Shoulder Injuries / PreHab / ReHab
Wednesday, June 4th, 2008So let me say right out of the gates that I am far from an expert on rehab, injuries, the shoulder, etc. Definitely a field outside of my area of expertise. However, being someone who has periodically run into shoulder issues, as recently as the last training month, I’ve been doing my fair share of reading, studying, etc., in order to help myself and others out. Now of course, in addition to that, I’ve been seeing my chiropractor regularly for some Active Release on various relevant areas.
Given that most trainees will at some point experience some kind of shoulder issue, I thought I’d summarize some of my findings on the topic and what I’ve done to eliminate my shoulder issues entirely.
In most cases, when we’re talking about shoulder pain, the injuries are progressive in nature. Progressive changes in posture, soft tissue quality, changes in the way we stabilize the shoulder girdle, etc., all function to develop specific patterns based on fatigue that alter the ideal function of the shoulder. So you basically develop stabilization ‘habits’ for lack of a better term based on your training. Now over time, the shoulder joint gets altered in terms of position, range of motion, etc., and this results in faulty recruitment patterns which can precede other chronic injuries. For example, shoulder impingement can develop, which if allowed to progress can also lead to even more problems. (rotator cuff tears, etc.) Impingement seems to be what I’ve been dealing with and let me tell you, it’s a bugger of an annoyance.
According to well known physiotherapist Bill Hartman, most people make the mistake of first looking at where the pain is coming from and focusing the attention and treatment on that specific area. For example, rotator cuff pain. The oft recommended approach is to focus on the muscles of the rotator cuff, but there are a lot of things that feed into this problem. For example, an improperly positioned scapula can alter rotator cuff strength by as much as 25%.
Bill recommends a progressive four-phase approach where one starts at the shoulder joint itself and from there you work your way outward. This is also the basis for his Upper Body Dynamic Warm Up program known as Inside Out.
Phase 1 - look at what is happening with the thoracic spine. Why? Because thoracic spine mobility determines the shape of the rib cage, which determines where the scapulae/shoulder blades sit. If you have a ‘forward posture’ (desk jobs anyone?) the result can be impingement. So a focus on restoring thoracic spine mobility (ability to extend, rotate, etc.) is of primary importance.
Phase 2 - look at the scapulae, and in particular, scapular mobility. Postural issues (short/stiff chest muscles for example) will result in the scapulae being pulled/tilted forward - the rest is potential impingement issues). So we have to have tissue extensibility in the front of the body and strength in the scapular muscles on back side of the body in order to have the ability to pull the scapulae back into a position to be stabilized.
Phase 3 - look at scapular stability. We’re looking for a balance between the upper and downward rotators of the scapulae. The upward rotators include the upper traps, lower traps and serratus anterior. The downward rotators include the rhomboids and the levator scapulae. So what is required is a recoordination of the relevant muscles, strengthening of upper rotators; potential soft tissue work on the downward rotators, etc.
Phase 4 - look at the rotator cuff strength and range of motion. The goal is to try to find balance internal and external rotation; a good rule of thumb is 180* of full combined internal and external rotation. For people that train a lot there is a tendency to lose external rotation. In addition Bill says the external rotators should be about 2/3 as strong as the internal rotators. The suggested goal for hard training people however, is to try to get it up to 3/4. Why is this important? Because the external rotators pull the upper arm bone into the shoulder joint which helps to avoid shoulder impingement.
That’s it for now. I’ll be back later with more including the general shoulder pre/rehab program that I used to eliminate the shoulder issues I was experiencing.


