Last post I discussed how everyday life factors into shoulder, neck, and rotator cuff health. In this post we look at the activity, sport, and gym side of the equation. Both perspectives are equally important for longevity and performance.
As a Ready State Certified Movement and Mobility Specialist, the intent of this post is to provide 5 general guidelines to help keep your shoulders moving in a healthy, strong, and pain free way. It's also an approach that may help you manage aches and pains related to the neck and shoulders for yourself. This is based on The Ready State principle that “all human beings should be able to perform basic maintenance on themselves.” Dr. Kelly Starrett.
I want to be clear that this post is not a replacement for medical advise or diagnosis. If you are unsure about a specific issue, please reach out to a health professional. You can also share these concepts with them, as I’m sure they will encourage the recommendations :)
1. Lack of Mobility. The shoulder is a ball and socket joint, which means it's designed to work in a large range of motion (think of an overhand serve in tennis, or the breast stroke in swimming). However, problems tend to arise when we lose our mobility slowly over time as we age. This gradual loss of mobility means we can no longer access the more extreme, or end ranges, of our shoulder's capability (think of the very top part of the overhand tennis serve). Kelly Starrett calls these end ranges, "book ends". These bookends can be viewed as test points for assessing our shoulders movement capacity.
Here are a couple of assessments, or "book ends" to assess your shoulder's mobility.
The first test point is shoulder internal rotation. Adequate internal range of motion means you can get your thumb far enough up your back to rest in between your shoulder blades. Make sure you test and compare both sides for symmetry.
Gym exercises that require a good amount of internal rotation are dips, dumbbell chest press, or bench pressing.
The second test point with my arms over head, (with elbows straight and ribs down) is shoulder flexion. We need good shoulder flexion capability for pressing over head, especially with a barbell.
So what does it mean if you are having trouble accessing these test points or "bookends"?
Basically, it means you should be cautious loading these positions with the exercises mentioned above. While you may have gotten away with doing the bench press every Monday for a decade, it will eventually catch up as mobility continues to decline. Think of it just like bending a credit card. It doesn't snap right away, but keep stressing it in the same pattern and soon enough it will break.
And by the way, mobility does NOT have to decline in a linear fashion with age. No matter what age, we can always improve it as long as you are willing to work at it :) As kelly says, "keep chasing those bookends"with a 10 minute daily mobility practice.
Without doing an individual assessment, the following mobility sequences should help most people improve these test positions.
Band Mobilization targeting shoulder Internal Rotation
Soft Tissue work focusing on Thoracic Spine Mobility
2. Poor Exercise selection. Machines are typically worse for the shoulders than cables or free weights. Machine’s lock you into a specific plane of motion that may not agree with your shoulders. Free weights also challenge the small stabilizer muscles more than machines (these are often weak and could be a part of a shoulder issue). If a certain exercise is causing pain, STOP doing it. At least for now. There are probably a ton of other choices that will likely accomplish a similar result. You can also experiment with changing the plane of movement, the angle, or the grip to make it feel more shoulder friendly. Generally switching from barbells to dumbbells with a neutral grip will dramatically reduce strain on the shoulders and neck. Especially when pressing over head.
3. Muscular Imbalance. The rotator cuff and scapular retractor muscles are smaller and usually undertrained ("weak") compared to the bigger muscles around the shoulder such as the pecs and lats. Even though the rotator cuff gets most of the blame, what tends to get missed is the fact that the rotator cuff is only one aspect of the bigger shoulder system. It's never just one muscle, so many other muscles join into the scapula! The rotator cuff muscle is just the weak link in the chain that typically gets broken. So when it comes to strengthening the weak links, try adding the following exercises to help bullet proof your shoulders by creating more structural balance.
You will notice these are all scapula retraction or external rotation exercises. This is by design and is to ensure a better "push to pull ratio". Some coaches say for every pressing exercise, you should perform 2 pulling exercises, some even say 3.
Another way of saying all this is having good shoulder stability. We need both mobility and stability for optimal performance.
3. Don't just isolate the rotator cuff muscles, make them work together (rotate). While the typical isolation exercises for the rotator cuff are okay, it's best to get all 4 rotator cuff muscles working together as a force couple to create external rotation. So be sure to include these rotational exercises to tie everything together to create torque and stability.
4. Poor technique. Put it the way, unless a world record is on the line, your last rep should look as technically sound as your first. Charles Poliquin referred to this as "technical failure". If you are dealing with pain in the shoulder, try slowing the movement down (tempo) and/or pausing in a pain free range and holding the weight for 10-30 seconds (isometrics). This is a great way to get some movement and blood flow into the system without escalating pain.
5. Be sure the shoulders are warmed up enough before training! I mentioned this in my last post but I feel this needs to be mentioned again because it's especially relevant to the gym rat crowd. Going from rest to redline is a recipe for disaster! Especially if you are planning on doing exercises that typically causes pain. Having a good sweat on is a good indicator that core temperature is elevated enough and the fascial system is ready to perform. While cardio does raise core temperature, it may not be the best use of your time. Try this shoulder spin up exercise instead, it is more specific and time efficient. I would also add in and experiment with any of the exercises listed in points 3 and 4.
Some final points before closing:
1. The shoulder is meant to work hard and last for 100 years
2. Pain is a signal for change (both mental and physical)
3. Our bodies have a miraculous ability to adapt and heal, and this applies to everyone from the varsity athlete to the grandparent. (There's no expiration date on this)
4. Before considering a limitation permanent, ask yourself how much time and effort have I put into trying to resolve the issue? Either with the above practices and/or working with a health professional.
5. Tissues do take time to heal, (typically 4-6 weeks depending on severity). So patience and consistency is key. If you are not making forward progress with the above suggestions after a few weeks please contact a health professional if you have not already.
Thanks for reading. Please comment and SHARE this post if you found it useful. You can also join my private group here so you don't miss my next blog post:)
If you, or someone you know, needs help or an assessment with a shoulder, back, or knee issue, please reach out. Either online or in the gym, I specialize in helping busy professionals over 40 get fit without burning out. My personal training studio services downtown Toronto and is just steps away from the UP train at Union Station.