Out of Kilter IV
Stop Shoulder Pain Cold!
by Ian King
Ian King is out to make you healthy and injury-free. So far in this series he's talked about back pain, knee pain, and postural imbalances. Now he's going to focus on the shoulders, because if they aren't healthy, hey, they aren't gonna get big!
The goal of this article is to reduce the incidence and severity of shoulder pain. Most shoulder pain begins fairly innocuously, so we ignore it and push on. Before we know it, we have a fully blown challenge that's preventing loading and participation in many exercises. Rehabilitating a shoulder can be very complex. It requires a lot of self-discipline and guidance. Best suggestion, follow the preventative measures listed later in this article so you don't have to go there!
As a long term user of high external loading, even with the best care I can assure you that your joints will show black under an MRI! They take a pounding. After ten to twenty years of heavy lifting, thats a likely outcome, so dont make it any worse! Be smart and avoid major shoulder issues!
I have a simple yet highly effective perspective on managing the shoulder joint. As per the Paretto principle, a few bits of knowledge can give you a whole lot of results! These simple concepts and methods are refined and tested in the real world. If you want to avoid the epidemic of shoulder surgeries I'm seeing, you'd be wise to master them!
Here's the secret: the ability to control the upper arm relative to the shoulder joint is the key to avoiding shoulder issues. Yes, thats it. Sounds so simple you want to dismiss it? Dont. Bite the bullet and hang in there with me. This point is going to prove very powerful for you if you have a desire to avoid future shoulder issues or remove current shoulder issues.
The challenge faced by the shoulder joint is the tradeoff between range and stability. Compared to most joints, the shoulder joint has extensive range of movement. The downside is, this needs to be controlled. Control and stability of this joint are a matter of conditioning and integrating the efforts of all the soft tissue which impacts the joint. There's a need for interaction or synergy of all the soft tissue involved.
Most shoulder injuries in strength training occur chronically, a series of incidences built upon one another. If there's an apparent "traumatic" event in strength training around the shoulder (which is less common), it's simply a case of that final event being the straw that broke the proverbial camel's back.
This is even true with impact injuries from sport. I believe the incidence and severity of these would be significantly reduced if the athlete were to condition his joints and connective tissues optimally.
In this article series I've listed my levels of dysfunction. If you haven't reviewed these, go back to a previous article. My message is simple: the sooner you recognize the issue and address it, the less negative impact it'll have on you and your training.
Typically with shoulders we experience a minor discomfort and ignore it. We hope we can "train through it." How do I know this? I've been guilty of this many times!
Sometimes we get away with this head-in-the-sand technique, but most times we dont.
The shoulder joint, as a joint with so much range, is relatively complex. It relies on two main areas: the relationship of the humeral head (top of the upper arm) and the glenoid cavity (the semi-circular cavity the upper arm is positioned within), along with the coordination of all tissues such as all the muscles that impact on this joint.
Why are there so many shoulder problems out there? Let's look at the anatomy of the over-incidence of shoulder issues. Here are some reasons why shoulder injuries are so common:
At this level you aren't going to be cognizant of an injury because any inhibition or pain will be below the level or awareness. Use my standing postural assessment; if you fail in any area, assume that you're being affected at this level, and worse, that at some stage in the future you're going to experience shoulder joint pain at a higher level.
Heres a ten point test to assess whether you're either suffering from low level inhibition in the shoulder joint or are a candidate for more serious shoulder issues:
At this level you're fully aware of the pain, but may ignore or misinterpret it. You may say, "My shoulder is a bit sore" and do nothing. Or perhaps you do the easy things like apply ice or take an anti-inflammatory. Both have a role (although ice is over-used), but these things aren't enough. They are, in many cases, simply masking the symptoms, not addressing the cause.
So what should you do? Again, I use my seven-step model:
Sometimes it can be hard to identify the cause. The point of pain isn't always the area of cause, but the site of the symptom. You want to treat the cause, not the symptom. If you have no better guide, use the ten-point test above. If you fail in any of these areas, correct this aspect.
It's my perspective that excessive shortening of the anterior horizontal (chest) and inferior vertical (lower lats) are the two main causes of shoulder problems. It's simplistic but accurate.
These conditions cause excessive lengthening of the posterior horizontal muscles (scapula retractors) and superior vertical muscles (in particular the muscles that control shoulder blade elevation). This means these muscles dont function optimally, and the movement of the humerus isn't guided in the way that's optimal, resulting in varied shoulder damage such as soft tissue impingement, joint wear, etc.
