Our exuberance with our "fitness" regimens are contributing to an increased incidence of painful shoulders. I am re-posting this article from my archives and adding this illustration from Whole9 website of the similarities between certain "exercises" (upright row) and their relationship/implication for pain and impingement of the rotator cuff; in this photo particularly the supraspinatus. From combat/boot camp style classes, high repetitions, increased velocity, low push-ups with excessive anterior strain to repetitive punching movements sometimes we are fortunate if the side-effects are only tendonitis or bursitis. It's a wonder (and a testament to our labrum and rotator cuff) that our arms don't simply come flying out of their sockets (which unfortunately also can happen!) I will share more up to date info soon. I am also more conscientious of shoulder pain and body mechanics after an hour of chipping away at inches of ice in my driveway.
I have been pondering the importance of our shoulders recently (perhaps a weekend of painting contributed to my focus). For years, when I practiced as an occupational therapist, I was regarded as somewhat of a "shoulder freak." The shoulder is a complex joint and easily susceptible to injury and pain. Our lifestyles place our shoulders in rounded, kyphotic, internally rotated positions (driving, computer usage, carrying laundry baskets, and any activity that necessitates pushing). Then we go to the gym and do push-ups, and chest presses, and bench presses which replicate the same movement patterns that contribute to the existing imbalance. The test for shoulder impingement (Hawkin's test) closely duplicates an upright row--do you really want to do an exercise that orthopedics use as a provocative test to determine nerve impingement?
Orthopedics, conditioning specialists, athletic trainers often recommend a 1:3 ratio of pushing to pulling. So if you do pushups make sure you add scapular rows, pull-ups emphasizing scapular depression and retraction, and a basic rubber tubing external rotation shoulder movement. Exercises lying prone (on your belly) where you lift your arms up to a "Y", "W" and "I" shape are quite beneficial. Very few people benefit from being tight and muscle bound in the shoulders...we tend to lack flexibility as we age and should emphasize full extension of the shoulders as often as possible. I have many clients who have difficulty elevating their arm straight overhead due to tight lats and serratus. In this case yoga and stretching exercises may be of greater benefit than shoulder strength building.
I am a fan of forearm and shoulder planks...done correctly...to create shoulder strength and stability with emphasis on maintaining a strong core engagement. Once your low back starts to sway, whether with planks or push-ups--you need to stop, rest and regroup. You don't do yourself any favors proceeding with an exercise to simply see how many you can do in a minute. If 75% of them are sacrificing form then eventually you will be complaining of shoulder and back pain. Go for quality.
Push-ups do have a correlation to anterior (front) shoulder pain. The USTA website's sports training advisor, Dr. Riewald states: "Push-ups are not one of the exercises we typically encourage for tennis players. The reason is, most players drop too far into the push up and end up placing unnecessary stress on the front of the shoulder (in a proper push up the elbows should not bend more than 90 degrees.)" The shoulder is already significantly stressed in tennis so why negatively influence it further with poor form and exercise selection? Form is critical to injury prevention. For sports like tennis and golf that require high velocity you want core strength and balanced, flexible joints--core gives you power, mobile shoulders can give you velocity and "whipping" action.
I think push-ups are a wonderful strength building exercise. There are modifications and advancements that will gradually build strength safely. You were born to impress nobody but yourself--impress yourself with good form and the strength will follow. Push-ups highlight my weaknesses, but I refuse to let pride interfere with common sense. Stay connected and aligned and if you have a history of shoulder pain, skip them altogether and focus on the opposing muscle groups to build integrity and balance within the glenohumeral joint.
I plan to post pictures of some great "planking" poses done on the Pilates reformer and chair--they add variety and "tease" our deeper muscles to respond and activate. In addition they add balance to the shoulder joint rather than stress. Until then, enjoy this article from The Physical Therapy Sports and Wellness website...particularly hint #4.
How to Avoid Shoulder Pain at the Gym Posted on October 21, 2011 There are a lot of ways to injure the shoulder—don’t let your workouts be one of them. If you’re already having pain (or would like to avoid it), the following tips will help you keep those shoulders safe in the gym.
References:
Upper Extremity Weight-Training Modifications for the Injured Athlete : A Clinical Perspective.Martin Fees, Tony Decker, Lynn Snyder-Mackler and Michael J. Axe Am J Sports Med 1998 26: 732
Orthopedics, conditioning specialists, athletic trainers often recommend a 1:3 ratio of pushing to pulling. So if you do pushups make sure you add scapular rows, pull-ups emphasizing scapular depression and retraction, and a basic rubber tubing external rotation shoulder movement. Exercises lying prone (on your belly) where you lift your arms up to a "Y", "W" and "I" shape are quite beneficial. Very few people benefit from being tight and muscle bound in the shoulders...we tend to lack flexibility as we age and should emphasize full extension of the shoulders as often as possible. I have many clients who have difficulty elevating their arm straight overhead due to tight lats and serratus. In this case yoga and stretching exercises may be of greater benefit than shoulder strength building.
I am a fan of forearm and shoulder planks...done correctly...to create shoulder strength and stability with emphasis on maintaining a strong core engagement. Once your low back starts to sway, whether with planks or push-ups--you need to stop, rest and regroup. You don't do yourself any favors proceeding with an exercise to simply see how many you can do in a minute. If 75% of them are sacrificing form then eventually you will be complaining of shoulder and back pain. Go for quality.
Push-ups do have a correlation to anterior (front) shoulder pain. The USTA website's sports training advisor, Dr. Riewald states: "Push-ups are not one of the exercises we typically encourage for tennis players. The reason is, most players drop too far into the push up and end up placing unnecessary stress on the front of the shoulder (in a proper push up the elbows should not bend more than 90 degrees.)" The shoulder is already significantly stressed in tennis so why negatively influence it further with poor form and exercise selection? Form is critical to injury prevention. For sports like tennis and golf that require high velocity you want core strength and balanced, flexible joints--core gives you power, mobile shoulders can give you velocity and "whipping" action.
I think push-ups are a wonderful strength building exercise. There are modifications and advancements that will gradually build strength safely. You were born to impress nobody but yourself--impress yourself with good form and the strength will follow. Push-ups highlight my weaknesses, but I refuse to let pride interfere with common sense. Stay connected and aligned and if you have a history of shoulder pain, skip them altogether and focus on the opposing muscle groups to build integrity and balance within the glenohumeral joint.
I plan to post pictures of some great "planking" poses done on the Pilates reformer and chair--they add variety and "tease" our deeper muscles to respond and activate. In addition they add balance to the shoulder joint rather than stress. Until then, enjoy this article from The Physical Therapy Sports and Wellness website...particularly hint #4.
How to Avoid Shoulder Pain at the Gym Posted on October 21, 2011 There are a lot of ways to injure the shoulder—don’t let your workouts be one of them. If you’re already having pain (or would like to avoid it), the following tips will help you keep those shoulders safe in the gym.
- Avoid all behind the neck exercises. Although behind the neck shoulder presses, lat pull downs and back squats might evoke fond memories of your first foray into strength training (myself included), they’re also a recipe for shoulder disaster. That’s the bad news. The good news? All of these exercises have alternatives which keep the hands and weight in front of the face and are just as effective at targeting the intended muscles.
- Keep those elbows close. Flaring your elbows out to the side during bench presses, push-ups and overhead presses places the shoulder joints in an incredibly vulnerable position. Perform those same exercises with the elbows in closer to the body and you’ll drastically reduce your risk of shoulder injury.
- Don’t lose sight of your hands. When performing chest presses and flyes, don’t let your hands disappear from your peripheral vision. This will keep the elbows from dropping behind the plane of the shoulders which can produce excessive strain on joint structures.
- Take a look at your push to pull ratio. If your routine emphasizes pushing (bench press, shoulder press, flyes) over pulling (rows, etc.), you’re asking for trouble. Much of our daily life already encourages excessive recruitment of muscles on the front of our shoulders (seated computer work, driving, lifting/carrying tasks). Reinforcing this imbalance in the gym is a surefire way to end up with unhappy shoulders. Aim for 3 sets of pulling movements for every 1 set of pushing movements at the gym. Can’t think of many pulling exercises? Look here (video for I’s, T’s, W’s and Y’s).
- Don’t neglect the rotator cuff. These (Shoulder ER and IR) simple exercises should be part of your regular workout routine—not just when you’re already hurting.
- No dips or upright rows. Although frequently staples of strength and bodybuilding routines, dips (both on a bench or in the parallel bars) and upright rowing place unnecessary strain on the shoulder joints. Avoid these exercises—your shoulders will thank you.
References:
Upper Extremity Weight-Training Modifications for the Injured Athlete : A Clinical Perspective.Martin Fees, Tony Decker, Lynn Snyder-Mackler and Michael J. Axe Am J Sports Med 1998 26: 732
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