Shoulder Strengthening 101

I mentioned that shoulder pain is probably the most common complaint my friends come to me with.  The next thing I usually get is:

... but I KNOW it's my fault. I'm supposed to be doing my shoulder exercises. In and out with the band.  I think I have that somewhere. In the garage maybe?

First of all, that exercise is boring. Helpful, but boring. Second, go find your bands, because there is a lot more they are good for. Ok, and third, that is not a complete enough strengthening program to help anyone prevent shoulder problems long-term.  Ideally, you want to:

1. Strengthen the muscles that give you stability

2. Balance out the rotator cuff so the shoulder is held tightly in the joint

3. Strengthen in the arc of motion that you need for your sport (ie overhead vs just by your side with a band)

4. Strengthen at faster speeds that mimic the quickness of your overhead motion
5. Stretch the shoulder so it can start in a good position

That being said, here are a few of my favorite exercises:


Plank

Why it works:  It uses a lot of muscles at once (do just one and count the areas you get a good burn in... it hurts sooo good), the muscles are acting all at once emphasizing stability, and it gets the muscles that hold your shoulder blade steady as your arm moves through an overhead motion, namely the serratus anterior. So much bang for your buck.

What to do: I love the basic forearm plank.  On your toes, body all in one tight line, avoid arching your low back, keep your shoulders rounded, and don't forget to keep your head in line with your body, too.  I like to do a total of 3 minutes with patients (ex 3 x 1 minute,  6 x 30 seconds, etc).  Test out one plank for time to assess where you are at before you start.

If you get bored:  Plank on hands (don't lock elbows), side plank (forearm or on hand), adding pushups in between holds, walk hands up/up/down/down on small object, walk on hands with weights, legs on a Swiss ball, hands on a Swiss ball...

Spiderman

Why it works: The muscles in your rotator cuff each have their own individual functions (turn in, turn out, pull out, pull in), but when they all work at the same time, the resulting force is a pull that hugs the shoulder close to the joint, protecting it from banging around as you move. If you consistently perform the same overhead motion of hitting, serving, swimming, or paddling, the muscles that turn your shoulder in are going to be way stronger than the ones that turn it out.  This throws the balance off, and the shoulder loses stability. This exercise is overhead (sweet), requires rotator cuff stability (sweeter), and is tough on the external rotators (sweetness).

What to do: Take out that exercise band, hopefully one with light resistance, because this is deceptively difficult! Keep your entire forearm flush against the wall, in little steps inch your way up the wall and back down, keeping the arms parallel or slightly turned out. Climb the wall like Spiderman. Go to fatigue 5 times.

If you don't have a band: Buy one, or get creative.  Most gyms have them. Any garment with an elastic waist is potentially the right size and enough resistance. A head band would work. Tie some panty hose...  

Upper cuts

Why it works: The plank helps strengthen the muscles that stabilize the shoulder blade (and therefore the shoulder) in a nice, steady, fixed position.  This exercise kicks in the same muscles but in motion, and although you're cutting from underneath, it is still gets overhead.

What to do: Use just your fists or add some weights like this fellow. You can emphasize endurance here (ex: moderate weight 3-7 pounds for 5 bouts of 30 seconds), or you can max out a bit (3 sets of 10 of a resistance that has you all out fatigued by the 10th rep).  I always prefer the endurance route, but it depends on your purpose and your preference. Or wale on a punching bag until fatigue, especially after a stressful day.

Basic pect stretch 

Why it works: Daily life is forward: we sit all day at computers, driving, slumping in front of the TV.  Overhead sports are forward, too.  The shoulder is in that forward position so often that for most of us the muscles on the front of our chests get so tight that they are stuck here. If the shoulder starts out more anterior, it is already in poor biomechanical alignment before you even begin to preform an overhead motion.

What to do: Find any good doorway and give yourself a nice, long stretch.  Anything over 30 seconds does the trick, but I usually do a 1-2 minute hold.  Stretch all the time. Whenever. Wherever.

Make it a part of daily life: Pick a doorway in your house that you must stop and stretch in every time you walk by, stretch in the shower where you actually have a moment to yourself no matter how busy you are, or find a nice foam roll and stretch at the gym after every workout.

Remember, you should not start any exercise or exercise program if you are limited by your health.  These are meant to help prevent problems in healthy, pain free individuals, and must be done with good form.  If anything causes pain, stop immediately.   

Strengthening can be very boring and hard to get in if you are a busy human being.  I personally work these things into my routine by doing power yoga (which I adore), working out with an exercise buddy who can challenge me, stretching in the shower, and devoting 3 minutes every morning to the plank. 

Next post will be a few ideas for some higher level plyometric drills and a few different ideas for those exercise bands. Then, I will share some insight on common mistakes and poor mechanics that predispose volleyball players, tennis players, swimmers, and surfers to shoulder injury!

M

Preventing shoulder pain in the (fun) overhead athlete: volleyball, surfing, swimming, tennis...

