Basic Runner's Strength Training: Program One

deadlift-down.jpg
deadlift down
deadlift down

Audience: Runner's looking to start a simple resistance exercise program who still want most of their time spent running Background

You can justify strength training for runners via performance enhancement and injury prevention.  Surprisingly, the evidence for performance enhancement is much stronger than injury prevention.

Components of a Good Strength Training Program

You can do thousands of different training programs.  Don't let someone tell you they have the best one or there is one best exercise for you.  I recommend that all good programs build comprehensive capacity.  Meaning you want a program that trains everything (or close to it)...you don't want to neglect a movement, a body part or some function (e.g. speed, power, strength) in a year round program.  If your program satisfies this simple goal then it is a good program.  You might be a fan of pilates, exercise ball training, kettlebell training, TRX, Olympic lifts or Yoga.  All of these can help and can be part of your conditioning.

What I am recommending below is just one introductory component of a year round program that you can do for 10-15 minutes before or after your runs.

Why should runners strength train?

Performance Enhancement

We have a great amount of research showing that lower body strength training, power programs, plyometric work and even some simple "core" work can improve mechanical efficiency during running.  The reason for this is debatable.  It is unlikely that strength training programs that see athletes doing a few sets of  10-15 repetitions translate to improvements in our physiological endurance capabilities.  Yet somehow strength and power programs lead to increased efficiency.  One theory is that strength training may slightly increase our muscular and connective tissue stiffness or even train the nervous system to modulate such a change.  In other words, strength training builds a better spring and running is nothing if not built on good springs.  Runners bounce they don't push.

Don't worry about becoming muscle bound.  This won't happen.  Putting on muscle mass is difficult and and even if you do it won't lead to a loss of performance

Injury Prevention

This is something we have been recommending for years but in all honesty we actually have little published research linking strength training with decreases in injury rates.  Sure, poke around on the internet and you will read about runners with weak glutes, weak hip abductors (I'm guilty of this) and weak hips in general and how these deficiencies are linked with current injuries.  The rub is that this is just a link in time (i.e. a correlation) and we actually suck at predicting future injuries.  Regardless, it is scientifically plausible that if we can increase the tolerance to tissue loading via strength training in a  novel and different manner from how we normally load our tissues (e.g. running) then we might expect some increases in the resiliency of our tissues to the repetitive stresses associated with injury (disclaimer: chronic, persistent pain is a whole other mess).  If you are in pain, strength training is a novel movement.  This novelty can sneak under our pain radar and modulate the brain's production of pain and even help resolve a painful running "injury".

Warning: Runners often train like endurance athletes instead of just athletes.  You need to choose exercises that make you tired before 15 repetitions.  You need to struggle and you need to push yourself.  If you can do 30 squats then you need to either get under a barbell or do one legged squats.  You are training strength not endurance.  Push yourself goddamnit.

Last Caveat: The exercises that might become easy can then be performed as a warmup or as  cooldown.

Alright enough preamble.  Below is the program.

6 Exercise Program:  All exercises are coupled with another exercise

I use exercises in pairs (couplets) and sometimes in threes (triplets).  This called a superset.  It is more efficient and decreases the downtime associated with the rest you need between exercises.  The exercises that are usually paired train muscles or even sides of the body (front versus back, push versus pull).

When, how much, how often?

  • before or after your run
  • two to three sets of 10-15 repetitions (if you aren't tired at 15 reps than you have to find another exercise)
  • this can be performed 3 times per week

Couplet One: High Knee Drive to Squat

1high knee lift
1high knee lift

Standing High Knee Drive

Standing tall drive your knee upwards. Brace through your spine.  This exercise can be preceded by a front scale.

Another option is hold your hip flexed (knee above hip) and perform a 6 inch knee lift with the hip already flexed.

Use resistance: add tubing around your knee or perform this on a 4-way hip machine

deep squat
deep squat

Deep Squat

Thats it. Squat deep.  One option is to shift your weight back and forth once you get deep.

You can combine these exercises by squatting, driving up and driving your knee upwards.  Then drop back into the squat.

Tip: vary the speed

Tip 2: add weight

Couplet #2: Core Couplet

front bridge
front bridge

The most popular exercises on the planet.    Bridging or planking.  Whatever you want to call it.

These exercises you work your front, your side and even your back.

