The shoulders have got to be the most-injured joint in weight-training populations. Virtually everybody walks around with some kind of shoulder aches.
Even I’ve had my issues with this. Years ago, I started noticing a pain in my right shoulder, near where the pectoral muscle inserts, when I was doing any kind of flat pressing movement. I’d assumed (naively) that it was some strain of the pec, and responded by just taking time off. This went on for years, alternating between getting (reasonably) strong on the bench, only to have this pain come back and sending me back to square one.
It turns out I actually had a partially-torn subscapularis (one of the rotator cuff muscles; thanks to Eric Cressey for helping me to figure that out), and according to my ART guy, a whole metric ton of scar tissue in both shoulders, though the right was the worst.
Since then, I’ve had to take a lot of steps to rehabilitate the area, and that’s what this is going to deal with: my attempts at fixing, working around, and maybe even preventing shoulder problems.
Shoulder pain is often blamed on an imbalance between internal and external rotation of the shoulder, which is controlled by four tiny muscles collectively known as the rotator cuff. Pressing motions tend to work internal rotation, while pulling movements tend to train external rotation. The idea is that the two need to be in balance to avoid injuries.
The RC is indeed a major trouble spot and prone to injury, but as I’ve learned these problems are often a symptom of deeper issues.
When dealing with shoulder injuries, one of the most common culprits is actually a weak upper back and the poor scapular control that results. The scapulae, otherwise known as the shoulder blades, are held in place by the muscles of the mid-back – namely the traps (III and IV, the middle and lower aspects), the rhomboids, and the teres group up around the rear head of the shoulder. The scapula connects with the shoulder at the acromio-clavicular (AC) joint.
I’m not going to get into all the anatomy, mainly because I don’t recall it off hand and it’s not that important anyway, but suffice it to say that a lot of important tendons and tiny muscles run through this region, and there’s not a lot of space considering all the things that get crammed in there. Certain positions and movements can create conditions where the tendons are actually scraping against bone. Over time this causes both pain and weakness.
Scapular positioning plays a big role in this. If the scapula isn’t where it’s supposed to be as your shoulder moves around, then those tendons and muscles start getting the hell beat out of them. Scapular control comes down to having strength in the muscles of the mid-back – namely, you want to make sure that scapular retraction (pulling your shoulder blades back and together) and depression (pulling the shoulder blades downwards) are balanced with elevation and upward rotation, which are commonly over-developed.
This is almost exclusively a result of common weight-training practices. Because most people lift weights like idiots, International Chest Night on Monday puts “chest” through about 10 different kinds of presses and flyes. Of course we can’t forget shoulder day on top of that, which usually boils down to a few more pressing motions.
While most Bro-workouts do have a back day, this seems to mainly target the lats and lower back. The upper back might get some shrugs, but that can actually make the issue worse – shrugs target the traps I and II, the upper aspects responsible for pulling the scapula upwards. Scapular retraction and depression, which can actually be trained with pullups and rows, are generally ignored with the form most people use on those exercises. Wide-grip pullups and (barely) bent-over rows that are more hip work than back aren’t cutting it.
Summarily, most people are training the shoulder joint far too often, and with an emphasis on internal rotation to boot. The back muscles which are necessary to stabilize the shoulder and balance things out are utterly neglected at the same time.
I should warn that even otherwise good programs can create these issues if you’re not paying attention. Retraction and depression of the scapula are things you have to pay attention to – while I did make it a point to do more back/pulling work than pressing, it turns out on reflection that the way I was doing that work wasn’t sufficient to protect the shoulders.
Between poor scapular stability/upper back strength and this imbalance between internal and external rotation, something’s going to give sooner or later. Given the incidence of shoulder pain and injury in weight-training populations, that something seems to give a hell of a lot.
A great many shoulder injuries can be prevented or at least mitigated by making sure the upper and middle back muscles are strong enough to hold the scapula in place, and that there’s no glaring imbalances with your pressing strength as compared to your ability to retract and depress your shoulder blades.
If you’ve got that handled, then you’re ahead of the game.
Eric Cressey, Mike Robertson, and Bill Hartman have written some great articles and books on this subject, and I’d highly advise you to read them if you’re interested in more clinical-type information on the issue.
What follows has been my own strategy for the last two years or so, ever since I my shoulders got too painful to deal with. This is a mish-mash of concepts and strategies that I’ve taken from several sources; so far, it’s been effective enough, though as you’ll see, there are some limitations that I’m going to have to accept.
