Your shoulders serve a lot of purposes during daily life and are used during virtually all upper-body movements. Made up of an intricate web of ligaments and tendinous tissue (muscle attachments), the glenohumeral joint (GH) offers the upper body a very mobile joint that is called upon during sports, active play and exercise. But, like a double-edged sword, the maneuverability of the GH joint enables the body to complete numerous tasks and also makes it susceptible to chronic and acute injury.
This maneuverability is aided by the congruent effort of the scapula. The scapula is considered the “anchor” of the shoulder. The scapula houses the attachments of the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis). These four muscles arise from the scapula and attach into the top (head) of the humerus (upper arm bone). During movements, the rotator cuff compresses the GH joint in order to bring the arm up and out. Without proper conditioning and function of the rotator cuff muscles, the humeral head would partially ride up inside the joint, lessening the efficiency of the deltoid muscle and potentially causing injury by virtue of compressing the tendons of the rotator cuff against the acromioclavicular joint. [1]
The Keys to Protecting Your Shoulders
In order to add miles to your upper body regimen, we have to examine a few key components to understand how to make a strategy to protect the shoulder joint:
Joint Stability
As the scapula serves as the “anchor” of the shoulder, it should be strong enough to stabilize the joint in order for the four rotator cuff muscles stabilize the humerus. Although all the rotator cuff muscles play a specific role of stabilizing the scapula during certain movements, the serratus anterior and pec minor also play important roles. Liken the role of the scapula stabilizers as a taut fishing line. As the fisherman reels his catch, the taut fishing line allows him to pull (create force) through the pole on each pull. If the line is not rigid and becomes droopy, the fisherman will possibly break the line on his next pull [of the fishing pole]. Strengthening the serretaus anterior and rotator cuff muscles to collectively stabilize when needed is crucial to shoulder health.
Joint Mobility
Just as the muscles that comprise the GH joint and scapula must be able to stabilize, they must also be capable of completing a desired movement without restriction. Capsular tightness, muscular stiffness, adhesions, and joint pain will restrict mobility at a specific joint. Past injuries that create faulty neurological patterns will also cause limited mobility. Without exercising proper joint mobility, we will severely handicap by the next component: flexibility.
Flexibility
Although the shoulder joint is considered highly mobile, muscle tightness can still limit its range of motion. Unlike mobility, which is centered to the structure of the joint, flexibility involves the length-tension of the muscles crossing the joint. In order to maintain flexibility at the shoulder, concentrating on the muscle’s length around the joint structure is vital. In this case, muscle length-tension should be balanced throughout; and maintained frequently with regular stretching. The more sedentary an individual is the more flexibility becomes an important component. Conversely, the more one lifts intensely, the more flexibility is vital to joint health.
Core Activation/Stiffness
What does the rest of the body do during overhead activity? More importantly, how does the rest of the body respond to LOADED overhead activity? Pairing core activation and stiffness may sound like a misnomer, but in actuality, when the core is properly activated, it “stiffens” to protect the spine and allow the muscular system to produce force safely and effectively. It does this by virtue of abdominal bracing. Once the intrinsic abdominal musculature is “braced” or stiffened, it stabilizes the spinal column via the pelvic girdle and entire torso. This stabilization allows the shoulders-particularly the scapula-to create stiffness so that the rotator cuff muscles can dynamically “hold” the humerus in place during overhead activity. The rest of the body becomes a rigid lever for the working muscles to produce force from. This phenomenal system of creating force couples in an intricate web of muscles and tissue allows joints to operate in an optimal fashion. When joints can work optimally, the body can accept challenges (load), in an environment that significantly reduces the likelihood of injury. Imagine having 5 wooden blocks stacked on top of one another. If you apply pressure to the two outside blocks with your fingers, the middle blocks stay positioned in place. Now try turning the middle block with your other hand. The harder you squeeze the outer blocks inwards, the more difficult it becomes to turn the middle one. If less pressure is applied, it allows the middle blocks to turn easier and possibly fall. The middle block succumbs to the force applied to its surrounding structures. This is how the core of the works by “stiffening”. In essence, when the core works effectively during activity, the body becomes a well-oiled machine.
