Blueprint to a Bulletproof

Shoulder
An A-Z approach through rehabilitation and performance

Tony Mikla DPT, CSCS, XPS Russ Dunning MPT, CSCS, SFGII

Evan Hauger DPT, CSCS, SFG1 Aaron Crouch DPT, CSCS, SFG1
 MOBILITY

PERFORM UPPER QUARTER STABILITY

PERFORMANCE

STRENGTH
 PROGRESSION FRAMEWORK

RESET REPROGRAM INTEGRATE PERFORM

 Anatomy and Biomechanics /
Neuromuscular Integration / Regional
Contributions

Section 1
STABILITY

VS

MOBILITY
PERFORMANCE FRONT ARM CHAIN
PERFORMANCE BACK ARM CHAIN
PERFORMANCE SPIRAL CHAINS
PERFORMANCE FUNCTIONAL CHAIN
RESET → REPROGRAM → INTEGRATE → PERFORM
Dysfunction STABILITY / MOTOR CONTROL STIFFNESS / MOBILITY

Presentation POOR MOVEMENT QUALITY POOR MOVEMENT QUALITY

Pathological RTC, LABRUM, BICEP, T/S RTC, LABRUM, BICEP, T/S

Intervention RESET, REPROGRAM, RESET, REPROGRAM,

INTEGRATE, PERFORM INTEGRATE, PERFORM
Compensation Presentations
ASSESSMENT
Section 2
MOVEMENT ASSESSMENT
 ASSESSMENT

CLEARANCE CAPABILITY CAPACITY

INTERVENTION
 CLEARANCE CAPABILITY CAPACITY

1. Combined Motion 1. Side Plank 1. Bottom Up

Shoulder Screen Kettlebell Press
2. Single Arm Push
2. Thoracic Rotation Up Hold 2. Pull Up

3. W Hold 3. Get-Up
3. Upper Rolling
Pattern 4. Stability Push Up 4. Med-ball Push
RISK

PROCEED WITH
CAUTION

GO!
CLEARANCE ASSESSMENT
CLEARANCE ASSESSMENT
 CLEARANCE ASSESSMENT CRITERIA

1. FMS Shoulder Screen 1/3 2/3 3/3

2. Thoracic Rotation ≤30 ≤40 ≤50

3. Upper Rolling Pattern Unable Able

CAPABILITY ASSESSMENT
CAPABILITY ASSESSMENT
 CAPABILITY ASSESSMENT CRITERIA
1. Side Plank ﹤30” ﹤60” ≥60”

2. Single Arm Push Up Hold ﹤30” ﹤60” ≥60”

3. “W” Hold (M=5 lb / W=3 lb) ﹤30” ﹤60” ≥60”

4. Stability Push Up 1/3 2/3 3/3

CAPACITY ASSESSMENT
CAPACITY ASSESSMENT
CAPACITY ASSESSMENT
CAPACITY ASSESSMENT
CAPACITY ASSESSMENT
 CAPACITY ASSESSMENT CRITERIA

1. Bottom Up KB Press ﹤1x ﹤3x ≥3x

M 10” M 1x M ≥ 5x
2. Pull Up
W 3” W ≥10” W ≥ 1x

3. Get-Up BW M ≤16 kg M ≥24 kg

W ≤12 kg W ≥16 kg
4. Med-Ball Push Asymmetrical Symmetrical
 INTERVENTION GUIDELINES
TIER 1 TIER 2 TIER 3 TIER 4

Movement Foundational Strength Athletic

Development Development Development Development

CLEARANCE CLEARANCE CLEARANCE CLEARANCE

CAUTION - GO GO GO GO

CAPABILITY CAPABILITY CAPABILITY

RISK - CAUTION CAUTION - GO GO

CAPACITY CAPACITY CAPACITY

RISK - CAUTION CAUTION - GO GO
RESET REPROGRAM INTEGRATE PERFORM

Section 3
Tier 1

Movement Development
SPINE RESET
SPINE RESET
SPINE RESET
SCAPULOHUMERAL RESET
SCAPULOHUMERAL RESET
SCAPULOHUMERAL RESET
RESET REPROGRAM INTEGRATE PERFORM