You can do these exercises separate from one another or you can roll from one hold to the other.

sidebridge feet
sidebridge feet

You can hold the positions for 2-3 seconds or go nuts and hold for 30 to 60 seconds.  You will get benefit either way.  Your goal is to feel tired.  When you feel that your form starts to weaken then you can wrap it up.

Options: lift a leg, rock up and down, roll a little bit

Couplet #3: Single leg squat to lateral birddog (aka birddog hip airplane)

one leg squat
one leg squat
birddog with leg out and hip dropped downwards
birddog with leg out and hip dropped downwards

Lateral Birddog Hipairplane: this exercise is a modification of the good old birddog where you lift your leg to the back and your arm to the front.  The modification sees you lifting your leg out to the side and then dropping your hip that has the knee on the ground out to the side.  You will feel increased pressure in the outside of the hip.  Let your other hip drop to the ground and then lift it back up.  To really stress things swing other leg side to side.

One leg squat: you can do this with your leg out to the side like in the picture or you can have your leg out back.  I recommend hinging forward at your hip and NOT trying to keep your trunk upright.  Let it bend forward to increase the strain on your butt.

Go through that circuit.  Twice.  Its easy, takes 10-15 minutes and is good for us runners who really only want to run but know we should do something else.  You can do this one day a week and on two other days make up your own strength couplets.  Or just do this 3 times a week but in 4-6 weeks you should mix things up.  Add some speed, more weight, different exercises...train variety build capacity.

Related Programs

1. Runner's Strength Videos

2. Patellofemoral Pain Rehab Sheets

3. Bridging Variations

4. Stu McGill's Big Three

5. Hamstring Tendinopathy Strength Training Videos: Hint not just for hamstrings

Hamstring Tendinopathy: Sample Rehabilitation Program Videos

Audience: Therapists and Patients Purpose: This post is video overview of the sample exercise progression I might advocate for patients (primarily runners) who present with persistent longstanding high hamstring pain.

Background

Runners, particularly faster runners, will often present with high hamstring tendon pain.  The pain is typically felt where the muscles insert into the bottom bone of the hip (the ischial tuberosity).  In addition to the hamstrings the adductor magnus can often be involved.

Patients will feel pain with running (particularly at speed), pain when pulling their shoe off with the foot, often pain with sitting and even some pain getting out of a chair.  When I see these patients they have often had this condition for months or years.

When the pain has been around for months you may want to consider this dysfunction a failed healing response.  Throw the ideas about inflammation out the window.  These patients have rested their leg and even done some remedial exercises but to no avail.

 

The exercise approach is simple – TISSUE RESPONDS TO LOAD.  Injury treatment is the judicious application of stress – applying this stress to an injured tissue is stimulus for adaptation.  This application of stress to the  non-responding tissue (i.e. your hamstrings) can be complimented with all other treatment techniques and assessments.  In addition to applying stress we also want to try the find the cause of the initial hamstring overload (Good luck).  Some possibilities being:

1. Weak glutes

2.  Poor trunk strength/endurance/control

3. Restricted joints anywhere (feet, fibular head, SI joints, Thoracolumbar junction)

4. Excessive anterior tilt while running (motor control or tight passive/active tissues?)

5. Overstriding

6. Understriding and “hanging” on to your hamstrings when running (rare)

7.  The big daddy – too much, too soon, for you at that point in time.

8. Poor tissue quality (sometimes our muscles and tendons just need a little rubbin’ lovin’  e.g. ART, myofascial, Gua Sha, Acupuncture, general massage)

OK, enough lecturing, you are still in pain

My clinical take is that many athletes get issues 1-8 somewhat taken care with usual care. (This assumes it is not crappy run of the mill care where someone sticks ultrasound and a TENS machine on you and then tells you to stretch). After the usual care (which is the non-horrible kind) patients are then given remedial exercises for the hamstrings (stretching, bridges, curls) but they still aren’t responding.

With these recalcitrant cases we often then need to stress the tissue harder (or find the other key link in the dysfunction).  Inspired by the painful eccentric loading protocol’s variable success in tendon pain (a nice review here and here) I choose to ignore some of the eccentric loading exercises alone and also add heavy resistance training.  For my patients, eccentric loading means that you just work a muscle as it gets longer not as it gets shorter.  It is like lowering a weight but never picking it up again.  It never made sense that concentric exercises would negate the benefits of eccentric exercises and why would daily loading be necessary? (Update: I should listened to  Jill Cooke's podcasts (search on itunes if you care), she is an amazing tendon researcher and has been saying this for a long time).  I had good success with heavy resistance training  but did not have any research to support it.  Fortunately, I found some (click here on a comparison of heavy resistance training versus painful eccentric loading), so I can go back in time and support my previous views and say I was evidenced-based(this is definitely some confirmation bias on how I select the papers that I read).

