Self-preservation is the fi rst law of nature.
—Samuel Butler
In chapter 13 we learned the first step of the human spring approach which is to Step 1—Release the compression of your body’s spring and the compression on your thoracic outlet and tunnel.
Now in chapter 14 we will learn step two which are how to use strengthening exercises to open the thoracic outlet and how to strengthen the outlet and tunnel to prevent future injuries and compression A few years ago, I was involved in a very high-speed impact motor vehicle accident in Los Angeles, California. The impact was so hard that the vehicle was totaled and my friend who was driving suffered multiple injuries to the neck, back, and shoulders that kept her out of work for months. I did not feel a single ache or pain after the accident. That is because I train with the strategy outlined in this The exercises and stretches outlined in this chapter not only serve to heal through active rehabilitation but to strengthen and therefore they prevent future injuries. I cannot guarantee you will not have an ache after a severe car, work, or sports accident, but I can tell you that this is the same routine we use to train our top amateur athletes for contact sports in boxing, tae kwon do, and MMA, where injuries to the neck are common.
The active rehabilitation involves the strengthening of the body’s lever and spring mechanisms in a two-step process.
Step 2—Strengthen Your Body’s Spring Suspension System to Suspend the Shoulder over the Thoracic Outlet and Tunnel with Resistance Exercises.
Step 3—Spring Train the Human Spring with Spring Training Drills and Plyometric Exercises to Enhance and Maintain the Body’s Human Spring Engineering.
Phase 2 and Phase 3 or the active rehabilitation phases are one of my favorite part of practice. In 1991, I designed, built, and opened one of the first active rehabilitation and strength training centers in the country. This is not personal training. You cannot compare the development and management of an exercise program for a healthy person to a patient who has just come out of extreme pain with proof of a severely herniated disc and a chronic thoracic outlet syndrome.
Patients loved graduating from passive care, consisting of manual therapy and physiotherapy, to active rehabilitation. Our practice was seeing 5,000 new patients per year. I have been rehabilitating thousands of patients since 1991. During that time, I developed innovative training approaches for not only actively rehabilitating patients but training top amateur and professional athletes. At Team Doctors®, we have managed the strength and conditioning programs assisting more than 20 athletes to fulfill their dreams of becoming either a national or world champion.
This active rehabilitation and training program did not come about from me copying anyone else’s approach, It came from what I learned from working with hundreds of national and world champions, working with top sports doctors at numerous national and world championships around the world, and my own experience determining what works with thousands of patients who were rehabilitated in our centers throughout the years.
I’m proud to say that I have finally been recognized, voted in by my peers into the National Fitness Hall of Fame and also the Personal Trainers Hall of Fame. In 2015, doctors from 35 nations recommended me for an honorary fellowship degree, which was presented by a member of the royal family, the Sultan of Pahang at the 2015 World Congress of Sports and Exercise Medicine. I hope this gives you the confidence that this active rehab program will help you reverse and prevent thoracic outlet syndrome from recurring.
Recently, I opened a new, exclusive, private treatment and training center in the River North neighborhood of downtown Chicago. I see far fewer patients, but patients are given more one-on- one care with me. The reason is because I think I have done everything I wanted to do with my medical career. At this time in my life, I would like to mostly work with cases that are extremely difficult to reverse or those patients who have been to many doctors and tried everything, yet have made no progress on their TOS or herniated discs. In this chapter, you will learn the active rehabilitation strategy I have developed for the treatment and prevention of thoracic outlet syndrome that has helped thousands of patients during the years avoid surgery and return to a more normal active, virtually pain-free lifestyle. With regard to conservative or surgical treatment, there is no agreement on how to classify, evaluate, and treat this syndrome, and whether or not treatment should be conservative or involve surgery (1).
Conservative treatments for thoracic outlet syndrome have been devised as far back as 1956 when Peet prepared a specific exercise program with the aim of correcting what he called morphodynamic problems that could affect the shoulder girdle and lead to thoracic outlet syndrome (2).
Peet outlined a treatment approach, which included
- moist heat,
- massage,
- strengthening of the levator scapulae,
- stretching of the pectoralis, and
- posture correction exercises.
