 Hi, I'm Lieutenant Commander Jim Cowan, physical therapist here at Buds Sports Medicine. I just want to wrap up our last series concerning sports medicine topics here at Buds and some better preparation, things that you can be doing here. This last segment is going to concern shoulder health, which is a huge problem here at Buds. We have a large number of students per class that get injured. At least two per class roughly require some type of surgery due to the overhead workouts that we do here. We also have a large percentage of our seal operators that go on to form problems later down the line and require surgery as well. So what we'd like to do now is put some prevention strategies in place as far as possible before you even come to Buds with the hope that throughout your seal career that this will eliminate any need for surgeries down the line. The problem that we see here quite often is to come to Buds you have to do a lot of push-ups and pull-ups. And so that really over-develops certain muscle groups while leaving others very weak. And just like you wouldn't want to have just a bicep and no tricep, you really want to have equal strength and balance around your shoulder so that it can perform the way that it needs to do. We find that routinely that most of the students because of all the push-ups have a very over-developed and strong chest and a relatively weak back. And so their chest and their lat groups because of the push-ups and pull-ups that dominate their shoulder and lead to problems that usually require surgery or at least some intensive rehab down the line. So we're going to talk about in the video a couple of key stretches that will keep your shoulders healthy and the exercises that we recommend most of our surgery patients and students to prepare to get here to have a good healthy shoulder before they come to Buds. Okay, so the first muscle group that we're going to look at that is typically over-developed is the lat group. This is because all the pull-ups you have to do to get here. We make that requirement, so this just happens to be one of the problems. So we really like to keep your lats stretched out because the tight lat muscles really tend to bring your shoulder blades forward and cause a lot of problems. You can see the way we look at this is this overhead position. In this position right here, your arms should really be able to touch the table. And if you can't, that really does kind of show that your lat muscles are a little tight and keeping you off the table. Your lat muscles need to be stretched out both from your shoulder health and also your ability to be able to do the log and boat overhead work that we require that's overhead and tight lats really restrict that. So the first stretch we're going to show you is how to stretch out your lat muscles. So one of the best stretches I like to work on the really focused lat stretch is this kneeling, we call it a prayer stretch. It really is a nice focused lat stretch here. You've got elbows on a weight bench or your desk or anything about this height and really drop into a nice, and most of my patients say really they feel a very nice focused lat stretch there. It's one of the two most important stretches for shoulder health before you come to buds. You've got to be able to be overhead comfortably from a flexibility standpoint and a strength aspect to really not have problems here. An alternative position to stretch out your lats and really do a nice overall back stretch if you prefer this is another one that you could try and really just go with the one that you feel the best and you feel the best stretch with is just a nice head down rocking back on your heel type of stretch. This is nice because it puts your shoulder blade in a good position to stretch works on your lats also stretches low back all at once so it's a pretty good all-encompassing stretch but really the focus needs to be in this particular stretch of your lat muscles. Okay the second really tight group of muscles that most guys prepare to stretch out before they come here is their pec muscles. They're very strong and that's great but they also get very tight. Usually tight muscles are very strong muscles. So in this position on your back I shouldn't be able to reach my hand under your shoulder blade. This forward shoulder position really is a tight pec muscle holding in there. The shoulder blade should really be able to lay flat on the table. As you see as he springs forward that really is just a tight pec muscle that does that and with that forward position causes a lot of problems. So the best stretch that I like to work on these tight pec muscles is just a nice corner stretch. You want your elbows slightly higher than your shoulder muscle and you really should feel it on this diagonal line right across your chest here deep. That really is going to help you stretch out to get your shoulder blade to a really nice neutral position and avoid the problems. And just like always you want to hold these stretches about 30 seconds or so. A couple reps at the end of your workout for 30 seconds would be a good idea. And this really is a good position right there to help stretch out those pecs. Okay let's start talking about some of the specific strength exercises. Like I said before guys work out a lot of the external group muscles but they don't really work out the deep muscles that help stabilize