Quick Fix – Shoulder Pain - Part 1
This misunderstood joint is what allows us to throw, punch, rotate and press heavy shit overhead.
A great set of shoulders can work magic.
They can make you looked jacked.
They can help you lift more.
But understand this ‘the shoulder is a complicated joint.’ Once we start to look in depth at the anatomy of the shoulder we realise why it is so prone to injury.
If you learn to understand the shoulder then you can help your clients avoid some of the most common injuries in the gym. Remember, your first job as a Personal Trainer is not to injure your clients.
The term shoulder complex is used to describe the two distinct joints that function together to provide a large ROM.
The glenohumeral joint is the synovial ball and socket joint formed by the scapula and head of the humerus. This joint allows for flexion, extension, abduction, adduction and medial (IR) and lateral rotation (ER) of the shoulder joint.
The shoulder girdle is formed by the sternum, clavicle and scapula providing elevation, depression, protraction and retraction. Still with me?
What makes the shoulder so complicated is the relationship between your humerus, clavicle, and scapula.
It is a 3 joint structure and as result comes with a lot of muscle attachment especially at the head of the humerus. Due to the high level of mobility that is demanded at this joint, it is predisposed to instability and related injury.
Your pecs major and minor, lats, deltoids, rhomboids, and upper and lower traps are what we call the prime movers. It is important that your pecs, deltoids and upper traps do not function as postural muscles (more on this later).
The rotator cuff group (supraspinatus, infraspinatus, teres minor, and subscapularis) and your serratus anterior play a huge role in shoulder stability. The angle of pull of the deltoid muscle causes the head of the humerus to be drawn into the glenoid cavity.
The rotator cuff group counteract this by pulling downwards at the same time and provides stability and strength to the glenohumeral joint whilst ensuring that sufficient subacromial space is maintained during abduction.
The rotator cuff group should keep the humerus and scapula in its correct position but the design of the joint itself makes it prone to injury and dysfunction. Time to find out why. Lifestyle factors As I sit in my chair writing this blog, unless I organise my spine correctly, im compromising my shoulder health. I’m setting myself up for internal rotation of the shoulder, forward neck-carry, over-active upper traps and lengthening of external rotators and mid to lower traps which is all a sure way of developing Kyphotic posture.
If you add the incorrect seat or screen height, reliance on the use of the mouse (let me guess that is the arm that is causing you shoulder pain), looking down at your Iphone (there is an increased number of ‘Iphone’ injuries at Chiropractors) and driving, you have more than likely developed shoulder impingement or are on the road to it.
Muscular Imbalances As you have probable guessed, as a result of modern lifestyle and developing Kyphotic posture you will also be displaying muscular imbalances – the posterior and shoulder stabiliser can no longer function correctly. Shoulder stabilisation is a dynamic activity. Many muscles fire in a coordinated effort to stabilise the shoulder as it moves through a range of motion. Along with the rotator cuff, this includes:
But as these muscles become lengthened due to the aforementioned, they are no longer able to stabilise and function effectively or efficiently resulting in muscular imbalances. Your prime movers (pecs, lats, upper traps) will pick up the slack and function as postural muscles, further developing your imbalances, kyphotic posture and therefore pain, discomfort and eventual injury. When looking at shoulder problems, it’s important to understand the complex roles that all of these muscles play. If some muscles are strong and some are weak or inhibited, they can’t work together effectively in order to keep your shoulder healthy. Spinal Health Thoracic mobility also plays a huge part in your shoulder health, and after working with 100s of clients, it was evident in most cases that people with shoulder dysfunction or pain, were also displaying a lack of mobility at the Tspine. Movement at the Tspine comes from extension (ability to extend arms overhead) and rotation and later in this article you will see a few simple drills to improve this. The body is very smart; it will get from A to B the quickest way possible but not necessarily the safest way possible! And as in any area of the body, dysfunction can cause compensation. So if you cannot achieve the movement through thoracic rotation then your body will be over reliant on using the shoulder girdle to achieve that movement, and this can lead to over use and imbalance. Daily movement and mobility is the best way to mobilise your Tspine and reverse the negative effects of dailiy sitting or lifestyle.
Exercise Programming If we are developing kyphotic posture and muscular imbalances (overactive anterior muscles and weak postural muscles) then why do we continue to train the muscles we see in the mirror. *Note to guys – women love a strong back and butt not internally rotated shoulders and a flat butt! So when you are training your clients consider your push to pull ratio to correct any muscular imbalances that you can see (a quick postural assessment or FMS) will highlight these. An example would be a push to pull ratio of 1:3 – 3 pull exercises for every push exercise.
Exercise technique When you experience pain it is your body’s way of telling you something is wrong and you should not ignore the signal. ‘No PAIN is GAIN’ Now you do not have to stop training completely, with smart programming and prehab you can still train while optimising shoulder health. You may need to limit the movements that are causing the pain or impingement, so for example, limited any overhead pressing or extension of the shoulder (if you experience pain when you lift your arm passed your shoulder it may be a sign of inflammation of the supraspinatus or impingement). Also it is worth considering changing the grip or variation that you use as this can also lead to shoulder discomfort, for example, switching to a neutral dumbbell press or supinated grip. Summary It is important to remember that as personal trainers or strength coaches we should not diagnose any injury. If your client is pain then please refer to specialist or doctor, as this will make you look more professional and more importantly is in the best interest of your clients.
BUT with smart programming and a better understanding of the shoulder joint we can improve posture, muscular imbalances, shoulder strength and stability and overall health. Part 2 of this blog includes is a quick fix approach to prehab that can be used in your clients warm up, as activation drills, fillers between sets or even as homework. At the end of this article you can also see an example program that was put together for a client who has now restored shoulder health and function.