INJURY PREVENTION

Shoulder Solutions

By Dr. Carla Cupido  |  PHOTOs BY ARSENIK PHOTOGRAPHY  |  MODEL: KEVIN PORTER

Athletes involved in sports that require overhead arm movements, including weight lifters and MMA athletes, run a high risk of shoulder injuries due to the repetitive and dynamic nature of their sports. However, a combination of strong shoulder blade stabilizers, optimal muscle movement patterns and adequate spinal mobility can significantly decrease the potential threat of a debilitating or pesky chronic shoulder injury. Strength is useless unless it is used at the right time, for the right movement. Even the best athlete is at risk of shoulder injury if he doesn’t know how to engage his muscles appropriately. Mobility limitations in the body also increase the risk of injury. If you lack mobility in one area, you will have to gain it elsewhere to compensate, and this can lead to hyper-mobility (a.k.a. instability) issues. Let’s first simplify things by breaking down the anatomy of the shoulder and then discuss how scapular stability is intimately connected to shoulder health.

SHOULDER ANATOMY DETAILS

The scapula, also known as the shoulder blade, is a very important anchor point in the body. It houses the head of our arm bone (humerus), it constitutes half of our shoulder joint, and it is the attachment site for our rotator cuff muscles, several arm muscles and our scapular stabilisers.

The muscles that attach on the medial and inferior aspect of the scapula are key scapular stabilizing muscles that are commonly neglected. These include the middle and lower trapezius, rhomboid major, rhomboid minor and the serratus anterior. The middle trapezius and rhomboid muscles function to retract the scapula. Scapular retraction is the action of squeezing your shoulder blades together. The lower traps take care of scapular depression, which draws the shoulder blades down the thorax, while the serratus anterior holds the medial (inner) border tight to the thorax.

The rotator cuff comprises four muscles (supraspinatus, infraspinatus,

subscapularis and teres minor) that function to secure the head of the

humerus (ball) in the shoulder blade (socket).

If the muscles that anchor your shoulder blade to your thorax are strong (scapular stabilizers), your shoulder joint and rotator cuff muscles are protected. Remember that your arm attaches to your shoulder blade, and since the old song lyric: “The arm bone’s connected to the shoulder bone,” holds true, we should all be well-rehearsed in recognizing that relationship between those body parts. Our rotator cuff muscles cannot stabilise the shoulder joint adequately if the bone on which they are anchored is not stable.

Weak scapular stabilizers are quite observable to the medically untrained eye. Generally speaking, when the lower trap is weak, a flaring of the lower aspect of the scapula can be noted. When the serratus anterior is weak, the scapula’s inner border flares. Weakness of the middle trapezius and rhomboid muscles contribute to a separation of the scapulae, also known as protraction. Identifying these weaknesses through detailed observation, muscle testing and functional testing plays a pivotal role in determining an optimal training program that will not only allow you to up the ante in your sport due to improved strength and stability but it will also significantly decrease your risk of being designated water-boy/girl due to a shoulder injury.

SHOULDER SENSE

An imbalance commonly exists between our internal and external shoulder rotators as well as our upper and lower traps. Our internal rotators are typically locked short (a.k.a. “tight”) and our upper traps are most often overly dominant. This combo creates forward rolling and elevation of the shoulders. We need to find a balance between internal and external shoulder rotators as well as upper and lower traps. By engaging our scapular retractors, external rotators and depressors, we anchor our shoulder blades back and down on our thorax; this is referred to as “packing the shoulder” in the strength and conditioning, and rehabilitation worlds. The “Y” exercise is designed to develop proper overhead motor programming and muscle recruitment patterns. This helps correct upper trap dominance in overhead positions by restoring proper functional mechanics and rhythm to the shoulder blade and humerus.

“Y” EXERCISE

The “Y” exercise is designed to develop proper overhead motor programming and muscle recruitment patterns.”

ONE

Stand against a wall with your arms overhead. Purposefully shrug your shoulder blades and slide your hands overhead, palms down, as far as possible.

TWO

Now, externally rotate the arms from the shoulder as much as possible, slightly turning the palms up while simultaneously pulling the shoulder blades down the thoracic spine by contracting the lower traps.

THREE

If you can, pull your arms off the wall while maintaining this shoulder packed position.

PACKING PROBLEMS

Shoulder packing can be challenging even with adequate thoracic spinal mobility; therefore, limitations can make this seem almost impossible for some. If this is a challenging position for you to maintain while your arms are overhead, seek care to help improve spinal mobility as it will dramatically improve your pack and subsequently your overhead shoulder stability and strength.

   Many of the exercises used to target these small stabilizing muscles appear fairly simple, yet require very intricate and precise movement patterns. After I demonstrate an exercise to patients, often their first question is, “How much weight should I use?” After I have them try the exercise, they appreciate how neglected these scapular stabilizers really are and how hard it is to engage the right muscles at the right time. More often than not we agree that no weight is necessary. There are numerous scapular stabilizing exercises, but the best plan is to find a sports focused chiropractor, physician, or physiotherapist to evaluate your shoulder weakness(es), neuro-muscular inefficiencies and spinal mobility in order to establish a prehab/rehab program specific to your needs. This will enable you to keep charging hard while avoiding injury and return strong to your sport post-injury.

About IFM Meet the Team Editorial Subscriptions
Inside Fitness Magazine Australia 216 Walters Road, Arndell Park, NSW 2148 © Copyright 2013 – Inside Fitness Magazine. All Rights Reserved