A quick guide to a healthier shoulder
Rarely a week goes by when I don't hear someone complaining about shoulder pain or see someone massaging a sore bicep tendon. I see it all the time in youth baseball/softball players, but also frequently in recreational athletes including volleyball players, surfers, and weight-lifters. It wasn’t until I got a text from a friend last week explaining that his shoulder even bothers him when he plays guitar that I had my eureka moment. Most San Diegans suffer from the curse of underdeveloped external rotators, and overdeveloped internal rotators!
San Diego is known for its Mediterranean climate. Most days of the year we have sunny days, cool nights and temperatures between the mid 60’s to high 70’s. Basically, you can be outside for 340 days of the year. Some of the most common activities here in San Diego are beach volleyball, surfing, climbing, crossfitting, swimming, running, cycling, baseball, and softball.
Whatever you do, I give you two thumbs up for being so active all the time! But let’s stop to think about the list of activities I just rambled off within 15 seconds. Think about the movement occurring at the shoulder during nearly all of these activities. Most of the activities require your arms to travel overhead, internal rotation, and excessive thoracic flexion. The muscle group responsible for the movements are the internal rotators, ie the lats, pecs, anterior and medial head of your delts, and subscap of the rotator cuff.
These are huge muscles. Large overall muscle mass makes it easier to exert a larger amount of force. Simple muscle physiology will show a greater amount of cross bridging taking place, i.e. more forceful contractions. Now to counteract the large force generating potential of the internal rotators we have the rhomboids, infraspinatous, teres minor, supraspinatous, mid and low traps, teres major, and posterior delt. Sounds impressive but when it comes down the it all of those muscle are small and do not add up to the the lats alone!
The internal and external rotators work synergistically to create movement and develop force within your glenohumeral joint. With this information in hand it is easy to see why shoulder issue are so prevelant in society. It's simply easier to let your internal rotators do most of the work, if it was easy for the shoulder external rotators, most people would remain injury free and have terrific posture. But take a quick look around and we quickly see that is not the case. Not to mention most time spent in a gym is used on muscles people can see...ie chest, lats, anterior and medial delts, abs and biceps. What a vain society we live in!
A rule of thumb in the training world is to train pulling exercises (posterior shoulder) 2-3x as much as the pushing exercises (anterior shoulder). Researchers have gone further to show the optimal relationship for shoulder health is your internal rotators of the rotator being 1.75x stronger then external rotators. As the ratios grows larger, risk of injury increases. And if you were to look most active life styles, it is safe to say internal rotation is being trained much more often (surfing, volleyball, swimming, cycling, crossfitting, baseball, softball, playing catch, and playing the guitar (although it's not really physically active it stimulates your brain).
So what issues can cause injuries at the shoulder?
1. Poor scapular stability – Poor scapular stability changes the position of the acromian. Continuous overhead movements have been shown to cause the scapular to have a slight anterior tilt and upward rotation. The change in acromian and scapular position decreases the space under the subacromial arch, increasing the likelihood of some external impingement of the rotator cuff tendons.
2. Poor scapular mobility – Poor scapular mobility is a combination of many factors including tightness in the Lats, Pecs, Traps, and rotators. Poor mobility could also be attributed to weakness of the Serratus, rotator cuff, mid and low traps, and pec minor. The lack of mobility within the scapula will cause the stress to be handled by muscles, tendons, and ligaments that weren’t originally design to do so!
3. Poor endurance within you rotator cuff and posterior shoulder musculature – It is understood that shoulder health is dependent on the endurance within the posterior musculature of the shoulder. Since the muscles responsible for deceleration (rotator cuff, rhomboids, posterior delt) of the humeral head are much smaller than those responsible for acceleration (lats, pec major, anterior head of delt), it is important to train the decelerators with a greater volume. Over development of the accelerators, as stated before, puts you at a mechanical disadvantage, increasing your risk for injury.
