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A Guide to Shoulder Pain-Part 1

Training

A Guide to Shoulder Pain-Part 1

By Ryan Brown

One of the most often injured joints. These two joints, having such a large range of motion, are often worked through this range with some serious velocity. This is especially with our olympic movements, but even powerlifters tend to do some “speed” work that increases the velocity and demands for stability in the joint.

I got into an argument one night at a party with a physical therapist who told me that nobody should do overhead work because it impinges the shoulder. I don’t know if you have ever been in an argument with me and know how it goes, but, as you can probably imagine, she got served. She did make a good point though. Overhead work does tend to cause some shoulder impingement if you do not have sufficient mobility/stability to achieve the correct position. Many, many powerlifters avoid the overhead press completely because they are stuck so internally rotated and their t-spine is so immobile that they can’t do it without wrecking their shoulders. However, if you have read anything that Brandon Lilly says then you know that the OH press has a great carryover to your bench…. so you should be doing it. There is absolutely nothing that I hate more than articles on the internet that talk about exercises that you should or shouldn’t be doing. Name an exercise and I can find someone who shouldn’t be doing it. My point to this physical therapist was that maybe instead of just saying nobody should do overhead work we should focus on what do we need to do to make overhead work possible.

 Mobile and strong shoulders are key for staying healthy when performing overhead lifts. JTSstrength.com

I have spent most of my time training doing some sort of rehab/prehab work on my shoulders. I even collect a check from the VA every month because of a partially torn bicep tendon, degenerative joint blah blah blah in my left shoulder… and that is the one I would consider my good shoulder. So, I feel like I have some experience in dealing with some shoulder issues, because I am still snatching, benching and pressing all the time (usually pain free) unless I do something stupid like miss a #240 snatch 25 or 30 times in a row. The end result is usually the inability to lift my arm above my head for a few days. It is what it is, I just like to fix it and move on.

Troubleshooting the shoulder, Do I have a shoulder “problem”???

The other issue with the shoulder is that there are tons of things that could go wrong with it. The T-Spine, scapulae, acromioclavicuar joint, glenohumeral joint and all the surrounding musculature must be properly aligned with full range of motion in order for the joint to reach it’s full capabilities. Sometimes,  a problem can reveal itself as “weakness” instead of pain (or before pain) Several athletes don’t even recognize that they have a shoulder problem, I have read Eric Cressey talk about different type/shape acromians. Some people may have more clearance than others and therefore have a greater capacity for shoulder movements, especially overhead.

Talking to Chad Wesley Smith the other day, over a romantic sausage and egg breakfast, I remember him talking about Strongman Nationals and how he thought that he would do well in each of the events. He was saying that the log press was going to be his weakest event. The thing that stuck out at me the most was the fact that, just standing and looking at Chad Wesley Smith for 5 min and watching him move around you can see that his shoulders don’t really move well. He says he is in no pain, so what does it matter? (even though, I read in his log that his elbow has been killing him on more than one occasion, and I have seen over and over again that lack of internal rotation in the shoulder puts strain on the bicep tendon and manifests itself as elbow pain, on the reg)


What I find to be odd about this is that Chad identifies overhead work as a weakness, but doesn’t attribute the role of the dysfunction as contributing to that weakness. I am only using him as an example because I feel like there are tons and tons of athletes out there who are not in any pain, who could still benefit from a more mechanically effective shoulder. He has log pressed #370 and is in no pain. Obviously, his shoulders are strong as shit, he has log pressed #370. but if you check out this video from the Sin City Strongman Challenge you can see a couple of things. A.) the lack of shoulder internal rotation forces his shoulders into a huge anterior tilt when he gets the axle up to his belt. This is going to be much slower and less efficient, so on an event for reps he will be loosing time and wasting energy. B.) lacking shoulder internal rotation causes that anterior tilt in order to get the bar up to his shoulders, this is very difficult to recover from and get back to an externally rotated position and leads to instability in the finishing position. Kellie always talks about passing “through the tunnel” and that you have to be able to enter the tunnel, especially with high velocity movements, in the correct position, or you will more than likely not be able to finish in the correct and most stable position. Better internal rotation in his shoulders is not only going to improve the clean portion of this lift, but also allow him to achieve more effective positions for the jerk.

Personally, I managed to set a #15 PR strict Press at #220 while doing very little pressing and just focusing on improving my shoulder mobility. Sometimes it is not about getting any stronger, it is just about being able to achieve a more advantageous position.

