Case Studies

Competitive high school swimmer
Female – 16 years old

Diagnosis: Partial tear in the labrum and supraspinatus
Objective: Improve structural integrity of the shoulder by strengthening the rotator cuff muscles, the scapular stabilizers, and mid- and lower-back

Swimming is an internal rotation (of the humerus) dominant sport. As such, this athlete presented with compromised structural integrity (i.e. stability) of the shoulder(s) caused by a muscular imbalance between the internal rotators of the humerus (the pectorals and subscapularis muscles) and the external rotators of the humerus and scapular stabilizers brought on by years of competitive swimming and a lack of strength training to offset this imbalance. This alteration in shoulder bio mechanics can cause abnormal stresses on the anterior shoulder capsule and decreased neuromuscular performance of the shoulder complex.

Strength training initially focused exclusively on unilateral (single-arm) corrective and remedial exercises to develop the:
• Supraspinatus, infraspinatus, and teres minor (three of the rotator cuff muscles)
• Serratus anterior, rhomboids, and mid-/lower-trapezius (the primary scapular stabilizers)
• Latissimus dorsi (due to its function drawing the upper arm downward and backward and rotating it inward – a motion critical to swimming efficiency)

During this time this athlete was also receiving regular soft-tissue therapy to ensure the tissues of the shoulder, scapula, and surrounding musculature remained free of scar tissue and adhesions.

As training progressed and the athlete’s shoulder mechanics began to normalize the remedial and corrective exercises were gradually phased out and replaced with more compound single-arm exercises. Focus still remained on strengthening the primary scapular stabilizers and the latissimus dorsi.

As strength improved and the shoulders were brought back into proper alignment exercises involving both arms (bilateral) were introduced. Focused remained on strengthening the primary scapular stabilizers and latissimus dorsi to offset the high volume of swimming (internal rotation).

Remedial exercises for the rotator cuff and scapular stabilizers were also periodically reintroduced to the program to maintain structural integrity of the shoulder and scapular stability.
While swimmers require an enhanced ability to clear lactic acid from the upper-body muscles, this athlete’s strength training volume remained moderate to low due to excessively high volume of swimming.

Over time, her shoulder bio mechanics were restored and she went on to perform well in all of her major competitions and is currently swimming at Division 1 University.

Competitive amateur Brazilian Jiu Jitsu fighter
Male – 22 years old

Goal: Make weight for a fight
Objective: Decrease body-fat, increase overall strength & power, develop grip strength and “injury proof the shoulders”
This athlete had 8-weeks to make weight for a Brazilian Jiu Jitsu match. He also presented with a pre-existing shoulder injury. While a medical professional never properly diagnosed this injury, it was likely a strain in one (or more) of the external rotators of the shoulder (supraspinatus, infraspinatus, or teres minor). Because Jiu Jitsu requires force to be produced and resisted from multiple planes strengthening the rotator cuff muscles and scapular stabilizers was a main priority, which also provided the foundation to increase strength in the primary pressing and pulling movements.

Strength training initially focused exclusively on unilateral (single-arm) corrective and remedial exercises to develop the:
• Supraspinatus, infraspinatus, and teres minor (three of the rotator cuff muscles)
• Serratus anterior, rhomboids, and mid-/lower-trapezius (the primary scapular stabilizers)
• Latissimus dorsi (due to its function when pulling opponents)

Priority was also given to developing:
• Grip strength – to enhance the athlete’s ability to hold and maintain control of their opponent
• Neck strength – strengthening the neck is critical to any athlete involved in a contact sport

As unilateral strength and flexibility improved the program then shifted to basic compound movements to increase overall strength. In addition to basic barbell exercises, bodyweight exercises, such as the Dip & Chin-/Pull-Up, were also included to improve this athlete’s ability to maneuver his own body efficiently through space.

For any athlete involved in a contact sport neck training is critical to preventing concussions. Therefore, this program also included specialized work to train the forward flexors, lateral flexors, and extensors of the neck.

