Training Around Shoulder Pain

Shoulder injuries are extremely common in sports and can be debilitating for any athlete. They are common for a couple reasons. Firstly, there is an awful lot going on in the shoulder joint. The articulations between the scapula (shoulder blade), proximal head of the humerus (upper arm), and clavicle (collar bone), are rather complex. With many ligaments, tendons, and supporting muscles interacting within the shoulder joint, there are plenty of opportunities for something to go wrong. Secondly, the shoulder joint is a pretty unstable joint, resulting in sublaxation, or dislocation commonly occurring in sports and athletics.

You may have heard of someone injuring their ‘rotator cuff’, or rotator cuff muscles, which is quite common.

The job of the rotator cuff muscles is to stabilize the humeral head, while allowing for a high degree of movement. However, there is a payoff for this increased range of motion (ROM) – greater instability of the shoulder joint.

Greater ROM = greater instability and increased likelihood of injuries.

I won’t delve too deeply into all the different kinds of injuries involving the shoulder joint/girdle because there are enough to fill a textbook. Here are a few of the more prevalent ones: inflammation occurring at a number of sites, impingement is a major problem due to small gaps, articulations, and an archway in the shoulder in which one of the rotator cuff muscles passes through. Various problems can arise relating to the smaller articulations within the shoulder such as the acromioclavicular joint (fairly common), or the coracoclavicular ligament.

Many of the exercise modifications I mention below will work on positioning the shoulder in a way that reduces pain from various sources by placing the shoulder in an optimal position for loaded movement.

Of course there are times when you should completely lay off your shoulder for a number of weeks or even months depending on the injury. Many of these modifications will be helpful for less severe injuries, or for rehab work post surgery. Use your judgement and stop doing a certain exercise if you experience pain or great discomfort.

I should add that performing these exercises is also introducing the concept of ‘pre-hab’, where one is taking preventative measures by performing safe exercises in hopes of avoiding injuries altogether. So these exercises/modifications can be used to avoid shoulder injury, as well as to come back from a shoulder injury in a rehabilitative way.

A full pre-hab program will be far more extensive and is an extremely expansive topic in itself, but without further ado, here are some alternatives that will help you out:

Modifications

1.  Lose the barbell/straight bar and switch to dumbbells. Dumbbells allow for a more balanced and natural movement of weight, engaging supporting muscles. You won’t be able to lift as much using dumbbells, but remember, we’re aiming for precautionary measures/rehab work, not trying to set a new PR (personal record). If you are finding it difficult to part ways with the barbell, simply substitute dumbbells instead once every three workouts.

2.  Switch to a neutral grip for presses. A neutral grip can be used with dumbbells, or if your gym has a barbell that allows for neutral grip, that can also be used.  Applying a neutral grip simply means your palms are facing each other. Try to keep your elbows tucked in when using this grip.

This grip allows for greater sub-acromial space. This is the space beneath your acromion process (end tip of your shoulder), creating the arch I mentioned. When this space is reduced, the tendon that runs through it becomes impinged. A neutral grip helps maintain this space, thus avoiding pinching of the tendon, allowing you to lift pain-free.

You will also find a supinated grip, or underhand grip to be very ‘shoulder friendly’. It is also referred to as a ‘reverse grip’.

Here’s a video of Ben Bruno starting his press with a supinated grip and then transitioning to neutral grip.

3. Decrease your ROM.  By decreasing the range of movement for a given exercise, particularly pressing movements, you are decreasing your chances of putting your shoulder in a contraindicated position. For example, if you are benching, try not to come down as far during the lowering, or eccentric phase.

4. Try the floor press (with dumbbells or “bottoms up kettlebells”)

Floor press simply means lying down on the floor, as opposed to on a bench. This limits how far you can lower your arm in the downward phase, and along with using the ‘neutral grip’ is a pretty safe exercise for your shoulders.

The bottoms up kettlebell press is great because it requires a whole lot of stabilizing due to the weight distribution of the kettlebell. Your intrinsic shoulder stabilizers (i.e. rotator cuff muscles) will be powering away and getting stronger.

5. Use a narrower grip. A narrower grip will open up areas where impingement is likely to occur (sub-acromial space).  Narrow your grip when using barbells, and simply bring the weights closer together when using dumbbells. Remember: keep elbows tucked, no flaring!)

6. Switch your squatting style – Change to a front squat, rather than back squat. Back squats require a fair amount of shoulder mobility and can cause discomfort in athletes with already existing shoulder pain/discomfort.

Should I overhead press with a shoulder injury?

Many people would simply omit overhead pressing from their training if they experience any shoulder problems; however, this doesn’t have to be the case. Try it out and if it hurts, then don’t do it. You may find overhead presses to be ok, but a simple task such as taking one hand and touching the opposite shoulder may be painful – it all comes down to the specific injury within the shoulder, so experiment a little.

Just because you have an injury doesn’t mean you have to stop exercising, or even stop utilizing a certain body part. You’ll find that using certain tricks or tweaking of movements is all it takes to work around injuries.

Ways to go about injuries

-Some individuals will train through injuries, resulting in a worsening of their current situation and perhaps lifelong damage.

-Smart people will train around injuries  to maintain a lot of the strength, size, mobility, etc. despite an injury.

-Some injuries will require immobilization of a body part, or require the avoidance of any weight bearing activities. These tend to be more severe and can be very frustrating. The above modifications of exercises/equipment can be helpful in terms of getting back into the weightlifting game.

Wrap up

You need your shoulders to be healthy for life. You use them every day for pushing, lifting, reaching etc. Try implementing a few of the above techniques in your pressing routines to maintain healthy shoulders, or if you are coming back from a shoulder injury.

As always, if you have any questions or would like to comment, please leave them in the comments box below as I would love to hear from you!

Safe lifting,

Jeremy

Advertisements

Tags: , , , , , , , , ,

No comments yet.

Did you enjoy this post? Let me know what you think by leaving a question or comment below!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: