Masters

SHOULDER INJURY

Preventing shoulder injury and dysfunction – Johnny Fuller, Manager, Paramedical Services, Swimming Canada

To do or not to do… the shoulder exercise conundrum

Shoulder and upper arm complaints are (by some distance) the most frequently reported musculoskeletal disorder within competitive swimming. Indeed, I suspect that this wasn’t a particularly ‘jaw dropping’ revelation for any individual involved and invested in our sport. However, despite this general acknowledgement, the way in which we try to maintain & enhance shoulder integrity varies greatly from therapist to therapist, coach to coach and from athlete to athlete.

My own approach is always focused on preventing injury and dysfunction – working proactively, rather than reactively, wherever possible. As such, in respect to the shoulder, my priorities revolve around ensuring joint stability, maintaining muscle length and promoting good movement mechanics. Generally, this is best achieved through consistent, structured and relevant activation work that is intricately blended into all elements of a program. By doing this, we actually enable athletes to get the most out of their pool and gym sessions – and, just as importantly, significantly decreases their potential for injury onset.

In my experience, wherever I’ve worked, there is a tendency to not place enough importance on activation activity – preferring to rush this element of the program or just rely on more traditional, often ineffective, ‘warm-up’ exercises. The expectation is that strength & conditioning (S&C) sessions will establish general shoulder robustness. At best, this approach will limit performance potential – at worst, an athlete will develop injury (often necessitating time out of the water or, at least, a significantly compromised training load). However, by introducing quality activation work before each pool & gym session – and combining this with effective recovery strategies post work-out – we can almost guarantee better results and fewer injuries.

In terms of effective shoulder activation, the ‘best’ exercises are very much dependent on the individual athlete. Indeed, there is enormous value in taking the time to identify areas of weakness, strength imbalances and/or misalignments so that the most suitable activity can be assigned. In my opinion, shoulder activation exercise should typically account for around 20-25% of the total pre-pool/pre-gym routine – perhaps even more if a shoulder vulnerability has already been identified. I advocate a pre-pool/pre-gym session of around 25-30mins – consisting of approximately 20% mobilization/stretching, 60% activation activity (a balance of shoulder stability/core control & alignment/lower body integrity – see previous technical bulletin article) and 20% power/strength based activity.

Having said all this, and impressing the need for bespoke exercise prescription for all athletes, I am often asked about my favorite (and least favorite) shoulder exercises. Certainly it is difficult to produce a definitive list – for instance, some exercises may be better employed during injury rehabilitation whilst others could be more suited to performance enhancement only. However, throughout my career (particularly within swimming where the shoulder is such a prominent joint), I find myself prescribing a small number of key shoulder exercises over and over again. What all these exercises have in common, in addition to their effectiveness, is their versatility and simplicity. They can be implemented at all stages of injury rehabilitation, integrated into general pre-pool/pre-gym routines, are easy to coach/teach, require little or no equipment, can be adapted/progressed easily and will almost always improve stroke biomechanics. Whilst these exercises may not be overly ‘sexy’, I personally believe that success (be it from a performance perspective or recovery from injury) is only derived by executing the simple/basic/compound practices effectively from the outset.

So, here goes with my top 5 shoulder exercises (in no particular order). Certainly, if you aren’t using any of these currently, then give them a try.

#1 Shoulder Isometrics & ‘Bouhler’ Exercises

Simple shoulder isometric exercises are all too often over-looked and under-used. However, there is a substantial amount of evidence to show that isometrics are a fantastic tool for both injury rehabilitation and general shoulder activation. Effective isometric holds can be performed through all 6 compound movements of the shoulder (glenohumeral) joint – flexion, extension, abduction, adduction, internal & external rotation – and used to stimulate key swimming musculature (rotator cuff complex, deltoids, pectoralis major/minor, latissimus dorsi, triceps & biceps). ‘Bouhler’ exercises can also be added to provide further co-contraction with lower trapezius and rhomboids.  Personally, I believe they are a key component in helping to alleviate a wide variety of shoulder issues and build joint robustness.

#2 Prone Y-Lift (combined with T, W, L & I prone lifts also)

A fantastic exercise for recruiting/activating posterior shoulder muscles and, as a result, combatting common sub-acromial complaints. Almost without exception, I include this exercise in all pre-pool/pre-gym sessions and encourage athletes to concentrate on the eccentric part of the exercise as much as the concentric for maximum benefit (applicable to Y, T, W, L & I’s also). Effective performed with either single or double arm movements, this exercise can also be progressed with the use of cable machines, dumbbells & resistance bands in a standing position.

#3 Lat Pull Downs

Lats (despite what many specialists believe) are normally a victim, rather than an offender, when looking at poor shoulder biomechanics, imbalances and dysfunction. Concentrating on this type of exercise can help to reduce over-activity of the deltoids – thereby, eliminating the ‘painful arc’ (swimmer’s shoulder) experienced by many athletes. Single straight arm movements, in a standing position, is generally considered best practice.  Again, a focus on a slow & controlled eccentric phase will reap the highest rewards.

#4 Single arm overhead press

The single arm overhead press is another excellent movement that establishes correct co-contraction (movement patterns) of key musculature through the shoulder, scapula and trunk. My favorite version of this exercise is the ‘Arnie’ press – primarily because it works the shoulder through a greater range and through multiple planes of movement (keep weights low at the beginning, to eliminate compensatory muscle involvement, and pay particular attention to the eccentric phase).

#5 Push-up

A superb closed chain (good for proprioception) exercise that increases posterior rotator cuff activity and strengthens anterior shoulder & chest musculature. It has multiple variations, can be simply adapted and is (therefore) relevant to all phases of rehabilitation and conditioning. In terms of the way we can adapt exercises to ensure effectiveness, think about increasing range of motion, changing base of support, disrupting inertia, increasing lever length, changing fulcrum, altering weight/sets/reps, decreasing stability, removing sensory perception, decelerating/accelerating movement, increasing time under tension (TUT), changing focus (concentric/eccentric speed) etc.

It is my hope that this article encourages you to reflect on your own practices and help you structure effective exercise strategies.