Strategies For Working With Shoulder Injuries

A significant number of Total Results clients deal with joint difficulties. This becomes more common as we age, especially if we have been active in participating in sports or other activities with repetitive motions. We see a lot of lower back discomfort (some muscle weakness, and some structural abnormalities), knee pain, elbow problems, as well as neck weakness that can cause headaches. Many, if not most of these obstacles can be overcome with regular Total Results workouts and some simple lifestyle modifications. One of the biggest and most rewarding challenges that I face as an instructor is how to work around shoulder maladies. Since part of the Total Results mission is to help people to improve and maintain their functional independence and live their best life, keeping the shoulder joints healthy is an absolute must. Over the years we have developed a comprehensive toolbox for improving the function of the shoulder joints and minimizing discomfort.

In order to gain a better understanding of the shoulder joint, we should discuss its anatomy. The shoulder is a ball and socket joint (the ball is the greater tubercle of the humerus, and the socket is the glenoid fossa of the scapula), and the bones involved include the humerus (upper arm), scapula (shoulder blade), clavicle (collar bone), and acromion (the small part of the scapula that connects with the clavicle). The major muscles that produce movement about the shoulder are the deltoid (upper arm), trapezius (a kite-shaped structure that spans from the rear part of the neck, across the top of the shoulders and down between the shoulder blades), latissimus (major upper back muscle), pectoralis major (chest), and the rotator cuff. The rotator cuff is made up of four small muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that help to stabilize the shoulder joint, but also work to perform abduction and external rotation of the humerus. The shoulder is a very mobile joint; as you have probably noticed, you can move your upper arm in a number of different ways. Unfortunately, because of this mobility it is an inherently unstable joint, which is why it can easily be injured. Common maladies include rotator cuff impingement or tear, biceps tendinitis, frozen shoulder, torn labrum (cartilage deep within the shoulder joint), instability from a previous injury, or simple muscular strain.

As I mentioned earlier, through trial and error over the past two decades we have created successful strategies for improving shoulder function and reducing pain. Bear in mind that I did not invent any of these modalities; I am simply fortunate enough to learn from some very smart people. Timed Static Contraction (TSC) can be a useful tool to allow clients to perform certain exercises (such as the Chest Press and Overhead Press) in a portion of the range of motion where they do not feel any joint pain. Regular readers of this blog are very familiar with TSC, so I won't get into too much detail. We can also substitute the MedX Overhead Press for the Super Slow Systems version; the two machines have movement arms that track differently. The MedX version moves in a slightly upward arc, which often feels more comfortable for people with shoulder maladies, and it is why we have both options at our disposal. In some cases we may need to entirely avoid performing any vertical pushing and pulling movements, as clients with shoulder difficulties can better tolerate horizontal exercises.

The External Rotation exercise can be performed in order to strengthen the rotator cuff. This can be done as a preventative measure or as a means of rehabilitating an injury and avoiding surgery. External Rotation can be applied as a TSC by the client, and resistance is provided with the opposite hand for 90 seconds. As a former quarterback with lots of wear and tear on my shoulder, I find this exercise to be extremely valuable. We can also do what is called "gapping the weight stack" when performing the Chest Press exercise. In this scenario we move the movement arm one or two pin holes forward so it does not come to such a deep position when the weight stack bottoms out. This can help reduce strain on the shoulder joint. Dr. Doug McGuff, owner of Ultimate Exercise, has a very helpful video on his website (drmcguff.com) that illustrates how this is accomplished. Finally, I have some clients perform a shoulder hang exercise that I learned from Ken Hutchins and has been recommended by retired orthopedist Dr. John M. Kirsch. This involves the use of the Nautilus Multi-Exercise machine; the client will hang from the top bar with their palms facing forward. First they will hang with their feet supported by the bottom step of the machine, and then they will gradually work toward hanging with their feet suspended in air. This exercise will usually last between 30-60 seconds and has been wonderful in improving frozen shoulders.

In a perfect world, clients would perform the full complement of exercises on all of the machines at Total Results in a dynamic fashion. We like to have a balance between upper body and lower body pushing and pulling exercises so that the body can develop symmetrically and without any muscular imbalances. However, life is rarely perfect and sometimes it is important to sacrifice symmetry in order to avoid further joint irritation. Ours is not a one-size-fits-all program, and these adjustments may be for either the short or long term. Whatever your situation, we can find the proper solution through patience, active listening, creative thinking, and trial and error.