Team Doctors, Treatment and Training Center

Muscle & Fitness - June 1989

Don't Shrug off that Shoulder Pain

by James Stoxen, D.C.

with Bill Dobbins

     As team chiropractor for the American Powerlifing Federation, I've had the Opportunity to treat a large number of Elite-level athletes. I have not only seen champion bodybuilders, but also a number of other people who do weight training as part of an overall conditioning program.

     I have found that injuries to the shoulder joint are all too common with these people, and that a large proportion of these injuries could have and should have been avoided.

     The shoulder is die most mobile joint in the body. It allows the arm to move through a virtual 360-degree rotation. By being so mobile, it is also vulnerable to injury. The shoulder is a very loosely packed joint. The head of the humerus (upper arm bone) articulates upon a shallow, concave surface and is held in place and supported by the rotator cuff mechanism, glenoid labrum, shoulder capsule and several ligaments.

     For people lifting weights, the shoulder is probably the most abused joint in the body. You put stress on the shoulder training chest and back as well as during your shoulder routine. Moreover the shoulder joint is involved in many arm training exercises as well.

     Most lifters don't realize it, but you can even hurt your shoulder joint by training your legs. I see it all the time. For example, doing squats, lifters support the weight of the bar across the back of the shoulder girdle. As they strain to come up from the bottom position, many lifters will press forward and upward with the shoulders in an attempt to help move the weight. But as the shoulders press forward, the head of the humerus is jamrned forward into the anterior (front) capsule, stretching it so that the head of the humerus can become subluxated (moved forward out of position) into the pocket created by the stretching procedure.

     Sometimes a lifter who has subluxated his shoulder like this will go to the bench press, where he'll feel pain in be anterior part of the shoulder and assume that the discomfort is coming from the stress of benching or from using an improper benching technique. Of course, sometimes the injury is caused by benching, but in my experience it is often a result of something that happened during the squat, and the lifter can be fooled.

     When a lifter comes into my office with this kind of complaint, I can make an adjustment to the shoulder joint by redirecting the head of the humerus within the confines of the shoulder capsule, which will help to restore proper motion to the joint. But this is only a temporary resolution of the problem unless I can determine what caused die injury in the first place and I'll then tell the lifter how to avoid making the same mistakes in the future.

     Out of all the possible ways a joint as vulnerable as the shoulder can be injured, only a few cause the vast majority of shoulder injuries I see. One major cause, and a factor that often underlies shoulder injuries apparently resulting from other factors, is imbalanced development of the entire shoulder girdle.

     The shoulder is surrounded by muscles that pull it in different directions. For example, the pectoral in the front, and muscles such as the lats, traps and rhomboids in the back. In addition, there are the primary movers of the shoulder itself - the anterior, medical (side) and posterior (rear) deltoid muscles. Finally, the shoulder stabilizers, such as the muscles of the rotator cuff, or the SITS group - supraspinatus, infraspinatus, teres minor and subscapularus.

     All of these muscles have to be strengthened and developed in just the proper proportion. When too great an imbalance is created, the stronger muscles overpower the weaker ones and a shoulder injury is likely to occur. For example, powerlifters do a lot of bench pressing, which works the pectoral muscles and the anterior deltoids. But they frequently do little to develop and strengthen the rear delts, the rhomboids, the upper and middle trapezius or the external rotators of the rotator cuff, the infraspinatus and teres minor.

     This over development at the front tends to draw the shoulder girdle forward, rolling it over on top of the thoracic cavity, making breathing more difficult, and pull the internal structure of the shoulder joint itself out of line. Bodybuilders will often spend a lot of time and energy doing bench presses, dumbbell presses and incline presses during their chest workouts, and shoulder presses, dumbbell

 presses and laterals during their delt training, but will spend very little time and energy on basic exercises to develop the posterior structures needed to balance off their anterior development. In other words, they'll do a quick three or four sets of bent-over laterals and let it go at that.

     Bent-over laterals hit precisely the areas of the shoulder that are need to balance off the forces that tend to pull the shoulder girdle forward and out of line. Bent-over barbell rows and other rowing exercise are also useful in this regard, but too many lifters and bodybuilders do them incorrectly. If you look around the gym you'll frequently see individuals rowing mostly with their arms and lower backs. They'll bend forward from the waist so that the initial movement of the weight is done by the lower back, then they'll bring their shoulders back only about halfway and do the rest of the lift using their biceps.

