Shoulder pain is on the rise and shoulder health is on the decline. On a timeline long enough, everyone gets hurt. Preventing shoulder injury is a MUST. Do yourself a favor and prehab before you rehab. #ShouldersOfSteel
Shoulder Savers: Training Smart & Preventing Injury
In this great article from T-Nation, fitness guru Eric Cressey outlines several ways to prevent shoulder injury and/or rehab shoulder injury when strength training. These tips from a well-seasoned powerlifter and coach will surely help save those shoulders.
Do you experience nagging pain in the shoulders when pressing weight overhead? How about when performing a pull-up or a push-up? As with so many people deeply involved with fitness, CrossFitters put their shoulders through overtime regularly.With CrossFit, it’s easy to overlook the volume and frequency at which we utilize our shoulders in training. Just like the hips (gluteals), your shoulders are a fulcrum necessary for stability and power; however, because of the complexity of this joint, injury and pain are almost inevitable due to the demands of most CrossFit programs.
The good news? You can be injury- and pain-free with the help of some of these shoulder savers.
#1: Avoid what hurts
The next time your shoulder starts to act up in the middle of a training session, put down the weights, take a deep breath, and walk over to the water fountain.
It seems logical, but we all know how tough it is to resist the exercises we’ve grown to love. Face the facts; you just might not be able to overhead press or bench with the straight bar.Not all bodies are created equal in the first place; a good example would be the different types of acromions, a portion of the scapula. Those with type III acromions are more likely to suffer from subacromial impingement due to the shape of this end of the scapula:
These are the 3 types:
Type I Acromion: flat, minimal impingement risk, normal subacromial space.
Type II Acromion: curved, higher rate of impingement, slight decrease in subacromial space.
Type III Acromion: beaked, highest rate of impingement, marked decrease in subacromial space.
Now, ask yourself this: when someone universally recommends overhead pressing, how often do you think they’re consulting x-rays to determine if it might not be the best thing for you?
If you feel shoulder pain while training, determine an appropriate course of action — including an alternative exercise.
Moreover, not all bodies are equal down the road, either. If you’re a type I or type II acromion process, you can “acquire” a type III morphology due to reactive changes. These changes may be related to a specific activity (e.g. weight-training) or just a case of chronically poor movement patterns (think of a hunchbacked desk jockey who’s always reaching overhead).There’s almost always going to be something else you can do to achieve a comparable training effect without making things worse. So, the next time your shoulder starts to act up in the middle of a training session, put down the weights, take a deep breath, and walk over to the water fountain.
Use this stroll as an opportunity to recognize that something is out of whack and determine an appropriate course of action — including an alternative exercise. You might need to experiment a bit, but it’ll come to you.
#2: Serratus Anterior Activation Work
The serratus anterior will always be the first muscle to “shut down” in the face of any sort of scapulohumeral dysfunction, and activating it is a crucial component of all rehabilitation programs for the shoulder girdle.
The serratus anterior is a small muscle, but it’s of profound importance when it comes to scapulohumeral rhythm and, in turn, shoulder health.Essentially, this muscle locks the scapula to the rib cage to prevent the scapula from winging out. It assists the pectoralis minor with protraction, but most importantly, it’s involved in a delicately-balanced force coupled with the upper and lower trapezius for scapular upward rotation, a movement in which you need to be perfect to function safely with overhead movements.
Serratus Anterior
Unfortunately, the serratus anterior will always be the first muscle to “shut down” in the face of any sort of scapulohumeral dysfunction, and activating it is a crucial component of all rehabilitation programs for the shoulder girdle.
I could literally give a day-long seminar on all the different pathologies in which serratus anterior dysfunction is involved in some way. So, why not take care of it ahead of time? Two great exercises are the scap push-up and supine 1-arm dumbbell protraction:
Scapula Push-ups
Supine 1-arm Dumbbell Protraction
Stick with high reps on these; a few sets of 15-20 a few times per week will do wonders for you without interfering with the rest of your training.
#3: Don’t Just Stay Seated While At Work
Although you may do everything perfectly from a technique standpoint while you’re in the gym for ONE hour per day, you have TWENTY-THREE hours to do everything incorrectly outside of the gym.
