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guy doing pushupsby: Taylor Simon

In the June issue Marc McDougal wrote and excellent article on correcting common issues with the shoulder joint that can lead to chronic injury. My work as a personal trainer and professional strength and conditioning coach has made this a topic of particular interest. From experience I have come to realize that most shoulder injuries are not usually caused by inadequate warm-up or weak musculature, but more commonly are due to faulty movement patterns and lack of rhomboid activation during activity.

Over the years protecting the shoulder has become a well integrated aspect of most weight training programs, which it should be. It is rare to see anyone on bench day not take the time to warm up the shoulder before stacking the plates and seeing if the numbers are up from last week. Most physically active people perform a very common routine before engaging in heavy exercise.

Stretching the joint is the most common warm up and does help to get blood flow in the area, as well as preparing the tendons for the workout ahead. After some mild stretching, most lifters will grab a light plate and perform arm swings for each side, front and back, and maybe some lateral raises.

Finally, the all important rotator cuffs. No experienced weight trainer has missed the fact that these muscles exist and how important they are to any upper body movement. The last warm up moves before working the chest are usually specific for the rotator cuffs. With the arms at a 90 degree angle a few sets of internal and external rotations through the transverse and sagittal planes are performed.

Once this set of exercises is completed there is not much thought given to protecting the shoulder while lifting, most people think that once it has been adequately prepared, the joint will take care of itself. However, to truly ensure shoulder health there must be thought put into each and every rep of each and every set. This is the only way to truly ensure optimal shoulder health.

Before I talk about what is the best way to protect your shoulders and minimize the risk of both acute and chronic injury, we must go through the reasoning behind why this is imperative to your training program, and why your current regime is most likely inadequate.

Correct Shoulder Mechanics

Let’s talk about the four small muscles that make up the group we refer to as the rotator cuffs. I will not get into the anatomy and physiology of the area, if you are unfamiliar with this please refer to the article mentioned above, as it does a great job of explaining the details. Instead I want to discuss the function of the rotators muscle, supraspinatus, infraspinatus, terres minor, and the subscapularis.

The main job of these muscles is to hold the head of the humerous in the glenoid cavity. In essence, they keep your arm in the socket. Now, these muscles are small and they are responsible for a very large and very mobile joint that is working during almost every movement of your upper body. They already have their work cut out for them without adding the stress of 200 pounds hanging over your chest or holding the weight of your body before you start the next set of chins.

It becomes important to alleviate as much of the stress from the rotators as possible so that they can both perform their intended function and not incur overload damage.

Most of the stress that causes injury during exercise can be linked with improper form. If you spend even a little time watching most lifters at the gym you will notice something very common on almost every lift you see, a very pronounced anterior shift of the shoulder.

Simply put, you can watch almost everyone’s shoulders move forward during the movement, almost to the point that many lifters appear to be hunching their shoulders forward. If you want to see this watch someone perform a bench press or any form of dip (especially bench dips) and you will most likely be able watch the shoulder pop forward.

This anterior movement of the humerous adds excessive stress to the rotator cuffs as they are still working to hold the head of the humerous in place. The load you are lifting is transferred through the joint and as the head of the humerous pushes forward from the excessive load. The rotator cuffs must work to keep the head of the upper arm bone in the glenoid cavity. If these small muscles fail at their task a dislocated shoulder is or torn rotator cuff is a likely result. The small size of the rotator cuffs is such that even a moderate amount of weight can overstress them and cause both acute and chronic injury. As they are supporting one of the bodies largest and most mobile joints, it is easy to place an unsafe level of stress on them.

The body does have a built in support system for preventing this from happening, but most people do not activate this system. You know it as your rhomboids. Their function is scapular retraction, or pulling your shoulder blades together.

Visualize a bench press during the bottom part of the rep, where it is very common to see the shoulder move anteriorly. This is normally where the rotator cuffs become excessively stressed as they try to prevent you from dislocating your shoulder. Now visualize retracting you scapula (squeezing your shoulder blades together). As you pull the shoulder back, it places the shoulder in the correct position and the rotator cuffs will no longer have as excessive a load placed on them. When the shoulder is in the proper position the force is better able to be transferred to the larger muscles. This is where the rhomboids become important.

The rhomboids are much larger then the rotator cuffs and much stronger. By utilizing the strength of these larger muscles to keep the shoulders in the proper position, it is possible to minimize the stress on the rotators during most movement of the upper body.
Training Function instead of Strength

You may train the rhomboids on a regular basis and think that this is adequate for the purpose of protecting the shoulders. There is a difference, however, between a muscle having strength and the muscle being used during movement.

One of the most commonly overlooked aspects of training is correct movement patterns. The last few years have seen the explosion of ‘functional fitness’, which is a phrase thrown around by trainers way too often and in the wrong context. Unfortunately, this has caused many people to ignore their body’s movement patterns. More commonly most lifters see movement pattern training as just another fad in the industry.

Your body was created to move through particular planes and ranges of motion and to work synergistically. When one muscle moves there is at a minimum one other muscle working along with it. Good, old school, isolation training has been perfected by bodybuilders for years and has its place in training, but ensuring the use of correct movement patterns is also important and should not be left out but, rather, incorporated into your current routine.

