Limitations in overhead shoulder mobility are common and often a frequent source of nagging shoulder pain and decreased performance. Any loss of shoulder elevation mobility can be an issue with both fitness enthusiasts and athletes. Just look at all the exercises that require a good amount of shoulder mobility in the fitness, Crossfit, and sports performance worlds. Overhead press, thrusters, overhead squats, and snatches are some of the most obvious, put even exercises like pullups, handstands, wall balls, and hanging knee and toe ups can be problematic, especially when combined with speed and force such as during a kipping pull up.
When assessing for limitations in overhead shoulder elevation, there are several things you need to evaluate. I’ve discussed many of these in several past blog posts and Inner Circle webinars on How to Assess Overhead Shoulder Mobility.
I am worried about what I am seeing on the internet right now.
I feel like the mobility trends I am seeing are focused on torquing the shoulder joint to try to improve overhead mobility. Remember, the shoulder is a VERY mobile joint that tends to run into trouble from a lack of stability. Trying to stretch out the joint or shoulder capsule should never be the first thing you attempt with self mobilization techniques. In fact, I have found it causes way more problems than it solves.
Think about it for a second…
If your shoulder can’t fully elevate, jamming it into more elevation is only going to cause more issues. Find the cause. [Click to Tweet]
In my experience, the focus should be on the soft tissue around the joint, not the shoulder joint itself. The muscles tend to be more of the mobility issue from my experience than the joint. Just think about all the chronic adaptations that occur from out postures and habits throughout the date.
Two of the most muscles that I see causing limitations in overhead shoulder mobility at the latissimus dorsi and the teres major.
Here’s a quick and easy way to assess the lat and teres during arm elevation.
Assessing and Improving Overhead Shoulder Mobility
For those interested in learning more, I have a few Inner Circle webinars on how to assess and improve overhead shoulder mobility:
Over the years, the idea of posterior capsular tightness and glenohumeral internal rotation deficit (GIRD) in baseball pitchers has grown in popularity despite not much evidence.
I routinely see baseball players ranging from kids to MLB pitchers that have been told they have GIRD and need to aggressively stretch their posterior capsule and into shoulder internal rotation. One of the first recommendations I make is essentially addition by subtraction – stop focusing on these areas! I’ve discussed at length my feelings on why I don’t use the sleeper stretch, which is something I haven’t used in over a decade and none of my athletes have a loss of internal rotation.
Many people assume that GIRD is caused my posterior capsular tightness, without assessing the posterior capsule itself. Blindly applying treatments without completely assessing the person is always a bad idea, especially considering GIRD may be normal and not even an issue.
Assessing the posterior capsule can be tricky and most text books continue to demonstrate the technique poorly. I wanted to share a quick video showing how to assess the posterior capsule of the shoulder.
Perform your assessment of the posterior capsule this way and you’ll realize most people can actually sublux posteriorly and that mobilizing the posterior capsule isn’t what they need for GIRD! Keep in mind this is applicable for athletes, you can certainly get a tight posterior capsule for many reasons, I just don’t think this is the primary cause of GIRD so shouldn’t be the primary treatment.
Learn Exactly How I Evaluate and Treat the Shoulder
If you are interested in mastering your understanding of the shoulder, I have my acclaiming online program teaching you exactly how I evaluate and treat the shoulder!
The online program at takes you through an 8-week program with new content added every week. You can learn at your own pace in the comfort of your own home. You’ll learn exactly how I approach:
The evaluation of the shoulder
Selecting exercises for the shoulder
Manual resistance and dynamic stabilization drills for the shoulder
Nonoperative and postoperative rehabilitation
Rotator cuff injuries
The stiff shoulder
Manual therapy for the shoulder
The program offers 21 CEU hours for the NATA and APTA of MA and 20 CEU hours through the NSCA.
Low back pain continues to be one of the most common health complaints that limit people, especially as we age. Rehabilitation of low back pain has transition from simply focusing on reducing the local pain to emphasizing a biomechanical approach of how other areas of the body, such as the hips, impact low back pain.
Essentially we have done a great job moving away from simply treating the symptoms and working towards finding the movement impairment leading to the low back pain. Sure, using something like a TENS device may have a role to neuromodulate pain, but it is now common knowledge that the improvements seen are transient at best and not addressing the real dysfunction.
