How to Avoid Shoulder Injuries: Part 1

How to Avoid Shoulder Injuries: Part I

Bill Hartman is a physical therapist and strength & conditioning coach in Indianapolis, IN. A lifetime athlete, Bill was a top ten finisher in the National Junior Olympics in the javelin, which he continued along with football at the collegiate level. He was a graduate with distinction at Purdue University and received his degree in physical therapy from Indiana University.

Bill has worked with athletes at all levels in a number of sports and is probably best known for his athletic approach to the physical preparation for golf. He is also an Active Release Techniques Practitioner, a cutting-edge soft-tissue treatment technique, with certification in spine, upper extremity, and lower extremity treatment. Bill has certifications with the National Strength and Conditioning Association as a Certified Strength and Conditioning Specialist and with USA Weightlifting as a Sports Performance Coach. Bill provides seminars on sports training and fitness, writes for national publications and websites, and is featured in "Inside Out: Upper Body Warmup DVD".

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CB: Bill, why do the shoulders get injured so often in athletes, lifters, and everyday people?

BH:
Well, for starters it's a naturally unstable joint. For a joint to have the ability to circumduct (move the arm in a large circle) like the shoulder does, it has to be unstable. The shoulder is not like a ball that's surrounded by a socket like the hip. It's actually more like a golf ball sitting on a tee. So the shoulder joint relies heavily on the connective tissues to maintain stability.

There's also a very limited space between the humeral head and the acromion called the subacromial space. In this subacromial space are the rotator cuff tendons, biceps tendon, and the subacromial bursae. During movements that involve the elevation of the arm and external rotation of the arm this space gets even smaller (i.e. throwing).

Movements that involve high force, high speed, "unsafe" motions, and repetitive movements, as well as postural adaptations can result in altered muscle recruitment patterns and/or abnormal amounts of instability which, in turn, result in impingement of the subacromial structures.

Repetitive impingement can then result in pain, tendonitis, tendonosis, bursitis, and at worst a tear.

These things rarely produce pain immediately but changes in joint position and function occur over time. It's pretty common to hear a client or a patient say, "I've done this for years and never had any problems before." Most incidents that seem to be the cause are more like the "straw that broke the camel's back" in that enough "wear 'n' tear" has taken place to finally produce symptoms and injury.

CB: What can be done to avoid shoulder problems?

BH:
It seems to be a matter of minimizing those activities that promote negative adaptations to the joint related to range of motion, strength, and posture. Being aware of those activities that will promote these adaptations is a great start.

For instance, folks who sit a great deal as part of their day, such as students, truck drivers, or desk jockeys, have challenges to their posture. Prolonged sitting can result in a kyphotic or rounded back posture. This posture forces the shoulder girdle into protraction (shoulder blades move apart). With time, tissues adapt, shorten or lengthen, or muscles get used to functioning in a restricted range of motion and limit flexibility. This can alter the mechanics of the shoulder joint and result in impingement.

If we're talking training issues, avoid behind-the-neck pressing and behind the neck pulldowns; they are not great exercises for shoulder health. Not only do they load the anterior and inferior portions of the shoulder capsule, but in the behind-the-neck position the biceps long-head tendon is rotated toward the posterior aspect of the shoulder joint because of the external rotation. This creates an anterior force when tension is created in the biceps. Over time, this will promote anterior instability resulting in impingement.

You may also want to avoid exercises that involve elevation of the arms with internal rotation like upright rows or dumbbell lateral raises with the pinkie finger higher than the thumb. I actually use these movements as test of shoulder health during assessments.

If you must do overhead pressing exercises, you may want to consider using squat jerks, split jerks, or push presses. These exercises limit the loading of the shoulder through the critical midrange arc of the shoulder joint during elevation.


CB: What should we do to take care of our shoulders?

BH:
Don't grow up to be a baseball pitcher, don't lift weights over your head, and sit up straight like your Mom always said.

Seriously though…Pay attention to your posture. What I tell my clients is to correct posture every time the check their watch or a clock for the time. A simple correction actually approximates what's called anatomical position. Sit or stand up as tall as possible with your arms at your sides with the palms forward.

Work to maintain your shoulder's range of motion. The shoulder should be able to rotate about 170 degrees from full external rotation to full internal rotation. If you can't reach behind your back and touch the opposite shoulder blades without straining, you need to work on your range of motion.

Don't forget the little muscles in your training. There was a study a year or two ago that assessed weight trainers shoulder motion and lower trapezius strength. What they found was that weight trainers had stronger absolute lower trap strength than controls, but when they corrected for body weight, the weight trainers were actually weaker.

The external shoulder rotators tend to need some attention as well. We have a heck of a lot more muscle that internally rotates the shoulder than externally rotates it. Be sure to keep them strong.

Don't work through shoulder pain. There is a reason you're having pain. In fact, there could be multiple causes. If pain persists more than a few days, consult with a health professional. Don't try to treat yourself.

CB: Thanks Bill. In Part II of this interview, Bill goes in-depth on methods to strengthen your shoulder to avoid future injuries and he discusses the nasty rotator cuff injury.


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