Update 5/2/2014: Hi there, if this is your first visit to My Trainer Chris and you are looking for more information on keeping your shoulders healthy I invite you to check out my other shoulder articles located here:
This blog combines information provided by the National Academy of Sports Medicine (NASM) and yours truly.
About your shoulder (from NASM)
Our shoulders are a part of virtually every movement we make during the course of a day from typing and driving to eating and opening doors. Add in regular workouts and our shoulders are always in motion. It’s no surprise then that shoulders are at a high-risk for injury. In fact, shoulders have an injury prevalence of more than 65% during a lifetime (Luime et al., 2004). This is second to only the lower back.
The shoulder, unlike other joints in the body, relies primarily on muscles for its stability (Norkin and Levangie, 1992). Therefore, the exercise choices made in the gym have a particularly large influence on the health of our shoulders.
Shoulder impingement is a very common syndrome among those who lift weights or perform overhead sports. Key prevention techniques include a proper warm-up, specific strengthening exercises and education on the warning signs of impingement (Chang 2004).
Let’s examine the mechanics of the shoulder first. The rotator cuff stabilizes the shoulder while the deltoid is a main contributor in moving the arm away from the body. When we exercise, we often strengthen the deltoid by performing deltoid raises and overhead presses. If the rotator cuff is not doing its share of the work, the deltoid can take over and create an upward shearing force (Wilk et al, 1997). This can pinch part of the rotator cuff and bursa against the acromion of the scapula, creating a painful shoulder impingement (Chang 2004).
Creating a balanced shoulder workout program and strengthening the stabilizing muscles of the shoulder complex are key to preventing injury.
Gaining stability in the shoulder requires muscular endurance, so the client should progress sets and reps before progressing load. If the client experiences any pain or restriction in range of motion, please refer him/her to a medical provider for evaluation.
Dangerous Shoulder exercises.
Done incorrectly, the following exercises can lend themselves to shoulder injury just like any exercise has the potential to cause injury. In my current practice the bench press, lat pull-down, lateral raises and dips are all utilized. The utilization of weight machines over the free weight variations shown below has not been proven to be safer alternative.
Bench Press. Usual problems: (1) Too heavy of a load. (2) Poor Form (3) Combination of 1-2. Most people take the bar down it lightly touches/almost touches the chest. In this position the anterior shoulder capsule is put under a heavy load and compresses the rotator cuff tissue between the humerus and the acromion (AKA Ball and socket.) Over time this can lead to rotator cuff inflammation rotator cuff injury or labral (shoulder cartilage) damage.
The safer method is to lower the bar until the elbow is bent to 90 degrees. This prevents the shoulder joint from moving into the unsafe range. The same advice applies to push-ups.
Lat Pull Downs. Usual problems: (1) Pulling the weight down behind the head. (2) Jerking/Swaying the body. (3) Trying to make this exercise into a lower back/ab exercise. (4) Combination of the above. Performed in front of the body this is a excellent exercise to strengthen the back. When performed behind the head is where you can run into problems. Pulling the weight behind your head positions the humerus in a great place to pinch rotator. While there are people with higher degrees of shoulder mobility that will swear this exercise is the cats pyjamas, I believe the risk outweighs any benefit. Keeping the bar in front of you activates the same movement for the target muscles, while eliminating the risk of shoulder injury and stress on the cervical vertabrae.
“Oh hell nooooo!”
Besides, this move was cool in the 1980’s and has since been scientifically proven as ineffective. Yet somehow it refuses to go away.
Do not to sway/jerk during the movement, and position the body in a slightly reclined position (although the upright position is also an option) pulling the bar toward the sternum.
Military Press. Usual Problems: (1) Lifting from behind the neck. (2) Too heavy of a load. Once again, an unfavorable position for the shoulder to be in, once again poor technical execution at fault. Just like the behind the neck lat pulldown your neck is exposed to heavy stress. Perform with dumbbells to work the scapula or perform with a front barbell and avoid arching the arching the low back. Can be performed on a bench with back support or done standing.
Dips: Usual problem: (1) Allowing the shoulder to move beyond 90 degrees. I always recommend stopping at 90 degrees to protect the shoulder capsule and the rotator cuff. The use of an assisted dip machine can help new clients develop the proper mechanics to dip.
Dumbbell Lateral Raise. Usual problems (1) Too much weight. (2) Keeping the arms totally straight. (3) Shrugging to get the weight up. Done incorrectly, this exercise places alot of force on the small rotator cuff. ALthough the lateral deltoid is the target muscle, the rotator cuff is very active during the lifts execution. The arm should moved in the scapular plane and the weight relatively light. If you havfe to shrug your shoulders then the weight is simply too heavy.
Chang WK. (2004). Shoulder impingement syndrome. Physical Medicine and Rehabilitation Clinics of North America. 15: 493-510.
Guildford Orthopedics (2010). Shoulder impingement image. Retrieved from: http://www.guildfordupperlimb.co.uk/shoulder/shoulder-impingement
Luime JJ, et al. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology. 33 (2): 73-81.
Norkin, C, Levangie P. (1992). Joint Structure & Function. 2nd Ed. F.A. Davis: Philadelphia
Reinold M, et al. (2009). Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. Journal of Orthopadeic and Sports Physical Therapy. 39 (2): 105-117.
Wilk K, et al. (1997). Current concepts: The stabilizing structures of the glenohumeral joint. Journal of Orthopeadic and Sports Physical Therapy. 25(6): 364-379.
Watching people in the gym all day and thinking “Something doesn’t look right here.”