Foundations of Shoulder Health

[Kenny Croxdale]

I went to the doctor about 10 days ago, and the most upsetting thing he told me was that my issue was not likely due to a singular traumatic event like benching too heavy with bad form on a single day -- he says it was likely building over a long time.

This upsets me because I thought I new what I was doing. Thought it was as simple as bench + row and press + chin. Now it could be that I am doing something terribly wrong on bench, and for that I'm going for some training at the new powerlifting gym that opened recently down the street, but I just don't think so.

Empathy

I have empathy and some understanding of you problem. Like you, I had a shoulder probelm pop up a couple of years ago.

Like you, I thought that I was doing a good job of training...insuring shoulder health, so to speak.

So I'm wondering if there is a simple foundation for shoulder health that I can put into practice, something more advanced than "Bench + row and Press + chin and that's it" but which does not require me to navigate complex multi-variable decision trees and learn a lot of latin. I'm not asking for it to be dumbed down, I'm asking for the beginning.

Experimentation

I spent most of the year experimenting with exercises that I felt like might improve my condition.

Baseball Pitchers Careers

One of the most interesting sports seminars that I attended had a PhD in Physical Therapy discuss baseball pitchers. Researchers looked at why pitchers like Roger Clemmons and Nolan Ryan were still playing in their 40s; while some pitchers threw their arm out in their late twenties and early thirties.

One of the reason for the length of a baseball pitchers career was the strength or the lack strength of their...

External Rotator Cuff

The external rotator cuff plays a major role in shoulder injuries. The stronger the external rotator cuff muscles, the less likely a pitcher is to have shoulder injuries.

The weaker the external rotator cuff muscles with respect to the internal rotator cuff muscles, the more likely they are to throw their arm out.

Pitchers and Other Athletes

The emphasis on external rotator cuff strength applies to other athetes that heavily use the anterior deltoid.

That means the best insurance policy is to make the strength of your external rotator cuff muscles is equal to the interiror rotator cuff muscles.

Rows and Pulls For The External Rotator Cuff

Like you, I believe that I got enough work for my external rotator cuff from pulling movements...that makes sense.

Evidently, that wasn't true for me. I found that I needed more external rotator cuff work, along with some overhead pressing.

Overhead Cable Pressing

One of the problem from constantly doing the bench press is tight shoulders. That is why Olympic Lifters limit bench press training.

What I found is that overhead cable pressing helped with my shoulder rehab by stretching my pec. For me that really helped improve my shoulder condition.

Must of my shoulder rehab work is based on...

Shoulder Shocker
http://www.t-nation.com/free_online_art ... er_shocker" onclick="window.open(this.href);return false;

Pull Aparts and Halos

Two of the best exercise that I found were:

1) Band Pull Aparts (in DeFrancisco's article)

2) Kettlebell Halos

1) I've never done a specific rear-delt exercise. If I've got the equipment for face pulls but not rear delt flyes, does it really matter? Or do I need to get really specific here and do the "right" exercise.

Be Specific Rear Delt Work

My suggestion is to put in some specific rear delt work, external rotator exercises.

2) Recently Oscar mentioned "Push like a powerlifter, pull like a bodybuilder". I had never heard that before. Is that considered strong enough advice that an intermediate can follow it as if it were (always) true and get more complicated later? For me this means converting rows from 5/3/1 to a volume exercise, and perhaps dropping weighted chins for higher volume as well -- so this question is important to me.

Oscar

I agree with Oscar's assessment. Chris Thibaudeau had a great series on this in one of his training videos.

Thibaudeau believes pulling muscles respond better to high volume, high rep, longer "Time Under Tension" movements. I agree.

With that said, I would not completely eliminate low rep strength pulling movements. However, I would cut back on them in favor or the high volume...training.

3) Is there a rule of thumb for pull vs. push for a guy like me in a "better safe than sorry" position who wants to avoid future injuries? Or might be as simple as making sure I'm doing at least 3 upper body motions/week with weights that allow 4x12 or better? (or pick 3x10 or whatever).

Rule of Thumb

My "Rule of Thumb" believe is to make sure you do some specific external rotator cuff work in your training.

