Accurate data are needed to determine which corrective strategies a client needs. A trained, experienced corrective exercise specialist will also be able to pinpoint movement errors. Repetition and coaching will sharpen assessment skills.
Common shoulder complex dysfunctions include the following:
Unwanted shrugging. This is fairly easy to spot. Underactive lower trapezius muscles let the upper trapezius and levator scapulae run away with the show and pull the shoulder blade up. This alters glenohumeral (GH) and cervical spine alignment, which can lead to headaches, a tight neck and inflamed bursa sacs.
Shoulder blades that don’t protract and retract. Think of the client on the seated row machine who is moving only from the GH and elbow joints. The loss of scapular action increases range of motion at the elbow and shoulder joints and, over time, may lead to tendonitis. This also closes off space in the anterior aspect of the shoulder, which may put more strain on the biceps tendons, bursa sacs and rotator cuff tendons.
Note the following training tips and programming guidelines:
Be careful about using the cue “Put your shoulder blades in your back pockets.” While it may be useful during a prone cobra pose, that doesn’t mean the shoulder must always stay back and down. Elevation and upward rotation are critical actions during overhead activities.
Avoid barbell upright rows, full-range-of-motion dips or anything that makes the joints go past safe end ranges when shoulder impairment is suspected. Behind-the-neck barbell presses can also be dangerous. As the bar is lowered past the crown of the head, two things typically happen: The head goes forward, placing the cervical spine in extension and causing greater uneven force distribution through the cervical disks; and as the bar continues to go down, the load transfers from the active system to the passive system. In the close-packed position of abduction, external rotation and extension at the GH joint, there is nowhere else to create movement without also creating laxity in the ligaments and joint capsule. If an asymmetry is present, the risk for injury is even higher. The combination of a bilateral grip, barbells and asymmetries is not a healthy mix.
Be aware that lateral and anterior raises increase impingement risk and add stress to the cervico-thoracic region (Osar 2012). Fixed-range-of-motion machines can be dangerous in this scenario, but you can work around them for a safe and effective workout. Lower the seat toward the bottom of most fixed-machine shoulder presses to limit exposure to excessive end ranges of motion. Bottom line: Know the range of motion for joints and don’t go past their physiological end range.
To read the full article Corrective Exercise for Shoulder Impairments from the October 2013 issue of the IDEA Fitness Journal click here.
Osar, E. 2012. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Chichester, England: Lotus.
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