Guidelines for Shoulder Health
Limit your pressing exercises, both in number and selection. These days, I just can’t do any full-range bench pressing without some pain, so I stick to 2-board presses and floor presses. They do what I need, and more importantly, they don’t hurt. Any powerlifting meets I do in the future will be shirted. This is partly due to my long arms relative to my body size; mechanically, my shoulders get put in a bad spot when I bench to my chest, and that’s with a pretty severe arch. I also stick to a limited number of pressing exercises each session (generally one), since my shoulders will only tolerate so much.
Keep the grip close. Lots of people inexplicably do wide-grip exercises. Wide-grip chins make the lats wide, bro. No, really, they don’t. The slight difference in the activation of the lats (hint: it’s slight) doesn’t make up for the stress put on the shoulder. When you do things with a wide grip, you’re putting the shoulder in a position of external rotation, then moving it around; that’s guaranteed to grind up your joints. This goes for pressing exercises, too. You guys benching really wide (without a shirt) or doing overhead presses with a grip past your shoulders are asking for it.
Work on scapular activation before and after your pressing workouts. This can help remind you to keep that area tight as you lift, besides helping to strengthen the area. Good warm-up/cooldown exercises are face pulls, band pull-aparts (horizontal and vertical), scap pushups (or pushup plus as it’s known in some places), scap shrugs on an incline bench, and YTW drills. As these aren’t overload exercises, there’s no need to get fanatical about progressive overload. You’re after activation and strengthening, so more sets and higher reps (8-12 range) would be advisable.
Be aware of your scapula during all back exercises. Always think “shrug back, shrug down” when doing rows and pullups. As you might expect, this is going to require you to actually do these exercises correctly, with a full range of motion and no cheating with the hips.
Stretch the pecs. Stretching the pecs will help loosen them up, and there’s the side benefit of stretching out those internal rotators, which have a way of becoming tight. Stretch them after pressing workouts, and if you’re really beat up, do it before as well (dynamic arm-swings might be a better option than static stretches before lifting).
Work on mobility of the thoracic spine. This is an area that gets tight in a lot of people, and it can contribute to shoulder issues as well. You can work on this with shoulder glides, both standing up or on a foam roller.
Soft tissue work. While the corrective exercise strategy I’ve outlined did help my shoulder quite a bit, what I really credit with saving it is the manual soft-tissue work done by my ART guy. It’s painful as all hell, but the difference in shoulder function is night and day. If you don’t have access to an ART guy, there are some substitutions. If you’re confident enough to do a little half-assed version on yourself, you can dig a thumb in and put the joint through a range of motion, which I like to call ghetto-ART. It’s not a perfect solution, but it does help if the pain starts up at an inconvenient time. Even foam-rolling and tennis-balling the trouble areas can go a long way; do it before and after your sessions, even on off days if you’re feeling beat up.
Inverted (or supine) rows are the bread and butter exercise for the mid-back. I stole this idea from a drunken Irish swim coach, but damned if it doesn’t seem to help with a lot of shoulder problems. These are dirt-simple and only require minimal equipment; they’ll also make you realize how weak you are in that area.
The seated cable row is excellent for this purpose, provided you do it correctly (not like all the jerks in your gym that make it into a lower-back exercise); keep the lower back tight and straight. Motion should be at the mid-back.
Overhead squats are good for both stretching tight pecs and internal rotators. You’ll suck at them at first, but these things are wonderful for strengthening the upper back. Again, no need for obsessive progressive overload; volume is the suggestion. Since these suck for high reps, unless you’re a CrossFitter you can just stick to multiple sets of 3-5 reps.
Also, see Heffo’s shoulder circuit and ranting about shoulder mobility/stability for good demonstrations and explanations of preventative shoulder work.
Thanks to rigorously following this advice, both of my shoulders are better than they’ve been in years. They aren’t pain free, and they’ll remind me in a hurry if I’m doing anything wrong, but in comparison I’m much more mobile.
Just something to keep in mind here, in any event.
5 thoughts on “Matt’s Shoulder Health and Rehab Program”
Matt – ART link should be http://www.activerelease.com/
doh, thanks for the correction.
I've been working on my upper back the past while and I can really feel a difference. i do a series of shoulder exercises with a #1 powerlifting band and it's really helped alleviate any pain I had. Thanks for the informative post!
Why is it that an overhead press with a grip wider than shoulder width is bad for the joints?
External rotation of the shoulder while moving the arm over your head.
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