This is a general rehabilitation program, however, he was way ahead of his time (2).
I don’t use moist heat. If you are doing massage, a shiatsu or relaxation massage is not deep enough or specific enough to relax the 10 muscles that are compressing the outlet. The massage you do must be specifically designed to relax super contractions or trigger points in the 10 muscles that compress the outlet and the 2 muscles that open up the outlet. Because the upper trapezius muscles and levator scapulae muscles involve the same shoulder shrug exercise, it is true that this exercise would open up the thoracic outlet tunnel. The shoulder shrug is a necessary exercise to strengthen the thoracic outlet to reverse and prevent TOS from recurring. In the late 1980s, specialists developed more logical and comprehensive, rehabilitation-strengthening programs with the goal of restoring a balance of strength in the thoracic outlet area anatomy. They divided the muscles of the upper body into the muscles, which open up the thoracic outlet, and muscles, which closed down the thoracic outlet (3) (4) (5) (6).
The muscles, which opened up the thoracic outlet and specifically the costoclavicular space, were determined to be the upper trapezius muscles and the sternocleidomastoid muscles (3) (4) (5) (6). In the 1990s, Dr. Sucher, an osteopath, devised a similar treatment and rehabilitation approach I use, which involves myofascial trigger point release of the contracted muscles. He also determined that the pattern and perpetuation of these muscles spasms were programmed as an engram (bran pattern) in the brain. He focused on reprogramming the central engram for the particular muscle length with deep tissue treatments (7) (8). In the 1990s and 2000s, doctors also determined it was necessary to exercise the muscles that strengthen the thoracic outlet aerobically (9) (10) (11) (12) (13) (14). This makes sense because aerobic exercises help to reduce early fatigue of muscles. When muscles fatigue, they can no longer maintain the shoulder and neck posture necessary to maintain an open thoracic outlet.
You know your muscles are overly fatigued when you hold your head in your hands or prop up your head with your hands. If you cannot sit without having the chair back hold you up, and if you can’t stand very long without having to lean against a wall or a doorjamb. If you feel burning pain in your upper back with simple short-term computer use or work activities, you are suffering from early fatigue.
If you find these signs of early fatigue, you must incorporate aerobic strengthening in your active rehabilitation and fitness program. In the late 1990s, doctors decided that it was medically necessary to release the shoulder girdle joints, such as the acromioclavicular (AC joint of the joint between the collarbone and the shoulder blade), the sternoclavicular or the joint between the collarbone and the beast bone, and the costotransverse joints (the joints that attach the ribs to the spine) (15) (16) (17).
I agree and do check and release the joint “spring” play in these joints. A constant contraction of the muscles can compress these joints and limit their movements causing adhesions to develop, which would keep the thoracic outlet in a compressed state. It is not always medically necessary for a doctor or therapist to release these joints with hands-on adjustments. I use the training exercises to mobilize these joints, which works magnificently.
The frequency and duration of the rehabilitation exercises varied, however, one author recommended sessions of two to three days per week for 8–30 sessions (3) (18).
Another expert recommended a graduated increase in the number of exercises each week (19).
Week 1: 15–20 exercises Week 2: 10–20 exercises Week 3: 10–30 exercises Exercises x five daily Unless I’m working with a highly trained athlete, I start patients off with about five or six exercises, monitor their form and technique, and add exercises every few training sessions once I think they have mastered the first set of exercises I have taught them.
Each patient I see is evaluated for cardio fitness and strength tested before we begin active rehabilitation. When can you begin active rehabilitation?
