the fact they were doing no strength training and the tiniest bit helped their strength. What saddened me the most was far too often I would see many of these people back with very similar issues.
My path of looking for better got me to renown physical therapist, Gary Gray. I was so intrigued at how Mr. Gray looked at the whole body when he created exercises, not only the whole body, but how specific parts of the body worked together to create motion. There is a lot we could go into, but three concepts that I believe really changed how I think about training the shoulder is represented here…
I am blown away at how many physical therapists STILL train the body like a bodybuilder. Far too often my peers try to isolate a joint or body part in order to “fix it”. Which truly makes no sense when you look not just at the anatomy of the shoulder itself, but the great interplay that the shoulder has with our core and lower body. Ironically, I see many people try to take away the core and lower body when they train the shoulder and that is one of the biggest mistakes people can make!
Drills like the one above are well meaning, but they completely miss the boat on making the shoulders better!
If we look at the lats for example, they make a strong connection of the upper body (starting at the shoulder) to the spine and pelvis. There is a reason that the lat is that big and makes such a connection like we see. That is because what happens at the core/pelvis, and lower body have a big impact on how our shoulder functions and performs.
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If there is an issue that I can relate to more than most is that of having problematic shoulders. After all, it was tearing both my shoulders that ended the hopes I had of making the Atlanta Olympics in swimming (does that make sound really old?!). Being a highly competitive swimmer, I was on that trajectory but causing serious damage to my shoulders killed those dreams. ______________ That is definitely part of the reason that I wanted to become a physical therapist. I wanted to learn all about my body and how to make it better. What I thought I had learned was school was the “answer” until I started actually practicing. I just wasn’t getting the changes I had hoped. Sure, I helped people get better, but nowhere near what I thought could be achieved, but I also didn’t know what I was missing. ______________ Don’t tell @joshhenkindvrt , but when he shared with me his ideas on functional training I saw another world open up. Things started to make more sense when thinking about the body as a whole rather than a bunch of unrelated parts. Instead of doing meaningless rotator cuff drills, I thought about how to engage one’s grip, the core, even the feet! Thinking more of how the shoulder worked with the entire body helped make me a better therapist and yes, even get my own shoulders so much better! _____________ ➡️That is why I get so excited to share the information that helped me and my patients with others. Whether you just want to get stronger or build greater resilience and mobility they are so important!.*fully aware of the typo in the main slide 😆no need to comment on that 👍🏻
That is why when you see me perform BETTER shoulder exercises like those above, I am trying to integrate my entire body from feet to shoulders. That includes important aspects like my grip and making sure my core is able to keep my positioning under different conditions. Knowing that the shoulders function WITH the core and lower body should help you quickly determine if the advice you are getting on shoulder training is good or not! The Arc Press in our DVRT system is a great example of how we can integrate the body to create better shoulders.
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You probably could see a “shoulder exercise” (tell you why I put that in quotation marks shortly) , but a great knee exercise? How so right?! In order to understand how we have to first understand what often impacts the knee and the shoulder as well! Let’s take the knee first… ____________ The diagram you see on the right is one of the several chains that makes our body move effortlessly in very complex ways. What you see is that everything starts from the ground up. This means the feet are essential to create stability to help stabilize up the chain, especially the knees. Most people put bands around knees to fix those legs that cave in, but the true culprit is the feet! Being on a small balance beam isn’t about “balancing”, but being in an inline position (the front leg in line with the back leg) forces us to use our feet more because if we don’t create stability in the feet we tip over. That is what we aim to do in all these #DVRT progressions and what different levels of half kneeling from this static position to a more dynamic lunge as you will see really reinforces. ______________ That brings us to also the fact using the Ultimate Sandbag for our Arc Press is just as much about teaching the upper body to work properly as it is in forcing the core to stabilize laterally and engage the glutes through the feet and how we use the upper body to also build knee stability from the “top down”. _______________ Believe it or not, the same concepts impact the shoulders as you see in the spiral line diagram. Most shoulder issues in the gym are due to an unstable core and inactive lower body. Since everything comes from the ground up, when we activate the lower chain of the body correctly and that builds stability all the way up the body, our shoulders have a better “platform” to perform. The gripping of “pulling apart” the USB also helps us stabilize the shoulder through the relationship our grip has to our shoulders in giving them better stability. ________________ Functional training is a purposeful methodology, but we have to know how our body works to create better solutions.
Whenever you read an article about shoulder training you typically see the first section reference the anatomy of the shoulder. You see muscles, tendons, ligaments, and joint structures, but what you rarely see or hear is how the body puts all of this together to produce motion. The shoulder should be a very mobile joint that should be able to move in all 3 planes of motion.
It is interesting that before gyms were mainstream, our understanding and appreciation of functional anatomy seemed better in many ways. You see, the 3 planes of motion means that the shoulder is made for circular motions like throwing. Yet, we train it typically in only up and down movements. That is why equipment like Indian clubs were popular in the early days of Physical Education classes. The purpose was to train circular patterns that were so natural and innate to the body.
While Indian clubs are fine to use, they don’t build a lot of strength with the mobility that we need. Often I see people use Indian clubs to warm-up their shoulders, but then their lifting is purely sagittal plane movement. One of the great things about what we do in DVRT is use tools and concepts that allow us to take these ideas and put them in very practical terms like you see below where we strength train, stabilize, and perform mobility all at once.
