ShoulderInjury_Max

Shoulder Injuries

At some point in their careers, most powerlifters will experience some form of shoulder pain or injury. Most lifters think of shoulder pain and injury as a normal part of the lifting experience. Still more self-diagnose pain as being a rotator cuff strain and try to work through the discomfort and pain. However, there are several possible reasons for shoulder pain, and very often the rotator cuffs aren’t the only key. Of course, as with any re-occurring problem or injury, it is advisable that you go see a sports medicine doctor to evaluate the situation. In the case of minor shoulder pain and discomfort, often a chiropractor, physical therapist, or athletic trainer can do some very simple range of motion tests to help assess the problem. The following article is meant to be a simple primer on shoulder injuries, and to help you integrate some key ideas into your training that will help you avoid shoulder problems in the future.

Anatomy and Function

What most people consider the shoulder are actually 4 separate joints: the glenohumeral joint, the scapulothoracic joint, the acromioclavicular joint, and the sternoclavicular joint. A total of 20 muscles are involved in movement of these 4 joints.


The main functions of the shoulder area are joint stability and eccentric and concentric muscle actions. However, due to the extreme range of motion in this area, the shoulder has some unique features. The ligaments are relatively lax in comparison to other ligaments in the body to allow for greater range of motion. Because of this, the rotator cuff muscles (infraspinatus, supraspinatus, subscapularis, and teres minor) and the deltoids take on the task of dynamic stabilization. While stabilization is a seemingly normal function of any muscle group, because of the great range of motion and force producing capabilities of the shoulder, these particular muscles undergo a great amount of stress. The primary function of the rotator cuff muscles aren’t to rotate as you would think (though they also do that); it is actually to hold the head of the humerus in the glenoid cavity of the scapula during dynamic muscle actions.

The anatomy of the shoulder is also very unique; for instance, the scapula is almost completely suspended by muscles, and therefore relies only on those muscles (as opposed to ligaments and/or bony processes) for stabilization. A weakness in just one of the muscles suspending the scapula can affect the overall function of the shoulder.

As you probably know, shoulder injuries in powerlifters are most commonly associated with the bench press. But it’s not actually the force being generated to push the weight up that is culprit. As I stated before, dynamic stabilization is a large function of the shoulder muscles. So while some muscles are generating concentric force to push the weight up, still others are providing resistance to stabilize the joints. But it doesn’t stop there; the shoulder muscles are also responsible for decelerating the weight at the top of the lift, especially in speed benching. Given the huge amount of stress we put such small muscles under, it’s no wonder there are so many shoulder injuries in powerlifters.

Muscle Function
Trapezius Elevates, retracts, depresses, and rotates scapula
Latissimus dorsi Extends, adducts, and medially rotates humerus
Levator scapulae Elevates and inferiorly rotates scapula
Rhomboid major and minor Retracts and depresses scapula
Anterior, middle, and posterior deltoids Anterior: flexes and medially rotates arm
Mid: abducts arm
Posterior: extends and laterally rotates arm
Supraspinatus Initiates arm abduction with deltoid and stabilizes the humerus
Infraspinatus Laterally rotates arm and stabilizes the humerus
Teres minor Laterally rotates arm and stabilizes the humerus
Teres major Adducts and medially rotates arm
Subscapularis Medially rotates arm, adducts and stabilizes the humerus
Pectoralis major Adducts and medially rotates humerus, draws scapula anteriorly and inferiorly, the clavicular head flexes humerus, and the sternocostal head extends humerus
Pectoralis minor Stabilizes scapula, draws scapula anteriorly and inferiorly
Subclavius Anchors and depresses clavicle
Serratus anterior Protracts, stabilizes, and rotates scapula
Coracobrachialis Flexes and adducts arm
Triceps brachii Extends forearm, long head abduct humerus
Biceps brachii Supinates and flexes forearm (though it doesn’t include movement of the shoulder girdle, injury or aggravation to the biceps tendon is often a part of shoulder problems)

Common Shoulder Injuries in Powerlifters

Before we progress to the prevention of shoulder injuries, you should be familiar with the more common problems lifters have.

