I don’t know about you, but probably a 1/3 of the athletes I see now have shoulder pain, impingement, rotator cuff tear, etc. as a diagnosis. Another 1/3 will complain of occasional symptoms and will have all the obvious signs of impending problems: poor posture, abnormal gleno-humeral rhythm, and scapular winging to go along with their poor training habits.
So what to do? For those of you who work with athletes on a daily basis, keep the following tips in mind.
Everyone knows a good warm-up is important. What most athletes do not understand is what they are supposed to be warming up!
ROM and Flexibility are critical but not just at the shoulder joint. The thoracic spine must be mobile enough into extension that the scapulae are allowed to retract and depress down the back for normal shoulder joint mechanics to occur. Pec minor must also be addressed, tightness will cause an anterior tilt of the scapulae and increase the chances of impingement.
Thoracic Extension using Foam Roller
Pre-activation is also key. Turn on the scapular stabilizers and rotator cuff musculature, as well as the abdominals, prior to lifting heavy weights for maximum shoulder protection.
Kettlebell Scapular Retraction
Kettlebell Scapular Depression
T’s, Y’s, L’s, and W’s
Even when the lower body is to be the focus of the session, you must still include these types of exercises in the warm-up. Squats, deadlifts, and the Olympic lifts all require great shoulder girdle mobility and stability. Consider the next two exercises to put it all together.
Deep Squat Progression (Gray Cook and Lee Burton)
Do’s and Don’ts
Do chin-ups and pull-ups, lat pulldowns are OK but for performance sake do chins or pull-ups.
Do not pull-up or pull down behind the neck, these place more stress on the anterior GH joint, a common cause of impingement.
Do rows with dumbbells, a barbell, or on a machine but posture must remain perfect with retracted scapulae.
Do not perform presses behind the neck. Nothing like creating more impingement with lots of weight. Guaranteed to increase business however.
Do Deadlifts. There are lots of varieties from which to choose, see our video library, but they all require great scapular stabilization along with core and hip work.
Do not perform upright rows. Check out the video. Kind of looks like the Hawkin’s Test for Impingement doesn’t it. Also hard to maintain any sort of shoulder joint stability.
Do inverted rows. These work like rows but incorporate extra work to the entire posterior chain by keeping the body rigid.
Do not shrug. Most athletes are already over active in their upper traps, this just facilitates that along with the poor posture from all the weight in front of the body. Deadlifts done correctly will work the traps enough.
Do the Farmers Walk. Hold a heavy dumbbell in each hand and walk, simple as that. Posture must be perfect, scapulae retracted maximally, and crush the dumbbells with the grip. The exercise ends when the grip fails or retraction is lost.
Here is the workout plan of your typical male athlete: bench press x 4 sets, incline press x 4 sets, shoulder press x 4 sets, dumbbell lateral and front raises x 3 sets each, two bicep exercises x 3 sets each, lat pulldowns and rows if time. Working the “beach muscles”, basically what you can see in the mirror. This is just begging for a shoulder problem. You would be amazed how many athletes work out this way. Or, if you have been doing this for a while you are shaking your head in agreement right now.
At the very least, volume should be 1:1 working front to back. So for every set of bench press, shoulder press, etc., there needs to be a set of rows, chins, etc. Mike Boyle and others are now recommending a 1:2 ratio front to back. This is not only to offset the training stresses but because we are a sedentary society and sit way too much. Fact is, most of what we do in our waking hours is capable of contributing to poor posture and poor shoulder mechanics.
I add this section knowing we can never fully rid the planet of the bench press. Athletes will continue to attempt to bench way more than they are capable of, keeping us busy for the rest of our careers. I’ve been there and done that so I know all about it. Nowadays I do push-ups for a variety of reasons, but that will be another article. So for those that must continue to bench, here are some tips for them.
Stop short. Slowly lower the bar stopping 2-3 inches from the chest before pressing back up. This prevents the last bit of anterior translation in the shoulder joint. With a barbell, stress is being shifted off the pecs and onto the shoulders at this point anyway. If chest training is the goal then it is a good idea. If you are a power lifter then you are screwed. Just kidding. A rolled up towel works well here too as a learning tool but no bouncing.
Another quick note on this. Many college football strength coaches demand their players stop short as well. Reason #1 is to protect the shoulder joints. They lose their jobs if too many guys are injured. Reason #2 is more functional in that this is the position to take on the opponent then extend the arms. If your opponent gets in too close to your body then you are in trouble. This will get the attention of the high school football players anyway.
Bench press grip should be less than or equal to 1.5 x bi-acromial width for less shoulder and AC joint stress. A literature review just published in the Strength and Conditioning Journal of the NSCA looks at all the research done on grip width and injuries. A narrow grip will reduce the abduction angle at the shoulder thus reducing stress. The optimal angle is around 45 degrees which is what you would see from an elite power lifter. Body builders and many athletes will approach 90 degrees thinking they are working the chest harder. The research shows no significant difference in pec or deltoid recruitment between 45 and 90 degree abduction angles. At 45 degrees there is much greater triceps recruitment which would desirable in sports like football and wrestling. No good reason for your athletes/patients not to try it.
Bench press one rep max should equal chin-up one rep max. This is just something interesting that Mike Boyle wrote about in regards to protecting the shoulders. This is something his athletes strive to do and he is reporting fewer injuries. Chin-up max is figured by adding body weight and the amount of extra weight hanging from the athlete’s weight belt. It is a fun test at the very least, gives the athletes something concrete.
To an athlete, getting back into the weight room is critical to performance. Our job is to get them there better and safer than ever. Following these recommendations will keep them going strong and out of the training room.
- Green, Carly M, and Comfort, Paul. The Affect of Grip Width on Bench Press Performance and Risk of Injury. NSCA Strength and Conditioning Journal. Vol 20, Number 5, pages10-14. 2007.
Joe Heiler PT, CSCS
Joe Heiler MSPT is the owner and content manager of SportsRehabExpert.com, a website dedicated to advancing the education of rehab and performance professionals. The site focuses on orthopedic and sports physical therapy topics through webinars, audio interviews, articles, manual therapy and exercise videos, and more.
Joe is also the owner of Elite Physical Therapy and Sports Performance in Traverse City, MI specializing in orthopedics and sports medicine, as well as athletic performance training. He is Graston Technique (GT) Certified as well as a GT Instructor, SFMA and FMS trained, and is passionate about a number of soft tissue and manual techniques including Trigger Point Dry Needling and manipulation.