your shoulder. You have four muscles that really hold your shoulder in socket and stabilize it and prepare it and protect it during these evolutions and these are also the four muscles that almost no one works out. So you need a lot of good endurance work on these exercises. Okay so the first rotator cuff muscle that we like to work is your internal rotation muscle. It's a very big muscle that sits between the back of your ribs underneath your shoulder blade. It rotates you to the inside. This is the movement right here. You would want to be able to do 10 to 12 reps. Nice and slow. Make sure you have good posture while you do it. Nice set of 10 to 12 repetitions. Okay work in the backside of your shoulder. The rotator cuff muscle is an external rotator shoulder and these are very important because they counteract all the pull-ups and all the overhead work. They're very good at protecting and stabilizing your shoulder against overhead activities. So they're very important. No one hardly works these. Really nice external rotator cuff movement. As you do these I want you to really focus on feeling it right here on the backside of your shoulder as you do that. And try not to cheat it and make it a tricep extension. It is not. His wrist is really facing forward as he does this motion and it's a really long down strong and away feeling that motion right here on the back of shoulder. An additional position to do those same type of exercises internal and external rotation and really work that cuff is really with the arm at your side position. You can put a workout towel under your arm and really make it a focus internal and external movement. Always with good posture. Keep your shoulders open. Keep those shoulder blades open while you do this so you're not causing problems. And like we said we want to recommend about 10 to 12 repetitions of all these exercises. I like to see them done as a circuit. I don't want you just doing three sets of 10 to 12 repetitions. Really do all of them as a single set but do multiple circuits through so that you're getting two or three sets of 10 to 12 reps. And once again here's another position for the external rotation. Now if this arm is tucked in and it's a pure external rotation. Do I come out just about where my hand is? Slow with good form. Looks good. All right this next rotator cuff exercise. We've talked about the muscles on the back and the front side of your rotator cuff. We haven't really talked about the one on the top. That's really done in this 45-45 degree coming up about halfway not too high. Through this mid-range causes a lot of tendonitis and problems. I like to keep it very low and focus. Looks just good. Right there 45-45 thumb up position. And that really wraps up the rotator cuff itself. Okay we're starting to leave the rotator cuff exercise and move into more of muscles that stabilize your shoulder blade which is also very important. The first group is this rhomboid group. It really sits between your spine and your shoulder blades and it really is good at pulling that shoulder blade back and fighting the chest dominance that so many of the students have before they come here. It's a really nice row. Most guys are familiar with this. But make sure it's happening between your shoulder blades. It's a very nice pinching of those shoulder blades. Really focus on letting that shoulder blade come forward and then you're attracting it really well here between your shoulder blades. Okay the next exercise really works the serratus anterior. It's a really big powerful muscle that comes up along your ribs. It's probably one of the most neglected but important muscles to strengthen before you come here because it really undoes a lot of the bad things that the strong chest impacts and lats do. Because it really takes your shoulder blade and opens up your chest and opens up things in a proper position. Many thrower athletes work on this. We see it along pitching athletes as being a problem. It's a very good exercise to work on. I like doing it with cable standing, just a nice forward punching movement and you should really feel it pushing your shoulder blades forward with a nice long straight arm. And really feel it working underneath that shoulder blade as you do this. Another way you can do it is laying on your back with dumbbells on a press and doing it this way as well just laying flat on a weight bench. But I like to really do it standing. It's unstable, it's very good for your shoulder to do it this way for me because it works on balance as well as strength. Another exercise that's very good for your shoulder is working the upper traps. They tend to be very strong already but it's still a very healthy exercise for your shoulder because of the way it comes along the whole top of your shoulder and opens things up for you. Just doing a nice dumbbell shrug is very good but I like to see it done really just in a single plane. I don't like a lot of rolling type of shrug. I like just a really pure upper trap shrug to work that upper portion along the top of the shoulder. Also with that, bicep curls. Nothing wrong with bicep curls. They're very good for your shoulder. The way the tendons come in they help depress the shoulder and really stabilize it. So bicep curling with dumbbells is fine. Preacher bench, however you like to do your dumbbell curls is just fine. They're very good for your shoulder.