One area that has received a lot of attention, and rightfully so, is looking at limitations in hip mobility as a cause of low back pain. Much of the research to date has focused on looking at the loss of hip external rotation and internal rotation mobility. In fact, I have an older article on the correlation between hip mobility and low back pain.
I can say that my own ability to help people with low back pain has greatly improved as I’ve learned to focus on hip mobility over the years.
Hip Mobility and Low Back Pain
A new study was recently published in the International Journal of Sports Physical Therapy that adds to our understanding of the influence of hip mobility on low back pain. In the current study, the authors evaluated hip external rotation, internal rotation, and extension mobility in two groups of individuals, those with and without nonspecific low back pain.
While using a Thomas test to assess hip extension, the authors found the follow:
Hip extension in those with low back pain = -4.16 degrees
Hip extension in those without low back pain = 6.78 degrees
That’s a total loss of 10 degrees of hip extension in those with low back pain.
A Loss of Hip Extension Correlates to Low Back Pain
So now in addition to rotational loss of hip rotational mobility, it has been shown that a loss of hip extension correlates to low back pain. To me, this has always been something I have focused on and makes perfect sense, especially as we age.
The vast majority of our society sits for the majority of the day and becomes less and less active as they age. Among many things, this results in tight hip flexors and an anterior pelvic tilt posture.
Putting recreational activities like sports and running aside, this anterior pelvic tilt posture with tight hip flexors causes a loss of hip extension mobility and the low back tends to take the load but hyperextending. This happens while simply walking and in a standing posture.
Think about the results above, people with low back pain have negative hip extension, meaning they can’t even extend to neutral!
As we all know, the human body is amazing and will compensate. Hips don’t extend? No problem, we’ll extend our spine more.
So a pretty easy step to take to reduce back pain is to work on hip extension mobility.
One drill that almost everyone that trains at Champion PT and Performance gets is what I named the “True Hip Flexor Stretch.” I’ve talked about it at length in past articles, but I am a believer that most of our hip flexor stretches commonly performed in the fitness world are disadvantageous and not actually stretching what we want to stretch.
The True Hip Flexor Stretch is a great place to start to work on hip extension mobility:
As you can see (and feel), this gets a great stretch on your hip flexors without causing any compensatory low back extension. And by focusing on posterior pelvic tilt, we gear this towards those with a lot of anterior pelvic tilt.
I really believe that the “True Hip Flexor Stretch” is one of the most important stretches you should be performing. [Click to Tweet]
Next, Focus on Reducing Anterior Pelvic Tilt in People with Low Back Pain
I’m not a big believer that static posture is the most important thing we should all be focusing on when outline our treatment and fitness programs, but it’s a start. Someone in an anterior pelvic tilt static posture isn’t always evil, and can be the result of many things such as poor core control, poor mobility, and even excessive weight. I tend to care more about how well people move.
But based on the current evidence, it’s a great place to start.
Once you’ve started to gain some hip mobility, there is a ton more work to do. We also have to work on glute and core control, among other things. If you’re interested in learning more, I have a hugely popular Inner Circle webinar on my treatment strategies for anterior pelvic tilt that goes into detail on what I recommend:
In summary, we now have a nice study that shows people with low back pain have 10 degrees less hip extension that those without. This makes sense, and focusing on hip extension should be one of the key components of any low back pain program.
This past weekend, I was speaking at the Elite Training Workshop that we hosted at Champion PT and Performance in Boston on the topic of Integrating Corrective Exercises with Performance Enhancement. As I was going through my slides, I actually tweaked it a bit and added one new slide with a simple statement:
Stop Trying to Correct and Start Trying to Enhance
At the beginning of the talk, I discussed what some people would use to define the term “corrective exercise.” I even asked around the room. In general most people refer to corrective exercises as an exercise designed to improve poor mobility, strength imbalances, and altered motor control.
But there are some people that still refer to corrective exercises as exercises designto “fix” someone or “reduce pain.” I would argue, this is not what corrective exercises are supposed to be utilized for within a training program. Fixing injuries uses rehabilitation exercises, not corrective exercises. They are different.
This may be why you see people doing a squat on an unstable surface and calling it a “corrective exercise.” What are you trying to correct with that exercise?
