A Systematic approach to shoulder health
Approximate Reading Time: 12-15min
By Keshava Raghuveer (@keshrags)
5th of February 2018
One challenge in addressing ‘prescriptive’ movement methods (i.e. “do this exercise”) is that each person has a different set of needs within their own bodies. The following overview of potential shoulder solutions isn’t an exhaustive list, but merely a sample from a complete toolbox that we at Restore Human use to build shoulder health with our members based on their individual needs.
The main purpose and intention for this blog (well, actually, any of my blogs) is to offer you a starting point for your journey so that you can use the information provided to begin and construct your own practice.
Before we begin it would be helpful to understand a bit about the shoulder complex. Imagine a golf ball sitting on a tee. Picture the head of the humerus (upper arm bone) as the ball and the shallow socket of the scapula’s glenoid fossa as the tee. The ball doesn’t really sit snug in the socket, which allows for immense movement complexity but at the cost of skeletal stability which makes the shoulder an inherently fragile area. Shoulder stability is provided by the rotator cuff complex of muscles, the surrounding bony processes and glenohumeral ligaments.
The immense complexity of movement available to the shoulder joint is due to the wide range of movement available at the scapulothoracic ‘joint’. Think of the ST joint as a flat bone (scapula) with gliding surfaces formed by subscapularis and serratus anterior. This forms the anchor that helps bring stability and cohesion to the shoulder area described above. If these gliding motions are compromised, they can play a big part in upstream shoulder health.
Two other areas which are also part of the shoulder equation are the acromioclavicular and sternoclavicular joints. The AC joint is at the top of the shoulder which serves as the junction between the acromion (the part of the scapula that forms the highest point of the shoulder) and the clavicle – allowing for the ability to raise the arm over the head. The SC joint, via movement of the shoulder girdle or scapula, will have some movement – but movement that is primarily associated with elevation, depression and some rotation.
Now that we know a little about shoulder anatomy, it makes sense that we need a variety of tools to adequately challenge the intricacies of the various tissue that interact within the shoulder complex.
Without further ado let us explore some of the options available to you!
JOINT INDEPENDENCE WORK
To assess and work on the ability of the humeral head to rotate freely in the glenoid cavity, I’m using an approach called CARs, or Controlled Articular Rotations, created by Dr. Andreo Spina. Can I actually rotate the upper arm in its socket without co-opting a whole bunch of other joints assistance? This is of crucial importance. Once these rotations can be done well, a key interaction within the shoulder - rotation without interference – can be ticked off as one aspect of shoulder health!
Many problems can occur due to the inability to perform this task. For example, a lack of internal rotation of the shoulder may cause problems in training, such as attempting to perform a chin-up. Problems in daily life can pop up by simply trying to put something onto a high shelf. It sucks not being able to reach your arms above your head pain-free, right?).
In the video, you’ll see I make sure my shoulder doesn’t collapse forward giving the illusion of rotation. Nor does my body move or rotate to ‘help out’. Take note of what happens as you perform the rotation as it will dictate the next steps. If you are pain-free and have healthy range of motion, perhaps you move on to adding force, as shown in the next segment. However, if you can’t do it without pain, where is the logical place to go? For the purposes of the blog, we will work on the assumption that you have pain-free access to the movements - if in doubt, consult your primary healthcare physician.
Come train and work with us in person to find out even more about Dr. Spina’s Functional Range Conditioning protocol!
BANDED SCAPULAR MOBILITY
Once you understand joint independence and can adequately perform all the movements of the shoulder, adding some force through the tissues an avenue for further exploration.
Attach a relatively challenging band to a fixed point. Then explore the permutations of the scapulae (elevation, retraction, depression, protraction), interact with the muscles around them and challenge them to get stronger due to the pull, or force, from the band. The key here is to keep your body as fixed as possible with your arms locked so you can ‘feel’ the movement being generated from the shoulder blade area.
When force is used to explore the various positions of the shoulder blades, we hope to increase their movement potential and build mobility in the scapula-thoracic joint. Scapular control is a key part of overall shoulder health - remember how the ball and socket is looked after by a whole gang of tissue? Well, the scapula-thoracic joint is like the anchor that binds the shoulder complex. Keep it healthy and strong and all the smaller muscles and joints connected need to do proportionately less work!
CUBAN ROTATIONS
Previously I addressed the importance of healthy internal rotation of the shoulder. Well, makes sense that we need healthy external rotation of the shoulder as well, right? A perfect exercise for those who possess these pre-requisites is the Cuban Rotation. To carefully load the relevant tissue, begin with a broomstick. Grasp it so your lower arms are perpendicular to the floor and the stick is about forehead level. Next, without letting the shoulders collapse forward, internally rotate the stick until it’s close to your solar plexus. Reverse back to the starting position in a controlled fashion.
Because Cuban rotations load the shoulder internally AND externally it’s a great bang for your buck exercise. They help balance out the impact from a lot of upper body strength training and strengthen the smaller rotator cuff tissue which helps protect the ball and socket. There’s also the option of only using the external OR internal parts if that is more suitable. The exact needs of each person will dictate how these tools are used! Remember, Cubans may be difficult for you if internal rotation is lacking in your shoulders.
HANGING
One of the most accessible and easiest thing we can do for shoulder health and mobility is hanging - something most of us grew up doing very naturally! It’s a shame that so many folks don’t keep this policy going. Pound for pound, it’s got a hell of a lot going for it as it’s so easy to do and requires minimal technical work. Hanging can be scaled as necessary by keeping feet lightly on floor or even by hanging sideways from a doorframe.
To perform a passive hang, allow the scapulae to elevate and stay relaxed. Again, there should be no pain, although there may be some grip resilience needed along the way. To perform an active hang, depress or pull down the scapulae. At Restore Human we employ the active hang as a base movement to set up the necessary tissue strength and shoulder health for activities such as rowing, pulls/chins and brachiating to name a few. You cannot oversell hanging as a fundamental tool in your movement arsenal.
Once you own basic active and passive hangs, you can combine them and create dynamic patterns and further test the shoulder abilities. Be patient and methodical; great rewards lie in store!
To sum up, focus on creating space and tension in varying degrees over the entire of the shoulder joint with all these exercises. It’s worth reiterating that these are a clutch of potential solutions - utilize some form of assessment protocol to choose the right exercise. If you have healthy and well-moving shoulders this little tool box will certainly boost your shoulder health by increasing varying elements of strength and mobility in both the bigger and smaller muscles that comprise this most complex and fascinating joint.