Isometric contractions – a muscle contraction that results in no change in joint angle – were also implemented to enhance the athlete’s ability to hold an opponent and continue fighting in a state of “fatigue”. Isometric contractions restrict blood flow in and out of a muscle, which means the cellular waste products that accumulate when a muscle is at work cannot be removed from the working muscle. Training with isometric contractions is important for Brazilian Jiu Jitsu, wrestling, or any other form of Mixed Martial Arts because it will improve the athlete’s ability to continue fighting as the metabolic waste accumulates in the working muscles.

While some conditioning was included in this athlete’s program, because he had excess body fat to lose, we did not prioritize it. For Brazilian Jiu Jitsu, wrestlers, and Mixed Martial Artists most, if not all, of their conditioning should come from sparring with opponents and/or exercises that closely resemble the demands required of their fighting style. While running, bicycling, or skipping rope increases aerobic fitness it generally has little carryover to different fighting styles. Using different sparring protocols develops and enhances the kind of endurance that is specific to the fighting style (or sport).

This athlete was also put on a nutrition program to help him make weight. He had to lose 20-pounds in eight weeks. His nutrition prior to preparing for the fight included processed foods, little water (consistent state of mild dehydration), and lacked vegetables and fruits.

His initial nutrition program eliminated processed foods, increased lean protein intake, increased cruciferous vegetables, low glycemic load fruits, and at least one gallon of water every day. Eliminating processed foods from his diet and increasing his vegetable and fruit intake helped reduce systemic inflammation and increased his fiber intake. Increasing his protein intake ensured he was able to recover from his training by bolstering his immune system, supported his liver detoxification pathways, improved neurotransmitter production, and gave his body the building blocks to synthesize new muscle tissue. Increasing his water intake ensured he was replacing the fluids lost through sweating and kept him functioning optimally on a cellular level.

This athlete was also on a strategic supplement protocol to aide in his recovery from training and correct nutritional deficiencies often seen in those with poor diets. His supplements included a post-training whey protein recovery shake, vitamin C, magnesium, fish oil, and a multi-vitamin.

This athlete went on to make weight and win his fight by submission (arm bar) one minute twelve seconds into the first round.

High school baseball pitcher
Male – 16 years old

Diagnosis: medial epicondylitis (right elbow – throwing arm)
Objective: Improve structural integrity of the elbow and shoulder by strengthening the rotator cuff muscles, the scapular stabilizers, and mid- and lower-back

Pitching is an internal rotation (of the humerus) dominant activity. As such, this athlete presented with compromised strength ratio between the upper and lower arm and compromised structural integrity (i.e. stability) of the shoulder(s). This discrepancy was caused by repeated bouts of pitching and a lack of strength training to offset this imbalance. The imbalance between the scapular stabilizers & external rotators (of the humerus) and the muscles surrounding the elbow caused uneven strength ratios between the muscle groups. In other words, the overdevelopment of the muscles responsible for throwing in combination with the underdevelopment of the muscles providing stability to the elbow left the elbow itself vulnerable to injury.

Strength training initially focused exclusively on unilateral (single-arm) corrective and remedial exercises to develop the:
• Supraspinatus, infraspinatus, and teres minor (three of the rotator cuff muscles)
• Serratus anterior, rhomboids, and mid-/lower-trapezius (the primary scapular stabilizers)
• Latissimus dorsi

Additional exercises were also included to strengthen the:
• Elbow flexors & extensors
• Muscles of the forearm

This athlete was also receiving consistent soft-tissue therapy as part of the training process.

As this athlete’s training and season got underway we dramatically reduced the amount of work done specifically for the aforementioned muscles as the amount of throwing he was doing increased. At this point, we transitioned to compound to continue developing overall strength and power. The result of strengthening the scapular stabilizers, rotator cuff (external rotators), elbow flexors/extensors, and forearms was increasing his throwing velocity by 5mph getting up to 88/90mph with his fastball even hitting 93mph.

This athlete was also put on a very genral nutrition program with the primary objective of removing processed foods. As a direct result this athlete lost twenty-three pounds of fat over a three-month period.

With this approach this athlete’s medial epicondylitis was relieved and he athlete is now pitching for a Division 1 University.