 

Here are some exercises that I often recommend for runners

A warning, don’t do these willy nilly.  Have your therapist or strength and conditioning coach guide you through these exercises and create the appropriate parameters (how much, how often etc).  Not all of these exercises are meant to be done on the same day.  Work with a professional to create a program.  You can also be doing a lot of other exercises for your core or upper body.

If you are my patient and aren’t sure, email me.

Stage One (2 weeks)

Rationale: Train the glutes, get the  hamstrings ready for more load, train the trunk, say hello to the external hip rotators

Bridge Series (Front to Side)

http://youtu.be/nOw87GtKgFY

 

Back Bridge

http://youtu.be/rjNLyGcfV8E

 

Bird Dog

http://youtu.be/xGHusEEYj6U

ClamShell

http://youtu.be/2aVy6sDVa4c

 

Squats with External Rotation

http://youtu.be/Js0JFw7N4QY

 

Perform the squat as seen in the video below but have tubing around both knees.  When squatting down attempt to press the outside of your knees against the tubing.

The squat in the video is not ideal.  You DO NOT want the knees to start the motion.  The first motion is the butt going backwards with the weight through the heels and the balls of the feet.  The squat starts with a bow or a “hip hinge”.

Hip Flexion Drives

http://youtu.be/HfZnPU1-XhI

Put a cable or tubing around your knee.  Drive your knee forward training your hip flexors.  If you can do 15 easily then add more weight.  Try to not let your spine bend forwards or backwards.

Cabled Hip Extensions

http://youtu.be/knovP_bSv4s

This exercise attempts to mimic the function of the hamstrings during running.  The hamstrings and glutes work to pull the swinging leg backwards toward the ground and support your weight during foot strike.  Hamstring strains occur during this phase.  Click on this link for a post about hamstring function during running (click here).

With this exercise you want a cable or tuning tied around your ankle.  You then pull your leg backwards with your butt and hamstring and slowly return your leg back to the start.  Try not to arch your back during this exercise.  Focus on feeling tension in your hamstrings and glutes.  You will also feel this in the leg that is standing on the ground.  For balance it is OK to grab onto something while doing this exercise (it will also take the strain off the leg that is on the ground).

Stage Two Learning Phase(weeks 2-6)

Repetitions: 8 to 12 (2-3 repetitions shy of muscle failure or form breakdown)

Sets: 1-2

 

Bridge Series (Front and Side)

 

Back Bridge Walkouts

http://youtu.be/TsjQOLHupCE

 

Deadlift Learn (light weights)

http://youtu.be/Mp_XwsEGQ-4

 

One Leg Deadlift

http://youtu.be/F8XBCWHJ3FA

 

Hip Airplane

http://youtu.be/0okjZoaSRLA

 

Cabled Hip Extensions

Cabled Hip Flexion

Stage 3 (weeks 6 to 12)

Repetitions: 4 to 8 (1-2 repetitions shy of muscle failure or form breakdown)

Sets: 2-3

Nordic Hamstring Curls

http://youtu.be/BgLDQ83jh7I

 

Bridge Series (Front and Side)

Single Leg Bridge Eccentric Slide Outs

http://youtu.be/8pw-Ek5AxWM

Deadlift

One Leg Deadlift

Hip Airplane

Cabled Hip Extensions

Cabled Hip Flexion

Basic Shoulder Movement Videos

Audience: Patients Purpose: Exercise videos for those doing shoulder rehabilitation

Preamble

The same exercises or movements can be used with different intentions and to achieve a different goal.  Some possible intentions being:

1. Motion is Lotion - we are moving your shoulder in a manner just to calm down nerves, decrease pain and get that pissed off shoulder happy with moving again.  The amount of weight or resistance is not that important

2. Stress loading - for whatever reason we want to stress your shoulder and shoulder girdle musculature.  You might have some weakness (e.g. prolonged immobility, post surgical) or we wish to increase the capacity of your joint and muscles to withstand load.  Appropriate weight selection, speed of movement and technique is important

3. Motor control - certainly there is some overlap with the previous two intentions mentioned.  But with this intention we might look at trying to change how your muscles work together.  An example, is training both the internal and external rotator cuff during alternating movements.  We are trying to get the cuff to pull the humeral head away from the scapula or just get the muscles happy working together again.  Load or stress is important but so is learning the movement.

