Bulletproof Shoulders - Part 1

Of all the issues I have seen in my five years as a fitness professional, shoulder problems are among the most common. They are also among the most difficult to resolve. One of the reasons for this is the complexity of the shoulder's anatomical structure. The "traffic jam" of bone, muscle, and connective tissue residing in the shoulder can send even the nerdiest anatomy geeks' head spinning. So where to we begin when attempting to resolve shoulder pain? In an attempt to spare you from a 10,000 word post on shoulder anatomy and physiology, I'll break things down into the simplest terms possible.

When constructing the ideal shoulder corrective/pre-hab program, I find it useful to consider Vladimir Janda's "Upper Crossed Syndrome".

In layman's terms, the pecs, neck, and upper traps become short and stiff, elevating the shoulder blades and pulling the humerus forward in the socket. This causes the muscles on the front of the neck and upper/mid back to "turn off". All of this contributes to decreased performance, injury, and you looking much less attractive.

The image above illustrates what occurs over time with a combination of three common factors:

1. Poor lifestyle choices
2. Poor exercise technique
3. Poor exercise program design

There are several other factors that contribute to poor shoulder position, but this gives us a pretty good idea of where to begin.

Let's look at each in a little more detail.

1. The lifestyle choices we make have huge implications on the way we move.

One of the reasons shoulder problems are more popular than Candy Crush Saga is because individuals spend way too much time sitting in a hunched over position in front the television, in their car, or on the computer. Consider the amount of time the average desk jockey spends in a sitting position. 1-2 hours in the car every day, 6-8 hours at their desk, and 2 hours in front of the tube. That's up to 12 hours a day!

This leads to a kyphotic and forward head posture, which puts the scapulae (shoulder blades) and spine in a horrible position. Since proper scapular and spinal mechanics are essential for healthy shoulder function, you might see how this can be problematic.

To illustrate my point, give this a try:

• Hunch over like Quasimodo and poke your head forward (some of you might not have to try very hard).
• Reach your arms over your head as far as you can. Didn't get very far did you?
• Now sit/stand up tall and reach over head. See how much farther you get?

Now imagine what happens to shoulder mechanics when you sit like this for extended periods of time, day after day. No wonder so many people have shoulders made of cement. Couple this with crappy exercise technique and you have a recipe for dysfunction.

2. Do something wrong long enough and your body will respond by getting injured or hitting a plateau.

Every repetition done incorrectly further ingrains a faulty motor pattern in the nervous system. This is where a good coach or training partner can be worth their weight in gold. You might have the perfect program, but that means NOTHING without proper execution. A good movement screen/assessment can help take your training to the next level. You might not notice your winged scapula, head jutting forward at the top of every pull up, or your humeral head migrating forward in the socket at the end of every row, but a good coach will. If a good training partner or coach isn't an option, make an effort to educate yourself. Invest in learning how to do things correctly and you will stay healthier longer.

3. Most individuals (trainers included) have no idea how to construct a balanced training program.

In my experience, shoulder problems are more common in men than in women. I attribute this to most men's obsession with exercising the "mirror muscles". I remember my early days of lifting when I would bench press 3 times per week, do a bunch of push ups, and finish up with some direct arm work and call it a day. What about rows and pull ups?

Others rush into high level activities like Olympic Lifting before they have developed the requisite stability and/or mobility to do so. Over time, this can lead to an unbalanced shoulder girdle and set one up for disaster down the road. One must train the body in several planes, employ preventative maintenance techniques, and use proper exercise technique to maintain optimal shoulder function.

Now that we have established why many shoulder issues arise, lets dive into a few strategies you can use to remedy or prevent these issues from happening.

1. Lifestyle Modification

You can train perfectly and do all the corrective exercise in the world, but if you practice bad habits the other 22-23 hours of the day, it wont matter. Make sure you are practicing these daily.

Sit Up Straight - Pretty self-explanatory. Do what your momma told you.

Move Around More Often - If you sit for long periods of time, set a timer for every 30 minutes so you get up and move.

Learn How to Breathe - I have discussed breathing at length before here and here. Breathing a very powerful thing and I believe we don't give it nearly enough credit. At 22,000 cycles per day, you might see how a crappy breathing strategy can screw things up. Knock out 10 deep, diaphragmatic breaths before bed and before and after each training session.

2. Exercise Technique

This could end up being a pretty long list. There are so many nuances of proper exercise technique that go way beyond the scope of this post. Keep an eye out for my Movement Mistakes series for more specific movement fixes. The most common technique flaws I see are with neck, scapular and elbow positioning during rowing and pressing variations.

Keep the Shoulder Blades Flush to the Ribcage - Scapular anterior tilt during rowing and pressing variations is probably the most common error I see. This anterior tilt of the scapulae causes a break in the kinetic chain as well as causing the head of the humerus to migrate forward in the socket. Here is an example of what it looks like. Notice how the elbow drifts behind the midline and the shoulder protrudes forward.

Keep the Chin Tucked - Don't let your head shoot forward at the end of rowing movements or at the bottom portion of pressing movements. It places excessive stress on the neck and shoulder. As evidenced by the photo, this can be a consequence to anterior tilt of the scapula.

Here are a couple of videos detailing some of the most common flaws I see. Thanks to Eric Cressey and Greg Robins for the videos.

 

 

That's it for the first part of this segment. Keep an eye out for part 2, where I will discuss specific considerations for balanced, upper body program design.