Rotator cuff strains

Pain in the anterior and/or lateral part of the shoulder, point tenderness, decreased range of motion in the joint and pain at night while lying on the affected side are symptoms of rotator cuff strain. Rotator cuff strains are most commonly caused by accumulative microtrauma to the muscle, or simple overuse. In the initial stages of pain or discomfort, simply taking 1-2 weeks off and the use of ice and anti-inflammatories will help heal it. However, a rotator cuff strain is usually indicative of a much bigger problem as you will read, so ignoring the problem once it goes away is not a good idea.

Rotator cuff impingement

Impingement syndrome is caused by the encroachment of the subacromial space under which the supraspinatus and subacromial bursa pass. Impingement can be caused by a variety of things. In lifters, weakness of the rotator cuff muscles, particularly the infraspinatus and subscapularis, can cause the humerus to mistrack and compress the supraspinatus tendon. Acute injuries to any of the surrounding soft tissue, including the biceps tendon, can cause inflammation, which will also compromise the normal capacity of the joint. Anterior glenohumeral joint instability can also lead to impingement as the demands of stabilization on the rotator cuff are increased leading to overuse, fatigue, and microtrauma, which leads to inflammation. Joint instability is most often seen in young athletes; however, chronic instability can also result from repetitive motions, such as bench pressing. If the musculature that supports the anterior capsule of the glenohumeral joint (pectoralis major, subscapularis, latissimus dorsi, and teres major) becomes fatigued, the capsule can become stretched or lax, and impingement will result in the posterior capsule. Pain, weakness, and numbness are symptoms of chronic instability.

Bicep tendinitis

Many lifters experience bicep tendinitis at the elbow joint, but few people ever relate their shoulder pain with biceps tendinitis. Like the rotator cuff muscles, the contraction of the biceps during the deceleration phase of the bench press can lead to inflammation and an improper traction of the biceps tendon through the bicepital groove. Tendinitis can also appear if there is a muscular imbalance causing the biceps and subscapularis muscles to be overloaded and become overtrained. Bicep tendinitis is also frequently associated with shoulder impingement syndrome. Signs of bicep tendinitis include pain with passive stretching and contraction of the biceps during resisted rotation of the arm and shoulder joints.

Acromioclavicular joint sprain

Acromioclavicular joint sprain is very common in strength athletes, often called “weightlifter’s shoulder.” Though usually a result of a fall or brunt force, AC sprains are also caused by overtraining. AC sprains are classified as first, second, and third degree sprains. Second and third degree sprains, characterized by partial (second degree) and complete (third degree) tearing of the joint ligaments, are uncommon in powerlifters, but can progress from a first degree sprain if it goes untreated. A first-degree sprain is characterized by localized pain, point tenderness, and swelling. Pain will be felt when the arm is horizontally adducted, such as in the last few inches of the bench press, and overhead pressing movements. First-degree sprains can also lead to impingement syndrome due to the weakness, muscle imbalance, and inflammation that result from a chronic sprain.

These conditions are only the more common shoulder problems powerlifters experience. There can be many other causes of shoulder pain and weakness, for instance any weakness and/or numbness can have a neurological basis as well. For this reason, it is important to have any chronic problems diagnosed by a health care professional.

Prevention

A well-designed training program can and will ensure that your career in powerlifting is not hampered by shoulder injuries. If you garnered any information from the descriptions of common shoulder injuries, it should be that most often muscle imbalances and/or overtraining are the main cause. Whether you are a new lifter or a seasoned veteran, here a few tips to consider in your training to avoid shoulder injuries.

Do not neglect your rotator cuff exercises. There are five main exercises you can do to help strengthen you rotator cuff exercises and prevent injury:

1. Internal rotation- Lie on your right side. Keep your left arm along the upper side of your body. Holding a light dumbbell, bend your right elbow to 90°. Keep the right forearm resting on the table. Now roll your right shoulder in, raising your right forearm up to your chest. Lower the forearm slowly. Repeat the exercise until your arm is tired. Then do the whole exercise again with your left arm. This exercise can also be done standing, using bands that are attached to a fixed object at about waist level.

2. Horizontal external rotation- Lie on your right side with a rolled-up towel under your right armpit. Stretch your right arm above your head. Keep your left arm at your side with your elbow bent to 90° and the forearm resting against your chest, palm down. Hold a light dumbbell in your left hand for resistance. Roll your left shoulder out, raising the left forearm until it is level with your shoulder. Lower the arm slowly. Repeat the exercise until your arm is tired. Then do the whole exercise again with your right arm.

