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
https://www.instagram.com/p/BFwBt2VKAHU/?taken-by=fitnesspainfree
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
https://www.instagram.com/p/BPC60Y9hKcD/?taken-by=fitnesspainfree
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
https://www.instagram.com/p/BTofo5AhONK/?taken-by=fitnesspainfree
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:
- 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
- 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]
- (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,
- 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)
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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/