…Poor posture is a big risk factor for hundreds of musculoskeletal injuries and conditions. Specific to the current discussion, rounded shoulders, an excessively kyphotic thoracic spine (think hunchback), and anteriorly-tilted, protracted scapulae will all predispose you to problems with the rotator cuff, long head of the biceps, labrum, and several crucial scapular stabilizers. With this in mind, I should introduce something I call the “23/1 Rule.”Very simply, this rule states that although you may do everything perfectly from a technique standpoint while you’re in the gym for ONE hour per day, you have TWENTY-THREE hours to do everything incorrectly outside of the gym. This is especially applicable to the desks jockeys in the crowd who spend 8-10 hours per day at the computer in hopes of winning a Kyphotic Derby crown.
The solution is very simple: quit your job. Okay, I’m kidding. Instead, make a point of getting up and moving around as often as you can. Reach up to the sky, walk around, and do some doorway stretches for your pecs and lats (and your hip flexors, IT band, and calves, while you’re at it). The best posture is the one that is constantly changing. Remember that although lifting is the straw that breaks the camel’s back with respect to your shoulder problems, it isn’t the only contributing factor; lifestyle plays a big role.
#4: Incorporate More Pressing and Pulling
Look for balance in three main pairs of antagonist movement patterns: scapular retraction vs. protraction, scapular depression vs. elevation, and humeral external rotation vs. internal rotation.
There’s been a lot of talk of balancing horizontal pushing (e.g. bench pressing) with horizontal pulling (e.g. rowing), and vertical pushing (e.g. overhead pressing) with vertical pulling (e.g. chinning). For the most part, this system works pretty well.Unfortunately, there are a lot of exceptions to these rules, and often times, people walk away more confused after hearing this than they were before the issue came up. With that in mind, I’ve come to the conclusion that about the only thing you can do is make a list of all the exercises that come to mind, and show how they “balance each other out.”
I look for balance in three main pairs of antagonist movement patterns: scapular retraction vs. protraction, scapular depression vs. elevation, and humeral external rotation vs. internal rotation. In the balancing equation, absolute loading isn’t nearly as important as total reps.
Accessory work is another important component of strength training that is also overlooked by most CrossFitters. Movements such as bench press, rows, pull-overs, and other dumbbell work are great tools to make you stronger and better. No program is without its flaws, but asolid foundation in strength will ensure longevity in training.
#5: Mobilize
Get rid of all the fuzz in your shoulders withmyofascial releasetechniques.
While the shoulder joint is designed for mobility at the expense of stability, that’s not to say that it isn’t “exempt” from significant soft tissue restrictions. Getting some work done on these adhesions can make a huge difference in helping you to establish and maintain proper functioning in your shoulder girdle. Modalities such as Active Release, rolfing, Graston, massage, and even foam rolling can all make huge differences in breaking down all the junk you’ve amassed in your shoulder girdles.
#6: Strengthen Your Upper Back With Classic Seated Cable Rows
Further accessory work should focus on not only the shoulders, but also on the midsection/trunk muscles, which play a big role in overall kinetic chain alignment.
For some reason, the seated cable row just doesn’t get the love it deserves. This might be my single favorite movement for overall shoulder girdle health; you won’t find a stricter means of training scapular retraction effectively with appreciable loading.With bent-over, chest-supported, and one-arm dumbbell rows, the tendency is just too great to cheat, and there’s always a tendency for the lats to take over for the scapular retractors. These benefits, of course, are dependent on proper execution of the movement; you can actually make your shoulder problems worse if you do any rowing variation incorrectly.
Proper seated row
#7: Don’t Neglect the Posterior Chain
The rectus abdominus runs from your rib cage down to your pelvis; when it shortens, it pulls the rib cage down toward your feet.
Let it be known, the era of the 800 daily crunches is over. And, this isn’t just because we’re concerned about hip and lower back health; would you believe that you can actually screw up your shoulders with inappropriate core training? Here’s what happens…The rectus abdominus runs from your rib cage down to your pelvis; when it shortens, it pulls the rib cage down toward your feet. So, as you can imagine, if the rectus abdominus is tight, it can pull the whole rib cage too far down — making you look more like Quasimoto than someone who actually trains hard.
We need to prioritize exercises for the posterior fibers of the external obliques, as these exercises will posteriorly tilt out pelvis without pulling the rib cage downward.
