Joseph M. Horrigan, Soft Tissue Center
This is first installment of a weekly blog from the Soft Tissue Center. Many of the blogs will be based on articles I wrote for IRONMAN Magazine about weight training injuries and efforts to prevent the injuries. Topics from sports injuries, sports performance, and health care will also be part of this blog as well.
The topic of injury prevention is even more important today in a world of rising health care costs. The last thing you want to do is make the effort to be healthy and fit by going to the gym, going for a run, hike, climb, swim, taking martial arts classes, yoga classes, Pilates classes and end up with an injury requiring health care. You may only then learn your deductible has doubled or tripled starting in 2014. Should you require surgery, your insurance company could challenge your surgical procedure after you already had the surgery. Let’s make every effort to reduce the risks of significant injury and reduce your health care expenses.
Shoulder pain from weight training has received much attention since I began writing about this problem in IRONMAN Magazine in 1989 and published The 7-Minute Rotator Cuff Solution in 1990.
The biomechanics of the shoulder can be made simple enough to make good choices of shoulder exercises to avoid pain and injury. As you raise your arm overhead (shoulder abduction, or flexion), your shoulder should move into a position of external rotation as if raising your hand to asking a question. The common gym exercises of the military press and behind-the-neck presses are performed in a position of external, or lateral, rotation throughout the entire movement. The muscles of the rotator cuff achieve this rotation.
The rotator cuff has several actions. First, it pulls the head of the humerus (the “ball” of the ball and socket joint) down in your shoulder joint to give you freedom of movement. Without your rotator cuff the initial contraction of the deltoid would pull the ball straight up into the bony roof of joint. The shoulder joint would quickly be destroyed without the rotator cuff.
The cuff’s second main action is to rotate the humerus in the shoulder joint for further freedom of movement. The cuff inserts into a bony prominence in the anterior, or front of the, shoulder. As you raise your arm to the side (abduction) this bony prominence laterally rotates away from the roof of the joint. The bony prominence passes under the roof without any difficulty. This enables you to continue the overhead movement.
By nature we are not designed to raise our arms high or overhead in any other position than external rotation without paying a price of pain and injury. When you understand this basic fact, you can see why so many trainees incur such complicated and ongoing shoulder problems.
The upright row is a common source of shoulder injuries. I have warned weight trainees about the hazard of this exercise for many years. By definition, this movement pulls the bar up towards your chin. Your shoulder is placed in a position of medial, or internal, rotation, which is a position it was not designed. Following the old gym myth of making sure to “pull the bar with your elbows high” increases the problem by over-emphasizing the internal rotation. If you perform this movement, you may experience an injury such as acutely inflamed rotator cuff and biceps tendons and bursae. If you keep returning to it to the upright row, the problem could well become chronic. There is an orthopedic test for the shoulder that is somewhat similar to an upright row position. It is a test designed to elicit pain in these same tendons and bursa.
If you perform upright rows and do not immediately experience pain, do not assume that your shoulder isn’t aggravated. If a major bursa of the shoulder is trapped or impinged because the row does not allow normal motion (not to mention the additional stress of the weighted resistance), the inflammatory process can go on for days, resulting in pain a few days and a few workouts later.
The upright row is an unnecessary exercise that can continually aggravate your shoulder. My advice is to eliminate it from your workouts and substitute the lateral raise and the shrug, two movements that are more biomechanically pure and clinically safe.
Even so, there is a common mistake to avoid when performing lateral raises that can also contribute to longstanding shoulder problems. Many years ago a gym myth evolved involving this exercise — that you should “turn your hand” until your little finger is higher than your thumb “as if you are pouring water out of a pitcher.” To “turn your hand” actually implies that your shoulder will rotate internally during the motion. This action goes against the way the shoulder works. Tendons and bursae are impinged — the more so the higher you raise your arms.
The solution is to drop the upright row from your workout. With regard to the lateral raises, keep your hand level or have your thumb a little higher than your little finger as you raise your arm to the side. This will reduce the probability of impinging the rotator cuff and biceps tendons.
There are many more specific topics regarding weight training from shoulder injuries, shoulder training efficiency and safety, shoulder injuries from overhead sports, and prevention of shoulder injuries that will be posted in the Soft Tissue Center blog.