Shoulder Pain Treatment in Chelmsford

Last month, I wrote about how to get strong and why we need it. I focused on the mechanics of how strength training works (this article can be found here). However, there was a gaping hole in my article as word count timed me out. The missing element was, well, what on earth do we do to get strong? 

Understanding the mechanisms by which we get strong is fine, but how do we go about it? The nutritional equivalent of this would be how understanding the physiology of digestion is one thing, but knowing what to put on your plate is another.

Today's article will teach you what to put on your plate.

With strength training for beginners, I like to keep it simple. In life, we push stuff, we pull stuff, we squat (bend mostly at the knee), we hinge (bend mostly at the hip), and we twist. All we need to do is target these five fundamental patterns, and we have most elements of strength covered. 

Push: The push motion involves driving weight away from your body. This simple action can be the foundation for developing strong shoulders, triceps, and chest muscles.

Beginner: Wall Push-Up

Stand facing a wall, place your hands flat against it, and push your body away. As you gain strength, increase the angle to make it more challenging.

Intermediate: Standard Push-Up

With hands slightly wider than shoulder-width apart and feet together, lower your body down and push yourself back up. Ensure your body forms a straight line. Start from your knees to begin with if it’s too difficult from the feet.

Advanced: Bench Press

For the bench press, you'll need a bench and a barbell. Lie back and press the weight upwards, engaging your chest.

Pull

Pulling actions engage the back, biceps, and shoulders. These movements involve bringing weight towards your body or pulling your body toward a weight.

Beginner: Band Pull-Apart

Hold a resistance band with both hands in front of you. Keep your arms straight and pull the band apart, squeezing your shoulder blades together. Focus on keeping your shoulder blades low, and not letting your shoulders hitch up towards your ears.

Intermediate: Inverted Body Row

Using a Smith machine or TRX bands in the gym, lie beneath the bar or handles. Pull yourself up, keeping your body in a straight line.

Advanced: Pull-Up or Chin-Up

Grab a pull-up bar with palms facing away (pull-up) or towards you (chin-up). Pull yourself up until your chin is over the bar. This is a tough movement to do, and gyms often have machines that can assist you to help build up to it.

Squat

Squats primarily target the quads, hamstrings, and glutes. They replicate the natural motion of sitting down and standing up.

Beginner: Chair Squat

Stand in front of a chair. Lower yourself down until your buttocks touch the chair, then stand back up.

Intermediate: Bodyweight Squat

Stand with feet shoulder-width apart. Lower your body as if sitting in an invisible chair, then return to standing.

Advanced: Barbell Back Squat

With a barbell resting on your upper traps, descend into a squat, maintaining an upright chest and then drive back up.

Hip Hinge

The hip hinge focuses on the posterior chain, particularly the glutes and hamstrings. This motion is akin to bowing or bending forward at the hips.

Beginner: Glute Bridge

Lying on your back with knees bent, push through your heels to lift your hips off the ground.

Intermediate: Kettlebell Deadlift

Stand with a kettlebell between your feet. Push your hips back keeping your back straight, grasp the kettlebell, and stand up by extending your hips.

Advanced: Barbell Deadlift

With feet hip-width apart, bend and grasp a barbell, keeping it close to your shins. Push through your heels, engaging the glutes and hamstrings to stand.

Twist

Rotational movements or twists work the obliques and help in stabilising the spine. They're essential for movements in daily life.

Beginner: Cable Woodchop

Using a cable machine, set the handle high. Stand sideways, grasp the handle with both hands and pull it diagonally across your body to the opposite knee.

Intermediate: Standing Band Rotation

Anchor a resistance band at chest height. Stand perpendicular to the anchor point, grasp the band with both hands, and rotate your torso away.

Advanced: Seated Russian Twist

Sit on the ground, lean back slightly, and rotate your torso side to side, hold a lightweight to make it harder if you want to.

To build these movements into a workout, just pick one exercise from each pattern, and do three sets of each, with a 90-second rest in between each set. At least one of the sets should feel very hard, meaning that you push as much as you can; this is the thing that stimulates strength improvements in your body. Doing this once a week is enough, but two or three times a week is better.

You’ll notice that some of these movements require a gym. It is entirely possible to build a strength routine at home with little or no equipment, but I do think gyms are a more efficient place to get strong. Gyms are very welcoming and ask your friends to see where they go.

Of all the elements of fitness, strength is the one that is most likely to reduce your risk of injury, and this is why I am so interested in it as an osteopath.

