Monday, September 12, 2011

The Steps I Took To Improve My Shoulder Health

As some of you who follow my training log probably know, I had been having some left shoulder impingement (I know it is a garbage term, but it will suffice for this post) issues for a short while.  I believe the problem started when I had a nerve injury in my neck sometime last year.  The injury prevented me from lifting my left arm above 90 degrees and my scapula was very unstable - a tiny, five-pound weight caused me to wing if held at 90 degrees.
Ever since this injury, my left scapula has not been as stable, and I believe this has been a major cause for the impingement issues I was having.  Anyway, today, I want to discuss some of the steps I took to correct my problem as it may give you some ideas for any shoulder issues you and/or your clients may be suffering from.
Here are some of the things that I did:
1.  Worked on my soft-tissue quality.
My posterior shoulder (specifically, my teres minor, teres major, and infraspinatus) was all jacked up.  I believe this was largely due to faulty rowing mechanics (see below).
2.  Fixed my rowing mechanics.
I have written a couple of blogs on improper rowing mechanics because it is so common.  Many people are unable to retract their scapula properly.  In fact, I have found that rowing is one of the hardest things to coach.  There are many ways to perform the movement incorrectly, but the problems I was having were: slightly shrugging because of low trap weakness and hyperextending my humerus.

The shrugging is problematic because I was not balancing out my upper trap dominance. Hyperextending my humerus (continuing to extend my humerus after my shoulder blade had fully retracted) was overworking my posterior shoulder muscles and causing them to stiffen up (which is why I needed to improve my soft tissue in this area).  
3.  Improved my scapular upward rotation.
During upward rotation, the scapula should moves roughly 1 degree for every 2 degrees of humeral motion.  This is referred to as scapulohumeral rhythm.  Also, for roughly the first 30 degrees of humeral flexion/abduction, the scapula does not upwardly rotate.  If this rhythm is off, then you will most likely impinge.  Because my scapulo-humeral muscles were very stiff, as soon as I would flex/abduct my arm, my scapula would begin to upwardly rotate.  Therefore, I "ran out of room" when I would raise my arm overhead.  
So the first step in improving my upward rotation was step 1 mentioned above.  Once my tissue quality improved, I began incorporating drills to improve my scapulohumeral rhythm, such as forearm wall slides (see video below). 

4.  Improved my left thoracic rotation.
Thoracic rotation is an often overlooked aspect of shoulder health.  Since I was born missing half of my right arm, I am constantly reaching and rotating to my right.  Therefore, I have great right thoracic rotation, but the left was not optimal.  This caused my left scapula to sit in a poor position on my rib cage.  
5.  Strengthened my low trap.   
This was a big one for me, and one that I am still working on.  Once I fixed my rowing mechanics, my lower trap strength improved greatly because I was actually having to use it to counterbalance my upper trap from shrugging, while my rhomboids and middle trap retracted my scapula.

However, the biggest help with my low trap strength has been the KB Armbar.  The first time I tried the armbar my low trap was sore for days!  It was awesome!  If you have the necessary mobility and stability, then I definitely recommend this exercise!

5.  Added in rhythmic stabilization exercises for my rotator cuff.

I have said this many times before, but the main function of your rotator cuff is to stabilize your humeral head in the glenoid.  Therefore, it makes sense to train this function of it.  Many people are stuck doing banded and/or cable external and internal rotation exercises, which can be great, but are not the only ways to train the cuff.  Try adding these into your program.

If you do these, please get into a better spinal position than this guy!:)

My shoulder feels great today, and I cannot contribute it to any specific one of these areas mentioned above.  All of them were important in addressing my issue.  The shoulder is very complex, and very rarely will improving one quality fix a shoulder problem.  Your plan must attack multiple areas.

Have a great week everyone!! 

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