Preventing Shoulder Injuries

Summary from Preventing Shoulder Injuries and Cracking the Rotator Cuff Conundrum

Impingement syndrome describes the pain originating from compression of the rotator cuff tendon or the biceps tendon between the head of the humerus and the bony arch just above the glenoid. One of the major causes of narrowing is an upward migration of the humeral head when raising the arm. This is usually because the rotator cuff is not strong enough to effectively pull the humeral head down and into the glenoid.

INJURY PREVENTION
Simply put, the secret to preventing shoulder injuries is to strengthen the rotator cuff and scapular muscles to allow for coordinated and stable shoulder movement. Yet these muscles are often overlooked in many strength-training programs.

Why Should I Train the Rotator Cuff?

1. Strength: Weak external rotators of the humerus are limiting factors to development of internal rotator size and strength, as the body will not allow progress to continue in the presence of an imbalance that could lead to injury.
2. Safety: The rotator cuff (particularly the external rotators) is of paramount importance in injury prevention. Internal rotator dominance is extremely common among bodybuilders, powerlifters, and athletes for whom the pecs and lats are prime movers. Strengthening the rotator cuff and the resulting improvements in glenohumeral stability significantly decreases the occurrences of humeral head subluxations, dislocations, and nagging overuse shoulder injuries. It goes without saying that injuries are one of the greatest barriers to progress in the gym; if you're in too much pain to lift weights to stimulate growth, you won't be doing any growing! By giving the muscles of your rotator cuff the attention that they deserve, you can eliminate the loss of valuable training time to injuries and increase your training longevity.
3. Size: In addition to all the indirect ways that direct rotator cuff training can lead to size, let's not forget that the four muscles of rotator cuff themselves are capable of hypertrophy! Unfortunately, hypertrophy in the subscapularis and supraspinatus is unlikely to be noticeable due to their positions behind the rib cage and deep to the upper trap, respectively. Growth of the infraspinatus and teres minor, on the other hand, will certainly further one's back development by enhancing the "V-frame." When an individual is quite lean and possesses good external rotator development, the separations between the posterior deltoid, infraspinatus, teres minor, teres major, and lats are readily apparent and quite impressive, especially during the back-double biceps pose.
4. Posture: Several factors can lead can lead to tight internal rotators. Many athletes and lifters who utilize these muscles extensively without attention to the external rotators can experience a marked shortening effect of the internal rotators due to tightness. Over time, poor posture can place considerable stress on the skeletal and nervous systems, leading to injuries and decreased performance in the gym. A combination of internal rotator stretching and external rotator strengthening has proven successful in decreasing the anterior inclination of the thoracic spine.
5. Improved Range of Motion on Mass Builders: Simply stated, exercises performed through complete ranges of motion yield superior gains in muscle mass. If your internal rotators are tight, your ROM and, in turn, potential for mass development will be greatly diminished
6. Confidence: Some might debate me on the psychological carryover of a physiological change, but I'm a firm believer that you'll have a lot more confidence supporting big weights if you know your stabilizers are healthy and strong. You wouldn't want to get under a squatting bar unless your core and lower leg muscles were comfortable supporting the load on your shoulders; the same is true of benching, chinning, and overhead pressing. Confidence is an often-overlooked component of strength training performance, even if it is only confidence that your humeral head is going to do what it's supposed to do during your set.

Exercises

1. Cuban Press: Grasp a barbell and perform a wide-grip upright row until the bar is about two inches below your clavicle. Once the bar reaches this level, hold the elbows steady while externally rotating the bar as if you were trying to touch it to your forehead. As the external rotation phase completes, press the bar overhead.
   Lower the weight along the same path and repeat for reps. This exercise preferentially recruits the infraspinatus over the teres minor, and there's certainly significant contribution from the delts and traps as with any upright row or press. Be forewarned that the Cuban press isn't an ego booster; the external rotation phase is a limitation to moving big weights with the movement.
2. L-Lateral Raise: To finish off the infraspinatus, hold a dumbbell in each hand and perform a lateral raise to 90° with the elbows simultaneously flexed to 90°. Once your upper arms are parallel to the floor, externally rotate your humerus so that your forearms are perpendicular to the floor (as in the mid-phase of a military press).
3. Side Lying Dumbbell Abduction to 45°: Think of this as a single-arm, half-lateral raise while lying on your side. The two-second pause at the end of the concentric (lifting) portion of the movement really intensifies the exercise. For some individuals, performing this exercise on a flat bench may feel awkward; a low incline is an acceptable alternative.
4. Y lifts: Lie on your stomach on the floor with the arms 45° above shoulder level, thumbs pointed up towards the ceiling. Raise both arms up off the floor trying to initiate the movement with your shoulder blades. Start with hands only and progress to one- to three-pound dumbbells.
5. T lifts: Lie on your stomach on the floor with the arms 90° straight out to the side, palms down. Raise both arms up and rotate them as you do so by pointing your thumbs toward the ceiling. Focus on pinching your shoulder blades together. As with the Y lift, start with hands only and add weight as your strength increases.
6. One-arm, one-leg row: Stand on one foot with that knee bent 30°-45°. In the opposite hand hold the cord or pulley handle attached in front at chest height. Start with the thumb pointing down and perform a one-arm row as you straighten the knee. At the end position the palm should face up. Focus on pulling aggressively, bringing the elbow well behind the body. Repeat with opposite arm/leg.
7. Elbow pulls: Use a cord or pulley attached in front at waist level. Stand with the feet shoulder-width apart, knees slightly bent, and with a slight forward lean. Hold grips with thumbs up and with elbows at 90° and close to the rib cage. Maintain the 90° elbow position and pull the cord straight backward quickly.
8. Side lying external rotation: Lie on your side with the top arm resting against the side of your trunk with that elbow at 90° and with the forearm resting across the abdomen. Hold a one- to three-pound dumbbell and rotate your upper arm outwardly to raise the forearm up and back towards the ceiling. Keep the elbow tucked at the side. Repeat on opposite side.
9. Scarecrow: Stand with both arms straight out to the sides at 90°. The elbows are also bent at 90° with the forearm dangling downward towards the floor. Simultaneously raise both forearms upward and backward by rotating the upper arms outwardly. Maintain a 90° position at both joints. Use one- to three-pound dumbbells.
10. Standing two-arm overhead medicine ball throw: Stand with feet shoulder width apart and hold a two- to three-kilogram medicine ball overhead in both hands. Throw the ball powerfully against a concrete wall or to a partner.
11. Alternating overhead dumbbell press: Stand with one dumbbell resting on each shoulder, palms facing each other. Alternately raise one arm up overhead rotating the dumbbell as you do so that the palm faces forward at the top. Alternate arms each repetition.