1. Balance your upper body workouts
A good way to avoid shoulder injuries is to make sure your upper body strength sessions are balanced. This means that every push or press exercise must be balanced with a pull or row exercise. Too many athletes and weight trainers focus on developing the 'mirror muscles', the upper trapezius, anterior deltoid and pectorals. As a consequence, the 'non-mirror muscles', lower trapezius, rhomboids, latissimus dorsi and rear deltoid, are underdeveloped. This leads to a muscular imbalance about the shoulder, which results in poor scapular stabilisation. since the non-mirror muscles are the ones that work to stabilise the scapula. In addition, over-developed mirror muscles can lead to a round-shouldered posture, which incorrectly places the scapula up and forward. Redressing this imbalance is very important for the prevention and rehabilitation of shoulder impingement injuries
The following is an example of a balanced upper body workout which I would recommend. Note the 1:1 ratio between push/press and pull/row exercises
Bench press (pectorals, anterior deltoid)
Seated row (rhomboids, mid trapezius, latissimus)
Rear lying prone flies (rhomboids, mid trapezius, rear deltoid)
Lat raises (anterior mid deltoid, upper trapezius)
Lat pull downs wide grip (latissimus, lower trapezius)
For those who are prone to shoulder pain or are recovering from a shoulder injury, I would recommend changing the ratio to 2:1 in favour of the non-mirror muscles. Remember, it is the push/press exercises that cause the problems, so you should change your emphasis until the imbalances have been redressed. Other pull/row exercises include: bent over row, single-arm dumbbell rows, single-arm cable pulls, bent-over rear fly, pull ups (wide or narrow), stiff-arm pull downs with cable/flexaband.
2. Limit your range of movement, and take it easy
Rehabilitation from a shoulder impingement injury should focus on rotator-cuff strengthening, as explained in Dr Kemp's article last time. However, it's important to remember that when it comes to re-introducing your weight training
exercises, you must progress slowly. Often this means avoiding certain ranges of motion where the shoulder joint sub-acromial space is compressed the most. The impingement zone to avoid is between 70 and 120 degrees of shoulder abduction (when you move the arm laterally away from the side of the body)
To start training the non-mirror muscles, begin with the seated row, because the shoulder joint is not abducted in this exercise. Once the pain is completely gone, then introduce the overhead exercises such as pull ups and lat pull downs. You should be even more careful when it comes to the mirror-muscle exercises. I would avoid lateral raises, upright rows and shoulder presses completely for a while. However, incline bench press with arm abducted to 45 degrees would be a good choice to start again. Slowly build up to the normal bench-press range as strength improves.
It is also important that you don't increase your weights too soon. Remember that the ligaments and tendons have to adapt to exercise as well as the muscles, and they may take longer to do so. I would suggest staying in the 12-20-rep range for a time before pushing up the weights, especially with the mirror-muscle exercises. While I realise that it is important for many athletes to be strong at exercises like the bench and shoulder press, I would recommend that you build up slowly to maximum strength. Reducing your reps by two every two weeks is a good guideline. During heavy workouts, ensure that you warm up
the shoulder joint and rotator cuff thoroughly prior to lifting
3. Correct scapula positioning when performing exercises
The correct position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a good 'military posture', with shoulders back and chest out. A round-shouldered or hunched posture is to be avoided at all times. To achieve the correct position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down.
When you perform any upper body weight training exercise, always get into the habit of starting with good upper body posture and pinching the shoulder blades together. You should feel that the scapula is a solid platform which keeps the shoulder correctly positioned while you perform the exercise. As mentioned last issue, a good way to learn the correct position is during the seated row exercise by keeping your scapula back and down while you move your arms. During the exercise, you should feel that the rhomboids and trapezius muscles are statically contracting to hold the scapula in place, and the latissimus is working to perform the movement. Once you have the feel for maintained scapula stability during the seated row, try to achieve it during all upper-body exercises. What you might find is that exercises such as the press up or front raise, where the shoulder may become impinged, will not be painful if you stabilise your scapula correctly. In effect, by using the scapular muscles you can achieve better shoulder mechanics and avoid injury
Correct scapular stability is difficult to learn and demands a great deal of practice and concentration during your training sessions. You first need to understand what the correct position is, and often this requires a trainer/physio to guide you. Then, during training sessions, instruction and observation from a trainer can help you achieve and maintain the correct shoulder position.
4. Sports specific exercises - plyometrics for the shoulder
Just as rehabilitation training for leg injuries requires a functional progression from simple strength exercises to sports specific exercises, so does rehab for the shoulder. This means that for the athlete, eg, a thrower or tennis player, conventional resistance exercises in the gym may not be enough to allow a full return to competition. Often what is needed to bridge the gap are plyometric exercises
for the shoulder that mimic sports specific movements. Plyometrics for the shoulder usually involve medicine balls of various weights.
have two advantages. First, they are performed fast, and, second, they involve stretch-shortening-cycle movement patterns. This means they are much more sports-specific than conventional resistance exercises. In particular, plyometric exercises
for the rear-shoulder and external rotator muscles are very useful because they provide eccentric training for these muscles. This improves their ability to control the shoulder during the powerful concentric actions of the pectorals and anterior deltoid involved in throwing or serving. Thus it's important to ensure that your plyometric workouts are balanced between the prime movers (pectorals, latissimus, anterior deltoid) and the rear-shoulder and upper-back muscles. I would recommend incorporating shoulder plyometrics during general conditioning workouts to prevent injuries and in the later stages of shoulder rehabilitation to guarantee a functional progression back to competition
Here are two suggestions. The key to both these exercises is that the medicine ball is caught, the impact quickly absorbed (fast eccentric phase) and then thrown back explosively (powerful concentric phase).
1. Power Drops (pectorals, anterior deltoids)
This exercise is like a plyometric bench press, using a medicine ball instead of a barbell
Lie on your back, legs bent and lower-back flat down. Partner stands above your head and drops ball (3-6kg). You catch ball with straight arms and then quickly let the ball drop to your chest, flexing your arms, and then immediately throw the ball back, powerfully extending your arms. Make sure you keep your back flat down, concentrating your effort on your arms only. Perform sets of 8-12 reps
2. Catch and throw backhands (external rotators)
This exercise is a plyometric version of the external rotator exercise described by Dr Kemp in the last issue, and is similar to a backhand shot in tennis
Stand with your feet shoulder-width apart, with a stable base and good posture. Bend your arm to 90 degrees and tuck your elbow into your side. Keeping your trunk facing forward, rotate your arm out ready to catch. Your partner stands to your right and throws a small ball (1kg) to your hand. You catch it, then quickly take the ball back across your body, rotating your arm inwards, and then immediately throw the ball back, powerfully rotating your arm out
Make sure you don't use your trunk, and keep your elbow tucked into your side at all times, concentrating the effort on your rear shoulder and external rotator muscles. Repeat for the left side. Perform sets of 12-20 reps.