Help, my shoulders are too high!

We see this plenty in martial arts, fencing and, well, normal life. People who keep their shoulders up too high, kind of bunched up or tense, but all the time. Or maybe just while they are training. For training it's most common in new fencers. Recently somebody asked about it on the HEMA Alliance Facebook page and here's my long response.

Let me get technical for a moment. I'm talking about excessive tension in the upper traps that elevates the shoulder joints. If you're actually looking at something else, then this won't help.

I'm going to address the common advice and suggestions as well as my own thoughts.

Stretching

A lot of people will suggest stretching for something like this. But stretching is seldom the answer, though it can be part of it. Here's why:

1. Go stand in front of the mirror.
2. Depress your shoulders, that is shove them towards the ground - see the third picture
3. If you can get them to normal posture (the second picture) then muscle length isn't the problem.

Hunched posture - the problem we are correcting

Normal posture - the objective

Depressed posture - should be able to get the shoulders this low

Stretching solves problems when the muscle is short. And such is seldom the case for this particular problem.

If stretching feels good then that's good and go ahead and do it.

If stretching helps relieve tension then that's good and go ahead and do it.

So, by all means, include stretching if you like, but also know that it won't solve the problem.

Yoga

Yoga for what?

If it's stress reduction then go for it. Lots of people are stressed and any kind of meditation activity that they find stress relieving is a good thing. Stress can be the primary contributor to the elevated shoulder problem. You've probably heard, or are, somebody who says, "I carry my stress in my shoulders".

Finding a good way to reduce your stress is quite important in life. But it's outside the scope of my blog.

If the yoga suggestion is based on the idea that certain of the yoga postures will cure the problem then I want to know which ones. All too often there is just a generic suggestion for yoga as if the whole of it is some cure-all, without looking at the specifics of individual yoga postures.

A quick google search on yoga poses for shoulder problems came up with a whopping zero poses useful to this problem. This does not mean that they don't exist. But it illustrates that a simple suggestion of yoga in general is not sufficient.

Strengthen the Upper Back

Well, we might expect me to be all over a strength training solution!

But the upper back strength isn't the solution to this problem. It's probably the cause, or at least an accomplice.

The upper back muscles are primarily the trapezius and rhomboids. You also have the top part of the spinal extensors, but they don't attach to the shoulder blade or joint.

The traps are a big muscle group that primarily elevates and upwardly rotates the scapula, so that's a possible culprit. And by possible I mean almost certainly it. Though with a possible contribution from the levator scapulae.

So strengthening the already overactive or tight muscles won't help!

The rhomboids downwardly rotate and retract the scapula, so we can rule them out. Strengthening the rhomboids might actually help us, but the upper traps are much bigger, and so we can't win that tug of war with just reverse flys.

Strengthen Other Things

Farmer's Carries - I love farmer's carries. I just spent good money buying equipment to do heavier carries. But that's an exercise where gravity pulls the shoulder down, so they won't help keep the shoulders down in other actions.

Indian Clubs - I'm not a big fan of these, because there is nothing they do particularly well, they're really just a conditioning tool. And they don't have a way to work the muscles to pull down the shoulders. Whether or not they help is entirely dependent on how good you keep your posture while using them. And that's true of a lot of options. So it's really independent of a solution.

But it does indicate something useful. Being mindful of posture during all strength training, especially standing exercises, will help.

Bodyweight exercises - Which ones? Most of them are simply not relevant to the problem. The only relevant one, really, is pull-ups. And so if you are capable of pull-ups then they should benefit this particular problem. But pull-ups are really hard for a lot of people, so they are usually not a good general purpose suggestion.

Posture

We are moving progressively closer to the best understanding and solution to the problem with this. Better posture is better. Work to increase the amount of time in good posture and your awareness of your posture - in every part of your life. In particular here is getting the shoulders back and down. If you have a desk job this is a challenge. And addressing that challenge is it's own big topic.

There is also your posture when you are on-guard. When you are in guards with the arms and sword above the level of the shoulder it's natural to also hunch up the shoulders. But you don't have to do that. You can get your arms overhead and keep your shoulders down.

Shoulders hunched high guard position

Shoulder neutral high guard position

You may also have your shoulders elevated in a lot of your guards. In which case switching to pflug or Fiore won't help. Sean Hayes talks about it in this video.


One of the cues for getting your scapula into the right position for overhead guards is to think about sticking your shoulder blade into your back pocket.

* Side benefit of this: it's healthier for your rotator cuff!

Tension

Are you tense while you are training? If you're new you probably are. I see this problem an awful lot. And it's understandable. When you start you don't understand any of it, it's all new. There's a lot to concentrate on. And many people naturally hunch up their shoulders in this situation.