Some experts recommend the obvious—that you would never begin rehabilitation exercises if you had
- a thromboembolic phenomena (a blood clot that broke loose)
- acute vascular insufficiency (where the flow of blood through the veins is inadequate)
- symptoms of chronic vascular occlusion (pain, ache, cramp, or severe fatigue, pain when resting, especially at night, and ulcers of the skin distal to the occlusion) (10)
- progressive neurologic deficit (weakness, loss of coordination, loss of muscle tone, tremor, or changes in sensation) (20) (21) (22)
I am even stricter starting my patients’ rehabilitation training when I have released all the super contractions or trigger points in all 10 muscles that compress the thoracic outlet and all joint play restrictions. I also make sure the first and second ribs are well adjusted out of the thoracic outlet before I start my patients on active rehabilitation. In my opinion, doctors and therapists start exercises before the super contractions have been relaxed in all muscles of the neck, upper back, chest, and shoulder. They don’t realize that exercise puts additional force on an already compressed outlet, risking additional exacerbation of the neck, shoulder, upper back, and ribs.
Before you add additional force and load on the neck, upper back, shoulder, and chest area with exercise, this is what has to be accomplished.
- You must be off all pain medication.
- All super contractions must be released in all muscles surrounding the outlet.
- All inflammation must be flushed out of the area.
- All joints must be freely moving and free from subluxations.
- You Must Be Off All Pain Medication.
If you are taking pain medication, then you won’t get the warning sign of pain when you are moving in a way that is causing tissue damage.
- All Super Contractions Must Be Released in All Muscles Surrounding the Outlet.
Protective reflexes that cause the muscle super contractions compress your joints and the thoracic tunnel. They are dominant reflexes that maintain compressive tension on your human spring system and specifically the thoracic outlet, regardless of your desire or attempt to release them. Therefore, you no longer have the ability to release the tension on your spring to make it more compliant or increase the tension to make it a stiffer spring.
The ability for you to increase or decrease the tension on your spring system is necessary to execute exercises, safely. In fact, these variations in the tension are necessary to safely execute any movements, including the simplest, from lifting your cell phone to your head or even simple walking.
It is a pathological tension that abnormally compresses your joints and the thoracic outlet, making it more vulnerable to injury if additional forces or stress are applied.
If your thoracic outlet is compressed, you might be able to still push blood through the constrictions in the artery, because you have a strong heart pumping the blood through. The veins don’t have a strong pump pushing the blood through, so you could end up with a stagnation of flow causing a clot in the veins. This would be called effort thrombosis or Paget-Schroetter syndrome. If you start too soon you might end up in the hospital.
I don’t allow any of my patients to start an exercise routine until I know every muscle fiber of the 10 muscles that can potentially compress the outlet are released. I also will not allow any patient to start exercise if I suspect there is abnormal tension in any muscles that might be causing abnormal compressive force on any area of the body.
If you start an exercise program before all compressive forces are removed from these super contractions, your healthcare professional has no idea what they are doing and is putting you at a high risk for reinjury, exacerbation, or an entirely new injury.
- All Inflammation Must Be Flushed Out of the Area.
This is because muscles compress when contracting. That can cause the inflammation to get pushed deeper into the nerves, muscles, and spindle cells, causing an exacerbation of the TOS. I always put the vibrating massager on every muscle that will be trained that day for at least 20–30 minutes prior to exercise as a warm-up, to flush any inflammation or lactic acid, and to stimulate the circulation of oxygen and nutrients into the area for improved performance of the training.
Also as a precaution, I do a hands-on deep tissue reexamination of all key 10 muscles that compress the outlet and the 2 muscles that lift the shoulder off the outlet to ensure there is no inflation. If there is, I do fine-tuning, deep tissue treatment and flush the inflammation out of the area with the Massage Assist vibrating massager.
- All Joints Must Be Freely Moving and Free from Subluxations.
If there is any locking of the joint spring or joint play, there will be strain on tissues when added force is applied to the joint throughout the movement. I always go through every joint that will be moving during the training to make adjustments to ensure joint play is as close to perfect as possible. If I find restrictions in joint movement, I make the necessary joint adjustments to restore movement.
Team Doctors® has been set up with a full training center since 1991. This way the treatment and training is done close together to make sure we have the maximum medical improvement with the combined positive effects of both disciplines.
The first goal of training is to strengthen the muscles that suspend the shoulder off the thoracic outlet tunnel. Patients with thoracic outlet syndrome have weakness in the muscles in the back of the shoulder, the muscles between the shoulder blades, and the rotator cuff muscles. This causes the shoulders to roll forward into the outlet resulting in forward head posture and rounded sagging shoulders (23). This is what causes the narrowing of the thoraco-coraco-pectoral space or compression of the outlet.