Here we go.  A bunch of videos.

Sidelying External Rotation (for training the rotator cuff and the lower trapezius)

http://youtu.be/2aVy6sDVa4c

Scaption (for training the supraspinatus and the posterior cuff during arm elevation)

http://youtu.be/3fRcgp2-nmM

Unilateral "Y" Exercise on Stomach

http://youtu.be/45tT5CsY7ws

 

Unilateral "T" Exercise

http://youtu.be/0ptjYqn0vbE

 

Unilateral External Rotation

http://youtu.be/N7KkQwL51cY

 

Standing External Rotation with tubing (care of www.mikereinold.com)

http://youtu.be/_G0feLqXA0E

 

 

 

Nerve Slider Videos: Calming down that irritated nervous system

Audience: Patients Purpose: Demonstrate simple movements to calm, move and make healthy some irritated nerves. Disclaimer: Not to be done if painful. Do 5-6 to start. Always under health professional guidance.

Radial Nerve

http://youtu.be/3HkILi6rwR4

Median Nerve

http://youtu.be/npFZL_nWP6g

Ulnar Nerve

http://youtu.be/J3GThNaZqhQ

 

Musculocutaneous nerve slider

Very similar to the radial nerve but instead of bending your wrist so that the back of your hand faces the floor and your palm faces backwards you should let your palm face upwards, keep your thumb tucked in and then tilt your wrist to the side of your pinky finger.

This slider may be helpful with those with anterior shoulder pain that are told they have bicipital tendinopathy.

http://youtu.be/tjsOuaEF68c

Sciatic, Tibial or Peroneal Nerve (Slump Slider aka Flossing)

http://youtu.be/y-cXei4e_wM

Sciatic, Tibial or Peroneal Nerve (Long sitting slider)

http://youtu.be/bgN4X0Qpqkk

Running and hip strength - my response to the Toronto Star

Audience: Runners and therapists Purpose: advocate hip strengthening exercises

 

The "core" gets all the press.    But when it comes to running research and injury prevention I would sooner extol the virtues the butt.  The side of the butt to be most specific.

 

These muscles (gluteus medius/minimus and gluteus maximus) are huge in the relationship to injuries to the knee, hip and spine.  If you want to split hairs you can call them part of the core (you should, but most people don't).

 

For a decade, I swear its been that long, researchers (and their readers like me) have advocated that runners should train these muscles and forgo stretching if they had to pick between the two exercise possibilities (I've softened my stance on stretching, more posts to follow).  The exercises are easy to do and can be fit in after a good run.

 

To support these views the Toronto Star just published a summary of a paper by Reed Ferber out of Calgary.  He runs a great lab and worked with Irene Davis (a superstar researcher in running biomechics), before starting his lab in Calgary.  His research publications are quite exceptional and if I were still a researcher they would make me envious.

See the Star article here: http://www.healthzone.ca/health/dietfitness/fitness/article/960175--researchers-get-hip-to-the-root-of-knee-pain-for-runners

 

For those interested in training their hips here are a slew of exercise programs (click on the links):

 

1. Patellofemoral pain treatment

2. Neuromuscular control of hip and knee function

3. Hip airplanes

4. Side Bridge variations - the best exercise to work the gluteus medius

One of my favorites is below.  The one leg squat with leg raise.  Most Toronto Physiotherapy places advise that you do the clamshell or side lying leg raise.  The problem (click here for a detailed review) is that the exercises only work the hip stabilizing muscles about 40% of their max.  This is not enough.  Muscles get stronger when you stress them. Unless you just had a hip replacement forget about these remedial exercises - unless maybe you truly are super weak here, then  you need them.

 

Otherwise, train harder.  You are an athlete and a runner.

 

 

 

 

 

 

 

 

 

Have fun,

 

Your Toronto Physiotherapy snob,

 

Greg Lehman

Hip Airplane Exercise Pictures

Purpose: I have found it difficult to find unlicensed exercise pictures of certain exercises.  One of the goals of this blog is to share exercise pictures with anyone that would like to use them.  Most pictures are in jpeg format so they can be inserted into documents that you create.  Below are pictures of a hard to find exercise - The Hip Airplane.  This exercise is ideal for training balance, a strong foot, posterior chain muscles and when you drop and rise from the open to shut position the hip external rotators (or is the piriformis now an internal rotator because of the hip flexion - I do not know), glut max/min/med.