One of the major components of using corrective exercises is a thorough assessment. Without an assessment you are just taking a stab at something. Without a through assessment, you are looking at an incomplete picture. This may be OK to try on some people, but will be ineffective with many people, and could actually be detrimental with people in pain. I’ve talked about this before in what I call The Corrective Exercise Bell Curve.
I would define corrective exercises more like this:
So Do We Really Need to Use Corrective Exercises in the Fitness and Performance World?
I still think we do, but perhaps we should really change our focus. Corrective exercises shouldn’t be used to “fix” people. That implies there is a problem. Don’t think of it as taking someone that is below their baseline capacity and getting them back to baseline, think of it as enhancing someone’s baseline and raising their capacity.
“Corrective exercise” is probably not the best terminology, perhaps that is part of the problem. Incorporate corrective exercises to help enhance people. Again, I’ll go back to that original phrase from my new slide:
Use corrective exercises to enhance someone’s mobility, or improve someone’s movement pattern, or to add a strength emphasis to an area that is weak. In this last example, if someone is quad dominant, has poor glute strength, and overuses their low back instead of their hips to hips, a “corrective exercise” may be a deadlift variation! That doesn’t seem like rehab to me, that seems like performance enhancement, doesn’t it?
Learn How I Integrate Corrective Exercises with Performance Enhancement
If you are interested in learning how I integrate corrective exercises into our performance enhancement programs at Champion, I have an Inner Circle webinar on the topic. In the presentation, I discuss:
What corrective exercises really focus on
How to classify corrective exercises into specific components
My system for determining which corrective exercises to perform
What you can do to maximize the effectiveness of your corrective exercises
How and when to integrate corrective exercises into your rehabilitation, fitness, or performance enhancement program
Any half way decent strength and conditioning program must be individualized to the unique needs and goals of the trainee. Developing programs that specifically address our clients’ “goals” is fairly straightforward, however, mastering how to design programs that also consider their “needs” can really take you to the next level as a personal trainer or strength coach.
When designing training programs, we often begin individualizing based on age. That’s a great place to start, but there are many limitations with just using age. I want to review how we design programs using “age” by starting with a review of chronological, biological, and training age.
More importantly, I wanted to introduce a new “age” we use at Champion called “movement age.” This may be the most important, yet most neglected as well.
Chronological and Biological Age
At the very beginning of the spectrum when discussing the “age” of your client is their actual chronological age, which is their precise age. While this probably isn’t as big of an issue when discussing the training program of two people aged 34 and 38, it is much more relevant when comparing two people aged 14 and 18.
Chronological age is a good place to start, obviously, but their biological age is far more important. The anatomical maturity of a 14 year old is quite different from an 18 year old and does become a variable that must be adjusted for within your program design.
Line up 6 kids that are aged 14 and you’ll see the difference. One looks like he is 10 years old, another looks 18, and the rest all fall somewhere in between. According to the data accumulated at Wikipedia, girls will go through puberty between the ages of 10 and 16, while boys tend to go through puberty between the ages of 11 and 17. That’s a 6 year range!
Our focus with those with a low chronological age is different that the older high school athletes. While strength and power tend to become more of the focus in the older trainee, we focus on what we call the ABC’s of movement with our younger trainees, focusing on Agility, Balance, and Coordination. Strength training is included but the results are obviously going to be limited by the hormonal and skeletal maturation differences.
But, I urge you to not downplay this stage of athletic development. Developing the basics of movement skills is important and unfortunately this generation of children are not getting the same development as past generations. In fact, our younger athletes at Champion see some of the biggest changes in athleticism. These programs are impactful.
Here are my 2 and 6 year olds working on their athleticism!
So it’s apparent that chronological age has limited usefulness and biological age is a much better place to start. However, chronological age does not take into consideration the experience of the trainee.
As chronological age becomes less relevant with older trainees, the next variable to consider is their experience in training. Image the difference in two individuals:
Trainee 1 – 28 year old – Wants to lose 10 pounds – Did not participate in athletics growing up, has never participated in a strength and conditioning program, currently has desk job.
Trainee 2 – 28 year old – Wants to lose 10 pounds – Was athletic growing up playing multiple sports in high school, and club sports for fun in college, trained at a sports performance center through high school, hasn’t trained consistently in 10 years.
Trainee 3 – 28 year old – Wants to lose 10 pounds – Was athletic growing up playing multiple sports in high school, and club sports for fun in college, trained at a sports performance center through high school, consistently trained through college and has continued since college.
