Saturday, May 5, 2007

Off the cuff. Shoulder anatomy and the Rotator Cuff

There are many, many injuries in the gym everyday. A lot of these injuries can be prevented with a little bit of caution and some basic knowledge in human movement and proper exercise form. One of the most common injuries are to the shoulder. The rotator cuff, to be exact.

The rotator cuff consists of four small muscles that form a sleeve around the shoulder and allow us to raise the arm overhead effectively. These muscles, consisting of the supraspinatus, infraspinatus, teres minor and subscapularis, oppose the action of the deltoid and depress the head of the humerus (upper arm) during shoulder elevation to prevent impingement. Rotator cuff injuries such as tendonitis, bursitis and tears are common among certain populations.

The most commonly injured muscle is the supraspinatus. It is responsible for initiating and aiding in elevation of the arm. If torn, the individual typically experiences persistent pain in the upper lateral arm and significant difficulty raising the arm without compensatory motion from the scapula (shrug sign). The hallmark signs of a supraspinatus tear are nocturnal pain, loss of strength and inability to raise the arm overhead.

Acute tendonitis may also present with similar signs and symptoms, as pain can inhibit motion and strength. However, symptoms associated with tendonitis normally respond to rest, ice, anti-inflammatory medication and therapeutic exercise. Pain is often described as a dull ache or sharp pain along the top of the shoulder or upper lateral arm.

Rotator cuff tears are most common in men age 65 and older. Tears and/or injury are typically related to degeneration, instability, bone spurs, trauma, overuse and diminished strength/flexibility related to the aging process. However, youth are also at risk for injury if they are involved in repetitive overhead sports including swimming, volleyball, baseball, softball, tennis, gymnastics, etc. It is also important to mention that instability can contribute to secondary rotator cuff pain and inflammation.

The key to avoiding rotator cuff injury is performing adequate conditioning prior to stressing it with vigorous activities. Many weekend warriors try to pick up the softball, baseball, football, etc. and begin throwing repetitively and forcefully without properly warming up. In addition, they are not likely to condition before the season like competitive athletes. This often leads to excessive strain on the rotator cuff and swelling. The inevitable result is soreness, especially with overhead movement or reaching behind the back. The act of throwing is the most stressful motion on the shoulder. Without proper strength and conditioning, the shoulder easily becomes inflamed.

Since the rotator cuff muscles are small, it is best to utilize lower resistance and higher repetitions to sufficiently strengthen them. Sample exercises include Theraband or light dumbbell external and internal rotation exercises and scaption, which can be performed at various degrees of abduction. In addition to cuff specific exercises, it is also important to strengthen the muscles around the shoulder blade.

There are some common exercises that are known to increase the risk of a shoulder injury if not performed properly. Here are a few of those exercises with some key points to keep in mind in reducing that risk and saving your shoulder.

  • Bench press – Do not lower the bar or dumbbells below where the arms are parallel to the floor
  • Shoulder press – Keep the arms 30 degrees in front of the body and do not lower much below where the arms are parallel to the floor
  • Bar squats – Avoid behind the head bar placement and opt for front barbell squats or dumbbells in standing
  • Dips – Do not lower beyond the point at which the upper arm is parallel to the floor
  • Push-ups – Do not lower below the point at which the upper arm is parallel to the floor
  • Rows – Do not pull beyond the plane of the body to avoid excessive strain on the anterior shoulder capsule
  • Lat pull downs – Keep the bar in front of the head
  • Upright rows – Limit the elevation of the bar or dumbbells to the point at which the arms are parallel to the floor
  • Lateral raises – Keep the arms about 30 degrees in front of the body (elbows are slightly bent) and raise the arms no more than shoulder height
These modifications will avoid excessive stress on the shoulder joint capsule and help prevent rotator cuff impingement. They will not limit hypertrophy (muscle gain-increased size), strength gains or function. They will, however, ensure that you are training safely and minimizing the chance for injuries. If you consistently follow these guidelines, you will have a pain free workout and a better chance of reaching your goal effectively.

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