AANS Neurosurgeon | Volume 28, Number 1, 2019

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Exercise for the Surgeon: Part 6 of Counteracting the Effect Surgery Takes on the Surgeon

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As the exercises become more advanced, it is always important to maintain good form. Form fatigue is a common source of injury and can decrease the efficacy of the exercises. It is better to do fewer repetitions with correct form than more repetitions with incorrect form. If you experience pain during any of these exercises, it is best to stop rather than trying to push past the pain.

OVERHEAD PRESS AND ROTATOR CUFF STRETCH

To perform this exercise,

1. Grab a straight bar so that when it is level with the clavicle the forearms are vertical (Figure 1,2)

2. Starting with a neutral spine, press the weight up keeping the distance of the 12th rib and the ASIS constant throughout (Figure 3,4). This is done with a strong abdominal and hip activation;

3. If poor shoulder mobility exists, the body will try to compensate by extending the spine and anteriorly tilting the hip to reduce the relative joint angle at the shoulder as the weight goes overhead

4. The end position should have the arms fully locked out overhead and the weight over the spine with the scapula elevated and upwardly rotated.

For the purpose of posture, the end position of the press is the most important part of the exercise. Maintaining a load overhead with the proper positioning of the spine, hip and shoulder challenge the musculature that hold them there with a very strong muscular coordination to balance the weight in an efficient manner overhead. To further take advantage of this position, the movement can be performed with other modalities such as dumbbells, which can allow for better positioning if a two-handed position is hard to obtain (Figure 5,6,7,8). The unique shape of the kettlebell also can be utilized to further challenge this overhead position by having the mass of the kettlebell placed posteriorly (or in other positions) creating a slightly different challenge for the coordination (Figure 9,10,11,12).

The rotator cuff stretch is a good supplement to the overhead press. It is performed by:

1. Lying on your back in a bridge position with your arms crossed just above the hip on your low back. (Figure 13)

2. Bridge the hip high and place your hands in the low back position. (Figure 14)

3. As you bridged up the spine of the scapula should come into firm contact with the ground.

4. Try your best to maintain that contact as you slowly lower your hip back toward the ground. As the lowering of the hip depresses the hands back to the ground, a stretch in the shoulder should occur.

5. Stop lowering at the first sign of stretch.

As a cautionary note, in this position, the weight of the hip and torso create a lot of leverage on the shoulder. Make sure not to lower too rapidly or over stretch. To exit the stretch, raise the hip again before removing the hands.

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