ExRx.net

This is my stab at summing up all of the amazing things I've learned from exrx forum members, and the resources they point to, combined with what my chiropractor and trainer have taught me.

Shoulder Basics
The shoulder is actually 4 joints, with 20 muscles controlling it. It's complicated.

Because the shoulder moves on multiple planes through wide ranges of motion, the tendons are looser than in other joints, and some of the muscles are there only to keep it stable under load. These muscles have odd latin names like "Infraspinatus" and "Teres Minor". If they are not kept strong the shoulder cannot stay properly in place when doing things like Bench Press -- even if your bench technique is perfect.

Source: http://www.protraineronline.com/exercis ... -injuries/

It's Personal
Everybody is different, lifter A will get an injury earlier than lifter B, while lifter C never seems to get injured and says, "What's wrong with those two jokers?" Until lifter C gets injured.

Caution When Leaving Beginner Programs
Personally I lifted on the Stronglifts program for 5 months and found it wonderful, and the author Mehdi is entertaining and informative.

But the big problem with this and other programs is that you are given no preparation whatsoever for real shoulder health -- for some simply doing barbell rows is all they need, for others, no such luck. Once you find out barbell rows are not enough, it's too late (or so it was for me).

Once you graduate from a beginner program, you may become interested in acccessory exercises to improve your main lifts and completely miss the fact that the most important accessories are the least glamorous, the ones that keep your shoulders healthy so you can enjoy setting PR's on the bench. More on those exercises below.

Bad or No Brakes
This analogy is courtesy of our own Kenny Croxdale, who points out that when one muscle, like the front shoulder, is a lot stronger than its counterpart, the rear shoulder, it is like having a souped up car with no brakes. The faster the engine, the better the brakes have to be, so all antagonist/agonist pairs have to be trained together.

Kenny's post: viewtopic.php?f=2&t=8623&start=4

Do You Have a Rotator Cuff Problem?
Notice we are not saying "injury", but "problem". If your shoulder is not overall strong and balanced, you can have referred pain that will make it difficult, if you are not informed, to understand what is really going on.

Check out this pretty good link, it describes the symptoms well. If you don't want to click on it, it says:

- Front Shoulder Pain. Pain down into biceps. Pain feels as if it's deep in the joint. Side shoulder, neck & shoulder-blade can also hurt.
- Stiff/Weak Shoulder. Shoulder & arm tire out more easily on one side than the other. Muscle imbalances. Stiffness. Arm going numb.
- Restricted Mobility. Reaching back – like when putting on your jacket – is difficult. Lying on your shoulder when sleeping hurts.

The crazy part is a problem in the rear of your shoulder produces pain in the front of your shoulder and your bicep. If you don't know that, you can waste a lot of time blundering through the internet looking for remedies to front shoulder and bicep injuries.

Source: http://stronglifts.com/how-to-deal-with ... aspinatus/

What Does the Doctor Say?
Our own resident MD, JungleDoc, gives this advice, which I call the JungleDoctrine: "Don't get paranoid over every ache and pain." That means that weird pain you got that one time, in your calf, for like five minutes, that never happened again? That is not an injury. Never will be, don't worry about it.

But, its a different thing if you notice a specific pain after a specific exercise, which seems to gradually get worse after each session for that exercise. Anything that starts small and gets worse after a particular lift is a developing injury. By the time you are having what doctors call "pain at rest", it hurts whether you do the lift or not, its time to find a doctor who knows something about lifting and can take some guesswork out of things for you.

EDIT: This section was added a couple days after the original post

Prevention and Cure
...are the same thing. Here are a few exercises that work wonders. If you do not have a problem, do these now and forever. If you do have a problem, skip benching for awhile and do these now and forever:

- Face Pulls
- Reverse Flyes
- External Rotations (I like the lying variation)

You also have to stretch your pecs, particularly your pec minor, this is a very easy stretch to do: http://www.exrx.net/Stretches/Pectorali ... Towel.html

Soft Tissue Work
One of the easiest symptoms to eliminate is the tingling or numbness in your fingertips or arm, which can be done by getting a lacrosse ball and rolling it around on your back shoulder area, either against a wall or the floor. If you find a spot that hurts like ******, go to it, it will feel much better afterward, and can help with the numbness.

Press Like a Powerlifter Pull Like A Bodybuilder
If you don't know this you need to know this. Large compound movements like Press, Bench, Squat and Deadlift can be done for low reps like 5x5, 3x5 or 5/3/1 and progress can be expected (assuming many other things like accessory work, diet, sleep and so forth).

