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By Charles Staley, B.Sc,
MSS
Director, Staley Training Systems
(Co-authored by Dr. Sal Arria)
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It's probably safe to say that
virtually anyone who has worked out for more than two or three
years has experienced shoulder pain at one time or another.
More than any other joint, the shoulder seems particularly
prone to injury, both chronic and acute.
Once shoulder pain has set in,
even routine daily tasks such as putting on a shirt overhead
or shampooing in the shower become burdensome. Training seems
beyond the bounds of possibility, since nearly all movements
involve the shoulder in varying degrees. Even squatting and
calf raises involve and can aggravate shoulder problems.
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The shoulder's role as the "black
sheep" of joints stems from it's structure. First, the gleno-humeral
joint (where the head of the humerus attaches to the shoulder complex)
is a ball-and-socket type joint, but unlike the hip, the G/H joint
is quite shallow— so much so that the bones contribute little
to the joint's stability— that role falls onto the surrounding
muscles and their tenuous attachments, as well as the capsular ligaments.
Always remember that the shoulder's
forte is mobility, not stability. The second structural factor leading
to shoulder dysfunction is the enormous leverage that can be applied
to the shallow G/H joint by the arm. Consider that for a person
of average arm length, a ten-pound dumbbell in the hand equates
to over 45 pounds of force at the shoulder joint when held out at
arm's length, such as in a lateral raise.
Causative Factors in Shoulder Injury
Shoulder injuries stemming from both
sports and training-related events are summarized below:
Sports-related shoulder injuries:
• Falling. In many sports,
including skating, soccer, football, wrestling, and baseball, falling
is inevitable. During a fall, the hand instinctively reaches out
to break the fall, decelerating the body's downward movement with
the arm outstretched. This instinctive reaction creates a long lever
which results in tremendous mechanical forces on the G/H joint-fulcrum,
often leading to injuries ranging from strains & sprains of
the surrounding muscles and ligaments to subluxation (less than
a full dislocation) or in the worst-case scenarios, dislocation
of the joint.
• Throwing. Not just in
the sense of throwing a ball, but also any hitting or swinging (such
as a tennis serve or hitting a baseball) movement is essentially
an attempt to separate the G/H joint, in biomechanical terms. During
any throwing movement, the rotator cuff muscle group is responsible
for decelerating the arm after the object has been released. Since
many individuals have very weak rotator cuffs and posterior deltoids
as compared to the anterior shoulder muscles, the deceleration aspect
of the throw often results in strains and sprains of the shoulder's
soft tissues, especially those of the rotator cuff.
• Impact. Football, boxing,
wrestling, soccer, basketball, and various other sports involve
direct and often violent impact to the shoulder and arm. Direct
blows to the upper arm in particular can "pry" the G/H
joint apart, creating injuries ranging from microtraumatic soft
tissue injuries to shoulder separations. Additionally, multiple
shoulder injuries stemming from years of athletic participation
often result in adhesions, loss of range of motion, calcium deposits,
and degenerative changes to the joint itself. With each new injury,
the shoulder becomes both more prone to, as well as less capable
of withstanding further injuries.
Training-related shoulder injuries:
• Bench Pressing. The
most popular current-day gym exercise, this movement also results
in legions of shoulder injuries. Besides contributing to the imbalance
between the anterior and posterior muscles of the shoulders, the
bench press has an almost mystical allure for many trainees, making
it more of a demonstration event than a training exercise for many.
The bench is the vehicle for more forced reps, heavy negatives,
missed attempts, and bad training form than any other exercise.
Over 90% of all shoulder injuries from bench pressing occur during
the transition or amortization phase between the negative and positive
portions of the movement.
Specifically, a rapid lowering of
the bar prior to pressing upward results in large linear momentum
forces which must then be quickly reversed by the shoulder musculature
before the bar can be raised. When the these forces exceed the strength
of the joint mechanism, the shoulder may not be capable of reversing
the accumulated momentum, which means that the lifter will miss
the lift, suffer a muscle tear, or both. For this reason, always
lower the bar with complete control— this doesn't mean a full
pause, however! Unless you're a competitive powerlifter, a controlled
"touch-and-go" movement is best.
• Muscle Imbalance. As
noted earlier, most trainees neglect the posterior shoulder musculature
in their gym sessions.Most popular gym exercises— bench presses,
seated presses, lat pulldowns, and so on involve external rotation
of the humerus at the shoulder joint. The movements that work the
internal rotators, or rotator cuff (bent laterals, etc) have little-to-no
cosmetic value, so few trainees
do them. That is, until they suffer a shoulder injury. Eventually,
the weaker rotator cuff becomes virtually useless in performing
it's intended role in stabilizing the shoulder.
