By Justin Dudley, PT, DPT, EMT – Owner and Physical Therapist of Cascade Sports Injury Prevention & Physical Therapy – In-House Physical Therapist for Crossover Symmetry

My name is Justin Dudley and I am a Doctor of Physical Therapy, owner of Cascade Sports Injury Prevention & Physical Therapy and the “in house” physical therapist for Crossover Symmetry. We specialize in treating recreational and professional athletes of all ages with a special focus on injury prevention in hopes of minimizing overuse and non-contact injuries. At Cascade Sports we rehabilitate a wide variety of orthopedic injuries as well as bridging the gap between rehabilitation and performance. This includes not only providing a complete evaluation of the injury and surrounding areas, but also looking for deficiencies and weaknesses that could have factored in to the injury taking place.

Today I want to tell you about a product that I have been using more and more in my clinic, not only with athletes, but with my general shoulder pain patients as well. A while back, I had heard other professionals in the sports medicine community talk about Crossover Symmetry, but I chalked it up to just another “band” company. It wasn’t until I took the time to look more closely at their specific programming and learn the story and research behind Crossover that I really began to realize its benefit and use it clinically.

Crossover Symmetry was originally developed by a physical therapist as a preventative shoulder care program for baseball pitchers. Not only did they find a reduced incidence of injury, but also an increase in performance of their athletes. Word about Crossover Symmetry quickly spread throughout the baseball community and the program is currently being used by the vast majority of NCAA Division I teams and MLB teams.

Because the vast majority of physical therapists do not work directly with this professional athlete population we need to look at how this product, that has been adopted by top level athletes, relates to our everyday physical therapy patient and weekend warrior. As therapists, we are movement specialists and have a great understanding of the mechanics of movement. Our goal is to highlight deficits within our patients and then correct those deficits or dysfunctions. Athletes and patients love to train what they are good at and hate to train what they are bad at. It is the role of physical therapists to be “weakness managers” rather than strength coaches in order to return our patient to normal function and prevent the risk of future injury. In patients with shoulder pain, this often means we need to manage the weaknesses of the scapula and rotator cuff. This applies to patients both post-operative and non-operative.

I see a lot of therapists struggle with appropriate exercise progression beyond early phase rehabilitation. One of the reasons for this is that as the patient can safely tolerate doing more advanced movements, therapists often suffer from “paralysis by analysis”. What I mean by this is, there are so many exercises available, we often flounder in overloading the patient and ourselves with too many different options. What we need are structured, efficient, practical and evidence based programs to not only introduce to our patients in clinic but also to send home with the patient for home exercise programs. If we are able to utilize protocols that incorporate these principals we will see improved clinical outcomes as well as patient compliance with home programs after discharge. This is exactly what you get with the Crossover Symmetry Programs.

Now don’t get me wrong, I don’t expect any single program or product to be appropriate for all patients all the time. This is why a program should not be a replacement for your clinical reasoning and ability to individualize patient care. As a clinician you need to know and understand which tissues are involved with each of your patients and select exercises that are safe to perform without overloading the painful or injured structures. Initially a patient may only be able to perform one or two of the exercises safely, and may need significant cueing and modifications. As time progresses, they will be able to incorporate more and more of this program into their routine.

By the time of discharge, I shoot to have all patients I treated for shoulder injury able to perform the Crossover Symmetry program correctly, and free of pain. That way, at discharge, I have a specific program to send home with them that is structured, efficient, practical and evidence based in hopes that their long term compliance will be better than it traditionally has been and they will not return for a similar issue.

Since starting to use the Crossover Symmetry and Iron Scap programs in my clinic I have seen faster return to activity times in cases of shoulder impingement, non-operative SLAP tears, chronic shoulder pain, thoracic outlet syndrome and even post-operative rotator cuff repair. And, as I eluded to earlier, I have a decreased incidence of patients returning to clinic after discharge due to repeat episodes of similar pathologies.

Lets shift gears away from this particular program and talk more generally about the typical factors that lead to overuse shoulder injuries. Most often shoulder pain is secondary poor humeral head control within the glenoid, ie poor functioning of the rotator cuff, or scapula dyskinesis; poor scapula position, strength and control. Notice I said, poor functioning of the rotator cuff, NOT a weak rotator cuff. Doing typical “strengthening” type exercises will only take you so far with the rotator cuff, we need it to function properly in a coordinated manner within the entire shoulder complex and throughout a full range of motion. Now, keeping these principles in mind as prominent underlying factors in shoulder pain, lets take a look at the Crossover Symmetry programs. Crossover Symmetry:  this is their original program of 7 exercises that takes about 4-5 minutes to complete. This is by far the program that I use most clinically with my everyday patients. However, depending on how you apply these exercises, you actually have 3 different programs.

  • Activation: through controlled concentric motions, with short isometric holds, this program helps to “turn on” or activate the rotator cuff and scapula musculature so they function efficiently during shoulder tasks. Great to use as a warm-up prior to activity.
  • Plyometric: by performing short oscillatory motions during the isometric hold, you are actually addressing the timing and coordination of muscle firing similar to performing rhythmic stabilization in clinic. This muscle timing and coordinated co-contraction is an essential part to optimal shoulder function, performance and injury prevention
  • Recovery: this can also be viewed as the eccentric part of the program. Research has shown the importance of slow controlled eccentric motion for tendon health. By slowing down the eccentric component of the program you will be stressing the commonly injured structures, the rotator cuff tendons, in a safe and beneficial way.

In addition to the original program and the three associated workouts, Iron Scap was developed to focus specifically on scapula muscles. Both in the sports performance and medical fields, a lot of attention has been given to the rotator cuff, but that is only part of the picture. Scapular stability, function and control are the foundation upon which all other shoulder motion is built, including rotator cuff function. The Iron Scap program was developed to focus on stability throughout the appropriate scapula ROM in order to minimize scapula dyskinesis. I have typically used this program more with my high level athletes as part of their regular training, or during late phase rehabilitation as we prepare for return to sport. However, I have begun to use this more and more on my everyday patients and have been seeing some positive results.

Whether you work with top level athletes, weekend warriors, or non-athletes, the principles behind shoulder mechanics, rehabilitation and injury prevention are similar. By combining your education and clinical expertise with an efficient and practical program like Crossover Symmetry and Iron Scap you will have a great system to improve clinical outcomes and patient compliance when treating your patients with shoulder pain.