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Strength

Shoulder pain reduction using resistance training

Danny O'Dell explains the shoulder anatomy and suggests an appropriate training programme to possibly lower your risk of shoulder injury

Shoulder pain does not have to be the inevitable consequence of exercise, overuse, or old age. Applying a small dose of common sense will go a long way toward the proper care of the shoulder joint. This recommendation needs to be kept in mind for maintaining an injury and pain free shoulder complex. Constant hammering away at the bench and military press, consistently throwing overhand, and many of the popular swim strokes can slowly eat away at the integrity of the joint. An athlete who is not working on the stabilizing underlying musculature is travelling down a road fraught with dangerous repercussions.

The shoulder anatomy

A quick look at an anatomy and physiology book (Tortora et al. 2002)[1] will reveal an intricate and complex joint which comprises of three bones and the tendons of the attaching muscles. The shoulder joint has a tremendous range of motion but this comes at a price. Damage occurs due to overuse and to the fact that the shoulder is not a true ball and socket joint like the hip. The three bones in the shoulder complex are the Clavicle, Humerus and Scapula (the collarbone, upper arm and the shoulder blade). These three bones are held in place by four relatively small underlying muscles called the rotator cuff muscles. They are the Infraspinatus, Subscapularis, Supraspinatus, and Teres minor. Some literature refer to these as the 'SITS' muscles. These diminutive muscles surround the shoulder joint and hold the Humerus in the shallow socket of the Scapula. They activate at the beginning of every shoulder movement and, as one physical therapist described them, they are the steering wheel of the shoulders. Common injuries to the four relatively small rotator cuff muscles are relatively easy to avoid with a few simple precautions.

Function of the rotator cuff muscles - SITS

The Subscapularis rotates the arm inward, bringing the elbow forward when the arm is held at the side of the body. It also aids in adduction (toward the centerline of the body) when the arm is above the horizontal position.

Body action

  • Arm inward rotation
  • Arm extension
  • Arm hyperextension
  • Arm adduction

The Infraspinatus lateral rotates the humerus with the teres minor and stabilizes the head of the humerus within the shoulder joint.

Body action

  • Arm outward rotation
  • Arm horizontal abduction (away from the centerline of the body)
  • Arm abduction
  • Arm adduction

The Teres Minor laterally rotates, and slightly adducts and extends the humerus and stabilizes the humerus in the shoulder socket.

Body action

  • Arm outward rotation
  • Arm extension
  • Arm hyperextension
  • Arm adduction
  • Arm horizontal abduction

The Supraspinatus abducts the arm with the deltoids and holds the humerus in the shoulder socket.

Body action

  • Arm abduction

Preventive measures that may aid in injury resistance

Keep at the forefront of your mind the tendons (like all tendons) of most muscles receive very little in the way of nourishment and oxygen from the circulatory system. A limited supply of blood and oxygen translates to a long recovery period if they become injured. This recovery is even longer if you are an older athlete. Add in the daily living degenerative effects of becoming older plus the constant stresses of the aforementioned exercises and its no wonder the shoulder fails over time. In some cases it is not matter if, but when an injury will happen. Setting up and adhering to a properly designed strengthening and stretching (only the strengthening of the rotators is addressed here) program can lead to many years of near injury free living. Some words of advice: if it hurts, stop the exercise or lower the resistance. Listen to what your body is telling you. Pain does not lead to gain, but over time, it will lead to the surgical table. The rotator cuff muscles do not need heavy weights to grow stronger. They are SMALL muscles and can become easily damaged with excessive workout resistance loads.

Strengthening program

This article contains a number of exercises that are commonly used to keep the rotators strong and injury resistant. If you are planning to use elastic bands make certain the attachment points are solid and the knots are tied correctly. An elastic band retracts violently from its stretched position back to the relaxed status when it breaks. Imagine how a large rubber band would feel when it breaks and then snaps back at you. NONE of these exercises or movements requires the use of heavy weights e.g. one to five pounds is more than adequate to strengthen them. Begin each exercise at the high end of the repetition ranges to build up muscular endurance. Then do fewer repetitions with a bit more weight to increase their strength.

