Let’s face it: shoulders get injured, and it sucks. Fortunately, in most cases, there is so much you can do to improve how they feel and perform.
I’ve had my fair share of problems keeping my shoulders healthy over the years. Chronic dislocations while playing football in high school and 4 years of rugby in college, 3 shoulders operations (2 for the labrum/subscapularis, 1 for the AC joint), and less than stellar program design addressing weaker areas throughout high school and early college, I’ve started to show early signs of an arthritic shoulder (yikes!). So what does this mean? Am I screwed for life? Throw in the towel, hang up the cleats, and resolve for a life of extreme limitations?
For those of you who are also dealing with recurrent joint pain, early onset of arthritis, or any arthritis at all, regardless of age/ability, pay close attention, because this is certainly the truth:
It is IMPERATIVE, that in the presence of degeneration of passive tissue structures (think menisci, labrums, cartilage, joint capsule), you still find the right blend of tolerable* movements that will create the minimal essential strain (MES) needed to stimulate/strengthen those passive tissues, as well as the active tissues (muscle/tendon/fascia) surrounding that joint.
*tolerable is key. Discerning pain and discomfort is imperative, but can be tricky. Working with a qualified specialist absolutely helps with this delineation.
Why is this important? For lack of a better analogy, think of a car’s brake pads and rotors. In order for the car to “brake”, or decelerate, the rotors must receive a signal from the user pressing the brake pedal, in which case the rotor responds and the brake pad pushes against the tire to slow it down. Therefore, you can think of the brake pads as deceleraters of the motion of the tire, and therefore the entire vehicle. You’re musculoskeletal system functions in a very similar way: Our passive tissue structures (the rotors of the body) contain proprioceptors that send a signal to the brain which then sends a signal to the active tissue (the brake pads of the body) to decelerate, control, stabilize, and/or accelerate motion of the joint. Over time, our passive tissue structures may wear down, and variables like magnitude and longevity of altered joint kinematics, lifestyle habits, physical activity level, genetics, and joint health all play a significant part in how quickly this occurs.
Moral of the story: train in a way that will strengthen and improve integrity of your passive tissue structures, or rotors, while maximizing stimulation of your active tissue structures, or your brake pads.
In many cases, MRI’s will reveal arthritic or degenerative tissue in certain areas of the glenohumeral (GH) joint (e.g. anterior, anterior superior, posterior), so any type of heavy pressing in the horizontal or vertical direction (think overhead presses, barbell bench presses) with sloppy form (e.g. shoulders abducted too far, unstable GH joint, faulty scapular/thoracic spine motion) is a big no-no, and must be adjusted.
So how do you approach training with injured shoulders? Well, for starters, we must re-establish more normalized, pain-free active motion of the affected joint structures. Since we’re talking about the shoulder, thoracic and cervical spine mechanics, GH, ST, and opposite side hip/foot would be the main places I would look to check for motion and integrity.
Closed chain exercises where the distal limb is in contact with a fixed surface, such as a wall or the ground is a very safe place to start. Using different body parts to drive motion that is lacking, manipulating the position of the body, or perhaps even add a load to the driver to increase difficulty, or taking advantage of ground based exercises to take advantage of distal stability are all areas I’d explore with the client.
This approach, when progressed appropriately, will gently stimulate painful, sensitive areas, building integrity in both passive structures, all the while developing an appreciable amount of lean tissue to help support the surrounding joint.
Rehabilitation from injury is not something to be taken lightly, and is CERTAINLY not something to be done on the individual’s own. Life altering compensations in how you move can and will occur if left unattended, which leave the individual feeling helpless, less functional, and depressed because they can’t do the things they normally could do pre-injury. It is imperative to enlist the help of a movement professional that have experience, a great referral network, and can provide the guidance, accountability, and motivation you need to get back to the things you enjoy. Thankfully at AG, we have an extensive network of PT’s, strength coaches, and massage therapists that we associate with on an ongoing basis that provide the care that individuals need.
If you, or someone you know is experiencing shoulder issues, or any injury issues for that matter, please don’t hesitate to email.