All the best,

Greg Lehman, Physiotherapist/Chiropractor

Shoulder Rehabilitation: Minimizing the Upper Trapezius to Serratus Anterior Ratio

Audience: Therapists

Purpose: I like the idea of quantifying the "dosage" of an exercise.  We can do this with EMG and this post will be part of a larger theme that catalogues the EMG amplitude of various shoulder rehabilitation exercises.  Further, it will also try to justify a number of exercises for their ability to avoid negative loading on the shoulder and promote a possibly optimal way of working the shoulder.

Caveat:  This review only looks at a few papers addressing the Upper Traps (UT) to Serratus Anterior (SA) ratio.  Other exercises must obviously be incorporated into a rehab program.

Exercises to maximize the Serratus Anterior (SA) to Upper Trapezius (UT) Ratio

To simplify: SA = good, UT = bad.  Basically, activation of the SA moves the scapula out of the way of the humerus while too much or too early activation of the UT tends to

anteriorly tilt the scapula and decrease the space for humeral movement.  Ann Cools has done extensive work in this area.  Here is a taste of her findings and recommendations.  You may want to consider using the exercises when you have a little scapular dyskinesis on your hands - you may see some medial border prominence of the scap, some winging during arm elevation and the scap can get a little jiggy with arm raising and lowering.

Three exercises were selected as exercises with a low UT/LT ratio:

  • side-lying external rotation,
  • side-lying forward flexion, and
  • prone horizontal abduction with external rotation.

Three exercises were selected for minimizing the UT/LT ratio:

  • side-lying forward flexion
  • side-lying external rotation and
  • horizontal abduction with external rotation

The authors conclude that no exercise satisfied their criteria for optimally minimizing the UT:SA Ratio.  But honourable mention was given to forward flexion and scaption with External Rotation.  We therefore have to look to other research to find the best exercise for this ratio - that exercise would be the Push Up Plus which demonstrates a ratio less than 20% for the "plus" portion of the push up and less than 50% for the push up portion of the push up.  Serratus Anterior activity waltzes in at more than 120% for the plus portion and greater than 80% for the push up portion.  Upper trap activity is between 20% for the push up portion and around 9% for the plus phase.  See Ludewig (2004) for the full paper

Some Raw Data

I have bastardized a table from the Supplementary Data of the Ann Cools article.  The following table shows the EMG activity (expressed as a percent of maximum for the Lower Traps, Middle Traps, Upper Traps and Serratus Anterior).  For simplicity I have only included the isometric portion of the exercise. The original article also looked at the concentric and eccentric phases.  Also in the chart is the Ratio of the above musculature to the Upper Trapezius.  Remember, the ideal is be lower.  Suggesting less Upper Trap activity and more of something else.

Table 1: EMG and Ratio Activity during various Rehab exercises (modified from Cools et al 2007)

EMG - % of MVC* Ratios
Exercise UT MT LT SA UT/LT UT/MT UT/SA
Prone shoulder abduction 50 78.4 76.7 14 75 71 597
Forward flexion 38 26.5 29.5 95.2 250 236 53
Forward flexion in side-lying position 8.6 35.5 63.7 34 16 27 50
High row 7.3 17.3 17.5 28.6 62 51 50
Horizontal abduction 33.7 63.8 50.3 17.3 77 60 339
Horizontal abduction with external rotation 43.7 78.2 79.2 15.5 65 65 467
Low row (1) 19.5 30.4 26.2 35.1 120 76 108
Low row (2) 21.6 31.9 20.3 19.9 162 77 206
Prone extension 15.9 30.1 30.9 34.7 82 62 84
Rowing in sitting 31.4 41.6 29.8 12.1 122 105 458
Scaption with external rotation 44.9 31.7 32.3 101.7 273 246 51
Side-lying external rotation 5.54 18.2 51.1 9.8 14 39 92

The next table describes all of the exercises.

