Training

How To Train With Shoulder Pain | Development Exercises

 

By Sports Rehabilitator Alex Hurley

www.phoenix-physio.co.uk

The shoulder itself is an amazing piece of kit! It’s termed as a ball and socket joint but really its more of a golf ball in a tee. This allows us to have full range of motion in all ranges including overhead positions. Some say we evolved this way from when we used to swing from trees etc.

These days however, many people don’t have the required mobility to perform many movements that we see in the gym. Often this results in pain, joint stiffness, and muscle atrophy – obstacles that we can train around, yet not  the optimal thing to do.

The aim of this article is to look at some basic exercises and assess if you have the range of motion available to perform them. From this you’ll see what structures could increase your likelihood of injury if they are restricted or stiff.


Shoulder Development Exercises

Exercise #1: Dips

The dip is a great exercise for chest and triceps development when performed correctly and with certain changes we make can shift the emphasis from one to the other.

However, there is a vital part of shoulder mobility that needs to be available if you want to save your shoulders, and this is internal rotation.

If restricted, this is termed: Glenohumeral Internal Rotation Deficiency (GIRD) and numerous studies show that it tends to occur in the dominant shoulder and can increase injury risk.

When performing dips in their full range of motion, having GIRD can pull on the structures on the front of the shoulder causing pain.

So how can you assess this?

Try the below

shoulder mobility

a) Lie on your back with your arm over the edge of your bed at 90 degrees with the elbow bent.

b) Take your hand up as if you were going to throw a ball and note the range of motion you have.

c) Careful not to lift the chest or extend from the lower back. Rotate down taking your palm towards the floor; again noting the range.

What you are looking for is a TOTAL of 180 degrees. If you don’t have 180 degrees and that lack of range is due to reduced internal rotation then this a positive GIRD. The jury is still out of why this may be, restricted rotator cuff or posterior capsule.

Increasing the flexibility of the shoulder without having strength in these ranges can lead to an unstable shoulder in some individuals, therefore it would be recommended to speak to a health profession.

Exercise substitute: Decline dumbbell press


Exercise #2: Incline Bench Press

incline bench press

Bringing the bench into an incline position will help develop the upper pectorals and anterior delts. However, many make the mistake of trying to go too heavy too soon with the idea that this will help them achieve their goals quicker. If you’re feeling shoulder pain when performing this, it will be caused by an issue with the biceps tendon.

If we look at the insertion points of both bicep muscles, the short head attaches to a bone-y prominence of the shoulder blade – this is called the Corocoid process (the same place your pec minor inserts). The long head inserts into the joint capsule before attaching to the shoulder blade. Both biceps then run down the arm, over the elbow joint and insert into the Radius and Ulnar.

Now… picture yourself (or even try it), in an incline position with the bar above your chest. As you lower the bar down onto the top of the sternum past parallel, you’ll start to put the tendons of the bicep on a stretch as the 2 points of origin and insertion move further away into shoulder retraction.brachii

If they are restricted in any way then they will become painful over time, especially if the load continues increasing. The more weight added, the more depending you’ll become on the shoulder, which will create more stress on the tendon. You can assess the range of motion your biceps will allow by checking your shoulder extension…

a) Lie on your back with you arm over the edge of a flat surface, your bed/sofa for example. Keep the elbow bent and palm up, extend the elbow over the edge as far as you can.

b) Allow your arm to relax as you extend the elbow, and keep going until you reach bone on bone.

If your elbow extension is restricted then this is a positive test for bicep tightness.

Soft tissue treatment can help, especially Active Release Technique (ART) and correcting any shoulder mobility issues you may have.

Exercises substitute: Incline dumbell press – neutral grip, incline football bar press.


Exercise #3: Overhead Dumbbell Press

Another basic exercise to help develop the shoulders, especially front and middle delts, lats and triceps. The difference between using a barbell and dumbbells is stability and the ability to reach full overhead lock-out.

Try this: with dumbbells, press above your head and get your shoulders to hug your ears and you’ll find your anterior delt reach a peak contraction. Now try it with a barbell, take your grip now press straight up and you’ll notice a bit more daylight between your shoulder and ear and not so good a contraction of the anterior delt.neck and shoulder pain

A problem with reaching full lockout with the dumbbells can be an elevated 1st rib, which is a very common issue with people especially with poor posture.

This can give you neck and shoulder pain, headaches, and paraesthesia. The 1st rib lies underneath your upper traps and connects to your sternum below the collar bone. With a forward head posture it can become elevated and problematic, giving you some of the symptoms listed above.

Ultimately this is one for your clinician to assess for your and it will be down to the ‘history’ of your issue.

You don’t ALWAYS have to have the symptoms above to find out you’ve got a fixed 1st rib either; check out your posture against a wall and see if you can spot any differences between the your left and right side.

A common thing to look for is an elevated shoulder:

Do you sleep on your stomach? One arm tucked under the head? A stack of pillows? Constant tightness of the traps?

It should be a relatively straight forward fix as well, I would recommend seeking out a clinician who can help to mobilise the rib and help with postural education.

Exercise substitute: cable/dumbell lateral raise.


Take Home Message 

All of the above ultimately boils down to education. Educating your brain as well as your body!

If you have asymmetries in your body that exist around around a joint, then sooner or later they will expose themselves and may leave you out of the game.

Don’t let it become something you have to ‘train around’, find someone with a good local reputation that can assist you on the road to recovery!

In part 2 we will be looking at the bench press and how to improve it to meet your goal.


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MR PROTEIN

MR PROTEIN

Writer and expert


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