Agnoist/Antagonist Muscle Strength

One of the reasons muscle injuries occur is due to overtraining the agonist and undertraining th antagoinist muscles.

What ends up happening is that the agonist overload the antagonist muscle. One that happens an injury occurs.

Hamstring Example:

Hamstring injuries usually occur because the quads are dramatically stronger. The quads end up producing more force than the hamstrings can handle.

What end up happening is a pulled or torn hamstring.

Driving A Car With NO or BAD Brakes

Increasing the agonist muscle strength and NOT the antagonist muslce strength is like driving a car fast but has NO brakes or bad brakes.

What end up happening is at some point, you go to fast and crash into something because you cannot stop in time.

Pain

As with any injury, I found that initially my shoulders hurt a little when performing the exercises. Over time, it should be less and less and you shoulder should get better...but it not an overnight thing.

You have to play with it and then evaluate whar is working for you and what isn't.

I also found taking some glucosamine helped jump start my shoulder recovery.

Kenny Croxdale

[KPj]

I tend to find that people can get too caught up on either volume or strength when it comes to the programming side of things. You need to focus on both. For example, you could do a 5:1 pull:push which in theory should give you way more than enough volume needed to "balance out" the pushing and general day to day posture (over)use but, at the same time, not actually get any stronger at pulling, so you'll still be pulled out of alignment and leave yourself open to excess stress on the joint. Therefore, get more pulling volume but, also make sure you're hitting up something for strength, too, whether it's a DB row, a pull up, or both, as long as some kind of pull is getting a strength emphasis, too. It's similar to how if you want a big chest you will generally work on strength via BB bench press then hit volume via DB and cable variations. With pulling, you want the strength to be at least that of the pressing equivalent and the volume to exceed the pressing volume.

This actually makes it easier despite it appearing more complicated. If you have the strength side taken care of, then you just need to add volume. In this case you can throw in circuits to get loads of reps from different angles (this where the "bodybuilder" plays a part) in a short amount of time. For example i'll often program a triset of face pulls, seated cable rows, and rear delt flies. I came up with this because the full stack for seated cable rows (which I love) is not very heavy and becomes limited (i can do sets of 30 with the full stack - at the end of a work out). So, to make it challenging I would do facepulls first, then seated rows, then just added the rear delt flies because I enjoyed feeling my traps scream and wanted the rear delts to join in. This kind of set up has now became a staple. In 5 minutes I can get 90-135 reps in, using 3 different variations.

Another staple is chest supported DB rows -> prone trap raises -> 1-arm DB protraction (in this case there's more emphasis on serratus anterior and lower traps).

Also just going back and forward from inverted rows to prone YTIW's at the end of the work out. Quite often i'll just run down the clock with one of these during the last 5 or so mins of a workout instead of a desired amount of sets. The aim is just volume.

That's a kind of random way of looking at it. People generally have their own individual weaknesses so I will choose exercises based on this.

If I could narrow it down in one list, the components would be:

Movement - T-spine rotation, upward scap rotation (basically, the ability to put your hands over your head), and internal/external rotation of the cuff.

Strength - horizontal and vertical pulling/pull up and row strength (technique needs to be good).

Volume - more than pressing

Getting more "muscle" specific:

Middle and lower traps, serratus anterior, RC external rotation - you need some kind of strategy to ensure you address these.

That's it in basic terms because, the upper traps have various functions, some feed the imbalance and some fight it, and I never specifically mentioned rear delts. This is because if you have a strategy for addressing the muscles I just mentioned, then the rear delts and upper traps will come along for the ride but, by all means, some extra work won't do your health or physique any harm.

Also, when there's pain, it's not just what you "add" to a program that matters but what you remove. Remove the things that hurt, for now, and see what you're left with.

As a starting point I would just try the things that have been mentioned and see what ones you're worse at. For example, i'll often give someone a 2KG DB to do side lying external rotations and they struggle to get more than a few reps. I've had people who needed to start with just the movement and no load - this would be a glaring weakness and something that needs prioritised. So, I would suggest a trial and error approach because just trying these things can expose glaring weaknesses that need addressed sooner rather than later. Getting stapled with a 2KG DB can be quite eye opening.

KPj

[stuward]

I love the car with bad brakes analogy. I think that hits the nail on the head.