Grip Position
Objects, particularly barbells and dumbbells, can be held in one of three positions: supinated, pronated, or neutral. Studies have shown that supinated and neural grip positions are stronger than the pronated position. This will prove valuable to long-term shoulder health because the position of the wrist during gripping directly relates how the tip of the humerus positions itself within the glenoid fossa. The glenoid fossa is the boney structure that houses the GH joint and resembles the flat top of a golf tee. Concave in design, the glenoid fossa allows the humeral head to move smoothly with the help of the rotator cuff muscles. The grip used during overhead loaded activity dictates how much room the humeral head and surrounding tendons have under the acromioclavicular (AC) joint. When the wrist is positioned neutrally, the lower arm corresponds to external rotation of the humerus, which makes more room under the subacromion space. [2]
Strength
In the end, strength at each joint is what makes all possible. When one is strong, all components work collaborately to enhance performance. Strong musculature around a joint enables the process of creating rigid levers, stabilization, and force production to occur under proper activation of the core and length tension relationships. When one is strong, challenging exercises become easier and easier to achieve.
The Factors that Affect Shoulder Health
To understand the factors that affect shoulder health, we should categorize the common risks typically seen in individuals that run the risk of shoulder injury.
Lifters lack joint mobility drills and proper warm-ups
Some athletes focus on joint mobility drills, however some may be neglected, particularly the thoracic spine
Flexibility
Prolonged seated causes passive fatigue which shortens muscles
Lifters “skip” stretching and create muscular imbalances from excessive pattern similarities
Athletes know the importance of flexibility and stretch regularly
Core Activation
Prolonged sitting utilizes no core activation, especially when fatigued
Lifters may know how to activate or brace the core in isolation, but may fail to do so during heavy lifting
Athletes are more in-tune with core activation when lifting; however, some do miss bracing at times.
Grip Position
Office materials call for different hand positions; ergonomics and movement imperative
Pronated grip from excessive overhead pressing and bench pressing may cause wear in unhealthy shoulders
Neutral grip is easier on the shoulder joint; perform proper movements and a decent mix of grip positions for exercises
Like a construction company erecting a building, we can’t look at the shoulders alone. We have to look at the foundation from which the shoulders will be constructed upon. In this case, we must address the core and overall static posture. If corrections and neurological adaptations are made to strengthen postural distortions, the body will become more proficient producing force under loads (exercise).
Next: The Seven-Phase Workout >>
The Seven-Phase Workout
Phase 1 – Isometrics
Building the foundation begins with training the entire kinetic chain by using isometric drills to enhance muscular endurance and activate the core musculature.
Planks Cue: Keep the head straight. Do not look up or sag the chin. The abs should be stiff and the back should resemble a table top. Think of pulling your navel toward your spine.
Recommended: 3 Holds for 30 seconds, 60 seconds, and 75 seconds
Side Planks Cue: Beginners should start with knees bent (shorter lever). Intermediates and advanced lifters can start with legs stacked and straight. Head should not sag and keep weight OVER the bottom shoulder.
Recommended: 3 Holds on each side for 30, 45 and 60 seconds each.
Half Push-up Hold Cue: Get into a top push-up position and slowly lower yourself so that the elbows are bent and your chin is a few inches away from the floor. Maintain this position while keeping the abs braced; arms slightly tucked towards your torso and head facing the ground. Hold this position. Do not perform push-ups.
Recommended: 3 Holds for 45, 60, and 75 seconds. Advanced hold for longer.
Phase 2 – Stabilization of Scapula/Intro to Mobility
In this phase, we will concentrate our efforts on increasing the ability of the muscles around the scapula to stabilize.