Common Problems

When assessing mobility I always want to start axial to periphial. Usually, before bothering with looking at someones shoulders I like to take a look at their hips, for alot of people dysfuncition in the hips tends to radiate elsewhere so spending a ton of time working on your shoulders before getting your hips right can be a futile effort. For our purposes here though, we are going to focus on the immediate area around the shoulder.

Breathing– Breathing is the building block of mobility. Ineffective breathing patterns will cause dysfunctional movement patterns. For the shoulders a couple of things happen. A short “apical” breathing pattern will cause the person to pull their chest up using the muscles of the neck and shoulders, constantly pulling them out of postion…. Thousands and thousands of times a day. Breathing is also the tool that will allow you to lock the ribs (and everything else) into position for you to move around. Think stability before mobility. Breathing patterns can also have a great effect on thoracic spine position which…. I stress to my clients/athletes all the time that the things that you do outside of the gym everyday have a far greater effect on your health/performance (as far as mobility goes) than anything that we are doing to be able to do in here. You can check out this post for a little more on breathing.

T-Spine– There are a couple of things that can go wrong with your TSpine. It can either be too curved (kyphosis) or too flat. A simple quick test that you can do to check yourself out is to have someone look at your back. Your scapulae should be lying flat against your back and should slide nice an smooth around your ribs. If they aresticking out then you have a problem. An overwhelming majority of people that I see are either excessively kyphotic, or lacking the ability to extend through their t-spine. An important note about the inability to extend through the thoracic spine is the fact that often this will not show up as shoulder pain while pressing. It will more often show up as having a “sore” lower back after doing overhead movements because your t-spine is stuck and you are making up for that lack of mobility by compensating with your lumbar spine. This also tends to put you into a little bit of an anterior tilt in your hips and it not a stable overhead position. If you are unable to achieve proper thoracic spine position then you will not be able to achieve the maximum mechanical advantage in any pressing or pulling movement which will either lead to injury, or even worse….. lbs left on the table.

Lats– Tightness in the lats is a huge problem when performing overhead movements. Often it either causes, or is a result of what we were just talking about with the t-spine. Or possibly if you are doing tons of t-spine work but still getting over extended in overhead movements then tightness in the lats could be the next hang up. Who knows what comes first, tight t-spine or tight lats? Either can cause similar overhead inefficiencies.

Trap/1st rib– Look at yourself in the mirror. If one of your shoulders is sitting way higher than the other, then either one shoulder is falling down and probably anteriorly tilted or the other is sitting higher due to a tight trap, which is going to be tugging your shoulder out of position and limiting your overhead range of motion.

Pectoral– I have to say that I think that t-spine is the number one suspect in any kind of shoulder dysfunction, but the pec… more specifically the pec minor is a close second. With the way that everyone lives their lives, working in front of them, or perhaps they were formerly a member of the “bench press everyday mafia” down at Urban Active before they came to me, this is a very common problem. A tight pec minor pulls the shoulder into an anterior tilt. Often, this reduces the amount of clearance of the acromian and causes impingement during overhead movements. Most people never really get a stretch on the pec minor. They will crank on the pec major all the time with bands and everything else, but ignore the fact that, due to the fact that the pec minor inserts on the coracoid process you must depress the shoulder in order to stretch the pec minor.

These are what I would consider the usual suspects in shoulder dysfunction. Obviously, it may not be as simple as this, but if you are in some pain, are missing range of motion in overhead movements, or are lacking the rotational capabilities of the shoulder, these are a couple of good places to start looking. Don’t underestimate the effect that better mobility can have on your lifts. Even if you are not in pain, better efficiency and the abiilty to get yourself into the most mechanically advantageous postion can benefit everyone. You should be constantly assessing yourself.

Check Out Ryan’s Training Log Here

 

 

 

 


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One Response to “A Guide to Shoulder Pain-Part 1”

April 02, 2017 at 2:16 pm, Amanda said:

Hi! I just stumbled upon this article. I’ve been strictly doing oly lifting for over a year now. Last May, I developed pain near my triceps/behind the shoulder. My doctor assured me it was bursitis and that I just needed to rest. I did that. 2 rounds of cortisone later and fast forward 11 months…. I still have pain in my triceps that we now think is from my neck/infraspinatus area. It’s been almost a year with pain. It never goes away. I feel it the most when I go into the scarecrow position and then try to open up to punch my fists to the ceiling (aka the snatch). If my arm is raised straight, there is no pain. Pushups/benching set it off unless I keep my elbows really close to my body. All of my doctors are stumped. I’ve been to 5 doctors and 4 physical therapists. What is this…how can I fix it? I’m so tired of having pain or being told to stop lifting. I’ve worked on creating my cylinder/breathing, strengthening my mid back. Nothing works.

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