Whereas the prevention of knee and ankle injuries seem to be the focus of many strength and conditioning programs, injuries to the shoulders should be ranked in any Top 10 list of sports injuries. Further, our increasingly sedentary lifestyle has made shoulder injuries much more common to the general population than it has in the past. That said, what can be done about it?
Before answering that question, consider that the extreme mobility of the shoulder joint makes it especially susceptible to injury. Strains and sprains can develop from performing ballistic movements such as throwing a football or hitting a tennis serve, and then there is the risk of dislocations from participating in sports that involve collisions, such as hockey, football, and even soccer. Add to this list shoulder impingement, rotator cuff tendinitis, osteoarthritis – well, you get the idea.
Although there is no workout that can guarantee that you will never have a shoulder injury, there are ways to reduce the risk of injury and to accelerate the healing process if you do get hurt. Let’s look at three.
1. Rethink the bench press. Iron Game athletes love the bench press! If you lift weights, and if you’re a male, you probably do bench presses. And if you’re an athlete, there is also a good chance that you do too much bench pressing and are not training it in such as way as to minimize the risk of injury.
As a bit of history, consider that one of the factors that set Arnold Schwarzenegger’s physique apart from his competition was his chest development. Despite his relatively long arms, Arnold could bench press 500 pounds for one rep (according to his one-time training partner Mike Dayton) and claims to have done 405 for 8 reps and 225 pounds for 60 reps! The record for the NFL Combine for 225 pounds is 51 reps. As for absolute numbers, several men have bench pressed over 700 pounds “raw” (i.e., without special supportive gear such as a bench press shirt) and over 1,000 pounds with supportive gear; one woman has bench press 600 pounds!
Although the bench press is blamed for many shoulder injuries, consider that those with good technique and sound training programs are less likely to get hurt. As proof, an extensive study of 245 elite powerlifters (representing 97 teams) was published in the September 2011 International Journal of Sports Medicine. Yes, the shoulders were the primary body part reported injured, but the rate of injuries was only .3 injuries per lift per year, so one injury per 1,000 hours of training.
To minimize the risk of injuries from performing the bench press, avoid using a wide grip as this places the most stress on the shoulders. The grip that places the least amount of stress on the joints is called bi-acromial width, which is the distance between the two bony prominences on the edges of the shoulders. Going a step further, take a break from regular bench presses by performing presses with a neutral grip (palms facing each other), which places the least amount of stress on the shoulders. Also consider occasionally performing bench presses on a decline or incline bench to change the angle of stress, and using dumbbells.
2. Strive for structural balance. The concept of structural balance suggests that there are ideal strength ratios among muscle groups. If one muscle group is relatively weak, this can lead to poor biomechanics and increased stress on the muscles, connective tissues, and joints. For example, if the strength of your pectorals is relatively stronger than the muscles that externally rotate the upper arm bones (teres minor and infraspinatus), this can cause pain in the upper arm (superior anterior portion).
One clue that there are structural imbalances in the upper body is a posture characterized by round shoulders (thus, an exaggerated curvature of the upper spine) and a head that is positioned excessively forward. Wrestlers, swimmers, boxers, and powerlifters often display this type of posture as their sports emphasize the development of the latissimus dorsi, an upper back muscle that internally rotates the upper arm bones, and the pectorals.
In addition to stretching, a structural balance program to correct postural imbalances of the upper body such as forward head/round shoulders should include exercises for not only the teres minor and infraspinatus, but also the serratus anterior, rhomboids, mid-trapezius, lower trapezius, and deep cervical flexors. Physical therapists, chiropractors, and personal trainers who have studied structural balance are a good resource to help you determine which of these muscles need special attention and how to perform the appropriate exercises for them.
3. Get some soft tissue work. Despite our best efforts, often adhesions form that can affect natural movements and lead to injury. Fortunately, there are many types of soft tissue treatment to deal with adhesions.
The FAT-Tool (Fascial Abrasion Technique™ Tool) and the more aggressive Graston Technique® use tools that slide over muscles to treat adhesions. However, the soft tissue therapy that has become the “go to” treatment of choice is ART, developed by Dr. Michael Leahy. ART is an acronym for Active Release Techniques™ Treatment, and this method has been shown to be especially effective in treating alterations in muscle tension and texture.
Two other types of treatment used to deal with soft tissue injuries are frequency specific microcurrent, which uses electrical current to restore natural functioning of injured areas, and the more popular dry needling. Dry needling, which is based on the neurophysiology of trigger points, applies electricity through needles to increase microcirculation and treat muscle spasms.
Finally, many athletes have found Kinesio® Tape, along with other similar products, useful in the rehabilitation of shoulder injuries. This is a special tape that is placed on the skin to help stabilize the joints and muscle tissues, provide pain relief, and may help decrease inflammation. With a little practice, athletes can tape most of their body parts themselves.
The shoulders may be considered a weak link in athletic and physical fitness training because they can be easily injured, but if you apply these suggestions you will significantly reduce your risks. As Iron Game athletes often say, “Train with brain, not pain!”