Are Lat Stretches Dangerous? and 5 Better Ways to Gain Overhead Mobility

So, I’ve said it myself.  It’s important to have mobile lats.  Having adequate lat length will allow for overhead mobility.  Overhead mobility is super important for:

• Optimal technique during jerks, push press, muscle-ups, pull-ups etc.
• Injury prevention

Basically if you ever go overhead in the gym, you’ll want mobility through this muscle group.  It’s that simple.  That being said, I think lat stretches are being thrown around too much.  You’ll see many-a-gym having their members throw a band over a bar, throw their arm through the loop and go to town on their lats.  I’ve even done quite a bit of this in the past.  All is good right?  Well, maybe not.

Trouble is, some people don’t really feel a stretch in their lats when they do this stretch.  Instead they report:

• A pinch in the top of the shoulder (by the middle deltoid)
• A block at the top of the shoulder
• Tightness in the top of the shoulder

Now, if the lat attaches from the arm down to the lower back, we should be feeling a lat stretch there right?  Well ya.  So why do people report these unusual sensations?  Talk to anyone who’s ever treated shoulder impingement, cuff tears or tendinopathy and they’ll be pretty familiar with what pain and tightness in this region means…

Let’s go back to the Neer’s test.  Neer’s test was created to assess for subacomial impingement syndrome and accompanying irritation of the rotator cuff .  (For way more information on subacromial impingement syndrome then you probably ever wanted click this link)  The test was designed to approximate the greater tuberosity of the humerus up against the acromion, thus compressing the rotator cuff (1).  This was accomplished by fully flexing the shoulder joint and blocking scapular motion.  A re-creation of the patient’s pain was indicative of impingement and irritation of the cuff.  For some info about this phenomenon read THIS.

Everyone loves a good Neer’s test, I know I do.  Look how happy I am.

One interesting phenomenon I’ve found over time is that a lot of people feel like their end range of motion overhead ends with a pinching or blocked sensation at the top of the deltoid.  What I’m curious about is whether this pinched sensation is actually the greater tuberosity bumping up against the acromion at end range shoulder flexion just as with Neer’s.  It’s actually pretty common for people to tell me that they feel like they’re blocked by tightness in the top of the shoulder even when they don’t have any pain.  Is this “tightness” compression of the rotator cuff?  I think so.

The reason I feel this is relevant is because the current theorized reason why rotator cuff tendinopathy and tears occur is through a combination of compressive and tensile loading (2-4).  If you’re programming contains a hefty dosage of pressing our rotator cuffs are certainly getting both compressed and loaded.  When we’re forcefully stretching overhead we might be squishing the cuff even more.

Now, who knows.  Maybe some compression to the cuff through stretching has little to no effect on our risk of injury over time.  However, when I see athletes come into the clinic that:

• Report pain in the top of their shoulder with movements that cause hyperflexion of the shoulder (backswing of kipping, lat stretches) and..
• Have a positive Neer’s test

This causes me to raise an eyebrow.  My athletes are already performing a ton of overhead motion so I’m sure their rotator cuffs are already taking a beating.

The other concern is that I also tend to see a lot of young (<30 years old) competitive athletes (Games level) with rotator cuff tears.  Rotator cuff tears are NOT common in people aged 20-40 years old in a general population (5).  Something has to be creating this problem.

I’m sure that overhead stretching is not the largest reason for cuff tears in young athletes but if we can help to minimize at least some of the compressive forces on the rotator cuff in our training programs maybe we can keep our shoulders a bit happier.

So the next questions becomes, “how do we gain mobility of the shoulder without the excess compression?”

1: Emphasize motion through the thoracic spine

• Gaining thoracic spine extension increases overhead mobility without forcing more flexion of the shoulder
• Extension can easily be cued prior to overhead pressing and with hanging exercises like pull-ups

2: Utilize more soft tissue techniques 

• Foam rolling, instrument assisted soft tissue mobilization, cupping, needling, pin and stretch techniques
• These modalities promote length without the compression that occurs with end range flexion of the shoulder

3: Stretch the lats in a position that doesn’t create impingement

• Bias spinal flexion and side bending to stretch the lat and not just shoulder flexion
• The lats attach down by the lumbar spine so we can stretch them by emphasizing motion down by the spine without excessive shoulder flexion