Section 3
Tier 2

FOUNDATIONAL DEVELOPMENT
FOUNDATION DEVELOPMENT
FOUNDATIONAL DEVELOPMENT
FOUNDATIONAL DEVELOPMENT
SPINE REPROGRAMMING
SPINE REPROGRAMMING
SPINE REPROGRAMMING
SPINE REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
- single arm prop sit
SCAPULOHUMERAL REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
SCAPULOHUMERAL REPROGRAMMING
RESET REPROGRAM INTEGRATE PERFORM

Section 3
Tier 3

STRENGTH DEVELOPMENT
DEEPER INTEGRATED MOVEMENT
DEEPER INTEGRATED MOVEMENT
DEEPER INTEGRATED MOVEMENT
DEEPER INTEGRATED MOVEMENT
DEEP INTEGRATED MOVEMENT
PUSH PROGRESSION
PUSH PROGRESSION
PUSH PROGRESSION
PUSH PROGRESSION
PUSH PROGRESSION
PUSH PROGRESSION
PULL PROGRESSION
PULL PROGRESSION
RESET REPROGRAM INTEGRATE PERFORM

Section 3
Tier 4

ATHLETIC AND HIGH LEVEL

DEVELOPMENT
HANDSTAND PROGRESSION
HANDSTAND PROGRESSION
ATHLETIC DEVELOPMENT
ATHLETIC DEVELOPMENT
ATHLETIC DEVELOPMENT
ATHLETIC DEVELOPMENT
ATHLETIC DEVELOPMENT
POWER DEVELOPMENT
POWER DEVELOPMENT
POWER DEVELOPMENT
LIFE DEVELOPMENT
 PROGRAM DEVELOPMENT

RESET REPROGRAM INTEGRATE PERFORM

 Section 4
CASE STUDY
CASE STUDY #2: Entry Level Crossfitter looking to
get ready for the upcoming Open
CLEARANCE = GO

CAPABILITY

- Side Plank = GO
- Single Arm Plank = GO
- W Hold = Caution
- Stability Push Up = GO

CAPACITY

- Bottoms Up Press = GO
- Pull Up = Caution
- Get-Up = Caution
- Medball Push = GO
CASE STUDY 1: Female 2 Months after Dislocation
and wants to play recreational volleyball
CLEARANCE = GO

CAPABILITY

- Side Plank = Caution

- Single Arm Plank = GO
- W Hold = Caution
- Stability Push Up = GO

CAPACITY

- Bottoms Up Press = Caution

- Pull Up = Risk
- Get-Up = Caution
- Medball Push = Caution
CASE STUDY #3: Fit 65 year old that wants to
continue to play with grandchildren
CLEARANCE

- Combine Motion Screen = Caution

- Thoracic Rotation = Caution
- Rolling Pattern = Caution CAPACITY

CAPABILITY - Bottoms Up Press = Risk

- Pull Up = Risk
- Side Plank = Caution - Get-Up = Risk
- Single Arm Plank = Risk - Medball Push = Caution
- W Hold = Caution
- Stability Push Up = GO
-
CASE STUDY #4: High School Baseball Player with
history of elbow pain
CLEARANCE

- Combine Motion Screen = GO

- Thoracic Rotation = Caution
- Rolling Pattern = GO CAPACITY

CAPABILITY - Bottoms Up Press = Caution

- Pull Up = Caution
- Side Plank = Caution - Get-Up = Caution
- Single Arm Plank = Caution - Medball Push = Caution
- W Hold = Caution
- Stability Push Up = GO
-
 TAKE HOME CONCEPTS
● Progression framework from movement to performance
● Resolve movement based dysfunction
● Checks and balances with assessment
● Pathway through open and closed chain control
● Progression of unloaded and loaded patterns
● Use of the intervention guideline tool
THANK YOU!

@kimehpi