The Head to Toe of Injury Prevention for Grapplers: Part 3, The Shoulders

Let’s talk shoulders this time. I had originally planned to have this post be an all encompassing arm and shoulder one, but the scope of the shoulder and the myriad problems caused by just this section of the body in grapplers warrants a full post. This is by no means comprehensive, since a comprehensive post on the shoulder would actually be a small novel, this is just an overview of the shoulder and a recommendation on how to prevent one of the most common shoulder injuries- impingement caused by poor shoulder movement and stability. This is the most common shoulder injury I see among grapplers, and this is what I recommend to prevent it. As always, remember I’m not a medical professional. If you are having shoulder pain, go to see a professional physiotherapist. This article is for people with healthy shoulders to keep healthy.

Let’s start with the basics, and in particular, let’s explain what the shoulder joint actually is. If you look in the mirror right now, you will see a rounded protrusion sitting into which your arm connects. This is what most people commonly think the shoulder is, but in fact the round bit on the top of your arm is only half of what makes your shoulder move the way it does. If you place your palm over your shoulder, this is the glenohumeral or shoulder joint, and you are also basically covering what is known as the rotator cuff. You’ve probably heard this term before. It’s so called because this is the part of your shoulder that allows multi-directional rotation (rotation, rotator, rotation… see what they did there?), though rather than being a specific muscle or joint, it is in fact a general term for quite a few muscle and tendon components of your shoulder. Raise your arm in front of you parallel to the ground, to the side parallel to the ground, or behind you as much as possible- you have now reached the limits of the glenohumeral joint’s movement. The rest of the movements of your shoulder- bringing you arm any further upwards as in over head movements, scratching your head, rolling your shoulder forward or backwards, shrugging, and so on, are the responsibility of the scapulae, or shoulder blades, and their associated musculature. This is something not everybody understands despite the giveaway colloquial name- the bony protrusions in your upper back are extremely important to your shoulders. In fact, they are your shoulders.

Most people can protract and elevate their scapulae quite well. Protraction is when your scapulae move away from you and forwards, pushing your shoulders out in front of you as though you are pushing someone away from you. Elevation is where we raise our shoulders upwards as in a shrug. This is because by and large, most of the work we tend to do in the gym or as kids involves pushing movements. Have you ever heard of anyone being asked to “drop and give me 20 inverted rows”? Of course not. We’re conditioned to push, and this is one of the causes of shoulder problems since we lack the corresponding ability to pull things towards us with a full range of motion, the last portion of which is known as retraction of the scapulae (pulling something towards our chest) or depressing the scapulae (pulling something downwards from overhead). We should be able to bring our shoulders down and back with a squeeze of our shoulder blades, and we should be able to do this under load. This type of push/pull imbalance is the bane of the shoulder joint. When this happens, the excess strength and tightness in the chest tends to pull the shoulders forwards and upwards, creating the sort of problems in the rotator cuff and acromion when we move our arms that people complain about.

What was that? The acromion? Ah yes, new word there, but if you have had some sort of shoulder issue then you’re probably already familiar with this, even if you never knew its name before. To find the acromion, bring your hand over your shoulder to the top of your opposite shoulder blade. The bony ridge on the top of the scapula is known as the spine. Now run your fingers along the spine of the scapula until it curves out towards the edge of your shoulder- just before you meet the collar bone you find the the acromion. Beneath the acromion is a space, and this space is quite small. Once some dysfunction develops as described above (the shoulder rolling forward  and up rather than downward and back) the space beneath the acromion becomes smaller and impingement occurs. This causes pain and discomfort when you raise your arm, which is bad. What is happening there is that the bursa of the humerous is now grinding up against the acromion, whereas previously it glided by normally and painlessly. The bursa is a sac of fluid that sits on the end of your bone to aid a smooth, gliding movement. Without it, life is a grind… get it? Grind? Anyone? No?

Worse again is the fact that the acromion comes in a veritable rainbow of 3 different flavours; Type 1- flat, Type 2- curved, Type 3- Hooked. If you are Type 3, you will almost certainly experience some level of shoulder impingement in your athletic career/work life/reaching for the snooze button on the alarm clock. If you have Type 1, you’re far less likely to get this type of shoulder pain. You lucky son of a bitch.