If you believe your joint pain is a result of impaired function to the muscles that impact the shoulder, your treatment should include the following steps below. Irrespective of whether your shoulder challenge was caused chronically or traumatically, you can and should use the following steps to counter changes that have occurred in the surrounding tissue:
Neck stretches: Place one hand by the body, turning the hand so that the palm is facing the ceiling and the hand is pointing outwards. Lower the head the other way and use the hand of the side that the head is leaning to pull the head gently over further, taking the ear to the shoulder. Do the same in reverse on the other side. Repeat the tightest side. There's another option for those keen to enhance this area, and that's to take the ear towards the outer pec, stretching the broader upper trap area near the spine.
Shoulder stretch: This is an old standby. There are three positions:
Forearm stretches: Place one arm straight in front of the body. Use the other hand to assist in creating the stretch. There are three positions I recommend:
Chest stretch: Stand close to a vertical frame or door frame and have one hand up on it. There are four positions:
Lat stretch: There are two here:
You can perform specific drills to selectively recruit and train these muscles, then progress to drills that aren't as isolated and more dynamic to retrain the integration of these muscles into daily human movement. However, if you have a shoulder injury, don't assume that gross strength training movements will adequately recruit and retrain the motor patterns of these stabilizers.
Encouragingly, more therapists and strength coaches are being taught shoulder rehab concepts in their training. This is fortunate, because the "innovation" of the 1990s, the old "one external rotation drill done for one set last in the workout with as much weight as you can displace" was as valuable as pissing in the wind!
If there was any impingement in the shoulder joint, there are going to be some "angry," aggravated tissues. I'd recommend you consider applying or at least researching the application of the four methods I outlined in the previous article.
Never lose sight that the best way to heal the body is to help the body heal itself. The rate of healing in the shoulder joint will be optimized when the length-tension-stability of the shoulder joint is optimized.
This is real tough, because most upper body movements are going to include the shoulder! Bench and shoulder variations are the first ones affected, but even pulling movements (more so vertically) can reproduce joint pain. Even sleeping too long on one side can stir up or prevent healing of a shoulder issue. There are even recreational activities such as surfing that can aggravate a shoulder condition!
My wisdom is this: the first lost is the best loss. So if it means missing out on your favorite exercises or muscle groups for a few days, do so. Bite the bullet early because if you're forced to do it later, it's usually a longer period of abstinence you'll be experiencing! Being conservative earlier usually means a more aggressive and advanced return. Being aggressive early in rehab usually means a more protracted and painful rehab experience.
This includes negating any negatives developed during the injured period, including joint surface damage. Supplements such as glucosamine, fish oil, and high doses of anti-oxidants have a major role to play here. You need to determine the optimal length, tension, stability, and joint position/relationship for each of your "at risk" joints.
Now its time to strengthen the movement again and the key word is progressive! After all, lack of appropriate progression in loading parameters is one of the greatest contributors to chronic injuries!
Now, this doesnt mean you get to go back to any exercise, full range, any loading, all at once. There may be a progression in which these variables are reintroduced. You'll find your program should change every few weeks. Many small changes result (in time) to a lot of bigger changes. Be prepared to recognize when you've erred. Stop, back track, and regroup. Dont try to outsmart shoulder pain!
For me, the goal of a rehab program is primarily to avoid reproducing the pain. If I achieve this goal, I've assisted the body's natural healing process. Dont under-estimate the seriousness of this step!
If you've gotten this far, you either have an impact injury from contact sport, or you've really mismanaged what started out as a relatively innocent shoulder niggle—or a combination of the two! Most of these situations should never have happened, but its too late to talk "if onlys" now! In the rare event you do serious damage in a single event in the gym, let's go over what you can do.
Remember, you only have two shoulders and if you want to be lifting for a few more decades, you'll need to treat them with respect! Shoulder surgery or being unable to train aren't options I recommend!
As always, this is my favorite part: prevention! Below are my top ten keys to preventing shoulder injury:
Keep doing the above ten things even after the pain goes away! It's so common to see a person cease his injury prevention/management techniques as soon as he thinks all is okay. Dont drop your guard! Keep some or all of these going all the time!
Most people participating in strength training are actually doing more harm than good, mainly because of the flaws in their program design. Strength training program design universally is still at a stage of development where I believe that most programs are fundamentally flawed.
Now this isn't one of those 1980 to 1990 ads in an iron mag where the header states that no one but this "handpicked to go to Russia" author knows what he's doing. I seek to gain nothing but share my perceptions, with the intent to help out as many of those training with weights get more than they lose from their training. After all, the slogan of my company is teaching the world how to train! (Check out my new website, www.coachking.com, in which we take this concept to a new level!)
Now take action to ensure that you can bench press, row, shoulder press, and chin-up without pain for years and years to come!
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