After training for several years, I have noticed several patterns in people who exercise. It seems that at some point, most of us seem to have a shoulder that sort of “bums out” on us. At least for a little bit anyway. In fact, Sher et al. reports that out of 96 asymptomatic shoulders that were evaluated with an MRI, 34% had rotator cuff tears. In addition, 54% of people over age 60 were found to have a rotator cuff problem. Keep in mind that these were asymptomatic – meaning there was no pain!
What does this mean to you? It means that there is a considerable chance that you may have something wrong with your shoulder and not even know it! For that reason, I would like to offer a bit of information about the structure of the shoulder, and two common conditions that you may come across in your quest for awesomeness.
To begin, the shoulder joint is basically made up the scapula (or shoulder blade) and the humerus (the upper arm bone). It is the articulation of these two bones that can either help a person throw a ball 100 miles an hour, or cause a person to use colorful language while trying to wash their hair in the morning.
There are a few important structures in the shoulder that are huge players in shoulder pain. They are the acromion (uh-crow-mee-un), subacromial bursa, and the supraspinatus tendon. You can see them in the picture below.
Here is how it works. There is a small space between the very top of the upper arm bone and the very tip of the scapula (the acromion). This is called the subacromial space. This little space is the home for the subacromial bursa, and one of the rotator cuff tendons. Specifically, the supraspinatus. This small space is supposed to be about 10 mm in thickness. It’s when the space narrows (to about 6mm or so) that we begin to have problems.
Once this space starts to narrow the structures begin to get squished like blueberries – just not as messy. This especially happens with movements such as side raises with dumbbells. Here is a visual to assist:
Notice that as the arm moves out to the side, the bursa and the rotator cuff tendon are squished between the tip of the upper arm bone and tip of the shoulder blade. This happens in the presence of a weak rotator cuff complex. This condition is a form of impingement. Impingement, if untreated, may eventually lead to a tear in the rotor cuff tendon.
While some exercises, such as the dumbbell side raise, can perpetuate impingement, there are other exercises that will lead to a tear in the rotator cuff tendon if executed in the presence of impingement syndrome. For example, lets take a look at a pushup.
In this example, not only do we have upper arm bones that are raised out to the side, but they are also moving back and forth. Now, imagine what is going on within the subacromial space! The rotator cuff tendon is not only being squished but it is also being ground down between the upper arm bone and the should blade. This may eventually lead to a torn rotator cuff tendon. Not good for anyone! So…what can we do about it?
If you suspect that you might have a weak rotator cuff here is a shoulder circuit that might prove to be helpful. Perform each exercise for the indicated number of repetitions and repeat the circuit up to three times.
1) Theraband shoulder extension. Do 20 of these with a light resistance to start off.
Keep the Theraband at waist level. Start with your arms forward, and be sure to keep your elbows as straight as possible. Pull your arms back as far as possible.
2) Theraband external rotations. This will help the external rotators in the shoulder. Do 20 of these with a light resistance.
Slowly pull the Theraband out to the side, while keeping your elbows close to your sides. Try to keep your shoulder blades down and back.
3) Theraband Internal Rotations. This helps with the internal rotators of the shoulder. Do 20 of these with light resistance.
Begin with one end of the band securely attached at approximately waist-height. Grasp the other end of the band with tension. Pull the band away from where it is attached, rotating your forearm toward your body. Hold and slowly return.
TIP: Be sure to keep your forearm parallel to the ground, your elbow by your side, and your wrist straight.
These three exercises are basic movements that can be done before each workout that involves upper extremity exercise. The purpose is to improve function of the rotator cuff so that the muscle group can stabilize the upper arm during pressing and pulling activities.
I hope these exercises help and if you have any comments or suggestions of exercises that you like to do to strengthen the rotator cuff, let me hear ‘em!!
- Danny Stephens
Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan ;77(1):10-5.
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