Let’s discuss some key concepts and ideas to consider when looking at shoulder health, in addition you will leave with some actionable items you can implement into your training/rehab. As always the best bet with any chronic pain/injury is to get a diagnosis telling you exactly what is happening and making sure that you are not doing anything to worsen your current condition. Finding a qualified doctor, physical therapist and trainer are vitally important.
About the Shoulder Joint
The human shoulder is a pretty incredible piece of biological architecture; it has the widest variety of possible movements of any joint in the body. This allows the shoulder to do some pretty incredible things. This fact also leaves it the most susceptible to injury. With these things in mind we need to remember to train the shoulder in a variety of ways in order to maintain strength, stability, mobility and flexibility.
Shoulder Range of Motion (ROM)
The shoulder is able to complete all of the following ROM’s
- Flexion – the arm starts at the side of the body and elevates upward in the Sagittal plane, in front of you to the overhead position.
- Extension – the arm starts at the side and moves backward in the Sagittal plane, behind your torso, allows you to do a reverse plank or crab position.
- Adduction – the arm moves towards the midline of the body, downward motion of the arms during a jumping jack
- Abduction – the arm moves away from the midline of the body, upward motion of a jumping jack.
- Horizontal adduction – the arm starts at 90 degrees of abduction and moves toward the midline of the body, think a seal jack or clapping in front of you with straight arms.
- Horizontal abduction – the arm starts at 90 degrees and moves away from the midline of the body horizontally, opposite of adduction.
- Internal rotation – the arm rotates inward toward the midline of the body.
- External rotation – the arm rotates outward, away from the midline of the body.
***many common shoulder movements, such as throwing, combine a number of these basic ranges of motion***
Owning the ROM
In order to maintain shoulder health it is imperative to build strength, stability, motor control (mobility), and flexibility in all various planes of movement that the shoulder is able to perform.
- When strength training be sure to target a variety of different movements, with proper form and with appropriate loading to challenge the shoulder thus forcing it to adapt and grow stronger. For example only focusing on overhead pressing for shoulder strength will result in a muscular imbalance in the shoulder and increase the likelihood of injury. Instead be sure to press and pull vertically (in both directions) as well as horizontally. Being sure to incorporate movements like pull ups, upright rows, overhead pressing, various rowing exercises at different angles, various chest pressing movements at different angels and lightweight internal and external rotation movements will help to ensure a balanced approach to training and keeping your shoulder health.
- Stability is often an overlooked training stimulus that is vital to shoulder health. Because the shoulder is considered a “floating” joint your ability to create dynamic tension through the tissue of the shoulder is important for protecting it through not only training, but athletic events and everyday play/life. Training stability is simple (not easy!), incorporate a healthy dose of holds and carries in a variety of positions (overhead, front rack, at your side, etc) along with exercises like a plank holds (push up position, side plank) handstand holds, Turkish Get-Ups (TGU), Kettlebell Windmills, etc.
- Motor Control or Mobility describes your ability to put a joint or multiple joints through a particular ROM with complete control. A number of people have the flexibility to put a particular joint through a certain ROM passively however are not capable of doing so actively or with an external load. Motor control/mobility go hand in hand with stability, the simplest way to train this is to slow the tempo of a movement way down and even incorporate some isometric holds (helping both your mobility and stability simultaneously). Exercises such as a slow ring dip with a 2-3 second pause at the top and 2-3 second pause at the bottom or a press & pause TGU are great examples of using tempo and control to help build your capability to actively control your body and external elements through space.
- Flexibility is directly linked to longevity and quality of life as we age; although this isn’t the most exciting thing for many people to train it has a ton of value long term. Being flexible enough (combined with adequate strength, stability and motor control) allows you to get into more advantageous and stronger positions that are more efficient, allowing higher performance while also decreasing risk of injury. In addition there is some long term pay-off as we age so be sure to take the time to get some stretching in, start with just 5-10 minutes a day of a full body strength session to build the habit. If you are spending 5-6 hours a week training hard you can at least dedicate an hour a week to stretching to help recover and improve the response of your training.
Common Shoulder Issues/Injuries
Shoulder Impingement – one of the most common culprits of shoulder pain, without getting too far in the weeds this is happening when you are running out of space for the tissue at the shoulder to move freely causing some pain. There are different types of impingements and consulting a health care professional can be helpful in determining what the problem is.