What you need to do is train the muscles that pull the head back and suspend the shoulder off the thoracic tunnel. You need to strengthen the anterior, middle, and lower trapezius muscles or muscles between the shoulder blades and top of the shoulders.
These are the muscles that are weak, causing the shoulder to fall into the outlet.
- Posterior neck muscles
- Upper trapezius muscle
- Levator scapulae These are the muscles that rotate the arm and shoulder off the outlet.
- Trapezius—elevates and depresses the scapula (depending on which part of the muscle contracts); rotates the scapula superiorly; retracts scapula.
- Teres minor—rotates the arm laterally.
- Supraspinatus—abducts the arm (initiates abduction).
- Levator scapulae—elevates the scapula.
- Serratus anterior—draws the scapula forward; the inferior fibers rotate the scapula superiorly.
These are the muscles that roll the shoulder blade up and back off the outlet.
- Rhomboideus minor—retracts, elevates, and rotates the scapula inferiorly.
- Rhomboideus major—retracts, elevates, and rotates the scapula inferiorly.
The second goal of retraining is to strengthen the 10 muscles that have been contracting 24 hours a day. If a muscle is contracting 24 hours a day, it is weak and cannot contract, because it is already contracted. Because it is contracting constantly, it is hard and stiff, thus choking the blood supply that replenishes the oxygen and nutrients to the area.
If you strengthen them, you will not make them contract into the outlet. That is because your exercise will be balanced. These are the muscle imbalances that occur in thoracic outlet patients.
These are the muscles that have been contracting constantly, compressing the outlet.
- Anterior scalene muscle
- Middle scalene muscle
- Posterior scalene muscle
- Anterior cervical (neck) muscles
- Subclavius muscle
- Biceps short head muscle
- Coracobrachialis muscle
- Pectoralis minor muscle
- Latissimus dorsi muscle
- Lower trapezius muscle What is vital is that you adhere to correct posture, form, technique, and timing of breathing. Each exercise in this book has a step-by-step guide to correct form and technique along with breathing instructions.
Breathing Instructions
The rule of thumb for breathing is to exhale during the exertion. This is to ensure you don’t have internal compression on your thorax or organs, while adding more force to the body when exerting force while pushing the weight. What I tell my patients and athletes is to count out the reps, as counting is done by exhaling. Ok, one, two, I can’t hear you!
This is what you can expect from your first few workouts.
- Clicking or cracking of the joints, because they are readjusting to changes in tension while they seek a balance or equilibrium tension across the body’s spring mechanism.
- On your first few weeks of exercise, you can expect what is called delayed onset muscle soreness (DOMS), which is the pain and stiffness felt several hours to days after new or strenuous exercise.
- Clicking or cracking—If there is locking or stiffness in the joint spring/play, you might hear clicking or cracking when exercising. If the clicking works out of the joint during the exercise and lessens after each workout, that could mean the exercise is resetting the movement pattern of the joint for you.
- Delayed onset muscle soreness—DOMS is thought to be caused by lengthening of the muscle when you are trying to get full range of motion. This is expected, because your muscles have been in a contracted state for so long.
The muscle soreness feels like a dull, achy pain in the muscles you just worked out with stiffness. The pain usually only happens when the muscles are stretched, contracted, during deep tissue pressure, or when using the vibrating therapy. The vibrating therapy is good at flushing out the soreness, so I highly recommend it to speed recovery from workouts. Because your muscles have been contracted constantly, choking off the flow of oxygen and nutrients into the muscle, the muscles will not have as many capillaries or blood pipes to remove the lactic acid and inflammation from mild muscle fiber microtrauma caused by the exercise. It’s like building a new subdivision without putting in an adequate sewer system to remove the waste. As you exercise, your system will adapt by growing more capillary systems to handle the need of additional circulation.