Scap Push Ups Cue: Position yourself in a top push-up position. Keeping abs stiff and arms extended, slowly lower your torso so that the shoulder blades retract, or squeeze together. Then raise the torso upwards by pushing your chest away from the ground.
Recommended: 2 sets of 15-20 reps
Wall Slides Cue: Stand against a flat wall with the back of your head, upper back, and buttocks in contact. Your feet (heels) should be approximately 6 inches away. Next, position your arms outstretched in front of you with palms facing up. Next, bend your arms and bring your elbows to the wall, away from your sides so they form a 90 degree angle relative to your torso. Finally, rotate your hands toward the wall keeping your palms facing each other (neutral). Most people will have difficulty getting their arms to touch the wall, but the goal is to achieve this. Work on moving your hands towards the wall without letting the body lose contact with it or arching your back. From here, you can slowly slide your hands up above your head and down toward your sides, keeping your forearms touching the wall throughout the movement.
Recommended: Beginners, work on just trying to touch the wall. Intermediates and advanced, once you can maintain contact with wall, slide the arms upwards until semi-straight and return to 90 degree against wall. Perform 12 reps total for 2 sets.
Y & Ts Cue: Lying face down on a slanted bench, focus on lifting your arms level to your ears. Do not bend your arms at anytime. First position should resemble a letter “Y” with arms tapering out as they are lifted. The second position they should come out to sides to resemble the letter “T”. Throughout the movement, think about trying to reach your hands as far away from you as possible. A common tendency will be to lead the movement by lifting with the scapula instead of keeping a proper movement pattern between the humerus and scapula. Try reaching as far away from you as possible, and keeping your shoulders down throughout the movement.
Recommended: Beginners, 2 sets of 15-20. Intermediates and advanced, focus on holding a light dumbbell in each hand and maintain straight arms while performing the same amount of sets/reps.
Standing Horizontal Arm Swings Cue: Stand about a foot away from a wall and position your arms like you would perform a push-up (against the wall). Now, drop one arm. With the dropped arm at your side, turn your body inwards and bring the arm into the middle of the body. Then forcefully, turn you torso outwards and swing the arm out to your side and back. This should resemble you giving someone a huge “backhand”. You should consciously “brake” the action once it gets to the end. This will enable the scapular muscles to “brake” or “slow down” an accelerated movement.
Recommended: 2 sets of 12 reps each side.
Phase 3 – Strength
Once we learn how to work the muscles in isolation, we must strengthen them so that they fire appropriately when called upon. A good part of this has lot to do with how well you “think” about it while you are performing these exercises.
Face Pulls Cue: At the end position of this exercise, the rope should be at the side of your head. If done correctly, you should be able to see your hands in your peripheral vision. Your grip should be neutral (palms facing you) to and keep your shoulders depressed to minimize impingement risks. Focus on squeezing the scapular muscles at the end of the movement.
Recommended: 3 sets of 12 reps
Limited Pullovers for Pec Minor Cue: Holding one dumbbell with both hands, lie back on a flat bench. Slowly lower the arms, keeping them straight, to your head. Once a comfortable position is reached-you should feel a stretch near your arm pits-raise the arms back up to the top position. Do not overstretch this position and maintain a “squeeze” in your shoulder blades. (Note: if you already present pain in your shoulders, skip this exercise). Recommended: 3 sets of 12 reps
External Rotation (Cuban Press Version) Cue: Position cable pulley at lowest setting and position one arm at a 90 degree angle. Holding the D-handle, turn you body and face the pulley column. Next, lift the hand up so that your arm resembles an “L” shape. The top position will carry the most resistance. Maintain the shoulder blades squeezed and abs stiff during this exercise. (Note: if you already present pain in your shoulders, skip this exercise).
Recommended: 3 sets of 10 reps
Phase 4 – Power Drills
Like mobility drills, now we will add some resistance and speed to certain movements simply to “teach” the muscles of the shoulder joint to “brake” when needed, and “speed up” when allowed.
