Shoulder pain is incredibly common as up to 67% of people will experience shoulder pain in their lifetime. Now if you’re an everyday weight lifter, your chances have just gone up. As much as 33% of weight lifters have had shoulder pain in the past 72 hours and 61% have had shoulder pain in the past year. That’s a lot of people!
There are a plethora of reasons why shoulder pain develops and are beyond the scope of this article, however a brief surfacing of reasons pertaining the “why” will be covered and this article will finish with one exercise that is unique, new and incredibly useful.
To provide a general sense of what is causing, or most likely causing the pain in your shoulder, it is helpful to understand how old you are and how this may be impacting your everyday life.
Ages 11-15: If you have pain at this stage, you are at risk for damage to the growth plates, apophysitis injuries and certainly need to follow up with a physician or physical therapist. Rest is often the best remedy at this stage if the pain has stemmed from an overuse of the shoulder joint or damage to the growth plate(s) is present.
Ages 15-40: Secondary impingement is a common cause of shoulder pain for this age range which basically means the humerus isn’t staying well controlled in the center of the glenoid. Common causes can be due to poor force coupling of the musculature around the shoulder, weakness, posture, or a combination of any of the above.
Think of force coupling as the analogy of two sumo wrestlers fighting each other. If part of your rotator cuff was a 5 lb sumo wrestler and your deltoid was a 50 lb sumo wrestler, it’s obvious that the 50 lb sumo wrestler will win. Parts of your rotator cuff pull at different angles, not to mention other global muscles such as the deltoids, pec major, lats or upper traps and their influence on the humerus. If these muscles are much stronger or even more active than the crucial muscles such as the rotator cuff, than they may influence the joint position of the humerus negatively and essentially place the humerus in an unfavorable position.
Force Coupling Moments on the Shoulder:
- Deltoid: Superior Component
- Supraspinatus: Approximation and Compression of the joint
- Teres Minor, Infraspinatus and Subscapularis: Inferior Component
- Upper Trap: Superior and Medial Component
- Pec Major: Anterior and Medial Component
The scapula has been coined the “trunk of the shoulder,” as it is the foundation for a healthy shoulder. A tight, immobile scapula is a recipe for increased stress at the shoulder joint. Not to mention weak musculature around the scapula that fail to do their job when you reach overhead. As seen to the left, the upper trap has an unfavorable force vector on the shoulder as it often times yields excessive elevation of the humerus which can lead to impingement of the subacromial space. The lower trap and serratus anterior muscles however are the keys to good scapular control and stability in overhead movements.
Ages 40 and up: More so as we get older, we become at risk for primary impingement. This means that the shoulder is literally running into a mechanical object such as an osteophyte, loose body, labral cysts, etc. The reason being that primary impingement goes up is also due to the fact that there are morphological changes in the acromion in the shoulder that usually starts around age 50. An altered curvature of a once, well established acromion into a type III acromion ( see below) can dramatically alter the space and health of the subacromial tissue ( subacromial bursa, subdeltoid bursa, supraspinatus muscle, infraspinatus muscle).
What Can We Do About It?
Understand that by all means there is no “1” exercise that fits all. Everyone is a little disimilar with different anatomy, background, activity level, age, etc. That being said, there are a few principles that can help everyone which can be formulated to create an exercise.
- Rotator Cuff Strength – Pivotal as these muscles are our best compressors, stabilizers and active, dynamic stabilizers of the shoulder joint.
- Scapular Movement – In particular, scapular protraction, upward rotation and retraction seem to be an unfamiliar movement amongst the everyday citizen. Most often people perform elevation as a compensational movement. This again can lead to shoulder impingement ( whether it’s secondary or primary) and can worsen the state of the shoulder.
- Movement Patterns – Sometimes we develop altered movement patterns or ways of moving and this can yield increased weakness of the rotator cuff compared to other muscles around the shoulder ( deltoids, biceps, upper traps). For instance, sitting all day at work at a desk job can promote a shrugged position of the shoulder and can instill faulty movement patterns that can lead to dysfunction. Work with a skilled physical therapist to ensure your ergonomics are right for you
Sidelying Scapular Weighted Punches
You’ve probably never heard of this exercise because it has been developed by me. It is essentially a therapeutic exercise component of Active Controlled Mobility Training that has been developed as a new upcoming paradigm of movement and exercise.
What Makes it Different Than Other Exercises?