The difference between injuries to muscles from exercise and DOMS is acute muscle injury happens usually 4 hours after training and not 24 hours after. If you think you aggravated or reinjured your neck, shoulder, upper back, or ribs, then you should see your doctor for a workup. It can happen with an inexperienced therapist or trainer. In 1991, I was one of the first doctors to have a full active rehab and training center in the office.
Having a doctor or trainer with experience is vitally important to guide you through the first few training sessions. It’s important to know when soreness is due to an injury or just normal DOMS from your first few workouts.
Practice Makes Perfect
People say, “Practice makes perfect,” when it comes to proper form and technique of exercise. They talk about improving muscle memory. You learned that there is no such thing as muscle memory. The memory of the proper form and technique of walking, running, dancing, and exercising is stored in the nervous system, mainly in your brain. So, we are retraining your brain. As I mentioned in previous chapters, the form and technique of movements, like exercises, are stored as patterns of nerve activation, similar to programs in your computers software called engrams.
Engrams were first presented to the scientific community in 1904 by a well-known memory researcher, Richard Semon (24). This pattern created by repetition we call training or conditioning. Revealing the engram is one of the greatest challenges in neuroscience (25).
How long should you do routines three days a week after release?
You never stop training for prevention of an exacerbation of thoracic outlet syndrome. The answer is “for the rest of your life.” The more you repeat exercises of movements of any kind, the stronger the patterns in the brain become. That is why it is difficult to break the bad habits that cause thoracic outlet syndrome. People say, “I try.”
The brain appears to retain a memory by growing thicker, or more efficient, communication lines between these cells with movement pattern repetition. It is also thought that the strength of connections between nerves or neurons is one of the major mechanisms by which engrams are stored in the brain (26).
How frequently should I exercise?
I train my patients two days per week for the first week allowing three or four days between the first and second training session. I might extend the gap between the second and third session to three days, depending on how long the DOMS lasts. Usually, we can get that flushed out faster with the Massage Assist vibrating massage treatments, so we seldom see DOMS last more than 24 hours.
After the duration of the DOMS is reduced, we train the patients every other day, allowing a day for rest and recovery. This allows the oxygen and nutrients to be replenished and allows the lactic acid and inflammation to be flushed out as circulation improves.
Patients ask, “How long do I have to go to rehabilitation?” This is best answered by asking how long they have had the condition, how bad the imbalances are, or how weak the patient is. When I can see that the patient maintains near-perfect form and technique and is motivated to do the routines in their health club or at home three days a week, I release them from active rehabilitation.
Repetitions and Sets
We don’t have time or space in this book to go over all the theory on strength training and rehabilitation.
What I am going to recommend here is a simplified approach to strengthening the thoracic outlet, and you can learn some more advanced approaches from the www.thoracicoutletsyndrome.org site.
What you need to do is select a body part to work, like neck exercises, shoulder exercises, etc. Then select an exercise to start. Pick up a weight you feel you can do 10 repetitions with safely. If you can do 11 repetitions, then you should increase the weight. If you pick up a weight that is five pounds heavier and can only do nine repetitions, then that weight should put a sufficient amount of stress on your muscles to allow them to adapt and get stronger.
So, the rule of thumb is simply to attempt to do 10 repetitions. If you can do eleven repetitions, then increase the weight.
Am I too old for exercise?
Some of you might be thinking that you are too old to change. In this past century, neuroscientists determined that the brain structure could not change after a certain time during early childhood.
There have been many findings revealing that the brain remains ever-changing and moldable, even into adulthood (27). Research indicates that experience can change both the brain’s physical structure and how it functions physiologically (28). You are never too old to build a stronger, more efficient, and injury-resistant human spring.
With further training, strengthening of this area will help you better absorb impacts of collisions in sports or auto accidents, and fend off fatigue from constant strain from handheld devices and the use of the keyboard and mouse after hours in front of a computer. Now spring to action and do these exercises!
STRETCHES
Stretch - Back, Chest and Shoulder Stretch
Lay back on the ball extending your spine across the ball. Let your shoulders and chest slowly stretch as much as they can without pain.
Stay in this stretched out position, stretching the spine, hips, and abdomen. To get back to the start position, perform a sit up to end in the seated position again.
Repeat.