I tell people to relax. I then I tell them that relaxing will take a while. You have to get better at the actions to be able to think about relaxing while doing them. When it's new you have too many things to think about to be able to also think about relaxing.

I'm really relaxed while doing the things that I've been doing with a sword for years. It's easy for me at that point. I'm sure a video camera would show more tension in the brand new stuff. But I've also got, at this point, 17 years of martial arts training, so I've got a habit of being relaxed while doing this stuff. And that took time i.e. don't expect a quick fix. This is a long-term project.

The take-away is spend more training time on the stuff that is not super challenging. That's doesn't mean spend it all on the easy stuff. But spend most of your time on the actions that you get mostly right, most of the time. This is actually my general advice to all my students, just based on learning theory. The advanced stuff, that may be stressing you out, should be practiced with a coach who can provide feedback.

Good Strength Training

Of course I'm going to conclude that strength training has a role to play in addressing this! But it may be a much smaller role than the above about stress and tension, depending on the person.

There is a reflex in the body to keep the muscles safe by turning down the activation of opposing muscle groups when activating a particular muscle. So an overactive upper trap is turning down the activity of the opposing muscles that pull the shoulders down.

And so we can use that to our advantage. As we train up the muscles that pull the shoulders down we increase their resting tone. This will have the effect of turning down the resting tone in the opposing muscles. And thereby reducing the tendency to hunch up those shoulders

What exercises pull down the shoulders? Lat pulldowns. And pull-ups.

You may think of these as primarily latissimus dorsi exercises, and they are. The lats are a big muscle that pulls the shoulders down - amongst other actions. Your rhomboids will also be helping with these exercises. As well as the lower traps.

And that's pretty much all the muscles that pull your shoulders down. So make sure you are including vertical pulling exercises in your complete strength training program.

Does it Hurt?

If yes, then see a medical professional. I am not a doctor.

If you aren't sure yet then ask following questions:

1. Has it hurt for more than 2 weeks? If so, see a doctor.
2. Does it hurt even when you are not training? If so, see a doctor.
3. Does the pain interfere with any other part of your life? If so, see a doctor.

Specifically, see a physical therapist or orthopedist.

Conclusion

In my experience, the most common cause of this is being new. And that can go on for a very long time. The next most common is generally carrying tension in your shoulders. As such, strengthening, stretching and other exercises have only a small role to play in this type of problem.

However, it's not a self-correcting problem. If you do this when you are new then you will do this always. That's what coaches are for, to spot your errors and remind you to fix them.

Bad Science

Hot Yoga? Really?

I started reading the Breaking Muscle blog and it's been a mixed bag. But then I saw a post on "3 Ways Hot Yoga May Benefit You". I have a strong aversion to "alternative" practices. By definition alternative means that it's not supported by the science. But this post is about some published scientific studies on the potential benefits of hot yoga.

I have no problem with yoga - when it's benefits are accurately described. Yoga can be a perfectly good way to meet the flexibility aspects of a complete physical activity program.

I just get all uppity when people say it's great for everything. (And I get that way when anything is called great for everything.)

Some of you may be wondering why I'm going to go on this rant about one study of hot yoga, when this is supposed to be a HEMA training blog. The point is to demonstrate the skills necessary to be a good consumer of science. To learn appropriate caution when encountering science-y sounding fitness claims on the internet.

So, is Hot Yoga good for Fitness?

Well, this blog post went over one study that looked at strength and cardiovascular measures and another for cardiometabolic risk factors. And both studies are flawed. And the results of both studies are overstated. This is a common problem with reporting on science - the results are overstated, and generalized beyond the scope of the study. Furthermore making strong claims about anything based on one study is bad science.

The basic prescriptions for how to improve strength and cardiovascular ability are based on hundreds of studies. So before it can be claimed that yoga improves other fitness components we should have a good evidence base. Not. Just. One. Study.

Bikram Yoga and Physical Fitness in Healthy Young Adults

This study appeared in the Journal of Strength and Conditioning Research. It's not terrible. But it's results are weak and then exaggerated. The study looked at just 21 people. Well, it started with 32 but 11 dropped out of the hot yoga group. That's a big red flag right there! 50% dropout from only hte experimental group severely effects the outcome of a study. The subjects were divided into two groups: hot yoga and control. The hot yoga group was allocated twice as many people, because they expected a high number of dropouts. So, they knew in advance that there would be a problem and went ahead anyways. Not encouraging.