[teafan]

KPj -whats your opinion on those Hammer Strength row machines from a strength perspective? (The one without cables or pulleys, just plate loaded). Do you think dumbell rows would suit better for a strength focused exercise?

[Proper Knob]

This is a good relevant Mike Robertson video -

http://www.youtube.com/watch?v=1QPMSriohyE" onclick="window.open(this.href);return false;

[commodiusvicus]

Kenny's and KPj's posts are both great and they're infinitely more experienced than i am (i might have to try those YTIWs, myself), but i just have a couple of things to add regarding what has worked for me in fixing my own shoulder pain.

Eric Cressey wrote a shoulder health article that's very good. Some of what he talks about has already been covered in this thread, but anyway, here's a link to part one: http://www.t-nation.com/free_online_art ... ers_part_i" onclick="window.open(this.href);return false;

Don't worry about it being too complicated. It might seem like a lot to remember at first but really i've made a lot of progress using just a few exercises. In addition to my staple inverted rows, i typically do facepulls, reverse flyes, external rotations, and behind the neck pull-aparts with resistance bands, as well as scapular push-ups, and dip shrugs. Also, stretching the chest every day, but especially before and after working the chest, has helped me a lot. I like this one: http://www.exrx.net/Stretches/Pectorali ... Towel.html" onclick="window.open(this.href);return false; (you can also do it with a resistance band, if you want to)

But i'm just throwing a few ideas out there for you. As KPj said, everyone has their own individual weaknesses, and i don't mean to suggest all your problems will be solved if you do those particular exercises. That's just some of the stuff that clicked for me. For you it'll probably be something different. All i'm trying to say is, you don't need a PhD in kinesiology to do this. The only thing that's even remotely difficult about it is learning to use the right muscles (the upper trap dominance that KPj alluded to, for example), and that's really just a matter of getting the hang of a particular movement. Shoulder strengthening has not taken over my entire life, and i doubt it will take over yours.

Edit: I meant pull-aparts, not pull-downs. My bad.

[KPj]

KPj -whats your opinion on those Hammer Strength row machines from a strength perspective? (The one without cables or pulleys, just plate loaded). Do you think dumbell rows would suit better for a strength focused exercise?

I don't have access to this machine so can't comment too specifically. However, it always "depends". If I had to pick one exercise to focus on getting stronger on, with the aim of helping your bench press or posture, I would prefer it wasn't a lever machine because I would also want all your stabilisers to be firing on all cylinders.

I'm not against the lever row machine in general. If someone is constantly doing DB, BB, and cable rows then they're already getting at the stabilisers so using the a lever row machine won't compromise this at all. I actually like it as a "chest supported" option which my gym lacks, particularly when you can't get a bench.

With that being said, for years I have failed to see past the DB row. I love it, and I think it has great carryover to your bench, IF you have strict form. I have no doubt the likes of Kroc Rows would be great for packing on some size but, if someones bench struggles due to upper back weakness or instability, a strict DB row addresses this directly. You can get really strong in DB rows, doing them strictly. In my gym they go up to 50KG, and there's no reason whatsoever that they need to be "jerked" up. If someone is in and around the 100KG mark for bench press (or aiming for that), and can't strictly DB row 40KG, I note this is a glaring weakness. I also think you should be able to strictly DB row atleast what you can DB bench press, if not more (for me, my training partners, and pretty much everyone I train and have trained, DB row was higher in comparison).

Not sure if that helps as I kinda rambled.

KPj

[teafan]

I kind of came to he same conclusion on DB rows based on a mess about today:

I have decided to add in a strength focused row once a week on top of the volume work I do. I decided to load up the Hammer Strength machine and see how that felt, charting 80, 90 and 100kg to feel my way through. I could have swung 90kg around the bar it was that light. I ended up loading 250kg on it and it still felt pretty easy.

Think i'm going to go back to Dumbbells rows for a while - do 531 on them perhaps.

[KenDowns]

So this is what I seem to be getting:

Press-Powerlifter Pull-Bodybuilder
So I learned something new, cool. This means that bench day might look like:

Bench 5/3/1
Row 5/3/1
Row Volume

This means I still want to get stronger and move more weight, but instead of another bench variation i'd be doing volume on the pulling exercise for that day.

