Hayley Spelman Returns From Shoulder Surgery (Part 1 of 2)
Hayley Spelman, six foot, six inch southpaw Stanford grad, called me for the first time May 25th, 2021. Her supraspinatus? Torn. Fuck. She was going to make her next season her last, and now had this major speedbump on her off-ramp from professional volleyball.
She got surgery, did the standard rehab, and seven months after scalpel met skin, she came to stay in Santa Cruz to train at Apiros. She wanted to finish her career on her terms and she knew that I have helped athletes come back from shoulder injuries. We trained for six weeks until she left for France where she finished the season healthy. Here is her story.
Raised Awareness
In our first session, I asked, “Does anything still give you pain?”
“Yeah, this one PT exercise where I externally rotate my arm.”
That’s odd, I thought to myself. What a simple movement, why would that give her pain? I nodded and said, “Let’s investigate. Can you show me?”
She sat down and propped her left arm on a box so her elbow was at shoulder height. She grabbed a band that was attached to a post and rotated her forearm flat to the box and perpendicular to it. She thought she was externally rotating her shoulder. She wasn't.
Immediately, I saw a potential cause for her pain and I’m flabbergasted that her PT didn’t catch it.
I told her, “You’re rotating your entire shoulder blade with your hand and not rotating the ball in your shoulder socket.”
“What do you mean?” she asked. “What am I supposed to do?”
I knelt down next to her, gently grabbed her shoulder blade with my right hand and her forearm with my left. I kept her shoulder blade still as I moved her forearm. This got her to actually rotate her humerus in her shoulder joint.
“Does that feel different?”
“Yeah, the pain is gone.”
Then I exaggerated what she did naturally. Several times over, I tilted her shoulder blade forward in sync with her hand dropping toward the box. What she was unaware of moments ago became immediately apparent. She became aware. Now I needed to step back, shut up, and let her figure out how to orchestrate this motion. She did and I asked about her pain. “It hurts when I do it the old way and feels better when I do it the new way.” Pain can be a fantastic teacher.
I didn’t try to treat Hayley’s pain, or her supraspinatus in this instance. I needed to make her aware. She tried to externally rotate her shoulder and instead, moved her shoulder blade. My intervention may seem like a subtle change but it had massive effects. All I did was lead her to put the motion where it belonged. I’m not surprised she felt better.
That was just the first session. For the next six weeks, we continued with lessons like those. Ones that increased Hayley’s awareness so that she could increase her control of her body. She learned that she moved her shoulder blade a lot more than she should in almost any instance that involved her arm. She substituted shoulder socket motion with shoulder blade motion, if she lifted her arm sideways, forward, or diagonal, her left shoulder blade moved excessively and much more than her non-injured shoulder. All those substitutions made her rotator cuff work a lot harder than it needed to, and basically stay in an isometric contraction during all arm motions. The human ball and socket joint has a ton of range, and that needed to be reinstated into Hayley’s shoulder if she was going to keep playing volleyball in one piece.
If Hayley’s story seems rare, it’s not. I see these compensations all the time. Every athlete that has started at Apiros has had similar levels of unawareness. In general, modern athletic environments and culture keeps athletes unaware. “Do this, do that,” they’re ordered. “Only cue athletes toward the external world, internal cues are bad,” says academia. I digress, this isn’t the post for my soapbox spiel about unaware athletes. That will come.
Once Hayley gained awareness of her movement, we could evolve how she moved which would improve her muscles and connective tissue. Without her awareness, she would not have been able to control her shoulder and we would have gotten her stronger but her risk for re-injury would have remained high. Her awareness allowed us to get to the three tenets I made for her program:
Strength and endurance of normal shoulder motion
Tendon density
Improved arm swing mechanics in volleyball
The first two points I’ll cover in this post. Improving her arm swing will come in the sequel.
#1 - Normal Shoulder Motion
My priority was to help Hayley move her shoulder in normal ways again. What I said earlier about her shoulder blade and arm was just one aspect of normalizing her motion. My next focus was her sternoclavicular joint. This joint is vital, it is the singular joint that connects her arm to her body, and no one I know outside of Apiros analyzes it.
The collarbone needs to be firmly attached to the sternum and scapula so it can transfer forces between the arm and the body. Transferring forces both ways along that tubular bone is essential, like when she hits a volleyball, does a pull-up, or lives her life. For her collarbone to transfer all these forces well, it must be bound to the sternum and hers was loose.
Without her collarbone pinned to her sternum, force was imprisoned into her shoulder instead of being shared with the rest of her body, and I’ll prove it to you. The muscles in her shoulder have overworked and been under prepared because no one caught her SC joint red-handed despite hiding in plain sight. No wonder her supraspinatus tore. Once you see it, you can’t unsee it. Let me show you.
Normally, the inner end of the collarbone is flush with the sternum. You can see that Hayley’s stuck out. (In the photo below: Hayley is in the bottom photo, a Hadzabe hunter-gatherer is in the middle, and I am in the top.)
Watch Hayley throw a ball. You can see her shoulder blade come off her body. That is visible evidence that kinetic energy is not transferring into her torso.
Now watch Mitch Haniger (MLB All-Star) throw. You can actually see the energy ripple down from his shoulder into his hips because his SC joint is intact and his shoulder blade stays on his body. Watch the wave of energy flow from his arm to his shoulder and down his lat into his core. This is so fucking cool.