Why did people dropout? We are told that some had scheduling issues and others were "dissatisfied". Quite a number of studies are published in this field without such high dropout rates from scheduling issues. So I think it's much more likely that half of their experimental group just couldn't take the hot yoga program - which is done with the thermostat set extra high and plenty of humidity to boot.

If only the strong survive your study then that will skew the results towards a positive outcome. We don't end up measuring the people who are struggling.

And since they knew in advance that the program was so hellish that half of the subjects (who are volunteers getting paid to do yoga) would dropout you have to wonder whether or not any benefit is going to be worth it.

The control group was doing no exercise and the subjects were all sedentary to start with. In such a group of people any exercise will show improvement. So comparing four and a half hours of exercise a week to no exercise isn't a test of hot yoga versus other methods. It's a test of whether or not it's better than literally nothing.

So what were the results? Unimpressive. Two strength measures were used: grip strength and isometric deadlift. The grip strength showed no improvement, but there aren't any gripping activities in Bikram so that's not surprising. The other test showed some modest improvement*. But it's an isometric test following an isometric program. It's not going to translate well into real world performance and health measures. Since in the real world you don't just pull on a chain attached to the floor, you move.

* Or it didn't because they used shady statistics. I'm not certain about this. But they used a statistical measure that is not common in this field. And they also reported the common measure, and that one came up negative. However, this other test (group x time point comparison) did show statistical significance. Anytime I see a brand new test I get curious - I asked my stats professor about this. So it seems like the test is legit for this purpose. But did the researchers pick this because the regular test didn't support their hypothesis? I don't know.

Flexibility: They measured two flexibility components, low back/hamstring, with a sit-and-reach; and shoulder flexibility. Unsurprisingly, the yoga training produced substantial increases in the sit-and-reach test. But that measure of flexibility is not well correlated with either performance measures or health/fitness measures (like low back pain). So, who cares if that improved?

They also measured active shoulder range of motion. The test involves laying face down and holding a stick overhead. Then you lift the stick as high off the mat as you can. This measure improved as well. But not by a huge amount. Given some of the postures in Bikram this result is not surprising either.

Body Composition: The changes here were slight to none. And we get to see the researchers use the phrase, "trended towards significance". Ha! Individual p-values do not have a trend. When most of the p-values you get in a category are not significant, then you definitely don't have a trend. This phrase is researcher bunk for, "um, we didn't get a positive result, but, we . . uh . . . almost got one."

So, 4.5 hours of light exercise a week barely beat sitting around for improvements in body composition (weight, waist-to-hip ratio, body fat % and lead body mass) - not exactly surprising. Nor noteworthy. Only one actually significant result out of four tested also smells a bit like a fishing expedition.

Cardiorespiratory: I don't know why the researchers thought that standing still in various poses for 90 minutes would have improved cardiovascular health. Maybe because it was so hot that the heart had to work extra hard to keep the body cooled? Suffice it to say there was no improvement in blood pressure or aerobic capacity.

Why is it so Damned HOT in Here?

Seriously? No attempt is made by the authors to explain why they thought that yoga in a super hot, humid room would be better than regular, comfortable room yoga. And none of the things they measured seemed to be related to the heat. None of the minor benefits that were seen can be attributed to the heat since they were all similar to what you would expect from a regular yoga program.

Why do I care, though? Because hot yoga is an unnecessary risk for heat injury. It's hot enough in that room to mess you up. There's a reason that half people in the program decided not to finish it.

A nice description of the risks is given here, and from the same website to boot.

And, no, hot yoga does not sweat toxins out of the body! That's just not a thing. Human physiology doesn't work that way. Sweat glands only selectively excrete specific substances - they don't sieve your bloodstream and leak out whatever they find.

In summary:
Higher risk than regular yoga or exercise.
Minimal benefits that can just as easily be achieved cheaper and comfier.

Conclusion: not worth it.

But why did I rip so hard into this one study? Because proper science means that the more outlandish the claim the better the evidence required. Saying that a single exercise mode will help everything while in an excessively hot room is an extraordinary claim. So it requires extraordinary evidence. This study fails to meet that bar.

The bibliography:

Tracy, B. L., & Hart, C. E. F. (2013). Bikram Yoga Training and Physical Fitness in Healthy Young Adults: Journal of Strength and Conditioning Research, 27(3), 822–830. doi:10.1519/JSC.0b013e31825c340f

Yoga for Cardiovascular Risk

The same blog entry also talks about a study looking at cardiometabolic risk factors. That is risk for heart attacks, strokes and diabetes.

You've got to be kidding me. Light intensity exercise like this has no plausible mechanism for improving any of the things they measured.