Most exercises are performed to isolate one particular muscle. However, while this isn’t a bad thing, it may make more sense to target multiple muscles at once to help them synergistically work together. This can help the mind-body motor connection and make it even stronger, further carrying over progress in your day to day life, not to mention weight lifting.
In addition, most common, everyday exercises lack consideration regarding traditional dysfunctional movement patterns associated with shoulder movements. For instance, most people tend to arch their back and rotate their spine/trunk when reaching into external rotation. This can ingrain poor movement synergies and leave the primary target, such as the rotator cuff, still weak with further imbalances in the shoulder.
How to Perform Sidelying Scapular Weighted Punches
- Lay on either side, the side being performed will be the side closest to the ceiling
- Bring your knees all the way to your chest. This will essentially lock out your lower back and not allow any excessive movement to come from the lower thoracic or lumbar spine.
- Bring your chin to your chest and can be held there with the other arm. This will put your nervous system and neck musculature on stretch and minimize any neck compensations.
- Reach as far as possible with the top sided arm while keeping it around 90 degrees of flexion. Once you’ve reached as far as you can punch forward ( the protraction phase of the movement), move the arm, while keeping it punched and straight, toward the ceiling while keeping it at 90 degrees of shoulder flexion.
- Bring the arm back down the body and repeat the movements at around 115 degrees, 135 degrees and full flexion.
Regarding your hand positioning, understand that performing this exercise with your palm up toward the ceiling will preposition you in external rotation and most likely further challenge the exercise. An increased recruitment in rotator cuff, lower trap and middle trap will most likely occur, further challenging the exercise. However with this challenge may come with some pain for a few select individuals so please do not push through pain. Every shoulder is a little different so keep your palm in the position that feels the best if you do have pain with any of the movements ( palm down vs thumbs up vs palm up ).
The reason that you bring the arm back down before straightening it back out is to make sure you reach to the same location every time and can be arguably an eccentric to the rotator cuff. Eccentrics have been shown to be more effective than traditional isotonics or isometrics and thus are implemented with this exercise as well.
Most users will feel a greatest challenge when they punch forward at around 130-150 degrees as this will require a maximal amount of scapular control including the serratus anterior and lower/middle traps. Make sure to NOT shrug and attempt to keep your scapula depressed towards your opposite side’s hip pocket as this reinforces the depression of the scapula that is desired.
If you particularly feel good during the “punch” phase of the movement where you reach out as far as possible, put a pillow underneath your trunk to accentuate this moment. If you feel really good with the shoulder blades coming closer together and the retraction movement, you can even obtain a position of a 1/4 turn onto your stomach and repeat the exercise. Basically you would be lying on your right shoulder ( using the video) which will put you in some right trunk rotation and increase the shoulder retraction moment.
Shoulder pain is incredibly common throughout all ages of life and even more common in weight lifters. This exercise can be incredibly useful as it targets the rotator cuff and important scapular stabilizers that are often weak in shoulders that are painful and/or dysfunctional. For one who has secondary impingement, this exercise holds incredible amounts of utility as it targets a large percent of the weakened muscles that are notoriously a part of secondary impingement. For those who have primary impingement, improved rotator cuff strength and scapular control, particularly protraction, can help “clear” the acromion despite its morphological changes and decrease your shoulder pain.
About the Author
My name is Chad Kuntz and believe in developing improved, efficacious exercises to better the profession of physical therapy. With a background of bodybuilding and 10+ years of weight training, I understand the problems that may arise along the way. Shoulder pain is certainly a common complaint and thus throughout my personal and professional career, have thought deeper into the rationale for the exercises that the public traditionally does. Personally I think there are much better ways of performing exercises than the traditional “cookie cutter,” exercises out there for shoulder pain and this is just one little insight into my thinking. The development of ACMT, or Active Controlled Mobility Training is well underway and I have hopes of bettering our profession and my patients with these skilled exercise techniques to improve mobility, motor patterns, efficaciousness, and efficiency with each and every step.
About the Author
Dr. Chad Kuntz, PT, DPT, OCS, SCS, CSCS, CISSN, TPI-1 is the founder of Pr1me Movement, located in Charlotte, North Carolina who believes in reaching out into the communities to help decrease or stop the pain before it starts!
Phone Number: 704-835-0831
Address: 601 N Polk Street, Pineville, NC 28134
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