4. Poor posture/ tightness of the pecs, internal rotators of the rotator cuff, and lats – tightness within your pecs and lats jeopardize the mobility of your scapula and shoulder. The tightness goes hand in hand with poor posture. Correcting both will allow the shoulder to move under interrupted, allowing forces to be handled by muscles designed to do so. Tightness in the shoulders is often compensated for by increased extension of the lumbar spine! This creates a problem all in its own!
5. Poor Thoracic Mobility - Your thoracic spine, in laymans term is the middle part of your spine. This area that is most effected by poor sitting posture (where most people tend to be rounded). By maintaining this poor posture you jeopardize the kinematics of your shoulder by forcing your scapula to anteriorly tilt (tilt forward), increasing the likelihood of pain and injury.
The combination of these five issues wreaks havoc on your shoulders. Just 1 out of the 4 is enough to cause pain. Most people I have talked to with shoulder pain have at least 3 of the 4 stacked up against them. Don’t worry; the remedy is not to quit surfing, playing volleyball, or whatever it is that keeps you active. It’s a matter of correcting what’s wrong!
Here are some exercises that you can do from home to help improve that nagging shoulder pain:
Fatigue is the underlying factor of nearly all injuries. If you just went surfing, take some time off before you play volleyball. Surfing involves a whole lot of internal rotation, therefore leading to fatigue of the muscles that are responsible for controlling your scapula. Ripping on a ball after surfing for 3 hours increases the chance of injury. Take some time, eat some food, rest up, and then go dominate the court!
2. Improve your posture!
Good posture centers the end of your humerus in the glenoid fossa. In other words…The glenohumeral joint is described to be equal to a beachballl (head of your humerus) sitting on the nose of a seal (glenoid fossa where the head of the humerus rests, and is surrounded by muscle, ligaments, and tendons). When the “beachball” is in the center of the “nose” no one has a problem. Let the ball slip a little to right or left and it is off the nose and it’ll take some work to get it back up there. All of the musculature, tendons, and ligaments surrounding the head of the humerus in your shoulder have a stressful time trying to keep everything in place.
3. Posterior/ Shoulder external rotation Exercises!
Train posterior dominant/exercises that involve external rotation 2-3x more than anterior shoulder exercises! External rotator strength in the key to a healthy shoulder!
4. TRAIN SCAPULAR STABILITY!
17 muscles attach or have attachment points onto your scapula. This means there is no single muscle you can train to improve scapula stability. Instead, train the movements your scapula is meant to go through. Use these exercises as a tool to improve your shoulder health. Pain doesn’t have to be the end to what you love!
5. Improve Thoracic Mobility!
Improving Thoracic mobility improves the posture of your thoracic spine. This will inturn lead to improvements in scapula position and decreasing your risk of/current shoulder pain!
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Below are some quick exercise to get those scapula moving better and the shoulders feeling healthy. I'd like to add a quick tidbit for all the parents and coaches out there. These exercises are a small tool in correcting a shoulder injury. Most of these injuring occur because of over use. Don't over-use your athletes!!! Athletes don't become a victim of over-use! You have one shoulder, and one career; get the most out of it! Parents and coaches... please remember that fatigue is the underlying factor of most injuries. The shoulder is a very fine joint and should be treated like one. Do your part to make sure your athletes stay healthy, and can play the sport they love at a high level. Don't let an overused shoulder be the cause of an early end to a career!
Wall Slides: These are a great way to improve scapula mobility. They look easy but don't be decieved, one of the hardest body weight exercises you can do!
Protraction/rectraction: This exercise is great at developing strength within your serratus anterior which will help control the scapula.
Scapula stability with perturbation: Another great exercise to help develop scapula stability. Make sure this exercise is done in a controlled setting!
Elevation/depression: This exercise will help correct the drop shoulder we see in just about all overhead athletes. This helps develop strength in the upper traps which is needed to move the scapula.
Planks with scapula in better position: By simply changing where you place your elbows and hands during a plank, you have the ability to improve the way your scapula sits on your ribs. By moving your elbow under your shoulders and externally rotating at the shoulder (hands outside away from your body) you will depress your shoulders against your ribs. This in contrary to the planks you see with elbows placed outside of your shoulders and shoulders externally rotating (fist touching under your chest)