     For some, rowing movements are their best biceps training. Instead, rowing has to be done with as little involvement of the lower back and arms as possible. You should extend your arms forward until the lats are stretched out, but guard against collapsing the lower back forward. On the way back up, the movement should involve a "shrug" of the back, not a pull with the arms. The scapula or wing bone should be drawn back and in toward the spine so that the shoulders are as close together in back as possible.

     Of course, if you lift too heavy you won't be able to perform this movement
 correctly. And lifting too heavy, as anyone who has spent any time around a
 gym knows, is one of the most frequent mistakes you'll see. Heavy lifting is
 also associated with another type of common shoulder problem, the traumatic
 injury.

     Traumatic injury occurs when the joint, muscles or tendons involved are subjected to a sudden jolt or strain that is beyond what they can handle.

 Lifting too heavy can be a cause of this, as can sloppy and improper technique, or both in combination. If you drop the weight too quickly, try to jerk it up from the bottom, lose control of the weight or the rhythm of the lift, traumatic injuries are all too likely to occur. Sometimes, however, injuries come not from one single traumatic event, but from long periods of overuse or over training. Just plain old wear-and-tear, an accumulation of micro-trauma that gradually builds up until it results in a problem such a tendinitis, bursitis or, if left untreated, the formation of calcium deposits.

     Overuse of a given area can be a problem even when the lifter or bodybuilders is not systemically overtrained, since, as we've seen, the shoulder joint is involved in practically all upper body movements. And this condition is accelerated when there are problems with training technique as well. In other words, training incorrectly or using sloppy technique, jerking the weight around instead of working toward a smooth extension and contraction of the muscles involved, all contribute toward wearing the body out more quickly. Of course, some exercises put more stress on the body, and hence contribute to accelerate wear-and-tear, to a greater degree than others. So one common contributor to injury, especially to the shoulder joint, is training in a disadvantageous position.

     Actually, when you think about it, a lot of shoulder exercises involve somewhat "unnatural" movements. How often in real life, as an example, do human beings find it necessary to lift heavy weights straight up overhead? And since this lifting involves what we've determined is a very unstable and vulnerable joint in the first place, the potential for problems is obvious quite high. But there are some exercises involving shoulders that put the joint at even greater risk.

 For example, when you do behind-the-neck barbell presses, the shoulder is forced into a position of extreme outward rotation and full abduction. Working the shoulder in this highly disadvantageous position exaggerates the potential for injury. Of course, there are some individuals whose physical structure allows them to do heavy behind-neck-presses year after year without suffering any harm.

     But because the potential for both traumatic injury and wear-and-tear is increased, a good many lifters and bodybuilders may eventually find themselves needing to switch to some other form of shoulder exercise. And because of the potential danger involved in a behind-the-neck pressing movement, anyone performing it should do so with great caution.

     For many lifters, simply using a barbell for shoulder training involves too great a degree of disadvantageous position. Barbells lock the hands into a set position and do not allow for full freedom of movement of the elbow and shoulder joints. Doing bench, incline and shoulder presses with dumbbells, on the other hand, frees the joints to move in the most natural manner. So for many lifters, dumbbell training is not only a way of preventing shoulder problems, but a means of continuing to work the affected areas without pain or discomfort after an injury as been incurred. As the old saying involving an ounce of prevention vs. an ounce of cure teaches us, it's a lot easier to take steps to keep an injury from happening than it is to treat a problem once it has occurred.

     And a significant step toward preventing chronic and debilitating injuries is to take minor problems seriously. If you develop pain, if you pull a muscle, if you start to suffer from tendinitis, bursitis or a joint sprain, your body is trying to tell you that there is something wrong. You're training in some way incorrectly, overdoing it or subjecting your body to a stress that is uncovering some basic weakness in your physical makeup. Rest is important whenever an injury occurs. If you're hurting, stop whatever is causing the pain. But if you're a serious lifter or bodybuilder, you can't let it go at that. You need to seek treatment as well. The worst thing you can say, and the phrase that helps keep so many chiropractors, orthopedists and a variety of sports medicine practitioners in business is: "Maybe it'll go away by itself." It might, but it'll be back later on, and a lot worse.

For questions and comments, Dr. Stoxen can be reached TeamDoctors Treatment Center 6432 S. Pulaski, Chicago, IL. 60629 (773) 735 5200