Ask the Doc: The Shoulder Rules

 by KYLE SELA | PT, DPT, OCS, SCS, CSCS

[F]or most strength and body weight movements these two rules will keep you safe, help you break through plateaus, and likely decrease pain.

The shoulder girdle. It’s complicated. Three true joints, one muscular joint, little inherent stability, much inherent mobility all mixed together with over a billion (I counted) exercises creates a shit storm of pain, injury, confusion and frustration for a whole bunch of people who just want to train or work out.

If you have current shoulder issues, want to prevent future problems or break through a training plateau, I want to lay out two simple concepts that can help you out as you move forward with strength training.  The concepts are simple but the execution is not. I treat some extremely fit and athletic people and most of them struggle with one or both of these rules.

FYI: shoulder blade = scapula

THE SHOULDER RULES:

1. When your elbow is near or moving towards your body, bring your shoulder blade back and down into the “set” position
2. As your elbow moves out away from your body, provide the force from your shoulder to externally rotate it

Do these two things with any strength lift, bodyweight movement, catch, or sustained position, and you might just stay healthy, perform well and potentially decrease any current shoulder pain with your lifts.

Now let’s dig in deeper to each rule:

Rule 1. When your elbow is near or moving towards your body, bring your shoulder blade back and down into the “set position.”

[W]e need to place the shoulder in an optimal position so that we don’t put too much stress on any one part of the shoulder

The elbow is the best indicator of where your shoulder is positioned. The higher the elbow is, the more the shoulder has elevated. The more the point of your elbow is out to the side (pointed laterally) the more the shoulder is internally rotated, etc. So, as the rule states, when you are performing a movement and your elbow is near your side, you need to bring your shoulder blade back and down. In the sports medicine and strength and conditioning worlds, this scapular position is often called the “set” position. The idea here is that we need to place the shoulder in an optimal position so that we don’t put too much stress on any one part of the shoulder and that our muscles and joints are in the optimal place to perform.

What typically happens with inexperience, mobility issues, or poor control is that as the elbows move towards the body (i.e. top of the pull-up or bottom of the push up), the shoulder blades tip forward as well as up towards the ears putting a great amount of stress and strain on the front and top of the shoulder. This is bad. Picture yourself at the bottom of your push-up position: your shoulders should be pulled back away from the ground and also down away from your ears. This is good. Same goes with the pull-up: as you near the top of your pull-up, the elbows are coming towards your side so your shoulder blades need to be pulled back and down. Get it?

Rule 2. As your elbow moves out away from your body provide the force from your shoulder to externally rotate it.

This rule deals with what muscles you want to be activating while your elbow moves away from your body and then being able to sustain that shoulder position under the load. This will happen while pressing the bar away in a bench press or overhead press. It could also be while you lower yourself during the pull-up, press yourself up during push-ups, or while sustaining an overhead barbell or dumbbell position. To imagine this in another way, if you were holding a dumbbell, as you pressed away from your body the thumb would rotate out to the side and your palm would face you.  There are a couple reasons why this is important and advantageous:

1. This can help avoid the onset of or decrease shoulder pain. There is not a lot of space between the ball and socket shoulder joint and the hard protective shelf above it called your acromion process. By externally rotating your shoulder during overhead movements, you maintain more space between these structures, which decreases the pinching of the soft tissues in this space.  That pinching is often called “impingement” and can be the cause of that all too common non-traumatic shoulder pain.
   
2. This creates a more stable shoulder. The external rotation will take out the slack of the connective tissue at the joint capsule increasing the static stability. The external rotation of the humerus (long bone of the arm) also facilitates an improved socket position by aiding in upward rotation of the scapula (shoulder blade). This also improves stability by creating boney shelf for the ball of the socket to rest on when pressing or sustaining loads above shoulder height.

By externally rotating your shoulder during overhead movements, you maintain more space between these structures, which decreases the pinching of the soft tissues in this space.

This concept is much easier to learn and apply when dealing with “open chain” exercises. These exercises allow your hands to move freely and independently so the applied rotational force will cause rotation of the shoulders and of your hands, which is easier to see and feel. For instance, a vertical press with dumbbells will be easier than with the barbell.

These shoulder rules sound pretty easy to follow, but they are often very challenging if you lack mobility and/or control, or if you throw fatigue and heavy loads into the picture. You can probably think of a movement or exercise to which this may not apply, but for most strength and body weight movements these two rules will keep you safe, help you break through plateaus, and likely decrease pain. Remember that retooling a movement may result in a temporary decrease in performance, but in the long run performing movements the right way will always get you closer to your genetic potential.