Filtering The Problem: A Shoulder Mobility Case Study

Written by Brett Jones Tuesday, April 10, 2018 FMS

The screen tells us what to Protect and what to Correct and sets our baseline for moving “well enough,” but once we have identified the weak link it is up to the movement screening professional and the corrective strategies to “filter” the problem to achieve a solution.

Within the Shoulder Mobility screen that means understanding that the upper limb reciprocal pattern is not just about the “shoulder.” The pattern includes the structures of the neck, t-spine, scapula, glenoid and upper limb. Along with the neurological, vascular, fascial, muscular, ligamentous structures and how these work in this pattern. Suffice it to say, there's a lot going on. So, within the SM we look at the neck first to make sure there isn’t any pain or restriction. Then the t-spine mobility is addressed. Static motor control for the scapula is looked at before progressing into dynamic motor control.

To the case study:

Mid-twenties male, fit with no injuries except an intermittent issue with the sternum.

Goal to prepare for a Level 1 StrongFirst Girya certification.

ASLR, Ankle mobility and SM as the weak links.

Correctives:       

    

Crocodile breathing improved ASLR and we started to use Half kneeing dorsiflexion for Ankle mobility. 

Interesting note here: Ankle mobility drills not only helped the ankles but immediately regained his toe touch (from top third of tibia to full toe touch). The body is an interesting place to live.

Now I checked in on t-spine mobility figuring it would be reduced but he had full t-spine mobility both in the Rib Grab and Brettzel.

    

I moved on to start him on some soft tissue work (foam roller) for the lats and scapular musculature and in combination with the breathing I waited to see if that would result in a change of the SM. 

Well, no huge surprise since I failed to find the drill that provided a positive short-term response there were not long-term adaptations, that the SM was unchanged after a couple of weeks. (this is also a limitation of online training and using live video as good as it is, has limits.) In this time, he had a friend measure his shoulder mobility revealing a solid 1/1 SM of 34.5 cm and 29 cm with an 18 cm hand measurement.

On the training front, we were working on the Get-up and building a good Kettlebell Swing from the deadlift up to the two-arm swing.

    

And now the filtering continues…

Since t-spine is normal the next stop is muscular/fascial with the Brettzel 2.0.  The rib grab and brettzel hit breath assisted t-spine and t-spine rotation challenged by the anterior chain of the opposite hip. But the Brettzel 2.0 is more of a posterior chain stretch/mobilization through the thorocolumbar fascia, lats, and even hips. I coached him through the Brettzel 2.0 and not only did it immediately help with a feeling of tightness in the QL but within a week it had brought the SM measurements to 23 and 24 cm.  A solid pair of 2’s.

(And now 21 and 22 cm March 27)

Had the Brettzel 2.0 not helped with the SM then I would have continued on to addressing scapular stability. If that had not made a difference I would have referred him out to an SFMA clinician for a more thorough evaluation to make sure I wasn’t missing something.

The client continues to improve from a movement perspective and from a skill perspective. Now practicing all the essential kettlebell lifts needed for an SFG Level 1 certification.

I hope this helps give a quick peak behind the thought process and filtering of a movement issue. When you have an SOP and process to follow you are protected from your assumptions and the corrective strategies are meant to provide just such a “blueprint”.


Brett Jones is a Certified Athletic Trainer and Strength and Conditioning Specialist based in Pittsburgh, PA. Mr. Jones holds a Bachelor of Science in Sports Medicine from High Point University, a Master of Science in Rehabilitative Sciences from Clarion University of Pennsylvania, and is a Certified Strength & Conditioning Specialist (CSCS) from the National Strength and Conditioning Association (NSCA).

With over 20 years of experience, Brett has been sought out to consult with professional teams and athletes, as well as present throughout the United States and internationally.

As an Athletic Trainer who has transitioned into the fitness industry, Brett has taught kettlebell techniques and principles since 2003; currently acting as the Director of Education for StrongFirst.  He has also taught for Functional Movement Systems (FMS) since 2006, and has created multiple DVDs and manuals with world-renowned physical therapist Gray Cook, including the widely-praised “Secrets of…” series and currently acts as an Advisory Board Member for FMS in the development of curriculum and instructors.

Brett continues to evolve his approach to training and teaching, and is passionate about improving the quality of education for the fitness industry.  He is available for consultations and distance coaching by e-mailing him at appliedstrength@gmail.com. Follow him on Twitter at @BrettEJones.


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    Wes Pomarensky 4/13/2018 1:11:12 PM

    Fantastic article Brett. Enlightens me a bit on why I sometimes struggle with this one. If you don't mind a few questions: When you say "full t-spine mobility both in the Rib Grab and Brettzel" do you look for a certain amount of rotation/distance from the floor to count as minimum acceptable standard? Out of genuine curiosity, as far as "scap stability" exercises, would this be things like quadraped, quadraped rocking, bird doges into crawling sorts of progressions? Thanks Wes