Shoulder Exercises: Injury & Pain Prevention

Sports fitness & injury chiropractor, Dr. Alexander Jimenez suggests additional exercises that will assist you avoid shoulder pain.

The functional anatomy of the shoulder an the way the weakness at the rotator cuff and an inability of the scapula to stabilize the shoulder are the significant contributors to shoulder impingement injuries. Three important exercises for strengthening the rotator cuff and approaches to boost scapula stabilization. This article provides more exercise suggestions and provides further practical tips to help athletes prevent shoulder pain.

1. Balance Your Upper-Body Workouts

A good way to prevent shoulder injuries is to ensure that your upper-body strength sessions are more balanced. This means that every push or press exercise must be balanced using a pull or row exercise. Too many athletes and weight trainers focus on creating the 'mirror muscles', the upper trapezius, anterior deltoid and pectorals. As a result, the 'non mirror- muscles', lower trapezius, rhomboids, latissimus dorsi and rear deltoid, are underdeveloped. This also contributes to a muscle imbalance in the shoulder, which results in poor scapular stabilization because the non-mirror muscles are those that function to stabilize the scapula. Moreover, over developed mirror muscles may lead to some round-shouldered position, which wrongly places the scapula up and forward. Redressing this imbalance is quite vital for the prevention and rehabilitation of shoulder impingement injuries.

The following is a good illustration of a balanced upper-body workout which I would recommend.

Note the 1:1 ratio between push/press and pull/row exercises.

● Bench press (pectorals, anterior deltoid).

● Seated row (rhomboids, mid-trapezius, latissimus).

● Flies (pectorals).

● Rear lying prone flies (rhomboids, mid-trapezius, rear deltoid).

● Lat raises (anterior mid deltoid, upper trapezius).

● Lat pull downs wide grip (latissimus, lower trapezius).

For those who are more prone to shoulder pain or are recovering from a shoulder injury, then I would advise changing the ratio to 2:1 in favor of the non-mirror muscles. Remember, it is the push/press exercises which cause the problems, so you need to change your accent before the imbalances have been redressed. Additional pull/row exercises include: bent-over row, single-arm dumbbell rows, single-arm cable pulls, bent-over rear fly, pull-ups (wide or narrow), stiff-arm pull-downs with cable/flexaband.

2. Limit Your Range Of Movement, & Take It Easy

Rehabilitation from a shoulder impingement injury should focus on rotator-cuff strengthening. But it is important to remember that when it comes to re-introducing your own weight-training exercises, you must progress slowly. Frequently this implies avoiding specific ranges of movement where the shoulder joint sub-acromial space is compressed the most. The impingement zone to avoid is between 70 and 120 degrees of shoulder abduction (when you move the arm laterally away from the side of the body).

To start training the non-mirror muscles, start with the seated row, since the shoulder joint is not abducted in this workout. Once the pain is totally gone, then introduce the overhead exercises for example pull-ups and lat pull-downs. You ought to be even more careful when it comes to the mirror-muscle exercises. I'd avoid lateral raises, upright rows and shoulder presses completely for a while. But, incline bench press with arm abducted to 45 degrees are a great place to begin again. Slowly build up to the normal bench-press range as strength improves.

It is also crucial that you don't increase your weights too soon. Bear in mind that the tendons and ligaments need to accommodate to exercise as well as the muscles, and they may take longer to do so. I'd suggest staying in the 12-20 rep scope for a while before pushing up the weights, particularly with the mirror- muscle exercises. While I realize that it is important for many athletes to be powerful at exercises such as the seat and shoulder press, I would advise that you develop gradually to maximum advantage. Reducing your reps by two every 2 weeks is a fantastic guideline. During heavy workouts, ensure that you warm up the shoulder joint and rotator cuff thoroughly prior to lifting.

3. Correct Scapula Positioning When Performing Exercises

The appropriate position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a great 'military posture', together with shoulders back and chest out. A round- shouldered or hunched posture is to be avoided at all times.To achieve the right position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down.

When you do any upper-body weight-training exercise, always get into the habit of starting with good upper-body posture and pinching the shoulder blades together. You need to feel that the scapula is a good platform which keeps the shoulder properly positioned as you do the exercise. As mentioned by Dr Kemp, a fantastic way to learn the correct position is through the seated row exercise by keeping your scapula down and back while you move your arms. Throughout the exercise, you should believe that the rhomboids and trapezius muscles have been statically contracting to maintain the scapula set up, and the latissimus is working to carry out the movement. After you have the feel for maintained scapula stability during the seated row, try to achieve it during all upper-body exercises. What you may find is that exercises such as the press-up or front raise, in which the shoulder may become impinged, won't be painful if you stabilize your scapula correctly. In effect, by using the scapular muscles you can achieve better shoulder mechanisms and avoid injury.

Correct scapular stability is hard to learn and demands a lot of concentration and practice during your training sessions. First you need to understand what the correct position is, and frequently this needs a trainer/physio to guide you. Then, during training sessions, instruction and observation from a trainer can help you reach and maintain the right shoulder position.

4. Sports-Specific Exercises Plyometrics For The Shoulder

Just as rehabilitation training for leg injuries needs a functional progression from simply strength exercises to sports- specific exercises, so does rehab for your shoulder. This means that for the athlete, eg a thrower or tennis player, conventional resistance exercises at the gym might not be enough to allow a full return to competition. Often what is needed to bridge the gap would be plyometric exercises for the shoulder that mimic sports- specific movements. Plyometrics for the shoulder usually involve medicine balls of different weights.

Plyometric exercises have two advantages. First, they're performed fast, and second, they demand stretch-shortening- cycle movement patterns. This means that they are much more sports-specific than traditional resistance exercises. Specifically, plyometric exercises for the rear-shoulder and external rotator muscles are extremely useful since they provide eccentric training for these muscles. This enhances their ability to control the shoulder through the potent concentric actions of the pectorals and anterior deltoid involved in throwing or serving. Thus it's important to ensure that your plyometric workouts are balanced between the prime movers (pectorals, latissimus, anterior deltoid) as well as also the rear-shoulder and upper-back muscles. I would recommend incorporating shoulder plyometrics through general conditioning exercises to prevent injuries and in the later phases of shoulder rehab to guarantee a functional progression back to competition.

Here are two suggestions. The key to both these exercises is that the medicine ball is caught, the impact quickly absorbed (fast eccentric phase) and then thrown back explosively (powerful concentric phase).

a. Power drops (pectorals, anterior deltoids). This exercise is like a plyometric bench press, using a medicine ball instead of a barbell.

Lie on your back, legs bent and lower-back flat down. Partner stands above your head and drops ball (3-6kg). You catch ball with straight arms and then quickly let the ball drop to your chest, flexing your arms, and then immediately throw the ball back, powerfully extending your arms. Make sure you keep your back flat down, concentrating your effort on your arms only. Perform sets of 8-12 reps.

b. Catch and throw backhands (external rotators). This exercise is a plyometric version of the external rotator exercise, and is similar to a backhand shot in tennis.

Stand with your feet shoulder-width apart, with a stable base and good posture. Bend your arm to 90 degrees and tuck your elbow into your side. Keeping your trunk facing forward, rotate your arm out ready to catch. Your partner stands to your right and throws a small ball (1kg) to your hand. You catch it, then quickly take the ball back across your body, rotating your arm inwards, and then immediately throw the ball back, powerfully rotating your arm out.

Make sure you don’t use your trunk, and keep your elbow tucked into your side at all times, concentrating the effort on your rear shoulder and external rotator muscles. Repeat for the left side. Perform sets of 12-20 reps.