Equipment

Required equipment:

  • Cable cross over with high and low attachment points
  • Tubing or elastic bands
  • Dumbbells
  • Barbell and weights

The Exercises

Arm abduction - arms away from the body

  • Side raises with dumbbell
  • Tubing or elastic bands attached low
  • Tubing or elastic bands attached at shoulder level-external rotators
  • Tubing or elastic bands held at shoulder level-external rotators with straight arms

Arm adduction - arms toward the body

  • Cable cross over
  • Tubing or elastic high attachments
  • Tubing held high in both hands and pulled down level behind neck in a downward motion
  • Tubing or elastic bands attached at shoulder level-internal rotators
  • Tubing or elastic bands held at shoulder level - internal rotators with straight arms

Arm circumduction - rotate the arms in a wide circle

  • Tubing attached at shoulder height
  • Bicycle wheel on the wall
  • Bicycle wheel on the wall with brakes and steering knob

Arm extension - arms brought downward to the sides from over head

  • Beginning position is on the knees facing the gear
  • Tubing or elastic high attachments
  • High attachment cables
  • Supine with over head tubing attachment

Arm flexion - arms brought upward from the sides to overhead

  • Low cable attachment point
  • Low attachment tubing or band attachment
  • Supine with dumbbells

Horizontal abduction - moving the arms away from the front to the sides

  • Tubing attached at shoulder height Horizontal adduction - moving the arms from the sides to the front
  • Tubing attached at shoulder height

Arm hyperextension - move the arms backward from the front

  • Tubing attached low
  • Low cables
  • Prone with dumbbells

Exercise protocol

Be conservative in addressing the shoulder complex unless advised other wise by your doctor or physical therapist. These exercises DO NOT require heavy weights, so set your ego a side and do them the right way.

The schedule

Reference to "a muscle group" refers to the Infraspinatus, Subscapularis, Supraspinatus, and Teres minor muscles.

Exercise selection:

  • First select a body action for the nominated muscle e.g. Teres Minor - Arm adduction (see body actions for the Teres Minor muscle above)
  • Then select an exercise for that body action e.g. Arm adduction - Cable cross over (see exercises for arm adduction above).
  • For each exercise choose a light weight and perform two sets of fifteen repetitions.
  • Allow a recovery of one minute between each set.

Day Activities

  1. Select one exercise for the Infraspinatus muscle
  2. Rest
  3. Select one exercise for the Subscapularis muscle
  4. Rest
  5. Select one exercise for the Supraspinatus muscle
  6. Rest
  7. Rest
  8. Select one exercise for the Teres minor muscle
  9. Rest
  10. Select two exercises for the Infraspinatus muscle
  11. Rest
  12. Select two exercises for the Subscapularis muscle
  13. Rest
  14. Select two exercises for the Supraspinatus muscle

For the next three alternating days (17, 19 and 20) choose one exercise for each muscle group and do twenty repetitions for two to three sets. Rest - one minute between sets. After this week is over rest for two days and then gradually build your endurance up over the next two months until you are able to do two exercises from each group for ten to fifteen repetitions for two sets. Once this is an easy task then continue to maintain the endurance by doing at least one exercise every other day. Do this as long as you continue to be involved in a sport or an exercise regimen that includes resistance training.

Summary

Exercise can be a beneficial activity, which maybe useful in maintaining a healthy life style. Too much of a good thing, however, can lead to injury or chronic pain. Heed your trainer's advice by working out correctly, with the proper intensity, duration, and rest periods built into the schedule.


References

  1. TORTORA, G. et al. (2002) Principles of Anatomy and Physiology, 10th edn, Harper and Row

Article Reference

This article first appeared in:

  • O'DELL, D. (2004) Shoulder pain reduction using resistance training. Brian Mackenzie's Successful Coaching, (ISSN 1745-7513/ 15 / September), p. 8-10

Page Reference

If you quote information from this page in your work then the reference for this page is:

  • O'DELL, D. (2004) Shoulder pain reduction using resistance training [WWW] Available from: https://www.brianmac.co.uk/articles/scni15a5.htm [Accessed

About the Author

Danny O`Dell is a NSCA Certified Strength and Conditioning coach from the USA. He is the author of a number of training manuals including: The Ultimate Bench Press Manual, Wilderness Basics, Strength training Secrets, Composite training and Power up your Driving Muscles. Danny has published articles in national and international magazines describing the benefits of living the healthy fitness lifestyle.

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