Not so for pulling motions like rows (db or bb), chins, or the three listed above. These break down into two categories.

Category 1 lifts, like rows, can be done with small reps to build a foundation of strength, but must also be done with volume.

Category 2 lifts, like the three listed above, do not benefit from the small reps, it's all volume with these.

For all of them, for the volume work, you want to start with very light weight, like weights you don't want your he-man buddies to see you with, and do really high reps, as many as 30, until you are totally confident you can feel the correct muscles doing the work. Only when you are totally confident of this should you raise the weights, and probably never use a weight that you can't do 15 reps with.

To wit: my trainer, a lifelong powerlifter, says that for lying dumbbell external rotations they never go over 5 pounds!

Cheating on Pulling Motions
It is extremely easy to cheat on pulling motions. On the face pull for example you can jerk the weight into motion with your biceps and traps, and your rear delts and rotators will get very little exercise, and you may not even know it! That is why we start with embarrasingly light weights and do many reps, to learn the feel in our back shoulders.

When Do I Bench Again?
Who knows? Certainly not before you've been doing lots and lots of the exercises above and can tense your rear delts (at very least) at will. Then they have to get much stronger, and the symptoms may begin to diminish somewhat. Sooner or later you can try EMPTY BAR benching, if it leaves you moaning afterward, it was too soon, sorry. Don't load the bar back up to your original weight! You'll get back to it, and even farther now that your shoulders are better balanced, but it won't happen overnight.

Mike Robertson Knows
Here is a video by Mike Robertson that talks about shoulders in general

http://www.youtube.com/watch?v=1QPMSriohyE


Eric Cressey Knows
A great source on shoulders in general is Eric Cressey, he has this three part series:

Part 1: http://www.t-nation.com/free_online_art ... ers_part_i
Part 2: http://www.t-nation.com/free_online_art ... rs_part_ii
Part 3: http://www.t-nation.com/free_online_art ... s_part_iii

There is a LOT in those articles, but it boils down to some things you may be doing anyway, and hopefully only a few new moves

_________________
The Angels have the phone box.

Mods, please sticky -- this is a good summary and people ask these kinds of questions all the time. I'm sure some of the other guys will have some good stuff to add also.

Good read Ken. I have some dissenting opinions. I'm not saying your are wrong, I just have a different viewpoint.

I used to have a lot of shoulder issues. Never anything really bad, just some constant impingments that would cause a lot of problems. That was back when I started doing lots of auxillary work to keep my shoulders healthy. When I started 531 and started military pressing with good form (no leg drive) and training it like I train bench, squat and DL, that is when my shoulder problems went away. I hardly see anyone military pressing and those that do, usually press with a leg drive. A strict press trains every portion of the shoulder and with the added unstability of having to keep balanced, you get strong healthy shoulders.

I'm intrigued by your press like a PL and pull like a BB comment. I disagree. You need a strong back so you need to pull heavy. The only problem with pulling heavy is it is easy to cheat like you pointed out.

To add to the discussion, from what I have seen, the people who have the most problems are the ones not using good form on bench and don't go all the way down. You see the half rep on the bench all the time, heck you see it trained. Here is what I think happens. People do the half rep and usually when asked it is because of their shoulder. They say if they go all the way down, it hurts their shoulder. I say because they don't go all the way down, they hurt their shoulder. As we all know, the bench is basically a transitional movement chest - delts -tris. Sticking points for raw lifters are usually in the transitional area (most common I see is the transisition from the chest to the delts). Ego gets in the way for people and they stop going all the way down. What I think tends to happen is that people go up in weight or at the end of a set when they are tired and they get the weight past the point they are comfortable with and when they try to press, they hurt the shoulder. I've seen it time and time again. I had a trainer that did this. He was talking to me one day about his shoulders hurting. I told him to drop the weight and drop the ego and press all the way to the chest. He did it for 8 weeks. At the end of the eight weeks, his shoulder problems were gone. At the end of three months, was pressing back to his old weight (full ROM) and making progress. That's just one anecdote. I can give you several more.

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Thanks TimD.

Hoosegow, that goes back to an earlier discussion about lifting with full range of motion improving flexability. Bench and squats seem to be the exercises that people cut the ROM short and flexibility losses are a result.

_________________
Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

I notice Wendler uses "military press" when he seems to mean simply standing press, as military means standing press with feet up against each other, as if you were at attention. Which do you mean?