Caution: If you stay in the stretched position inverted with your head lower than your body the blood in your body will rush to your head, and expands the blood vessels throughout, including those in your brain and eyes. Your body is supposed to know how to adjust to the stress of changing blood pressures as you move around.
If you feel faint, faint or black out or have headaches after doing this stretch, this may indicate a medical problem such as high blood pressure, low blood pressure, infection or even something more serious. So if you faint or feel faint check with your doctor before doing anymore exercises or stretches with your head inverted below your body.
Stretch - Pectoralis Major and Pectoralis Minor
Stretch - Swissball Chest Stretch
- Grasp a bar or a door jam with your arm at your side.
- Rotate your body while maintaining your arm in a static position.
- You should feel the stretch in your shoulder, chest and rib cage.
- Stand so you have the Swiss ball positioned at the end of your outstretched arms.
- Slowly walk the swiss ball up the wall as you take small steps forward to maintain constant stretch on your chest, shoulders and arms.
- When you get to the top, push the ball as high up the wall as you can.
- Slowly walk the Swiss ball back down the wall to the original position.
- Repeat.
Stretch - Ribcage Lunge
Lateral Calf, Leg, Hip, Rib Cage and Shoulder Stretch #1
- Grasp the handles of the suspension system.
- Stand with your arms stretched out at 30 degrees.
- Lean forward until you feel a slight stretch in your arms, shoulders and chest.
- Slowly lunge forward and down feeling the stretch in your arms, shoulders and chest area.
- Step back while at the same time pull your body back to the original position.
- Repeat.
Lateral Calf, Leg, Hip, Rib Cage and Shoulder Stretch #2
Stretch - Upper Back
- Grasp the handles of the suspension system.
- Stand facing the wall with your arms stretched out 90 degrees to your body with a slight tension in your arms, shoulders and back.
- Lean backward and down until you feel a stretch in your arms, shoulders and back.
- When done, pull your body back to the original position.
- Repeat.
Stretch - Ribcage with Side Bending
Stretch - Rib Cage Stretch with Rotation
- Place the suspension cables at a 135 degree angle to your body.
- Grasp the handles of the suspension system.
- Stand facing the wall with your feet parallel to the wall.
- Stand with your arms stretched out 135 degrees to the wall your body with a slight tension in your arms, shoulders and back.
- Lean backward, rotate to the side and drop down until you feel a stretch in your arms, shoulders and back.
- When done, pull your body back to the original position.
- Repeat.
- Place the suspension cables at a 135 degree angle to your body.
- Grasp the handles of the suspension system.
- Stand facing the wall with your feet parallel to the wall.
- Stand with your arms stretched out 135 degrees to the wall your body with a slight tension in your arms, shoulders and back.
- Lean backward, rotate to the side and drop down until you feel a stretch in your arms, shoulders and back.
- When done, pull your body back to the original position.
- Repeat. Position the pulleys in a position at the level of your head or higher.
Grasp the handle.
Lean your body forward to get some body weight on the suspension cables.
The more you lean the more positive strain is on the chest and shoulder muscles.
Put a slight bend in the elbow.
Lower your body slowly into a press by bending at the elbows until you reach 90 degrees of elbow bending.
Stop when you get as low as you can Hold the stretch on your shoulders and chest at the bottom.
Press your body weight back to the fully extended elbow position.
Repeat.
CHEST
Suspension System Standing Bench Press
Suspension System Standing Bench Press (Poor Form)
She has a form break on this exercise because the rings are too high. The ring height should be at a height where your hands, arms, and chest line up when you have reached the bottom.
Chest - Dumbbell Bench Press
Grasp the dumbbells.
Sit on the bench with the dumbbells on your lap.
Slowly lay back down on the bench while simultaneously positioning the dumbbells directly over your head with your arms extended but slightly flexed.
Lower the dumbbells.
Push the dumbbells while maintaining the forearm perpendicular to the ground. Push the dumbbells up until you almost have your elbows fully extended. Do not fully extend your elbows. Repeat.
Cable Chest Fly or Cable Crossovers
Position the pulleys in a position at the level of your head or higher.