We have people that are 28 years old and want to lose 10 pounds. Same age, same goal. Do they all start with the same program? Of course not.
Training age takes into consideration the experience of the trainee. Have they strength trained before? Do they know how to perform the lifts with proper form? Do they know how to exert force with intent (more on this in a future post…)?
Remember the success of your programs are based around how the body adapts to the stress applied. You can pretty much do anything to Trainee 1 to stimulation enough stress to make a change, which is good because they have a lot to learn! On the other end of the spectrum, Trainee 3 has a great understanding of how to train and has been exposing his body to different stresses for years. To make progress in this trainee, you’ll likely need a more complicated periodization scheme to create a different stimulus for their body.
There is one HUGE flaw with training age. Just because you have been training for several years does not mean you understand how to train, or even that you know proper technique!
Don’t assume that since someone has been training consistently for years that they have been training correctly!
This is a common finding in people that have dabbled in strength training in the past and are starting a formal program or starting to work with a personal trainer or strength coach for the first time.
The last age we consider when designing strength and conditioning programs is one of the most important, but often neglected. We can have an advanced trainee in regard to chronological age, biological age, and training age, however, can they move well? At Champion, we’ve started to use the terminology “Movement Age” to discuss someone’s ability to move.
We don’t even have to make this too complicated – can they hinge, squat, lunge, step, rotate, push, and pull?
We simply define the ability to “move” as using proper form through the movement’s full range of motion. This then becomes a scale:
Can they move with assistance?
Can they move without assistance?
Can they move without assistance with load?
Can they move without assistance with load and speed?
It’s amazing how our movement skills have deteriorated. How many of your high school athletes can touch their toes? Isn’t it amazing?!?
In order to advance from beginner, to intermediate, to advanced trainee in our Champion program design system, you need to demonstrate maturation of your chronological, biological, training, and movement age.
On the Performance Therapy side of Champion, we work with a lot of athletes that want to optimize themselves and get the most out of their bodies. It’s amazing how many of the “advanced” athletes we see have poor movement skills. They don’t hinge well, or squat well past neutral, or can’t even balance themselves in a half kneeling position!
This can lead to imbalances, asymmetries, and compensation patterns that can suck performance, lead to tissue overuse, and eventually breakdown. This is especially true if you try to just blast through your poor movement skills and add load and speed to your lifts.
Sometimes we don’t need an advanced and complicated strength training periodization scheme, sometimes we just need to clean up movement patterns. Consider this taking one step back to take 5 huge steps forward. Movement age may be the most important variable to consider when designing strength and conditioning programs.
One of the most common areas we attempt to improve in clients at Champion PT and Performance is overhead shoulder mobility. If you really think about it, we don’t need full overhead shoulder mobility much during our daily lives. So our bodies adapt and this seems to be an movement that is lost in many people over time if not nourished.
I’m often amazed at how many people have a significant loss of overhead mobility and really had no idea!
That’s not really the issue. The problem occurs when we start to use overhead mobility again, especially when doing it during our workouts and training. Exercises like a press, thruster, snatch, overhead squat, kipping pull up, toes to bar, handstand push up, wall ball, and many more all use the shoulder at end range of movement. But here are the real issues:
Add using the shoulder to max end range of overhead mobility and we can run into trouble
Add loading during a resisted exercise and we can run into trouble
Add repetitions of this at end range and we can run into trouble
Add speed (and thus force) to the exercise and we can run into trouble
4 Ways to Improve Overhead Shoulder Mobility
In this video I explain the 4 most common reasons why you lose overhead shoulder mobility and can work on to improve this movement:
The thoracic spine
The lumbopelvic area
The first three are commonly address, but not so for the lumbopelvic area, which is often neglected. I’m going to expand on this even more in this month’s Inner Circle webinar. More info is below the video:
Assessing and Improving Overhead Shoulder Mobility
For those interested in learning more, I have a few Inner Circle webinars on how to assess and improve overhead shoulder mobility:
Mike is the President and Co-Founder of Champion Physical Therapy and Performance, located in Boston, MA. Champion offers an integrated approach to elite level physical therapy, personal training, and sports performance.
Click below to learn more about seeing Mike and his team for 1x consultations or ongoing physical therapy, personal training, or sports performance training: