Shoulder Pain: Taken Out by the Bum Wing

 

Shoulder injuries happen, but you there's plenty you can do to prevent and fix them. 

Dave Lipson February 07, 2013

 So you hurt your shoulder again! Congratulations, bro or brosephina. You obviously didn’t pay heed to the warnings the first time this happened. It must have been that last dicey muscle up or thruster or overhead squat that did it. Don’t worry. You’re not alone and your training career is not over. This article will discuss the major reason why these injuries happen so often and what you can do as an athlete and coach to prevent and fix them!

Why Me?

Well you have obviously overloaded the old ball-in-socket joint again. Most likely you had a previous mobility or stability issue in the joint. Gymnastics and weightlifting require mobile, supple and stable shoulder girdles. Any lack of these components under load will result in a compromised and exposed position of the glenohumeral joint. Some common symptoms and telltale signs of this are:

• Shoulders that appear slouched forward
• Overdeveloped traps that pull the scapula and especially the rhomboids out of retraction
• Pain that runs down the biceps tendon, indicating the head of the humerus is not a in a neutral position
• Slap tears on the labrum, resulting in a squishy loose feeling and instable joint
• General internal rotation deficiency

Are Your Shoulders Tight?

Shoulder mobility is an essential component of good human movement and effective training programs. If we are training the upper body to pull and push in multiple planes through a full range of motion, shoulder mobility is a foundational need. Too many times I have walked into CrossFit gyms and watched tight shoulders muscle through a compromised range of motion. There are lots of unstable spinal positions and open rib cages working in an effort to steal movement for tight shoulders, lots of pressing in front of the head and grinding kipping pull-ups. For many people, it is not a matter of if but rather when they will injure their shoulders.

Before we start adding load and intensity to those overhead exercises, let’s look at the ability to stabilize the spine while opening the shoulder in an overhead support known as the active shoulder position.

What Is Active Shoulder Support?

Active shoulder refers to a position of the body in which the bones of the upper extremities stack up evenly and on each other in neutral joint position to provide a structural support overhead, while the midline (spine) of the body stays braced and locked down by the rib cage. It is indicated by the following:

• Elbows locked out, shoulders shrugged up and scapula retracted (not winging)
• Actively and continually applying pressure upward
• Braced belly with a closed rib cage
• Shoulder angle open with arms directly above the mid-foot, bisecting the hip and knee in the frontal plane

Self Shoulder Assessment #1

Preparation: Raise one arm, bend elbow and reach down across back, with palm facing upper back. Position opposite arm down behind back and reach up across back with back of hand against back.

Execution: With fingers extended, try to cross fingers, upper hand over lower hand. Repeat with arms in opposite position.

Measurement: Measure distance from fingertip to fingertip. If fingers overlap, score it as a plus. If fingers fail to meet, score as a minus.

Rating	Men		Women
	Right Up	Left Up	Right Up	Left Up
Excellent	>5 in. (12 cm.)	>4 in. (9 cm.)	>6 in. (14 cm.)	>5 in. (12 cm.)
Good	1-4 in. (1-11 cm.)	1-3 in. (1-8 cm.)	2-5 in. (4-13 cm.)	2-4 in. (4-11 cm.)
Fair	0 in.	0 in.	1 in. (3 cm.)	1 in. (3 cm.)
Low	< 0 in.	< 0 in.	<1 in. (3 cm.)	<1 in. (3 cm.)

Self Shoulder Assessment #2

Preparation: Lie on the ground in a supine position (belly up) with a dowel grasped in an overhead position, hands slightly outside of shoulders.

Execution: Go into a hollow position (feet and shoulder blades off the ground 1-2’’) belly tight and rib cage closed, lumbar spine pressed into the ground. With arms locked out, maintain the hollow position and try to pull the bar back towards the ground.

Measurement: Measure the distance from the ground to the dowel in inches.

Scoring:

• Bar on ground = excellent
• 1-2 inches = good
• 3-4 inches = fair
• 5+ inches  = poor

Where To Go From Here?

So the point here isn’t to make anyone feel bad or inadequate. Tight shoulders doesn’t make you a bad person, a bad CrossFitter or un-fit. We just want you to have long, fruitful and injury free careers in CrossFit and in life, as well as allow you reach your highest athletic potential. Next, we will get into some methods to work on and maintain good shoulder mobility stability in our shoulder buffet bonanza.

Shoulder Mobility/Stability Buffet:

Banded Shoulder Distraction

Place a superband on a rack 2 inches above your head, face into the rack and hold the band supported on the back of the wrist. Go into a lunge position and allow the band to pull your arm up and forward, palm up to the sky. Drive your chest toward your knee.

Lacrosse Ball Posterior Capsule Release

Lie supine on your back, a lacrosse ball on the back of your shoulder. Roll over onto the ball and work it into the back of the shoulder.

Lacrosse Ball Sub-Scap Release

Lie supine with the ball along the edge of the shoulder blade proximal to the spine. Take straight arm, thumb down, to the opposite hip and move it diagonally across the body to an overhead position, thumb into ground. Perform five reps slowly, then adjust the ball up the edge of the scapula and rinse and repeat in three different positions.

Partner Posterior Cuff Stretch

Lie supine with knees bent and the soles of your feet on the ground. Go into a hip bridge — hips high, femur congruent with torso angle — and place the back of the hands on the lower back. Have a partner hold your shoulders down while you slowly lower your hips to the ground. Rinse and repeat.

Kneeling Shoulder Stretch

Go on your knees facing 24-inch plyobox set 3 feet away from you. Place your palms on the box and drive your chest down, brace your abdomen and relax, straightening arms.

Reach, Roll, Lift

Lie in a prone position, facedown, and make a fist, placing the thumb of that hand on your forehead. With the opposite arm, reach and pull the arm overhead out of retraction, crawling with fingertips. When you can’t go any further, turn your thumb up and lift your arm for one second. Rinse and repeat on both arms.

Shoulder Retraction

Go to a plank on your elbows. Relax and sink deep into shoulder retraction as you let your scapula pinch down and back; the shoulder blades will touch each other. Then press up through your elbows, going deep into protraction as you work into a hollow position. Repeat for 10 reps. For another variation, hang from a pull-up bar.

Internal/External Shoulder Rotation

Sit on the ground with one knee crossed over the opposite leg. Grab a 3- to 15-pound dumbbell and place the same elbow on the knee that is up. With your arm at 90 degrees, shoulders pinched down and back, slowly internally rotate the arm, bringing the hand toward the ground and keeping the scapula pinched back, then externally rotate the arm back up. Repeat for 10 reps.

Bent-Over Ys, Ts and Ws

Grab a 3- to 15-pound set of dumbbells. Bend over to 45 degrees, keeping your back flat.

Y: With thumbs up and straight arms, raise weights to a Y shape at head height.

T: With arms at side and thumbs up, raise weights in a T to shoulder height.

W: With bent arms, drive the back of the hand and elbow to shoulder height in a W shape.

Do two sets of eight reps of each movement.

Test and Retest

Test and acess your shoulder mobility. These stretches and exercises are great preparation for overhead or upper-body intensive workouts. They’re also great ways to cool down and make substantial gains postworkout, when the tissues and tendons are hot and malleable. I would encourage you to test your mobility, go through some mobility work and then test again to assess which protocols work best for you.