Medicine Ball Pitches Cue: Like throwing a baseball, you are going to pretend you are throwing a medicine ball. Weight-wise, typically 2lb. and 4lb. balls are sufficed. If you have a concrete wall you can throw the ball against, give it a try. Wind up your arm like a pitcher and throw the ball. If you don’t have either, hold a dumbbell and mimic the throw. Remember don’t throw the dumbbell!
Recommended: 2 sets of 15-20 reps
DB Snatch with Half Windmill Cue: Snatch the dumbbell up and slowly lower your body towards the opposite direction of the snatched arm. A half windmill consists of just slowly lowering the opposite hand (empty hand) down towards the side of the knee. (A full windmill consists of lowering that hand to the floor).
Recommended: 2 sets of 12
Phase 5 – Integrating Segments
Because the kinetic chain is linked together, we must now concentrate on integrating the total body. The selected exercises utilize the torso and pelvis; so it is imperative to brace the core throughout each movement.
Supine Reverse Ab Curls with Triple Extension Cue: Lying down on a bench or floor, grab a fixed object near your head and raise your knees above the floor. Bend your knees and your flex your ankles, so that your hips, knees, and ankles are approximately 90 degrees. While holding on to the fixed object, curl your torso up so that knees are close to your face. Try this exercise with minimal momentum.
Recommended: 3 sets of 8-15 reps
Standing Trunk Flexion with Band Cue: Attach tubing to a fixed object higher than arms length (example: power cage top, cable top, chin up bar, smithy machine top). Grab handles and take a couple of steps back to create some tension in the band with your arms stretched overhead. To execute, flex at the trunk and curl your body down while keeping your arms straight and try to touch the floor as you bend. The lower you get, the more the tension (from the tubing) grows. The goal is to be able to touch the floor as your crunch.
Recommended: 3 sets of 12-15 reps
Bird-Dogs on Stability Ball Cue: Place a stability ball slightly below the naval and lie face down. From an overhead view, your body should look like an “X”. Maintain your position and slowly execute the bird dog exercise, extending your opposite arm and leg. Pause at the top and hold position for a count of 2. Most advanced exercisers can perform this movement with ease, so in order to enhance proprioception and difficulty; you can perform this exercise with eyes shut. Maintain a neutral spine and core activation throughout the exercise.
Recommended: 3 sets of 12 reps
Phase 6 – Mixing It Up
The name of the game is continuous integration. This will cement the nervous system to accept and execute scapular stabilization and humeral head depression automatically. This is achieved if the rotator cuff muscles stay strong and good form is exercised routinely. Here is a sample program:
Side Planks Scap Push-ups Face Pulls Med Ball Pitches Limited Pullovers Standing Horizontal Swings DB Snatch with Windmill
Phase 7 – Maintenance
Addressing the health of the shoulders never ends. However, with the amount of movements performed with the upper body, it is also important to rest the joint adequately, and perform self-myofascial release (SMR) techniques to combat imbalances and muscle shortening. SMR will also increase blood flow and keep muscles pliable, as well as increase mobility. The most relevant areas to perform SMR in terms of shoulder health are: the pec minor, latissimus dorsi, rhomboids, trapezius, and glutes. Tools of the trade include: foam roller, Theracane®, Massage Stick®, tennis balls, lacrosse ball, or good ole fashion massage therapist hands.
In conclusion, care for the shoulders is paramount to improve the quality of life in every aspect of activity. With regular care and attention, the shoulder joint is maintained strong and functional; which leads to a healthy outlook on life absent of pain and sedentariness.
References
1. Morag Y, Jacobson JA, Miller B, De Maeseneer M, Girish G, Jamadar D (2006). “MR imaging of rotator cuff injury: what the clinician needs to know”. Radiographics 26 (4): 1045-65. doi:10.1148/rg.264055087. PMID 16844931.