Table 2: Exercise Description

Exercise Description
Prone shoulder abduction Subject prone with the shoulder in neutral position; subject performs shoulder abduction abduction to 90° with external rotation in a horizontal plane
Forward flexion Subject standing with shoulder in neutral position; subject performs maximal forward flexion in a sagittal plane
Forward flexion in side-lying position Subject in side-lying position, shoulder in neutral position; subject performs forward side-lying position flexion in a horizontal plane to 135°
High row Subject standing in front of vertical pulley apparatus with the shoulders in135° forward flexion; subject performs an extension with the shoulders until neutral
Horizontal abduction Subject prone with the shoulders resting in 90° forward flexion; subject performs horizontal abduction to horizontal position
Horizontal abduction with external rotation Subject prone with the shoulders resting in 90° forward flexion; subject performs horizontal abduction to horizontal position, with an additional external rotation of the shoulder
Low row (1) Subject standing in front of pulley apparatus, shoulders in 45° forward flexion an
Low row (2) Subject standing in front of pulley apparatus, shoulders in 45° forward flexion and neutral rotation; subject performs extension with the elbows flexed
Prone extension Subject prone with the shoulders resting in 90° forward flexion; subject performs extension to neutral position with the shoulder in neutral rotational
Rowing in sitting Subject sitting in front of pulley apparatus with the shoulders in 90° forward flexion;position with 2 handles subject performs an extension movement with the elbows flexed and in the horizontal
Scaption with external rotation Subject sitting with the arms at the side; subject performs maximal elevation of the arms rotation in the plane of the scapula (30° anterior of the frontal plane)
Side-lying external rotation Subject side-lying with the shoulder in neutral position and the elbow flexed 90°; subject rotation performs external rotation of the shoulder (with towel between trunk and elbow to avoid compensatory movements)

WHY IS THIS RELEVANT?

I think this paper tells us that these are not the exercises that we should be doing if we think that the ratio between UT and the SA is the biggest problem. When we look at the EMG values and not just the ratios we can see that few of the exercises investigated appropriately challenge the SA with the exception of Forward Flexion and Scaption.  Fortunately, they also have relatively good UT:SA ratios (please note, when performed dynamically the ratio is higher, in other words worse for the shoulder).   If we look at previous research by Paula Ludewig who investigated Push Up Plus variations we learn that sticking with the Push Up Plus is still the ideal exercise to train the SA while minimizing Upper Traps.

Do Push Up Plus Exercises for the best UT:SA Ratio

As for the push up plus and its varations (Standard Push Up Plus (SPP), Knee Pushup Plus (KPP) and Wall Pushup Plus) look at the Serratus EMG activity and the associated ratios in the following modified charts.

The chart to the left shows eccentric (blue) and concentric (red) EMG activity during the non "plus" portion of the push up plus.  The "plus" portion is 20-40% MVC higher.  This graph shows that the Push Up Plus activates the Serratus between 40-80% of its maximum (depending on type of movement).  The Plus portion achieves values close to 120% of maximum.  Kneeling push up plus (KPP) and Wall Pushup Plus (WPP) tend to have less activity.

When we look at the Upper Trapezius to Serratus Anterior ratio we find the lowest ratios occur with the Standard Push Up Plus.  Showing less than 50% for both concentric and eccentric portions of the push up  activity (non plus phase) and less than 20% ratio during the "plus" phases of the activity (not in the chart) as I wanted to show the worst case scenario.   Note how the wall push up starts to have a lot more Trap activity and therefore it throws the UT:SA ratio way to high for it to be ideal.  Upper trap activity typically reaches between 15 and 25% during the eccentric portion of the pushup and between 6-12% during the eccentric portion of the "plus" phase of the push up plus.

Bottom Line:  The standard push up and standard push up plus demonstrate the highest levels of Serratus Anterior EMG activation as well as the lowest ratio the UT:SA activity. The wall push up plus should be avoided and it may even lead to impingement.

Further References

Reinold MM, Escamilla RF, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther. 2009 Feb;39(2):105-17. Review.

Kibler WB, Ludewig PM, McClure P, Uhl TL, Sciascia A.Scapular Summit 2009: introduction. July 16, 2009, Lexington, Kentucky. J Orthop Sports Phys Ther. 2009 Nov;39(11):A1-A13. Review.

Escamilla RF, Yamashiro K, Paulos L, Andrews JR.Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-85. Review.

Ludewig PM, Hoff MS, Osowski EE, Meschke SA, Rundquist PJ Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004 Mar;32(2):484-93

Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, Cagnie B, Witvrouw EE.Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007 Oct;35(10):1744-51. Epub 2007 Jul 2.

Raw Data