3 Hacks to Get the Most Out of Your Lat Stretches We all know that the lats can limit overhead mobility but what you may not know is the best way to mobilize them. The Lats are unique because they attach from the humerus down to the lumbar spine on the thoracodorsal fascia. Follow these 3 pro tips to ensure you're maximizing your stretch. 1) Palms Up – The Lats are internal rotators and a palms up grip will stretch them best 2) Flex the spine – The Lats function to extend the spine. If we flex the spine prior to flexing the shoulder we get more of a mobilization. 3) Sidebend the spine – This is done to further lengthen the Lats at the spine level. You can best see this in the top video. Lastly, sit back as you normally would to get a stretch. Just make sure you keep your spinal position as you do. Feel free to contract relax until your heart is content. Give this a share if you know someone who could benefit from it! @powermonkeyfitness @crossfitverve @jasonleydon @shift_movementscience @themovementfix @suppleperformance @thebarbellphysio

A post shared by Daniel Pope (@fitnesspainfree) on May 23, 2016 at 5:51am PDT

4: Emphasize scapular positions during training that minimize compressive forces

• Scapular upward rotation and posterior tilt
• Scapular motion promotes greater motion without hyper-flexion of the shoulder

3 Keys To Optimal Shoulder Health for Kipping. Hanging from a bar and kipping can create quite a bit of compression on the rotator cuff and biceps tendon. Shoulder blade position is important when teaching people to hang on the bar to help minimize stress on the shoulder structures and maximize performance. There are 3 major shoulder blade motions to work toward to optimize shoulder health. 1) Upward Rotation – This moves the acromion away from the humerus allowing space for the rotator cuff as well as centering the joint. This goes against traditional wisdom of "shoulder pack" 2) External Rotation – This moves the greater tuberosity away from the acromion further creating space for the cuff. External rotation also increases ligamentous support of the shoulder. 3) Posterior Tilt – This last movement also brings the acromion further from the humerus creating more space for the cuff. Posterior Tilt and thoracic extension also places the cuff and scapular musculature in a stronger position to produce force. Try the exercises that follow to help teach your athletes how to hang and kip in a safer fashion. @powermonkeyfitness @championptp #crossfit #reebok #teamreebok #pullups #kippingpullups #performancetherapy #physicaltherapy

A post shared by Daniel Pope (@fitnesspainfree) on Jan 9, 2017 at 5:39am PST

5: Utilize other ways to improve soft tissue length like eccentrics

• Partial pull-ups, pull-overs, roll-outs
• Eccentrics not only are great for building muscle and optimizing positions during complex movements but are also great for improving range of motion

3 Unique Eccentric Exercises for Overhead Mobility [link in bio] Eccentrics are a great way to gain new mobility and accomplish 3 things that either stretching or foam rolling alone doesn't. 1) Stability and control at end range – Eccentrics help to build proficiency at end ranges of motion. More strength and stability in the bottom of a pull-up will most likely help to decrease injury risk during higher rep sets of muscles and Kipping pull-ups. 2) Efficiency – Eccentrics help to build strength and range of motion in the target area but can also promote things like core strength as demonstrated in this video. 3) Hypertrophy – Eccentrics have more time under tension then other movements which is an important variable in building muscle. Long story short, if you aren't regularly using some Eccentric work in your regular training you're missing out! @championptp @powermonkeyfitness #mobility #physicaltherapy #crossfit

A post shared by Daniel Pope (@fitnesspainfree) on May 3, 2017 at 6:58am PDT

Now I don’t want to scare people out of stretching their lats with this article, but did want to spur some thought about what the best interventions may be to gain overhead mobility without provoking problems.  Let me know your thoughts in the comments below.

In case you haven’t realized it, I’ve been on a shoulder kick lately.  This is because Dr. Dave Tilley from shiftmovementscience.com and myself have made a big new shoulder product to help physical therapists, coaches and athletes get out of shoulder pain, back to level high levels of performance and to stay pain free for the long run.  

Click HERE to Learn More about Peak Shoulder Performance

I’ve got another fun one brewing for you next week,

References:

1. Woodward, T., & Best, T. (2000). The Painful Shoulder Part 1: Clinical Evaluation.American Family Physician. Retrieved June 5, 2016, from http://www.aafp.org/afp/2000/0515/p3079.html
2. Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163–168. doi: 10.1136/bjsports-2011-090414. [PubMed] [Cross Ref]
3. (SEITZ A., McCLURE P., FINUCANE S., BOARDMAN D., MICHENER L.; Mechanics of rotatot cuff tendinopathy: intrinsic, extrinsic, or both?; ‘http://www.clinbiomech.com/article/S0268-0033(10)00221-4/fulltext’; 16 september 2010, clinical biomechanics. Level of evidence: 2C Level: 2C,
4. LEWIS J., Rotator cuff tendinopathy: a model for the continuum of pathology and related management; ‘http://bjsm.bmj.com/content/44/13/918.long’, Br J Sports Med 2010;44:918-923 doi:10.1136/bjsm.2008.054817. Level of evidence: 2C level: 2C)

5. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768248/