Select the weight you want to push.
Grasp the handle.
Bend forward a little bit at the waist.
Extend your arms to the side until you feel some tension on the chest and shoulders.
Put a slight bend in the elbow.
Press your arms to the midline with the largest arch possible.
Stop when your hands reach the middle.
Repeat.
Chest Dumbbell Flys
Lay fl at on the bench with the dumbbells in your hand and resting on your thighs.
Flip one dumbbell up to the starting position of the dumbbell held above your chest with your thigh. Your palms should be facing each other.
Bend your elbow slightly.
Lower the dumbbells. down to the side with a wide arc so it stretches your arms, shoulder and chest.
Breath in as the weight is lowered. When you get to the bottom get a healthy stretch of the chest, shoulders and arms.
The press the dumbbells up to the starting position along the same wide arc feeling a stretch and strain on your chest, shoulders and arms.
Repeat.
Straight Arm Pull Downs
Attach the straight bar to the pull down machine.
Grasp the bar with your arms overhead with hand position slightly greater than shoulder width.
Maintain the hands an arms width arc from the body as you push the bar down towards the thighs while exhaling. When the bar touches the thigh then let it raise back up to the original position.
Repeat
Chest Pullover
Lay the dumbbell on its side on the bench.
Lay perpendicular to the bench with your upper back and head resting across the bench with your feet fi rmly planted on the ground.
Grasp the dumbbell with both hands with the hands grasping the bar of the dumbbell. Position the dumbbell directly over the chest at arms length to the chest to start.
Keep your arms slightly bent at the elbows.
Lower the dumbbell in a wide arch over your head so it is hanging off the end of the bench while inhaling. When you have reached the lowest point, stretch your shoulders, rib cage and chest muscles for a few seconds. While exhaling, raise the dumbbell back to the original position in the widest arch away from your body as possible.
Repeat.
Upper Back – One Arm Rows
BACK
Lay the dumbbell you want to lift next to the bench.
Straddle your feet with the foot opposite the lifting arm positioned directly under you’re the chest.
Bend at the waist until your back is fl at or parallel to the ground.
Grasp the dumbbell.
While keeping your arm and elbow close to your body lift the dumbbell with the muscles between your shoulder blades fi rst.
Once the shoulder blades are at full rotation then bend at the elbow to complete the lift.
Roll your shoulder blades back and turn your head to the involved side.
Lower the weight back down on the same path.
Repeat.
Straight Arm Pull Downs
Attach the straight bar to the pull down machine.
Grasp the straight bar with a grip that is wider than shoulder width.
Grip the bar with an underhand grip (not an overhand grip)
Sit down while you maintain the tension on the pull down bar.
Lean back slightly.
Pull the bar down with by pulling with your muscles between your shoulder blades fi rst.
Then pull the bar down to touch the middle of your chest with your shoulder muscles.
Try to touch your shoulder blades together at the bottom.
Remember not to move your upper body through the entire exercise.
Next raise the bar back to the starting position and try to feel the pull of the bar lifting your shoulders off your chest or rib cage.
Use this exercise to open the thoracic outlet and tunnel.
Repeat.
Pull Downs (Poor Form)
Do not use a narrow grip as this can cause excessive twisting strain on your shoulders, elbows
and wrists Your entire upper extremity (wrist, forearm, arm and middle shoulder) must be in alignment from the front.
Hanging Half Pull up
Grasp the bar. Let your body hang down while you totally relax. Do a slight pull-up motion, tensing the muscles between your shoulder blades with your shoulders. You should feel your shoulder blades sliding inward toward your spine.
Shoulder - Dumbbell Front Raises
SHOULDERS
Stand and grasp the dumbbell with your thumb pointing up.
Lift the weight with a straight arm contracting the front deltoid shoulder muscles until your arm reaches a parallel position to the ground.
Use the stabilizing muscles of your legs, hips and core abdominals to keep your body completely still.
Do not swing your arms. Complete the lift up and down on one side before you lift the weight on the other side.
Repeat
Shoulders / Neck - Dumbbell Side Raises
Grasp the dumbbells.
