A Strength Coaches Guide to Dealing with Pain, Part 1: Shoulder Pain
By
Andrew Paul
As a strength coach, I work with many athletes who suffer from chronic joint
pain. When I hear them complain about shoulder and knee pain, my first reaction
is to blow them off and tell them to go stretch. However, after suffering from
the same types of nagging pains myself, I know that their pain is very real.
While minor injuries like tendonitis aren’t debilitating, they do hold
athletes back, especially in the weight room. The key is to understand that
there are some things that we, as strength and conditioning coaches, can do to
improve these conditions.
Throughout this series, I’ll discuss a few, very common sources of pain in
the athletes whom I work with and how a strength and conditioning coach can
manage it without stepping over their bounds.
Pin point pain on top of shoulder
This will usually be diagnosed as some sort of impingement of the shoulder.
The red flag is when the athlete has pain with abduction and flexion. This is
due to the humeral head and the acromion process coming too close together.
While this is annoying and painful, it isn’t debilitating.
Here are four things that we can do to help.
1. Stay away from rotator cuff work (for the time being).
The obvious response to shoulder pain is to always do more rotator cuff work.
However, with impingement, there is already friction and inflammation of the
rotator cuff tendons. Doing rotator cuff work incorrectly could make it worse
and produce a tear. Stay away from causing any more damage and be safe. Once
pain has subsided, go ahead and resume working the rotator cuff. A strong
rotator cuff is a must.
2. Activate and strengthen the lower and middle traps.
These muscles are commonly weak because they are underworked in traditional
training programs. They are a big part of scapular upward rotation, depression,
and retraction. It is in these positions that the gap between the humeral head
and the acromion process is widened. Strengthening these muscles will give your
humeral head more room to breathe. Use exercises that force your scapulae into a
retracted and depressed position.
Here are some wise choices:
Wall slides (my favorite)
Prone Ys and Ts (Ws and Ls work as well)
Scap pull-up
3. Check pectoral major and minor for trigger points and tightness.
A tight pec major and minor can cause two things that are detrimental to
shoulder health—internal rotation of the humerus and anterior tilt of the
scapulae. If you’re certified in active release therapy (ART) or know someone
who is, use them. ART on the pec minor hurts like hell but will keep your
shoulder healthy. If you don’t have that available, use a tennis ball or
lacrosse ball. They can work wonders. Also, add some pec stretching at the end
of your workouts, and you can help keep your shoulders out of harms way.
4. Take a look at your posture. It can tell you a lot.
There is a lot out there on posture assessment. I’m not an expert in this area,
but I can spot a kyphotic posture when I see one. When someone has exaggerated
kyphosis, it puts their scapulae in an anterior tilted position. Posture is a
difficult thing to fix. It takes time and expertise. Chiropractors and physical
therapists can help, but we can do things to mobilize the thoracic region as
well. Bill Hartmann and Mike Robertson did a great job showing how in their
Inside-Out manual. The biggest thing we can do is to learn what thoracic
extension is and coach it during every exercise. Be sure that your athletes are
squatting and overhead pressing in thoracic extension as well as doing overhead
squats from time to time to loosen up.
Posterior shoulder pain
This is one of the most common types of shoulder pain in big benchers. This
nagging pain will come on after big pressing workouts, and it feels like you
have a golf ball stuck in your posterior delt. This one takes a little thought
because the initial reaction to the pain is to do the opposite of what is
actually needed.
1. Check for a glenohumeral internal range of motion (ROM) deficit
(GIRD).
This is the red flag with this problem. Perform a posterior capsule stretch (as
pictured). The key with this is to hold good posture. Don’t allow your scapula
to fall into anterior tilt. More than likely, there will be an internal range of
motion deficit in the effected shoulder. This is a clear sign of what is more
than likely going on in your shoulder and is extremely common in overhead
athletes who do a lot of throwing or any other explosive overhead movements
(baseball, volleyball). If this is the case, follow the remaining steps.
2. Stay away from external rotation (for the time being).
Like I said, your initial reaction may be wrong in this case. Doing more
external rotations will exaggerate an imbalance occurring in the rotator cuff
itself. When looking at the stabilization of the humeral head, we know that the
teres minor and infraspinatus are external rotators. However, they’re also in
charge of posterior stability, meaning they prevent the humeral head from moving
posteriorly. Conversely, the subscapularis is an internal rotator and is
responsible for anterior stability of the humeral head. In this case, we have a
damaged subscapularis. After benching, the pecs get revved up and begin pulling
the humeral head anteriorly. With a weak subscapularis, there is nothing to
prevent the anterior glide. The teres minor and infraspinatus attempt to pick up
the slack. This results in trigger points and tightness in the posterior
capsule. More external rotations only put more work on our already overloaded
muscles.
3. Strengthen the subscapularis.
The true dysfunction may lie within the subscapularis. This muscle lies inside
the scapula and, as stated earlier, is in charge of internal rotation and
anterior stabilization of the humeral head. During throwing actions, it is
quickly lengthened in the cock back phase and is quickly shortened during the
forward motion of the arm. This can produce some major damage, which will result
in a lengthening and weakening of the muscle. This muscle also opposes the
forward pull of the pecs by preventing anterior gliding of the humeral head.
Having a strong subscapularis becomes essential, not just for overhead athletes
but also for big time benchers. Internal rotation exercises are a must. Two good
choices are prone internal rotations and subscapularis pulls using a theraband.
When doing these, be sure to maintain good posture by keeping your scapulae in a
retracted and depressed position. Never allow them to fall into anterior tilt.
Prone internal rotations (actually meant to be done on an athletic training
table)
Subscapularis pulls with a theraband
4. Lengthen the posterior capsule.
The GIRD that we observed earlier is a clear indicator that we have a stiff
posterior capsule. By lengthening the teres minor and infraspinatus, we can
balance the joint and take some load off of the external rotators. We’ll also
give them a lot more time to decelerate the humerus during throwing motions by
creating more internal rotation ROM. Perform a posterior capsule stretch every
day (it’s the same as the test to check for GIRD). It will help immensely.
5. Use soft tissue work on the posterior shoulder.
If you feel around the posterior shoulder, you will most likely find some major
trigger points in the rotator cuff. Again, if you are ART certified or have a
massage therapist, use them. If not, get on a tennis ball and perform slow
internal and external rotations while putting pressure on the dense tissue.
Again, it’s very painful but worth your while.
References
- Sahrmann S (2002) Diagnosis and Treatment of Movement Impairment
Syndromes. St. Louis, MO: Mosby.
- Hartman B, Robertson M (2006) Inside-Out: The Ultimate Upper Body
Warm-Up.
- Kendall F, McCreary E, Provance P, Rodgers M (2005) Muscles: Testing and
Function with Posture and Pain. Baltimore, MD: Lippincott Williams &
Williams.
Andrew Paul currently serves at the assistant director of strength and
conditioning at the University of Missouri working with their football,
softball, and volleyball teams. He can be reached via email at
andrewpaul@mizzou.edu.
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