Look at Hayley in the photo below. Notice her SC joint, it separated in the initial phases of her throw. You can see a large gap between her collarbone and her sternum. Compare that to Mitch. You don’t see a large gap, there’s no divot.
Now that you know what to key into, watch this next video to see her collarbone disembarking from her sternum.
SC joints are vital for arm health. They’re so important it’s one of the first things I look for when I evaluate athletes—all it takes is a glance. The more the collarbone pokes out from the sternum, the higher risk of injury for the athlete because excess stress is being put on the shoulder. You can prevent such disjointedness by tempering how much you pinch your shoulder blades together, I’ll explain why later. You can also do exercises that bring your AC joint and scapula forward; or your arm toward your midline so the upper fibers of the pec fire and keep your collarbone attached to your sternum. The neck is also responsible, as many of the muscles that control the head attach to the collarbone and SC joint. So, Hayley and I trained her neck too. I don’t like to go into further detail than that in blog posts because it’s better understood in my course or individual sessions with athletes.
PATIENCE WITH CONNECTIVE TISSUE
Unfortunately, Hayley’s SC joint wasn’t going to be as quick of a fix as the shoulder pain she walked in with. I hope to see changes over months, or maybe even a year. I told her that stabilizing her SC joint needed to become a habit, like brushing her teeth, because connective tissue takes so long to change.
Since this would take so long, I wanted to develop an insurance policy. I knew her shoulder would take the brunt of the stress she would create, so we doubled down on muscle size and strength. I wanted all the muscles in her left arm and shoulder to get, well, beefy. Straight up jacked. If her shoulder’s gonna work overtime, it better be prepared. This meant her training had reps and sets to failure for hypertrophy, long bouts of endurance where she held muscular tension for minutes, and really heavy lifts and intense bodyweight exercises, like assisted one arm pull ups.
CAUSATION
You might be wondering, how’d her SC joint get here?
One of the reasons her SC joint became so disjointed was she used to pinch her shoulder blades together—a cue I’m trying to eviscerate. Here’s my reasoning: The collarbone is kind of like a teeter-totter. (Physics nerds: yes I know there’s no fulcrum in the middle. Shh, hear me out.) The opposite end of the SC joint is the AC joint and it attaches to the shoulder blade. When shoulder blades (and AC joints) teeter toward spines, the SC joint gets tottered forward, out of its home. Homeless collarbone, bad. (Just go home!) So, when I explained it to Hayley like that and then told her to stop pinching her shoulder blades together in posture and training, she stopped, her shoulder felt better, and we made progress faster.
#2 - Tendon Density
Normal shoulder motion was a prerequisite to building tendon density. If her shoulder blade continued to move all over the place, it would never be the stable foundation that her arm needed. And since her sternoclavicular joint was compromised, I needed to make all her muscles on and around her shoulder blade extra strong. The stronger these muscles are, the more robust her tendons become. One of the muscles we prioritized was her supraspinatus, obviously, because its tendon was surgically repaired. Getting that muscle strong gets the tendon strong. So, we loaded her supraspinatus as heavy as she could tolerate, even if her shoulder motion was imperfect.
I also prioritized her other rotator cuff muscles, those are vital, and if she continued to rotate her arm in and out against latex bands ad nauseam, she never would have developed the strength or tendon density required to spike countless volleyballs a year. Tendons require intense efforts to get more dense, to turn from fraying twine to steel cables. And they don’t get that way from easy stretchy bands handed out like treats at PT clinics. We loaded her rotator cuff through intense overhead pulling exercises because rotator cuffs evolved to hang, climb, and swing. Hayley did one arm scapular pull-ups and assisted one arm pull-ups; she climbed for minutes on end, endurance routes that put tension on her tendons for long periods of time. These workouts aren’t part of some six-week periodized plan, they are a lifestyle change. I told her that tendons take time to change and that she needed to keep these workouts going for as long as she plans to play volleyball. Taking care of tendons is a habit, a movement mantra repeated two to four times a week.
One of my goals with every athlete is to get them so robust that they can tolerate imperfect movements from time to time—because that’s realistic. Perfect movement all the time is an LSD hallucination with one-horned-sparkle-ponies and idealist coaches and athletes. Great movement has variability, a bandwidth of tolerance, a range of norms. Sports are chaotic and athletes need to be able to tolerate the storm. When Hayley plays volleyball, she’s going to have imperfect attacks and her training made her tolerant to those inevitable deviations. But, that doesn’t mean we couldn’t clean up some of her volleyball mechanics. That’s what I’ll cover in the next blog post and if you generously hand me that sweet, sweet email of yours, I’ll send it to you before anyone else gets a glance at my words.
— Austin
P.S. Look, I’ll be real with you: I want you to share this blog post with someone. Yeah, sure, it will help grow my audience, thanks for that, but that’s not the point. If you’ve made it this far, you probably enjoyed the read and I bet you learned something too. Those are my goals with my writing, fun and learning. But my enjoyable and educational words are in service of a larger goal—I want to make noncontact injuries extinct. And you play a role in that. The more people who learn better concepts for movement and training, the more injuries we can prevent. Hayley’s injury, I firmly believe, could have been prevented if more people knew what I know. SC joints are easy to observe and can be wildly informative. So send this blog to one person, it may prevent yet another shoulder surgery.
(Below: Here’s a training montage of some of Hayley’s upper body training.)