Most athletes and clients I have worked with develop shoulder problems due to the fact that they do not actively engage their rhomboids during training and more generally, during regular daytime activities, like walking, sitting, recreational sports, and carrying groceries.

Training a particular muscle to be strong is important, and just as important is training that muscle to activate, or turn on, during movement. A program designed to strengthen the rhomboids and upper back musculature should be included in your workout routine. Again, refer to Marc McDougals article for a comprehensive program. My purpose with this article is to cover a different aspect of shoulder health.

Everyone at some point has at least heard of the mind-muscle connection. This is simply the ability of your brain to tell your muscles what to do. Why is flexing the muscle during contraction and between sets important? It brings blood flow to the area, but more importantly it improves the mind muscle connection. It reinforces neural pathways that allow the appropriate signals get to the appropriate muscles at the appropriate times.

Even if you perform a healthy shoulder strengthening program and train the correct muscles, it is important to teach the muscle to turn on, which they may most likely, are not learning on their own. It is irrelevant how strong your rhomboids are if they do not activate to retract your scapula during movement.

How can you train this activation during exercise? For each and every repetition it becomes important to activate the rhomboids. This is easy to do, simply squeeze the shoulder blades together. It sounds simple because it is.

Pretend there is a thousand dollar bill between your shoulder blades, pinch it, and perform your set. The goal is to keep the bill there for the entire set until the load is taken off the upper body. By ensuring the shoulder blades remain retracted throughout the movement you are forcing the rhomboids to activate and keep the shoulder in a natural position, keeping the minimum stress on the rotator cuffs. It is just that easy.

This is why performing exercises to strengthen the musculature is not enough to protect the shoulder. You must train the rhomboids to activate during all exercise movements. This can only be accomplished by consciously retracting the shoulder blades throughout the range of motion and in particular, at the point of the movement where the greatest amount of strain is being loaded on the joint. During pressing movements this tends to be at the bottom of the eccentric phase and during most pulling movements this is typically at the beginning of the concentric phase. It is at these times that it is most important to retract the shoulder blades to prevent as much anterior movement of the humerous as possible.

For true shoulder health it is important to train this movement pattern during any exercise that involves the shoulder, so almost every upper body exercise. There are particular exercises that excessively strain the shoulder and during these it is imperative that the scapula remain retracted throughout the entire range of motion.

In particular, bench press (any angle), dips (any but particularly bench dips), chins, lat pulls, and any form of rowing exercise. All of these exercises create a situation in which the shoulder commonly will move anteriorly and the rotator cuffs are stressed to keep the humerous in the proper position. By consciously pulling the shoulder blades together during these movements you will train the rhomboids to actually activate during the exercise.

While people often don’t think of their shoulders during many other exercises, it is just as important. Overhead shoulder press, bicep curls, tricep presses, tricep overhead extensions, pullovers, and chest flyes, are all exercises that involve the shoulder and can cause strain on the rotator cuffs. During each of these exercises it is just as important to keep the shoulders in their proper position for optimal shoulder health.

As you become more proficient at keeping the rhomboids activated, they will begin to do this on their own during most movement. This doesn’t mean you can stop training muscle activation, like anything else, if you do not consistently train it the benefits will diminish and eventually disappear.

A very common comment I receive from athletes is that the retraction of the shoulder blades causes the lower back to arch, which traditionally is a mortal sin in the gym. Again, optimal movement patterns come into play and the mind-muscle connection is important.

t is true that a slight hyperextension of the lumbar spine can occur once the scapula are retracted, particularly during the bench press. However, there is not enough of an arch to cause worry if the transverse abdominis (TVA) is correctly activated. This often forgotten muscle is a significant abdominal muscle that lies deep to the rectus abdominis and acts as a support for the vertebral column. During movements that cause strain on the lumbar spine, the TVA can be turned on to assist with supporting the spine. By drawing in the abdominal wall (think of touching the back of your bellybutton to your spine) the TVA will activate and protect the lower back. To feel this try performing a reverse crunch with straight legs and letting your stomach relax. You will most likely feel strain or outright pain in your low back. Now do the same movement and activate the TVA by sucking in your stomach for the entire range of motion, the pain in the lumbar region should be significantly reduced or completely disappear. The TVA is now supporting the lumbar spine. As long as the TVA is kept strong and activated the slight hyperextension of the back is not a serious issue. Relax the TVA, however, and that will not be the case.

Repeatedly I have touched on the same theme, the mind-muscle connection. Most of you who read this article will be used to focusing on what you are doing while you train and realize the significant difference that can be made through simply thinking about activating the muscle(s) that are being trained.

Protecting your shoulder is simply a matter of shifting your focus, not just while training your shoulder, but during all movements involving the shoulder and upper body. Simply strengthening the rhomboids, posterior deltoids, and other back musculature, will not automatically protect the shoulder joint. It is easy to perform a seated row or rear deltoid lateral raise and still have a pronounced anterior shoulder displacement. In this case you are not doing anything to help protect the joint and in fact are stressing the rotator cuffs.

It is most important to train your body to learn the proper movement pattern and use larger muscles to support a large joint. A little bit of a shift in focus and a small shift in movement patterns will lead to long term benefits that will greatly reduce the chance of both chronic and acute shoulder injury.

Movement Patterns and Rhomboid Activation for Optimal Shoulder Health