The “Missing Link” in your Shoulder Workouts

Your story may look something like this…

You’re killing it in the gym, day after day.  You are crushing WODs like no one’s business, getting tons of Olympic lifts and pull/push work in on the daily.  But you feel something is missing.  You are beginning to have aches in your shoulder you have never really had before.  You attribute it to “getting older” or soreness from the last workout pull-ups and burpees, two exercises that didn’t used to hurt.  Week after week, you can’t seem to shake the discomfort.  The sensation of pulling, and sometimes pain, that is now present in the side of your shoulder can no longer be ignored.  It is starting to affect your gains, and you can’t have that.  How can you be having shoulder problems?  After all, you’ve been pushing big numbers in the gym for a long time.  You’re not fragile, so what gives?

Chances are you are experiencing subacromial impingement syndrome, or SIS. Pain or discomfort is usually felt in the outside of the shoulder.  This typically occurs in the presence of increased upper trapezius activation during overhead lifting, increased tightness in the pecs, lats, and upper trap (see: upper cross syndrome), and decreased strength and motor control of the periscapular musculature (see: scapular force couple).  This triad of dysfunction creates a literal guillotine effect on the structures in the subacromial space, which houses the bursa and the tendon of the rotator cuff (supraspinatus).  Over time, this can lead to bursitis, rotator cuff tendonitis, or worse, rotator cuff tears.


SHOULDER IMPINGEMENT

One of the pioneers in the treatment of shoulder impingement, retired orthopedic surgeon Dr. Richard Hawkins, explains in detail the pathoanatomical characteristics of SIS.  Dr. Hawkins also goes into the importance of non-operative interventions like exercise.

 


UPPER CROSS SYNDROME

One common problem that contributes to SIS, is Upper Cross Syndrome (UCS). UCS describes a position of poor thoracic spine mobility, tightness in the pectoralis major/minor and latissimus dorsi, weakness in the muscles around the scapula.  This leads to poor overhead mobility, secondary to decreased tissue mobility in allowing smooth and fluid movement.  Correct this and you’ll not only feel better in your shoulders, but also in life as you will have more mobility and freedom of movement.

uppercrosssyndrome
Notice the tight/strong pectoralis and UT musculature, and the weak LT.  The chronic, poor posturing related to UCS can lead to inhibited scapular force couple, leading to SIS.

 


SCAPULAR FORCE COUPLE

Another common problem that leads to shoulder pain is poor scapulohumeral rhythm, or scapular force couple activation.  The ability of the upper trapezius (UT), serratus anterior (SA), and lower trapezius (LT) to work in concert with each other when lifting your arm overhead is termed the scapular force couple. When there is a huge difference in strength between these muscle groups it can cause decreased posterior tipping and upward rotation of the scapula, thus closing off the subacromial space and leading to impingement.  The typical culprit is two-fold: hypertonic/over active UT, and weak/deconditioned SA/LT.  Upward rotation and posterior tipping is crucial in opening the subacromial space and taking stress off of the structures within.

scapularforcecouple2
When working efficiently, UT/SA/LT work in unison to create upward rotation and posterior tipping of the scapula, clearing the subacromial space.

 


The Missing Links in your shoulder workout

Below, you will find keys to preventing and decreasing shoulder pain, improve mobility, and have you well on your way to Becoming a Better Human:

In these videos, you will find unconventional tips and tricks I use for my patients experiencing shoulder pain. Enjoy!

 


Basic Upper Cross Syndrome Mobility:

Extensions over the foam roller

Directions:

  1. Start by laying down perpendicular to the foam roller, placing the bottom of your shoulder blades against the roller.
  2. Clasp your hands behind your head, and draw your elbows inward.
  3. Lift your bottom, taking note not to overextend the lumbar spine (low back)
  4. Extend your back, taking your head to the floor.
  5. Slowly lower your buttocks.

Targets: Hypomobility/stiffness of the thoracic spine

 


Child’s Pose Lat Stretch

Directions:

  1. Get into Child’s Pose position, and put the hand of the side you’d like to stretch on top of a foam roller or plinth, turning palm up.
  2. Place opposite side’s hand on top, and clasp hands.
  3. Sit back into Child’s Pose (buttocks to heels).
  4. Lean your trunk to the side you’re trying to stretch, until tension is felt in the flank.

Targets: Tightness of the latissimus dorsi

 


Scorpion Pec Stretch

Directions:

  1. Lay face down, with a foam roller or plinth angled 45 degrees towards you (see video) above the shoulder of the side you’d like to stretch
  2. Place your forearm on the plinth/roller.
  3. Use the opposite arm to push you into thoracic rotation, adding stretch to the arm on the roller.  You should feel a stretch in your chest.  Stop, or change the angle of stretch, if you have pain.
  4. Continue to rotate the spine and kick the opposite side leg over, to gain spinal rotation and a deeper stretch.
  5. Repeat on the other side.

Targets: Hypomobility/stiffness of the thoracic spine, hip flexor tightness, pectoralis tightness

 


Scapular Force Couple Series:

Child’s Pose Lower Trap Drill

Directions:

  1. Get into Child’s Pose, extending the thoracic spine.
  2. Place forearms on the ground, with hands above head.
  3. Externally rotate one shoulder, with focus on posterior tipping of the shoulder blade. Careful not to perform a biceps curl, which is a common mistake.

Targets: Poor lower trapezius muscle strength/activation

 


Supine Y with Resistance Band

Directions:

  1. Lay on the ground (or foam roller as in video), and push your low back into the ground (posterior pelvic tilt)
  2. Using a resistance band around your wrists, externally rotate your arms, keeping elbows by your side.
  3. Without losing tension, perform a press, then perform a serratus punch (see video), extending hands as far away from body as possible.
  4. Keeping hands as far away from body, go into “Y” Position, without losing tension on the band throughout movement.
  5. Return to beginning position by reversing the sequence of movements.

Targets: Poor scapulohumeral rhythm and scapular force couple activation.

 


Scap Roll-Ups (with Medicine Ball)

Directions:

  1. Place a ball or foam roller (medicine ball used in video) on the wall, placing your wrists on the object, with thumbs facing you.
  2. Push your forearms into the ball, creating tension.
  3. Roll the ball up the wall, without losing tension into the ball.
  4. Attempt to reach fully above head. Caution not to lose stability in the spine (do not hyperextend during the movement).
  5. Return to starting position in a controlled manner.

Targets: Poor scapulohumeral rhythm and scapular force couple activation.

 


Extra:

Quadruped Scap Lift-off

Directions:

  1. Assume the quadruped (all fours) position. Perform a scap push-up (push chest away from the ground, with arms extended)
  2. Turn one hand over, and slide it forward as far as possible, without losing your neutral spine.
  3. Reach arm as far away from your body as possible, then lift up (palm side up) to the sky.  Attempt to not “shrug” as you raise arm.  Think of this as “scooping” your shoulder blade backwards to perform the motion.
  4. Return to the floor. Repeat on both sides.

Targets: Poor scapulohumeral rhythm and scapular force couple activation.

 


You’re encouraged to leave questions and comments below.  Thank you, we hope you enjoyed the interventions outlined in this article, in your quest to #BecomeABetterHuman!

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