Ed Batista

Executive Coaching

Shoulder Health with Peter Attia and Jesse Schwartzman

Peter Attia is a physician with a keen interest in physical activity and nutrition, and he’s teamed up with physiologist Jesse Schwartzman to document a series of exercises to strengthen the shoulder. I’ve found Attia’s work on a number of topics thought-provoking, and these videos are no exception. But I find it difficult to use videos as a tool to help me implement a workout routine, so I’ve transcribed them as accurately as I can. Here’s a text-only version of this post that includes the checklist below.

Part I. Introduction

Part II. Soft Tissue Preparation

Part III. Dynamic Stabilization

Part IV. Loaded Movements

Part V. Diagnostic

Part VI. Checklist

Part I. Introduction

  1. Neck Range of Motion
    • Use it or lose it
    • Goal is to keep head centered over the body
  2. Glenoid Fossa
    • Shallow depression where the head of the humerous fits into the scapula
    • Highly mobile and shallow joint (unlike the robust and stable hip)
    • Emphasis here will be on overhead strengthening, not overhead pressing, to avoid repetitive motion
  3. AC (Acromioclavicular) Joint
    • Responsible for pivoting and rotation
    • Last stabilizer in overhead reach
  4. Scapula/Shoulder Blade
    • Free floating and activated by many muscles, all of which need to be strengthened
    • Transfers energy to the trunk and vice versa

Part II. Soft Tissue Preparation

  1. Breathing and Relaxation
    • Lie along a foam roller parallel with the spine
    • 5-count inhale, 5-count hold, and 10-count exhale
    • 3 breaths/minute x 3 minutes
    • Inhale through nose, exhale slowly through pursed lips
  2. Thoracic Spine Roll
    1. Dorsal
      • Run mid/upper back over a foam roller
      • Don’t over-extend lower back
      • 30 seconds
    2. Side
      • Turn onto side
      • Start with roller under armpit, arm extended forward, palm up
      • Roll forward toward hip, propelling with bent legs
      • Let legs and forward arm take some of the weight
      • 30 seconds per side
  3. Pectoral Ball
    • Use a firm-but-not-hard, melon-sized foam ball
    • Lie face down, ball on one side in front of armpit, to the side of the pec
    • Extend that arm out and forward to form a Y-angle to the body
    • Pull the arm back until the elbow is at 90 degrees
    • Extend the arm out from the body sideways
    • Pull the arm back again and repeat the sequence
    • 6 reps per side
  4. Neck Range of Motion
    1. Shoulder rolls, forward and backward, 4 each
    2. Drop chin to chest, hold for 8 seconds
    3. Look to side
      • Turn head to side 45 degrees
      • Look down toward collarbone
      • Hold for 8 seconds, 4 each side
      • Increase difficulty by clasping hands behind back
    4. Tilt to side
      • Look straight ahead
      • Hold for 8 seconds, 4 each side
      • Increase difficulty by clasping hands behind back
    5. Chin tucks/extension
      • Glide chin forward, hold briefly
      • Glide chin back to create a “fat chin”
      • Look up while maintaining the “fat chin”
      • Hold briefly, release, repeat 4 times

Part III. Dynamic Stabilization

  1. Hands Behind Head
    • Glide chin forward and then back again to create a “fat chin”
    • Light pressure from the hands on the back of the head, light resistance against the pressure
  2. 90/90
    • Lie on side, end of a foam roller (or folded towel) under head to keep it level and neck relaxed
    • Arms together, straight out in front of the body
    • Legs together, knees drawn up partially
    • Keep upper arm straight and rotate it across the body, reaching back behind to the other side
    • Turn head with arm, looking at the hand
    • Reach at a high angle, keeping the shoulder up
    • Hand should be supported at terminal point, either on the other end of the foam roller, on a pillow, etc.; it should not be dangling in space
    • Keep knees together throughout the motion
    • Don’t over-rotate the lower back
    • If knees are coming apart and/or lower back is rotating too far, put a block or pillow under the knees to “pre-rotate” them
    • 6 reps each side?
  3. All Fours
    • On all fours, rock back so hips are almost touching ankles
    • Hands under shoulders, so chest is higher than hips
    • One arm behind back (back of hand flat on back), but don’t go too far–keep shoulder upright and not tilted down
    • Look over shoulder toward arm-up side, turning head and rotating upper spine
    • Squeeze shoulder blade in, hold, relax, return to the starting position
    • 6 reps each side?
  4. Head Down
    • Kneel in front of a chest-high surface
    • Hands behind head, elbows up on the surface
    • Knees back sufficiently to stretch out spine, wide enough to provide stability
    • Alternately arch down and raise up thoracic spine, keeping lower back straight
    • A small range of motion is fine
    • Slow, steady motion, briefly holding position at the end
    • Keep neck relaxed and in a neutral position
    • Increase difficulty by reaching hands all the way behind upper neck and flattening palms on the top of the spine
    • 6 reps?
  5. Broomstick
    • Very wide and relaxed overhand grip on a broomstick or light dowel
    • Slowly rotate arms up and over head, continuing as far back as possible
    • Hold briefly and return slowly
    • If there’s any discomfort, widen grip further
    • Hands will rotate at end of range of motion, so grip is maintained between thumb and forefinger
    • 6 reps?
  6. Alphabet
    • Lie face down on top of a yoga ball or cushioned stool, chest slightly forward of the surface, legs wide for stability
    • Hold arms out to side in a “W” shape and raise slowly until parallel with body, then hold briefly and lower slowly
    • Repeat with arms out to side forming a “T” shape
    • Repeat with arms up, out and forward forming a “Y” shape
    • Repeat with arms straight ahead forming an “I” shape; keep palms vertical
    • 6 reps in each position before advancing?

Part IV. Loaded Movements

  1. Wide Row
    • Use resistance band with handles
    • Maintain a downward angle to keep the focus on the scapula, not the traps
    • Hands out wide and shoulders up
    • Don’t bend elbows in past 90 degrees; this shifts the load to the biceps
    • Instead, use shoulders and back to complete the motion
    • Keep head neutral, rather than letting it extend forward at the end
  2. Hanging
    1. Dead Hang
      • Use a relatively close overhand grip, with thumbs just outside shoulders; a wider grip will stress the shoulders
      • Start at 15 seconds and work up to 1 minute
    2. Hollow Hang
      • Dead hang, but with an engaged trunk
      • Tighten abs, curl hips forward, and scoop legs slightly in front of the body, keeping them straight while raising them off the ground
    3. Rocking
      • Advance to this only after being able to dead hang for at least 1 minute
      • With toes on the ground or a stool, transfer weight from one side to another, loosening grip slightly on the light side
      • Progress to doing this with feet in the air
      • Next step is actually releasing the bar on the light side and reaching up with the free hand
  3. Farmer’s Carry
    1. Basic
      • Important because of correlation between grip and shoulder strength
      • Use a weight that’s too heavy to bicep curl to insure that arm stays straight
      • One arm at a time, kettlebell or dumbbell down at side
      • Stand very straight: shoulders level and hips even
      • Maintain a space between the weight and the leg on that side
      • Walk steadily until loss of grip
      • Switch sides and repeat
    2. Front Load Carry
      • Use a lighter weight for B-D
      • Fold elbow into side with forearm straight up
      • Weight rests against body
      • Walk as above
    3. Upright Carry
      • Sim to B, with elbow folded into side, but weight is away from the body
      • If using a kettlebell, grip handle upside-down, with weight up top
      • Walk as above
    4. Overhead Carry
      • Use both hands to get weight overhead
      • Release second hand once weight is up and elbow locked
      • Keep shoulder back–if it slips forward, weight is too heavy
      • Only progress to this step with good shoulder health
      • Walk as above
  4. Loaded Twist
    • Hold weight in both hands down at knee level, slightly out to the side
    • Rotate and lift up to the opposite side, raising up and punching out
    • Back foot will come up and pivot on ball
    • End motion with arms fully extended and slightly raised
    • Hold position for a beat, then return and repeat
    • Keep lower back steady; most of the rotation is from the hips

Part IV. Loaded Movements (Continued)

  1. Rotator Cuff
    • Use a weight instead of bands in order to maintain a linear resistance through the entire range of motion
    • Light weight: 3lbs to 15lbs max
    • Aim for maximum range of motion
    • Key is to recruit small muscles involved in the rotator cuff, not the large strong muscle groups like the delts
    • Sit on the floor with one leg straight out and one leg in toward the body, knee up and foot flat on the ground
    • Alternatively, sit on a bench with one foot up on another object and that knee up
    • Pin the elbow on that side to the raised knee, forming a fixed rotation point
    • Maintaining a 90 degree bend in the elbow, rotate the weight in an arc in front of the body

Part IV. Loaded Movements (Continued)

  1. Resistance Band
    • Similar motion to “Broomstick” exercise above, but with resistance
    • Grip a resistance band in both hands with arms shoulder width apart
    • Raise hands straight overhead and widen arms to form a “Y” shape; there should be modest resistance at this point
    • While maintaining the “Y” position, shrug shoulders up and hold briefly
    • Lower shoulders below their natural resting point and hold briefly before returning to a neutral stance in the “Y” position
    • Lower arms, widening hands apart and bringing the resistance band behind the head until it’s level with the shoulder blades
    • Hold arms straight out toward the side, forming a “T” shape, with palms up
    • Rotate arms forward, keeping them parallel to the ground
    • Turn the palms down as the arms move forward, and pause when arms are facing straight ahead
    • Thrust shoulders forward against the resistance from the band and hold briefly
    • Retract shoulders, pinching shoulder blades together and hold briefly
    • Rotate arms back and return to the “T” position, turning palms up in the process
    • While keeping arms straight and parallel to the ground, bring hands back behind body
    • Go as far as possible, but keep arms up; don’t allow them to drop in order to move hands farther back
    • Stretch the pecs and hold briefly
    • Return to “T” position, then return to “Y” position and repeat the entire sequence

Part V. Diagnostic

Brief demonstration of a range of motion exercise to determine shoulder flexibility and health.

Part VI. Checklist

Soft Tissue Preparation

  1. Breathing and Relaxation
  2. Thoracic Spine Roll (Dorsal and Side)
  3. Pectoral Ball
  4. Neck Range of Motion
    • Shoulder rolls
    • Chin to chest
    • Look to side
    • Tilt to side
    • Chin tucks/extension

Dynamic Stabilization

  1. Hands Behind Head
  2. 90/90
  3. All Fours
  4. Head Down
  5. Broomstick
  6. Alphabet

Loaded Movements

  1. Wide Row
  2. Hanging
    • Dead Hang
    • Hollow Hang
    • Rocking
  3. Farmer’s Carry
    • Basic
    • Front Load Carry
    • Upright Carry
    • Overhead Carry
  4. Loaded Twist
  5. Rotator Cuff
  6. Resistance Band
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