Beyond just the fact that poor posture isn’t all that aesthetically appealing and actually makes you appear smaller, excessive kyphotic postures have biomechanical implications at the shoulder girdle. When your thoracic spine gets too kyphotic, the scapulae abduct (protract) so that they slide outward on the rib cage (toward your arms). This repositions the aforementioned acromion process, as the entire scapula becomes anteriorly tilted. An anteriorly tilted scapula dramatically increases the risk of impingement on those rotator cuff tendons.How do we counteract this problem? As Mike Robertson discussed in detail in Core Training for Smart Folks, we need to prioritize exercises for the posterior fibers of the external obliques, as these exercises will posteriorly tilt out pelvis without pulling the rib cage downward.
And, by increasing the strength of these muscles, we’ll take some of the burden off the rectus abdominus and shift things back into balance. When I see this problem, I drop all traditional trunk flexion movements (pulldown abs, crunches — and people should know to not do sit-ups by now) and replace them with pure stabilization movements (prone and side bridge) and “lower ab” exercises, most notably the reverse crunch.
The “SITS” (supraspinatus, infraspinatus, teres minor, and subscapularis) muscles serve to assist in the rotation of the shoulder and arm.
The “SITS” (supraspinatus, infraspinatus, teres minor, and subscapularis) muscles serve to assist in the rotation of the shoulder and arm. Specifically, full shoulder elevation requires external rotation of the humerus. Also, as the humerus elevates, the humeral head (which articulates with the glenoid fossa of the scapula) is depressed and compressed by the SITS — basically creating a nice smooth glide and articulation within the socket. If the SITS muscles are weak, or inflamed and not activating correctly, then the deltoid will elevate the arm without a depressor effect, allowing the head of the humerus to rise and hit the acromion, which is what we call subacromial impingement.
External Rotation (Infraspinatus, teres minor):
Keep the elbow against the side of the body and bent 90 degrees. Bring the hand away from the body without changing the position of the upper arm. Be sure to maintain the same elbow position, as it is common to extend the elbow to compensate for external rotation weakness.
Internal Rotation (Subscapularis):
Elbow and arm position are the same as with external rotation exercise. Resistance should be applied while bringing the hand in towards the body.
Scaption (Supraspinatus):
Start with the arms to the side. Elevate the arm to shoulder level at a 45 degree angle away from the body.
Progression of rotator cuff exercises
Once your shoulders are stronger and there is pain-free motion without added load, we’ll start targeting the RC at 90 degrees of abduction. If you have pain here, drop back down to the previous RC exercises and work on mobilization.
External Rotation and Internal Rotation:
Same arm position with 90 degrees of abduction and 90 degrees of elbow flexion. Rotate the hand backward for external rotation (resistance band in front) and rotate the hand forward for internal rotation (resistance band behind).
Scaption:
Elevate the arms to above 90 degrees.
Scapular Pivotors:
As outlined in Shoulder Rehab, Part 1, there must be adequate scapular movement for full shoulder elevation. We’ll be targeting these muscles here:
I’s, Y’s, and T’s (rhomboids, middle trapezius, lower trapezius):
Y’s in particular will be the hardest as it targets the neglected and often underdeveloped lower trapezius.
Don’t let these fool you. If you’re getting proper scapular retraction and full range of motion, they can get difficult; the key is for the scapula to move towards the spine. It should feel like you’re squeezing both scapula together. This isn’t an arm exercise; the extended arm is used as resistance for the scapular muscles. Y’s in particular will be the hardest as it targets the neglected and often underdeveloped lower trapezius.
Push up plus (Serratus anterior):
The key here is to get full protraction of the scapula, which means bringing the whole shoulder girdle forward.
This is one of the key muscles along with the trapezius for scapular rotation. In fact, the serratus anterior and trapezius work together as a force couple. Start against a wall, then progress to working off the knees and finally move into a full push-up position. The key here is to get full protraction of the scapula, which means bringing the whole shoulder girdle forward. It should feel like you’re pushing away your body as far as it can go.
Spiders:
All I’ll say as a warning is this: Prepare to feel the burn!
This exercise will activate all the muscles we’ve individually targeted, but now the focus is on stabilization positions and dynamic movement combined. Yes, I know spiders have eight legs, but we’re doing six positions (3 each side), and we’re calling it the spider exercise (go with me on this one). Keep one arm stable with the resistance band, then reach above, to the side, and down. Touch each six times before moving to the next one, then switch arms. All I’ll say as a warning is this: Prepare to feel the burn!
Remember: You do not have to wait until you are recovering from an injury to make sure that your shoulders have a full, healthy ROM. Taking good care of this important and complex joint should be part of your regular body maintenance.