Overall
Overall dropping press and bench completely for 3 weeks has had no effect. I've iced, taken ibuprofin, and will have to get back to the chiro for the follow-up. No better, no worse. So I'll resume on Press and Bench day, but just do the pulling stuff.


MD and Training
I was not going to the new powerlifting gym until the shoulder was improved under medical care, but I think I'm going to switch this. I'm going to go to the gym and ask them if they know a doctor who specializes in this. Nothing against the chiro I'm going to now, just looking for a second opinion.

Exercises - Various
I tried face pulls on Tuesday with volume rows. Will try many of the suggestions made: cable press, shoulder shockers, and others. Will put that in my journal.

Antagonist
So the "Curl or not to curl" question is answered at last. If one exercise hits triceps, there must be a bicep exercise. Rows don't count, doing some curls makes most sense. Repeat for other pairs.

Drop Press?
One of the referenced articles mentioned dropping press. I went 45 years w/o doing it, I can certainly "risk" a couple of months leaving it out for other things.

Other
There is a lot of good stuff in this thread, thanks to everyone. I can't absorb it all at once, but what I've listed above is where I'll start.

[commodiusvicus]

Dropping (overhead) press: i would say only if it gives you pain. I experienced pain with it (mostly on the side of my winged scapula, which i doubt is unrelated) and had to change how i did it. I was doing it with dumbbells like the guy in the picture here ( http://www.exrx.net/WeightExercises/Del ... Press.html" onclick="window.open(this.href);return false; ) but i began to experience grinding, popping, back pain the next day -- all the familiar bad stuff. So i stopped for a few weeks, began doing behind-the-neck band pull-aparts, and then started pressing again with the DBs held in a neutral grip, my elbows tucked to my sides, and my shoulderblades squeezed tightly together. I really have to struggle to put up less weight than i was doing before, but it doesn't hurt anymore, which is good. By the way, the form i described is pretty much the same as the form i use for DB floor presses, which you can try if you find benching gives you trouble.

[JasonJones]

Don't forget that it's very difficult to 'jerk' a pressing movement like a bench or a squat and very easy to do so with a pulling movement. One can cheat the range of motion on almost any upper or mid back exercise by adding in unnecessary movements through the erectors or legs (and simultaneously fool oneself into believing they have a strong pull!) The more pulling movements you can do with strict form, retracted scapulae or modify to be chest supported, the better it will be on your shoulders.

[Oscar_Actuary]

So this is what I seem to be getting:

Press-Powerlifter Pull-Bodybuilder
So I learned something new, cool. This means that bench day might look like:

Bench 5/3/1
Row 5/3/1
Row Volume

This means I still want to get stronger and move more weight, but instead of another bench variation i'd be doing volume on the pulling exercise for that day.

Of course, in a recent thread I "confirmed" we should press with volume too. So you got that
More importainly, I'm learning how to assess my program as I consider what I read hear. Before, I would take what I read and let that drive my decisions.

[KenDowns]

Ken mate, I wish you wouldn't worry so much about the whole, beginner/intermediate thing.

You've convinced me. All I really know now is I can lift enough to hurt myself

[Jungledoc]

One can cheat the range of motion on almost any upper or mid back exercise by adding in unnecessary movements through the erectors or legs (and simultaneously fool oneself into believing they have a strong pull!)

So true! It's fun to watch guys in the gym doing hammer curls with lots of body english. I've often wondered how much I could curl given unlimited body english, but I never have time, or I'm embarrassed to be seen "lifting" like that!

[KenDowns]

The shoulder is not really any better or worse than it was, even with ice and ibuprofen. Good days, bad days, never hurts a lot, just "not quite right."

Tried a lot of new motions today and yesterday. Lots of DOMS in places where I didn't know I had places.

The external rotations I tried with bands and dumbbells. The bands felt wonderful, like discovering a new favorite exercise. Did like five sets they felt so good.

Tried Press at deload weights and it was very nice, felt like going home to an old friend.

Will try bench at deload weights tuesday. Can go pretty high before I feel any discomfort, I'll let that be the guide.

For bench and press I will likely reduce weights by 20# for cycle 7 and go very modest on the all-out sets and continue to monitor.