“Just put some RockTape™ on it.”
I swear that I've heard this spoken from one member of the gym to another who was complaining of shoulder pain. Ummmm, no. [Insert my eye roll here.] I mean, RockTape™ (or any kinesiotape for that matter .... doesn't have to be ROCKTAPE™!) may help a bit, but what is wrong with the shoulder? Shouldn't we figure that out; not just duct tape it together!?
Ok, so in our quest to figure out what is WRONG with the shoulder, we cannot assume that the same thing is wrong with every athlete. Similarly, the same cues do not correct every movement. We need to consider mechanics and movement strategies for each of our athletes and each of their movements .
“Pull your shoulder blades down and in.”
This is one of the most common shoulder cues I hear from doctors, physical therapists, and personal trainers. But, are we actually cueing our athletes to do this at the correct time? In my opinion, no. Read on for my insights on this topic.
Shoulder impingement is a fancy word for pinching in the shoulder. There are a few types of impingement:
External impingement:
External impingement happens when the rotator cuff is being impinged by the acromion via subacromial impingement. In short, muscle is getting trapped under the roof of the shoulder blade as the arm is elevated.
there are two types of external impingement
Primary: related to the shoulder architecture (mostly the shape of the acromion) and has little to do with movement quality or exercise technique. Outside of an x-ray (and surgery) this is something you’re never really going solve outside of changing your programming to better suit your needs.
Secondary: affected by poor scapular positioning/control, poor thoracic spine mobility or stability, improper exercise technique, rotator cuff weakness, lack of core or hip control, stiff/short lats, inefficient breathing patterns, or overtraining. This is what we will discuss mainly in this article.
Internal impingement:
Internal impingement refers to the contact between the articular side of the external rotator muscles and the posterosuperior rim of the glenoid. This is usually quite specific to baseball pitchers.
So, with regard to secondary external impingement; the kind you probably have if you are reading this:
When patients come in with shoulder impingement they are typically at a point where their workouts are really affected, they are having a hard time getting a shirt or sports bra on or off without pain, they may struggle to sleep on the arm, and even have pain with every day activities. I recall that the most painful movements for me when I had a bout of shoulder impingement were sleeping on the arm, pouring coffee into a cup, the required position of my shoulder during a front squat, dips, and wiping off my treatment table between patients.
Commonly, in CrossFit and weightlifting athletes, we see shoulder pain related to a few different activities:
Pulling motions like rowing, pull ups and ring rows
Dynamic kipping movements like toes-to bar or pull ups
Catch positions like dips and muscle ups
Overhead pressing positions which are usually only painful in either the snatch/OHS grip width or the clean/jerk grip width
Other overhead positions like handstands, KB swings, and even V-ups
Some folks are unlucky enough to experience pain with a combination of these movements, but many times the pain is very specifically related to one of these types of activities. In short, it is typically pushing or pulling that is the issue and when it is pushing, there is sometimes pain with one grip width and not another (clean vs. snatch or vice versa).
Ok, so here is where things get dicey when we cue corrections.
There are several reasons for shoulder impingement, and therefore, several solutions. It is best to have this pain evaluated by your physical therapist to determine a) the tissue in pain (victim) and b) the mechanic that needs to be addressed (bully). The impingement pathology is typically driven by a faulty mechanic in the shoulder complex’s many available movements. So, the cue for an athlete in pain cannot just be “pull your shoulders down and in”! In fact, in some cases, this can make the pain worse!
Let’s examine:
Athlete #1: Izzy Haransdottir: pain when doing movements on the rig like kipping pull-ups and toes-to bar, no pain with pressing overhead, no pain with strict pull-ups.
Athlete #2: Gary “Gainz” Fraser: pain with both jerking overhead and snatching, increased pain with full depth in these positions like a full (squat) clean, (squat) snatch, and overhead squat, pain with dowel pass-thrus and thrusters.
***
It is likely that Izzy needs to pull her shoulderblade down and in and to gain some core control when kipping in order to avoid her pain. But, it is probably the case that “Gainz” needs to learn to move his shoulderblade up/around the ribs into what we call upward rotation. I mentioned this to a coach once and he admitted that he didn’t even know the shoulderblade moved that way. So, if this is news to you, that’s ok!! For years, I preached, “shoulderblades down and in” because that is what I learned in school, that is what was cued to me as an athlete and and is what everyone else was cueing their patients to do. But, as always, I was (and am) open to changing my views as I gain more experience, talk to more high-level athletes and coaches, and as new scientific evidence is published.
Below is why I think “Gainz” needs to upwardly rotate that shoulder blade in order to avoid pain.
Quick anatomy briefing:
rotator cuff muscles
-The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your humerus (upper arm bone) firmly within the shallow socket of the shoulder.
-There are four muscles: Suprasinatus, Infraspinatus, Teres Minor and Subscapularis
-The most commonly injured cuff muscle is the Supraspinatus, the muscle that lives in the subacromial space!
Subacromial space
This is the space between the acromion (shoulderblade) and the ball of the humerus. In this space sits a the supraspinatus tendon. Impingement can occur when the tendon of this rotator cuff muscle becomes irritated and inflamed as it passeds through this subacromial space.
Depression of the scapula (shoulder blade)
-pulls the shoulderblade down
-responsible muscles: pectoralis minor, lower fibers of the trapezius, subclavius, latissimus dorsi
-if the humerus (arm bone) is moving upward and you are depressing the shoulderblade, you are closing down on that subacromial space, causing potential impingement
-this movement should be used for pulling motions, as in initiating a row or a pull-up when the arm bone is moving in a downward direction
Upward rotation of the scapula
-rotates the shoulderblade up and out so that the socket of this joint faces outward
-responsible muslces: middle and lower serratus anterior muscles, upper and lower trapezius muscles
-if you are moving the humerus (arm bone) upward and overhead, you need to allow the shoulder blade to upwardly rotate so as to not cause impingement at the subacromial space
-this movement should be used for pressing overhead
Unless the shoulderblade truly does need to be pulled down and in, let's cue our athletes correctly in order to avoid their shoulder pain. Consider when pressing overhead that many people lack the mobility, strength, coordination, and motor awareness to upwardly rotate their shoulderblades.
They often need to be cued to press UP!
A few drills to help with your much needed upward rotation:
primal push
wall slides
behind the neck press
Good luck and remember to get checked out by your physical therapist to find out WHY you have shoulder pain. Contact me at www.arrowptseattle.com for questions, comments, or concerns!!