• Overtraining. Not in
the traditional sense (i.e., performing deltoid exercises too frequently),
but in the sense that whenever you have a bar or dumbbell in your
hand, there is stress on the shoulder joint. So from this perspective,
even exercises for the back, biceps, or triceps can significantly
aggravate existing chronic shoulder symptoms. Avoiding this type
of overuse demands that you take a purposeful, conscious approach
to nearly every movement you make, both in and out of the gym! Some
of the most common movements, such as getting up off of the floor
after doing crunches, opening a car door, or putting on a sweater
can add stress to a mal-functioning shoulder.
Conservative Solutions For Shoulder Pain
1) Strengthen the arms! This
may seem like odd advice, but the fact remains that your arms are
the conduit through which forces are transmitted to the shoulder.
If your arms are weak, the shoulders must pick up the slack. If
you find that during dumbbell benches or inclines, you have a harder
time picking the dumbbells up and getting into position than doing
the exercise itself, you need to strengthen your arms. Heavy dumbbell
curls, hammer curls (i.e., with thumbs up), and dumbbell triceps
extensions will go a long way in strengthening your biceps, triceps,
and brachioradialis muscles, as well as indirectly fortifying the
shoulder girdle itself. Get yourself to the point to where you can
handle heavy dumbbells with ease. Machines are ok, but they don't
challenge the synergistic and stabilizing muscles nearly as well
as dumbbells.
2) Circumvent problematic exercises.
If military presses (for example) cause you shoulder pain, don't
do them, even if every shoulder-training article you ever read says
that military presses are the best shoulder exercise going. For
you, they might aggravate prior or existing injuries, or, it may
simply be that your particular shoulder structure isn't well suited
to the exercise(s) in question. In either case, make modifications
(such as grip, range of motion, or slight deviations to the usual
movement pattern) or use another exercise altogether.
3) Bench press technique. As
was noted earlier, a controlled descent of the bar is essential.
Another "fine point:" most benches are 11" wide.
This is necessary to allow proper range of motion during the lift,
but it creates a very narrow support for the scapulae. To keep your
shoulder blades supported during bench presses, shrug them together
as is if "pinching a quarter" between them, and also tighten
the upper back just prior to unracking the bar. In this way, the
scapulae will remain supported by the bench during the lift.
Your shoulder joints will thank you!
A final note on benching— the
authors have observed everything from trainees putting both feet
up on the bench (better "isolation" supposedly) to keeping
one foot on the bench and one on the floor (!) to pinching the knees
together during the lift. All of these technique deformities create
an unstable base, which can lead to injury. Keep both feet flat
on the floor, a bit wider than shoulder width, and keep them there
during the lift. Use your feet like the extended pods of a backhoe,
for support and stability during the lift. If you can't keep your
feet from "fidgeting" during the lift, you're using too
much weight!
Categories of Shoulder Injury
Inflammatory: The body's first
response to joint injury is inflammation, or a "bleeding"
of serum into the joint capsule. Anyone who's ever experienced a
rollover type ankle injury playing hoop can attest to the amazing
speed of this process as the ankle quickly takes on baseball-like
proportions. In the shoulder, however, such inflammatory events
are not as visible. Therefore, assume the presence of inflammation
after any significant joint injury, and immediately apply ice packs
to the area (for 10-15 minutes, three times per hour) until you
can get to a sports medicine physician for diagnosis and treatment.
Impingement: In the shoulder
joint, the acromium process, or the "roof" of the shoulder
becomes routinely impinged by the head of the humerus during chest
and shoulder exercises. The pain that many people experience at
the top portion of upright rows is an example of this type of impingement.
Do not advise your clients to "work through" this type
of pain! Instead, circumvent it by altering exercise form or selection.
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Strains & Sprains:
A strain is a muscle pull or tear, while a sprain indicates
tendon or ligament damage. Strains and sprains are categorized
by severity— a grade I strain involves a cramp or pull
of the muscle fibers, a grade II strain is characterized
by a small to moderate amount of muscle tearing, while a
grade III strain involves tearing of large numbers of muscle
fiber. In tendons and ligaments, a grade I sprain involves
minor fraying, a grade II indicated moderate damage, and
a grade III sprain involves massive or total tearing of
the connective tissue.
Adhesive capsulitis: A
web-like network of adhesive fibers throughout a joint.
This phenomenon is the body's response to the immobilization
that results after an injury. Immediate and aggressive physical
therapy is warranted to prevent the formation of these adhesions,
which, if left untreated, can permanently reduce the joint's
range of motion.
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About The Author
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His colleagues call him an iconoclast,
a visionary, a rule-breaker. His clients call him “The
Secret Weapon” for his ability to see what other coaches
miss. Charles calls himself a “geek” who struggled
in Phys Ed throughout school. Whatever you call him, Charles’
methods are ahead of their time and quickly produce serious
results. His counter-intuitive approach and self-effacing
demeanor have lead to appearances on NBC’s The TODAY
Show and The CBS Early Show.
Currently, Charles competes
in Olympic-style weightlifting on the master’s circuit,
with a 3-year goal of qualifying for the 2009 Master’s
World Championships.
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