So let’s try to stop this. What we’re going to aim for are some nice healthy shoulders that sit down and back into the back. When I start coaching someone who has that forward-rounded shoulders look I begin with this sentence. Let’s call this our first answer to the problem of shoulder injuries.

“Start to think of every upper body exercise as a back exercise”

What this means is that I always want them to be conscious of their shoulders and where they should be. When they’re doing the very simple push up, I want them to concentrate on their shoulders retracting and depressing into their mid back when they’re in the “down” position of the exercise, then pushing out to full protraction of the shoulders when they’re fully extended in the “up” position. This is a very fundamental way of training people how their shoulder should work in conjunction with their mid back. Likewise with rowing movements. Okay, the world and it’s mother knows that rows are an exercise for your back, but walk into any commercial gym tomorrow and you’ll see guys and girls performing rows in a stooped over position, rowing barbells to as far as their arms will allow and no further, practically slapping their shoulders off their ears. In other words, their scapulae remain protracted and elevated for the entire movement. We want retraction, so start to think of the rowing movement, be it single armed or using both arms, as an exercise that absolutely must have full retraction and depression of the scapula. The last pinch at the end of the movement is what you want here.

While thinking about this article I made a call to a friend of mine who works extensively with rehabilitation. I asked him what sort of guy he never sees for shoulder rehab. It was a stupid question that I hadn’t thought through, and I got the obvious answer- “the sort of guy who never hurts his shoulders”. He didn’t really answer the ridiculous question directly, but what he did say about the people he sees with shoulder injuries was that “If they can do lots of pull ups and a barbell row of their bodyweight with good form I’d be very surprised”. In other words, the people he sees with shoulder injuries tend to have weak pulling strength. No surprise there then. So our second short answer on how to avoid shoulder injuries is:

“Have a good ability to pull heavy things towards you with good form and full range of motion.”

That balanced ability to push and pull with good strength will get you out of a lot of shoulder strain, since the forces acting on the shoulder (pulling them forward and backward) will be balanced. However what if you don’t yet have that strength, or have bad movement through the shoulders already? Here are a few exercises to help you out. You can use these in your warm ups or as a standalone home workout for prehab. These are strength exercises inasmuch as doing them will help you to perform strength exercises with good form through training your shoulders and scapulae to perform properly, but really what we’re doing here is training movement, so resist the temptation to weight the movements too heavily, and remember that we’re trying to make our shoulders move correctly.

1)      Scap push up- like a push up but 100% of the movement occurs through your scapulae. Remember, shoulders down and back, don’t shrug to your ears.

2)      Band pull-aparts. Grab the band, pull it apart. Keep the movement parallel to the ground and once again make sure your shoulders aren’t rising. Start with a light band.

3)      Dislocates. Use a belt or a band. Part stretch, part movement training. If you’re tight this will be just a stretch at first, but as you progress you will be trying to keep your shoulders down and back throughout.

4)      Bent over shrug/chest supported shrug. Performed in a bent over row position, or if you like, using an incline bench.

5)      Face pulls. You can use a band or a cable machine. Choose a light weight and concentrate on pinching your shoulders down and back… man I’m repeating myself here. Look, just always down and back, down and back… depression and retraction.

If you’ve ever studied anatomy to any degree, you will probably be as fascinated as me by the human body, and the shoulder is particularly absorbing. The sheer range of movement and biomechanical excellence are astounding. There is no comparable joint in the body that allows movement with such freedom in multiple directions. In fact, one other thing makes it even more unique; the joint itself is moveable! But we do pay a small toll for this amazing range. It is exposed to the common impingement injury we’ve spoken about here, but also to separation, and of course, dislocation due to its position and relatively weak structural position in the body. Keeping your shoulder healthy and strong is a necessity if you’re interested in staying healthy and on the mat. In addition, strong and stable shoulders will help with any upper body movement that requires strength and stability- from falling after being swept right through to arm-dragging.

That’s all for now. Next time- the hands!