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It can be hard to say in any situation what is the “best” exercise. However, we can often discuss what are the most overlooked drills that can help people move better. People have been seeing a lot of exercises that have a weight going around the body, but what makes what we do in #DVRT different? _______________ For us in DVRT these are called Around the Worlds (ATW), what makes them such a great drill is that they combine elements of lift/chop with a plank to create a real powerhouse core drill. The range of motion and the ability to open the shoulders more than any other tool we get a very unique effect from using the Ultimate Sandbag. ______________ The result is not just great core stability, but also better mobility in both the hips and shoulders. Using the ATW with the movement patterns is effective in connecting the core to the rest of the body as well as developing the “pulse” that spine expert, Dr. Stuart McGill talks about being the highest level of core work! “Interestingly, we measured the same qualities that we find in many top athletes, from many sports. If we had to name a single variable common to these overachievers, it would be the incredible rate of muscle contraction and rate of relaxation.” ____________ ➡️ Find out how we teach, progress, and use the ATW in this great article by DVRT Master, @corymcripe. Get the 🔗 in my BIO
As I have been helping Josh return to training after his neck surgery, we have been using these principles to help solve the nerve damage that came with the spinal degeneration and surgery. Many times people don’t know that the neck contributes to a lot of shoulder issues, but that is a topic for another time. Nerve damage in many ways can be more difficult than structural injuries because the nerves regenerate so slowly and we need coordination, stability, and strength all at once. That is why the exercises you may see Josh using for his shoulder don’t look like what you might expect in your shoulder rehab.
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To hell and back, that is what I would describe my body and mind have been through in the last 8 years. It didn’t start then, it began when I was 14, but my spinal disease got to the point where I’ve had 6 spinal surgeries in the last 8 years. Going from having completely lost my right leg, to losing my arms, it has been rough mentally as well as physically. The only saving grace was finding solutions that allowed not only to help myself, but others as well. ____________ While I would have preferred NOT to have gone through what I have, I also have the perspective that it has allowed me to be a much better coach. I don’t know if I would have been as thoughtful or dug really into creating systems if I hadn’t gone through the challenges that I have faced. ____________ Now as I rehab myself again, I do have the principles and systems in place to feel confident that I will get back to my normal. Yes, one of the biggest challenges overcoming any injury is the acceptance that you will probably have a new normal. It probably is easier physically, than mentally to get to that place and I should know. Years ago I did competitive Strongman, Weightlifting, and was an avid hiker and recreational athlete. Now, almost none of that exists. I can be active, but I have to be far more aware of what those activities are and I have a lot more limitations on what I’m allowed to do. ____________ It is easy to let that get you down, but I’ve found other ways to keep myself challenged in doing things that if I didn’t go through these experiences I don’t know if I would have ever come to appreciate and find to be so effective. So many coaches have helped me over the years the way I pass it on is by doing the same for others. For example, these 3 #DVRT drills probably wouldn’t be seen by many to be foundational for stability of the hip, low back, and shoulders, but they are just that. Using great tools with greater purpose like our Ultimate Sandbag, kettlebells, and the @functionalmvmt screen (their principles have been a big influence and using the kit for inline alternating kettlebell presses is tough!) allows me to not only share what works for me, but ideas of how you can make
The way we have been able to restore function for Josh so fast is by thinking about the whole body contributing to his motion, not just his shoulders. That means again, everything from feet to hands. Not just putting him in positions where he has to use his whole body, but cuing it as well. From simple strategies like making sure he grips an implement tightly or the ground to giving feedback to using his feet. When we combine that with using important functional training ideas like diagonal patterns, we get some pretty powerful and unique shoulder exercises as you see my perform below.
My hope is the more you understand about the body, the faster and more significant the results you can achieve as well. NOTHING stops a well meaning training program like injury and exercise should NOT be a risk factor as Dr. Lee Burton says. Instead, our training should make us stronger, leaner, but also healthier and move better. I hope these training ideas show you how we can do it in fun and dynamic ways so you can enjoy not just the result of your training, but the journey as well.
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These exercises don’t seem like any type of your typical “making better shoulders” routine. That is because most times in our exercise programs we think the shoulder functions by itself, I know I did as a young physical therapist, but learning from our mistakes is what allows us to evolve to deliver better to those that comes to us for help. So, what makes these #DVRT drills such good shoulder drills to help mobility, stability, strength, and overall health of the joint? ____________ Renown physical therapist, Gary Gray, has some great points about the shoulder. 1️⃣ The pelvis, trunk, and scapula all tie together. 2️⃣ In functionally analyzing the shoulder, we want to focus on all three planes and at both ends of all three planes. 3️⃣ Functional rehabilitations of the shoulder requires that we allow every part of our patient’s body to become successful to contribute to the success of the shoulder. There is more, but if our shoulder training could appreciate these 3 principles we would be so much more successful. ___________ If we combine this with concepts we know about fascial lines like the spiral line, we see how Mr. Gray’s points are spot on. What is the spiral line? “The Spiral Line loops around the body in two opposing helices, right and left, joining each side of the skull across the upper back to the opposite shoulder, and then around the ribs to the front to cross again at the level of the navel to the hip. From the hip, the Spiral Line passes like a ‘jump rope’ along the anterolateral thigh and across the shin to the medial longitudinal arch, passing under the foot and running up the posterolateral side of the leg to the ischium and into the erector spinae myofascia (of either side, depending on posture or position) to end very close to where it started on the skull.” ____________ It isn’t just moving or lifting that I am doing in these drills. I am trying to use concepts of grip that is correlated to shoulder stability. Whether that is gripping the ground, pulling apart the Ultimate Sandbag, or gripping the kettlebell, we want to be very intentional in how we engage with the ground and the weights we lift …cont in comments.