3. Vertical external rotation- Start by lying on your stomach on a table or a bed. Put your left arm out at shoulder level with your elbow bent to 90° and your hand down. Keep your elbow bent and slowly raise your left hand. Stop when your hand is level with your shoulder. Lower the hand slowly. Repeat the exercise until your arm is tired. Then do the whole exercise again with your right arm. This exercise can also be done standing, with the use of the shoulder horn.

4. Straight arm pulldowns- Grasp the bar of a lat pulldown weight stack. Instead of bending your elbows and pulling the bar to your chest, pull the body out in front of you in an arc, keeping your elbows straight. Your arms will be out in front of you, just below chest level, at the end of the movement. This exercise is similar to dumbbell pullovers, in which you lie on your back on a bench, grasp a dumbbell with both hands extended above your chest, lower the weight by brining your arms above your head, then extend your arms back to the starting position.

5. Empty can exercise- In a standing position, start with your arms halfway between the front and the side of your body, thumbs down. Raise your arms until almost level (about a 45° angle). (Hint: This is like emptying a can.) Don’t lift beyond the point of pain. Slowly lower your arms.

Very light weights are used on these exercises. Remember, you rotator cuff muscles are very small, so start out with 5-pound dumbbells, or even lighter. Using heavier weights will probably result in the larger muscles, such as the deltoids, doing the brunt of the rotation. Also, if you feel that you have time constraints in the gym, the good thing about all of these exercises is they can be done using resistance bands instead of dumbbells. Buy a pair of light bands to keep at home and do these exercises while watching T.V. as a “feeder” workout instead of doing them in the gym during your normal training time.

There are also some proprioceptive exercises you can do to increase the stability of the shoulder muscles. As corny as it sounds, quite possibly the best tool for this is the Body Blade. Yes, that is that long plastic thing that you have seen on infomercials that you hold in your hands and it rapidly wiggles back in forth. In reality, the Body Blade has been a physical therapy tool for quite some time in rehabbing shoulder injuries. If you can’t bring yourself to try one, then exercises such as push ups with your hands on a Swiss ball, or trying to lean on the ball and balance yourself with one arm will also be helpful.

Do maintain shoulder flexibility.

Most lifters find that their shoulder range of motion decreases as their career progresses, especially the superheavyweights. Though increased muscle mass will decrease your range of motion somewhat, the extreme inflexibility that some lifters have could lead to or exacerbate already existing impingement.

Don’t neglect your upper-and mid-back strength.

Since upper-and mid-back aren’t muscle groups that are directly responsible for one of the three lifts, they are often neglected. However, several of the back muscles, including the latissimus dorsi and rhomboids are involved in you shoulder joint motion. Neglecting exercises such as pulldowns, rows, and rear deltoid exercises could actually be a factor in developing shoulder issues. To ensure that this doesn’t happen, check your training logs and compare the volume you do for any upper-body pulling movements (i.e. upright rows) to the volume you do of pushing movements (i.e. bench press movements). If there is a large discrepancy in the total number of repetitions, sets, and weight you do, then you may benefit from adding another short workout to your regimen just to do upper back. And extra 20 minutes a week in the gym is worth avoiding a career-ending shoulder injury.

Listen to your body.

Very often athletes will work through the pain, or take on the attitude that if it hurts it must be weak and therefore trained even harder. Constant maximal work, exercises that stress the eccentric motion (such as band presses), and especially heavy over head lifts such as shoulder presses can severely wear on the shoulder. If your shoulder begins to show the signs of a problem, back off of these particular exercises for a few weeks. A few down workouts may be all you need to avoid a serious overuse injury. Squatting can also put a strain on a fatigued shoulder. A very simple way to avoid unnecessary wear and tear on your shoulder if it is beginning to show signs of injury is to squat with a Safety Squat Bar or use a Manta Ray for a few workouts to take the stress off of the joint.

As you can see, shoulder pain can caused by a variety of factors. Furthermore, all of these issues can work in conjunction to exacerbate the problems. Tendinitis can lead to impingement which can lead to a tear, etc. The best course of action you can take is to prevent the injuries from happening. Train smart, and you will be able to continue to train hard.

About Disa Hatfield

Disa Hatfield has written 3 posts in this blog.

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