While standing let the dumbbells hang at your side. While keeping your elbows bent, lift the dumbbells to the side until they are parallel to the fl oor.
Lower the dumbbells back to the side.
Repeat
Shoulder - Internal Rotation (Rotator Cuff) - Correct Form
Grasp the handle of the pulley.
Use your, lower body, hips and abdominal core muscles to maintain your body completely still throughout the exercise.
Make sure your humerus (long bone of the upper extremity) is directly perpendicular to the ground.
Bend your elbow to 90 degrees.
Rotate your shoulder inward until you reach your body.
Repeat
Shoulder - Internal Rotation (Rotator Cuff) - Poor Form
Her form break happens when her arm drifts off on an angle wish is not perpendicular to the ground.
Her second form break is when she rotates her arm across her body.
SHOULDERS (ROTATOR CUFF)
Shoulder - External Rotation (Rotator Cuff) - Correct Form
Grasp the handle of the pulley.
Use your, lower body, hips and abdominal core muscles to maintain your body completely still throughout the exercise.
Make sure your humerus (long bone of the upper extremity) is directly perpendicular to the ground.
Bend your elbow to 90 degrees.
Rotate your shoulder inward until you reach your body.
Repeat
Shoulder - External Rotation (Rotator Cuff) - Poor Form
Her form break happens when her humerus (upper arm) drifts off the perpendicular position on an angle.
Her second form break happens because her elbow is not at a 90 degree angle and her forearm is not parallel to the ground.
Her third form break is when she rotates her torso in an attempt to complete the lift.
Arms Biceps (Poor Form)
Grasp the dumbbell.
Stand with your arm hanging down slightly bent.
Align your wrist, forearm and arm to the dumbbell.
Lift the dumbbell to a position at the top which is between your coracoid process and your humerus bone (long bone of the upper arm).
Her form break happens when she lifts the dumbbell to a position at the top which is lateral to the humerus.
This causes a twisting strain on the wrist, elbow and shoulder.
Exhale or count out every repetition.
Arms Biceps (Proper Form)
ARMS
Grasp the dumbbell.
Stand with your arm hanging down slightly bent.
Align your wrist, forearm and arm to the dumbbell.
Lift the dumbbell to a position at the top which is between your coracoid process and your humerus bone (long bone of the upper arm).
Exhale or count out every repetition.
UPPER BACK/NECK
Upper Back / Neck – Incline Back Flys
Grasp the dumbbell.
Lay, face down on the incline bench.
Your palms should be facing each other.
Hang your arms down dangling the dumbbells directly below your shoulders.
Lift the dumbbells up to the side, in a wide arc above your head as high as you can without strain or pain while exhaling.
Squeeze your shoulder blades together like you are trying to touch them together.
Lower the weights back down to the starting position and repeat.
Upper Back / Neck - Dumbbell Shrugs
Grasp the dumbbells.
While standing let the dumbbells hang directly at your side.
Slowly raise your shoulders up as high as you can while exhaling.
Do not bend your arms or wrists during this lift.
Lower the dumbbells back to the original position.
Repeat
Neck - Flexion
NECK
Neck - Extension
Sit down at the machine and determine your seat height fi rst.
Set the seat height so the pad is positioned on your forehead just above the height of your eyebrow Keeping your body completely still, slowly forwardly flex your neck to no more than 45 degrees of flexion.
Caution, do not rotate your neck during the motion Slowly come back to a neutral position Repeat Sit down at the machine and determine your seat height fi rst.
Set the seat height so the pad is positioned on the back of your head just at the height of your eyes Keeping your body completely still, slowly forwardly extend your neck to no more than 45 degrees of flexion.
Caution, do not rotate your neck during the motion Slowly come back to a neutral position Repeat
Neck - Lateral Bending
Sit down at the machine and determine your seat height fi rst.
Set the seat height so the pad is positioned on your head just above your ear or just above the height of your eyebrow Keeping your body completely still, slowly side bend (laterally flex) your neck to no more than 45 degrees of side bending.
Caution, do not rotate your neck during the motion Slowly come back to a neutral position Repeat