Rotator Cuff Tear – the “rotator cuff” is actually a group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) so a tear may be in one or several of these muscles. Consultation with a health care professional and imaging is needed to determine if there is an actual tear in the tissue. Incorporating slow eccentric movements with light resistance will be important in the rehab process, at our facility we use and have access to the Crossover Symmetry systems that are designed around common physical therapy exercises used to regain and build shoulder strength and ability.
Bicipital Tendonitis – typically felt in the front of the shoulder, and can be caused by inflammation in the shoulder joint, impingements, rotator cuff disorders, labral tears, etc. Again consulting a health care professional is your best bet to determine the specific origin of shoulder pain. Utilization of slow controlled eccentric exercises is important to incorporate with any tendonitis or tendonosis.
Shoulder Dislocation – often a result of a severe lack of strength and stability and/or a traumatic injury. Working to build strength and stability in the shoulder in a variety of positions is vital to rehabbing this injury as well as in order to help prevent it.
Bursitis – you have bursa throughout a number of joints, bursitis is when those small sac-like structures become inflamed and irritated causing pain/discomfort. This can be a cause or result of a shoulder impingement and many times will improve with increased shoulder health (strength, stability, mobility, flexibility). Modifying movements that are painful and avoiding repetitive overhead movements are helpful in reducing the inflammation.
What to do??
Let’s discuss some things that are really easy to incorporate into your training, that have a big return on investment.
The vast majority of the shoulder issues we have seen in the walls of our facility are impingements of some type, so we will start there.
Although a number of movements and protocols can be useful in repairing an impingement we want to keep it simple…
- 4-7 times a week (daily is great if you can)
- Accumulate 2:00 in a relaxed hanging position from a horizontal (pull up) bar, this can be done with the feet hanging off the floor or with the feet touching in order to govern the amount of force/load hanging from your grip and your shoulders. Break this into manageable time frames that allow you to accumulate a total of 2:00. In this relaxed hold let the shoulders passively rise to the ears and let your bodyweight just hang. (side note this is also great for spinal decompression)
- Perform single arm upright rows with a light Kettlebell or dumbbell using a slow controlled motion. 2-3 sets of 8-12 reps.
For Rotator Cuff weakness, preventative pre-hab or rehab work…
- Utilize the Crossover Symmetry systems 4-5 days a week
- Be sure to stay in a strict position for all movements, the motion should be controlled and you should be able to pause at end ROM.
- 1-2 days of the week (not back to back) incorporate either the recovery protocol (rehab) or the iron scap protocol (pre-hab)
- If you are recovering from a tear or dealing with tendonitis/tendonosis utilize the recovery protocol, making sure to use a very slow eccentric motion
For issues with instability, including dislocation or subluxation of the shoulder…
- 3-5 Days a week perform a combination of movements like Turkish Get Ups or Windmills along with holds, carries of some sort.
- Carries should be challenging loads and you can increase the distance and/or load as you progress.
- An example week could look like the following:
- Day 1
- 3-5 sets of 1-3 TGU’s each side with a challenging load
- 4×100’ Contralateral Carry (one KB/DB overhead and one at your side)
- 4×20 sec Side Plank (on your palm rather than elbow)
- Day 2
- Accumulate 2:00 in an Overhead Hold with a barbell (use KB’s/DB’s for an added challenge), if you complete this in less than 3:00 total then add more weight next time
- 4×100’ Farmer Carry
- Day 3
- 3-5 sets of 3-5 Windmill’s each side with a challenging load
- 3-4 Sets
- Active Pull Up Hang x :20
- Dip Hold x :10 top position + :10 bottom position
- Push Up Plank x :20
- Day 1
Some general considerations to keep in mind is to appropriately modify movements that worsen or pain/discomfort, keep an eye on volume of repetition, practice controlled, well executed movements and seek out the help of a health care professional as well as a qualified trainer to help you correct your shoulder issues and get back to the life you want. Please keep in mind, there are a number of different effective ways to approach each persons individual shoulder concerns, above are just a few simple examples. If you have specific questions about your shoulder pain/injuries please reach out and let us know, we will point you in the right direction to address your needs. For now try some of the suggestions we have listed here!
Keep those shoulders healthy and strong!!!
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