What do you mean by leg drive in Press? Do you mean something of "hop" like some kind of half-breed push press/standing press? Or do you mean something else? I generally keep my legs and torso tight to produce a "column" that the shoulders push against, is that what you mean?

I notice John Broz recommends only doing push presses (he calls it the upper body squat), unless your shoulders hurt, and then you should do strict press.

Warning: John Broz's opinions are not embraced by all.

_________________
Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

Military is just standing up - versus a shoulder press with a backed seat. It is called military because they do everything standing up.

You got the picture on the leg drive. If you dip a little and then use the body's momentum, that would no longer be strict. The biggest thing I think is to train that movement like you do the big three. You get the strength in the shoulders to support the weight in your bench. Like I said, once I started training my military press exactly like I do the other big three, I stopped having shoulder problems (within a reasonable time period).

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Thanks TimD.

Ken's right about the terminology. "Military" press is with the heels together. Simple press uses whatever stance is comfortable. Neither implies any leg drive. Many (most?) trainers would allow a little hip-kick at the start of the movement, as long as the knees stay locked out.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

Hoose, sounds like we're talking about the same thing. I've always trained Press the same as any other major lift, both on Stronglifts and 5/3/1 -- yet I still developed the shoulder issue. Also, I've "hopped" the weight with leg drive exactly once, which I know because I startled myself when I did it instinctively on 1+ day one time, and kept very strongly to never doing it again.

Anyway, I'm not saying I disagree with you, I think I have more questions to work out the difference between your experience and mine. When you say in your first post that you trained Press with accessories that will make it better, which accessories do you mean?

_________________
The Angels have the phone box.

Pretty basic - dips/arnold presses/close grip bench or something similiar and then chins or some other lat work. I just recently switched my training up, but when I was doing 531 all I would do would be:
Military - 531
One of the accessories mentioned above 5X10
Chins or other lat work 5X10

That is about all I'd do. Maybe it is a volume thing for me. I just switched to a program with no overhead press work (10 week strength program I'm trying). I'm in week three and I have had no problems (other than I'm exhausted and hungry ALL the time now).

Maybe it's a physiological thing. I have relatively narrow shoulders. They aren't overly slanted, I'm just not broad shouldered. My back is broad and my delts are big so maybe the combination of it all allows me not to be prone to shoulder problems.

I am definitely not saying that it is a cure all. It just was my experience that when I switched and started training my overhead press for pure strength, I stopped having problems. Then again, all my minor problems were just impingement problems. I never had serious structural damage (I can't say I avoided it by luck, training or technique). All this is information is just my experience (that's my disclaimer). Maybe my lack of any serious shoulder injuries should be enough to discount anything I have to say. I don't have the experience to speak intelligently about curing a serious shoulder problem.

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Thanks TimD.

Hoose, sounds like the difference between us is that you had more lat work, where I had only chins and only on one day. After my injury I went to both a power lifting trainer and a chiropractor, it was the trainer who told me to do a lot more lat work specifically to address safe benching, which would indirectly have a positive effect on the shoulder. So now I have a 3 exercise lat superset on press day, and also more rowing.

So I would think only time will tell if our experiences converge since I'm now doing something closer to what you were/are doing.

It's always hard to compare injuries, especially in a complex joint like the shoulder. I'm betting that each of your original problems was different.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

ya, when I hurt my shoulder military pressing was the last thing I needed

No matter how much you train them and how strong they get, your infra or teres can't overpower muscles like the pec minor or the biceps if they're drawing the humeral head anteriorly. Since strength training causes hypertrophy in tendons, excess rotator cuff training can actually exacerbate impingement syndromes and contribute to shoulder pain.

You're still thinking way too much about the rotator cuff vis a vis shoulder dysfunction. Consider this: how many people do you see in the gym doing rotation-based shoulder rehab and prehab? How many people are doing isolation work for the scapular stabilizers, like lower trapezius or serratus anterior?

It's amazing how much you've learned about the shoulder in such a short period of time! But: don't let a compartmentalized view of an area of convergence let you overlook the big picture (AKA: don't make the same mistakes I did). The rotator cuff can't be healthy if the other structures in the shoulder don't move out of the way to let it do it's job.

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don't you know there ain't no devil
that's just god when he's drunk

Pretty interesting article relevant to the topic:

http://articles.elitefts.com/articles/products-reviews/rotatoreliever-an-effective-new-option-for-repairing-shoulder-injuries-rach-edit/?utm_source=Store+Orders&utm_campaign=616d32e4a4-newsletter_12_3012_22_2011&utm_medium=email

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Thanks TimD.