While there is a growing trend of strength and fitness in the modern world, many of my patients still don't practice strength training on a weekly basis. This article will be the place I send them when they don't know where to start. And as with all these habits of health, starting is the most important part. If pain or injury are holding you back, we can help in my clinic with our team of osteopaths and sports massage therapists. We all love to help people build their fitness routines to help their wellbeing.

And until next time, have a healthy and happy week! 😊🙏

If I were to write one article that would do me out of a job, this would be it.

As an osteopath, I treat people's aches and pains. If you want to know the number one thing that reduces your risk of injury, and helps you to overcome injury faster, it's this:

Get strong.

That's it. Get stronger. It really is that simple.

Having strength protects your joints and gives your tissues resilience to strain. It improves your balance and makes you less likely to fall. It also builds muscle, which helps a whole host of metabolic and hormonal functions around the body.

Sounds too good to be true? Well, there is one caveat.

I'm asking you to train for the rest of your life.

As long as you are alive, you need to do strength training. Sorry.

Think of it like showering. Did you take a shower in 2013 and call it a day? No. It's an on-going process of self-care.

You need to aim for at least one day a week (although three days would be best) ... for the rest of your life. But, it will be fun! I can promise that.

So, how do you get strong? 

When I'm taking a case history with my patients and ask them if they do any strength training, the most common answer I get is, 'yes, I walk every day'. Walking is like a superfood for the body. It's wonderful. It is fantastic low-intensity cardio that helps us live longer and clears the mind. It is not, however, strength training.

What about HIIT training, yoga or Pilates? Well, we're getting closer, but there are some very specific features that make a workout strength training. If we're not careful, our training can fall into the 'muscular endurance' bucket, or the 'anaerobic conditioning' bucket.

To optimise your training for strength, you need to think about three things:

1. Time under tension
2. Relative perceived exertion
3. Rest

'Time under tension' is the time your muscle fibres are under tension in your training. This is where 'reps' and 'sets' come in. Each time you move a weight (or your body), this is a rep. Once you have done as many reps as you can, this is a set. 

We can go a little deeper than this and improve the quality of our time under tension by thinking about how we do our reps. We can label our reps with four numbers. The first number is how long it takes to lower the weight. The second number is how long we pause before changing direction. The third number is how long it takes to push the weight. And the fourth is the rest at the starting position. A good rep might be something like '4-1-1-1' where we take four seconds to lower the weight (this is known as the eccentric phase, and it's where we cause the most stress to the muscle), take a one-second pause in the deepest part of the rep (I like to take a breath and check my posture here), explode the weight for one-second with power and control, then take a one-second pause at the top (I do another mental check-in for posture here too). 

To begin with, three sets of about ten repetitions per movement would be perfect, but this leads us to the next point; relative perceived exertion.

Relative perceived exertion (RPE), is the fancy way of saying 'how hard do I think I am working?'. In order for something to get us stronger, we need to be working in the 9/10 to 10/10 range. As a complete beginner, you might want to start with 7/10 or 8/10, just while you are refining your technique.

Above, I said that three sets of ten reps is a good approach for your strength movements, so you need to adjust the weight to find your tenth rep a 9 or 10/10 on the RPE scale. If you can do more reps, then increase the weight, if you find it too hard, reduce the weight. More advanced strength trainers will use lower rep counts like 5 or 3 reps per set, or even 1-rep-max attempts, but to begin with, aiming to max out your RPE at 10 reps is a good goal.

Between each set, you need to rest. Once you hit your maximum RPE, all your fibres in a muscle have been recruited and they need a little rest before they can fire again. If you go too soon, your muscles won't be ready, and you won't be optimising for strength; you will be targeting muscular endurance. There are times when this might be what you want, but if you want to get strong, use at least a 90-second rest between sets (advanced athletes may even need up to five minutes).

Now we can look back and answer the question about HIIT, yoga and Pilates. While these things can get us stronger compared to not doing any training, and they can improve our anaerobic fitness, balance and flexibility (all very good and important elements of health), unless they get you to an RPE of 10/10 and you take a rest of 90-seconds before moving again, they are not optimising for strength.

I think of health like a puzzle, and we need all the pieces of the puzzle. Walking is low-intensity cardio. Running and cycling etc, are higher intensity cardio. Yoga and Pilates are great for body control, flexibility, and balance. HIIT is anaerobic fitness. And strength is strength. And that's not even mentioning all the mental well-being and even spiritual benefits all these forms of exercise bring.

To be clear, all these forms of exercise are fantastic; no one thing is better than anything else, they all have a place in our life. But if you want to avoid trips to the osteopath, there is only one winner, and that's to get strong. In my clinic, it is our greatest joy to help get people back to living an active life, free of pain. If you are struggling and want to get back to a more active lifestyle, please get in touch 😊