And this can't be taken seriously. We can see that with information contained within the citation alone. It's from the Journal of  Alternative and Complementary Medicine, which makes the Quackwatch list of Non-recommended Periodicals. This journal has an impact factor of 1.5 which means that most scientists won't cite stuff from it. Neither of these pieces of information is perfect in determining quality, but they show a trend.

The actual study continues the trend.

• No control group. Seriously, this journal published a study without a control group. Why?
• A large number of disparate measures are used. I feel like they just used everything they had in their lab.
• Paradoxical results. One group improved in one measure the other group did not. But the other group improved in something else, unrelated, which the first group also did not improve.

This is not a good study. It should be ignored. Instead of cherry-picking weak studies that show what you want if you squint, the blogger should have looked for good research and clear patterns in the literature.

Yoga for Mental Health

There was one other study in the blog post that I'm ripping on. It was on mental health improvements. However, that exercise and a meditative practice improved some mental measures is not noteworthy. Of course it did. And that's a good thing. If you want to do yoga for the meditative aspect then more power to you.

Conclusion

We have three weak studies of hot yoga. None of them even attempts to address the core issue: does hot yoga have any benefit over regular yoga? Read any text on exercise, personal training, sports medicine etc. and you will have a section on how high heat and humidity is dangerous. How training in those conditions should be avoided, and when it can't be avoided you have to take additional precautions to keep people safe. 90 minutes straight of activity in that heat would not be considered safe in any other context.

Only in alternative practices would this even be considered. Take something known to be dangerous and then declare it superior. Then don't bother testing it. Remember, none of these studies compared regular temperature yoga to hot yoga.

This is the kind of research that's considered good enough for alternative medicine. And it's why these kinds of claims must be scrutinized more closely.

(/rant)

Balance Training & Agility

The approaches I commonly see for training 'balance' for HEMA are a problem. The problem is lack of specificity. Single-leg balance and yoga poses are encouraged. Long holds in various stances are recommended. Even things like wobble boards and BOSU's sometime are suggested.

Don't Do This!

(updated when this topic came up on the HEMA Alliance forum)

 

These all fail to be good choices for a simple reason: they are based on the idea that balance is a singular trait that you can improve. Like your Dexterity score in D&D. The human body just doesn't work that way. Our wires are not set-up that way.

Balance is always task specific. The best programs for preventing falls in the elderly aren't yoga and single-leg standing. They are obstacle courses. Walk and deal with obstacles - 6 inch high hurdles and the like in this situation - and that makes a person less likely to fall while walking.

Avoiding falling is also about power. When you are off-balance it does not take a 30 second sustained low-intensity contraction to right yourself. It takes a brief high-intensity action. And this is another way that strength training benefits HEMA and long-term human health and wellness.

And in HEMA the kinds of situations that lead to falls are when you are almost always when you are moving and moving fast.

So really, balance for HEMA is agility training.

I write this now because of a recent post over at the HEMAists. But I'm not picking on them. There is good stuff there too, just scroll down to see the part I liked. I've encountered similar suggestions in many places.

One guy on the Alliance forum FB page suggested holding a lunge position with arms extended out to the side for 60 seconds. He said I should try it to see how hard it is. But how hard that would be is irrelevant. In fencing I will never hold the end of a lunge that long. And the difference is an order of magnitude. And I'll never hold my arms out to the side that long either.

So the fact that it is hard tells us nothing about whether or not it is relevant to fighting. These are separate characteristics being measured.

How do we train 'balance' for HEMA?

We do it with agility drills. Exercises like ladder (or sword) drills, dots, cones, rings and hurdles. (Nah, I don't get any money from these folks. I just like their products (however their are frequently cheaper options available.))

I'll be talking about agility drills some more in the next few weeks. And I've talked about it a bit before.

Balance v. Stability

Balance and stability don't mean the same thing. This is me being pedantic because I'm professionally a nerd on this topic. But I think the difference is relevant and I'll provide an example in a moment.

In exercise science we use the terms to mean:

• Balance -  keeping the whole body upright or in position
• Stability - a characteristic of an individual joint being capable of holding a position

I'm not thrilled with the balance exercises from that HEMAists article. But I do like the stability exercises at the bottom. The exercise is a plank with a punch out, then rotate to a side plank and punch up. This exercise doesn't train balance. It trains maintaining a stable spine while moving around it. It's another way to do dynamic core work. I'm starting my guys on this exercise tomorrow.

I would make one addition about the exercise as described. An easier version is to start with the down arm on the elbow. A lot of people will need to start there.

Conclusion

Think hard about what specificity means before adding in new, neat  exercises.

P.S. I've got a sale going on right now for in-person training.