There is a 93% chance that if you are my facebook friend you enjoy one or more of these sports.  That being said, shoulder pain is probably the most common question/complaint/drunken rant that my friends have come to me for advice about, so I thought I would share with everyone.  Nothing would make me happier than to see "out in the surf" as your status message when we are 60 years old.  For some of us that is sooner than others :)

This is meant purely as preventative advice and for your educational enjoyment and is not meant to diagnose, treat, or otherwise do anything to take the place of professional medical attention.  (Is that ok, lawyer friends?)

I decided to break this into a three part series:

1. Understanding the shoulder, overhead motion, and what is causing your pain
2. Some great exercises to protect your shoulder and prevent shoulder problems
3. Proper overhead mechanics with volleyball, surfing, swimming, and tennis and common errors in each sport that can lead to injury

Understanding Shoulder Mechanics with Overhead Motion

Remember from third grade that the shoulder is a "ball and socket" joint (it moves in all directions).  It is, and it also has a roof.  Between the humerus (your arm bone) and the Acromion (the roof)... which is actually part of your scapula (shoulder blade), run all of the tendons to your rotator cuff muscles, some nerves, some blood vessels, and even your biceps tendon.

Look at the space between the rotator cuff and the Acromion

When your arm is by your side, there is typically plenty of room for all of these structures.  When you raise your arm overhead, the space closes down a little bit.  Typically, no problem.  Your body is designed to handle this stress.  If you have one very crazy traumatic pinch, if you repeatedly and thanklessly perform the same overhead motion before your body can recover, or if you put your shoulder in a poor position that pinches it even more... it hurts.

As the arm raises, the shoulder moves closer to the roof, putting pressure on the rotator cuff

Ouch


Our bodies are awesome in that they tell us right away when something is going wrong.  Unfortunately, we often think of this as a challenge:

I can handle waaaaaay more pain than this.  

This really isn't convenient to the fact that I want to keep playing volleyball on this beautiful 80 degree day in February. 

If I pop a pill, it feels better soooo....

All legitimate arguments, but don't forget that your body is trying to help you out.  We treat pain like a nuisance, but really it's a gift.  As early as the very first signs of tissue damage, we know. Sometimes pain is almost instant, and sometimes it really isn't even that bad.  Great communication skills body, thanks!




What is causing the pain?  This is the part where I don't diagnose you.  Just know that you could be feeling anything from slight pain you would like to ignore (see above) to excruciating pain, to maybe even significant weakness when lifting your arm, which could signify anything from slight inflammation inside the joint along the muscles (impingement), to a small tear in the tendon, to some pretty massive damage. 

Even if, say, you have the very common case of mild shoulder impingement that feels better after one day of rest and a little ice, if you are consistently having episodes like this every few months or even more often over the course of years of being active, you could be tearing up your shoulders.  Literally. You could be cutting years off your time spent doing overhead sports.  Even worse, you could end up not being able to do simple things like brush your hair, reach for a can of soup, or fasten your bra without major surgery.
 

My advice is simple:  Protect yourself from injury and listen to your body at least a little more often!

The next two sections will be focused on how you can protect your body from shoulder injury. I will include some (hopefully new) ideas for strengthening and stretching with a little rationale on why each are my favorites next time!

M

Need a good read?

Sick Girl
I first read this book about a year and a half ago and have since read it about four times.  A bright young woman in law school with mysterious symptoms that end up leading her to a heart transplant wrote this memoir, and she is witty, straight forward, and raises a lot of interesting questions.  I find her reaction to her physical therapists enlightening, too.

Complications: A Surgeon's Notes on an Imperfect Science
Totally recommend this to anyone in the health profession.  From my own personal experience with misdiagnose and seeing some very negative sides to the medical world, it gave me a better perspective on our limitations and our responsibilities.    


The Diving Bell and the Butterfly: A Memoir of Life in Death
This is the autobiography of the former editor of Elle magazine... which he wrote entirely by blinking.  He blinked out, tediously, something that is absolutely beautiful about his experiences with locked in syndrome.  You have the words of a man whose entire life's work was about creating beauty.  Again, very interesting perspective on his physical therapists, too.

Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen
This book is insanely awesome.  If you are interested in running a marathon or need some inspiration with your running, wowww!  I love this guy's writing style.  He encompasses his own story (plantar fasciitis), with the history of the Tarachumara and some other bad ass runners, and builds on several ideas that are pretty popular right now: Are we actually designed to run? Is barefoot running a good thing?  I love love love it.  

It's Not About the Bike: My Journey Back to Life
Anytime I read a book about someone in their early twenties who has struggled with life and death, I see the same common themes. From my own experience to Amy Silverstein's (see above), there are many striking commonalities.  But this is LANCE ARMSTRONG.  I honestly didn't know much about his story despite the yellow wrist band craze a few years back.  He is another candid writer, and it is definitely worth a look.

In Defense of Food: An Eater's Manifesto
This is something I have become very passionate about lately.  What is the best diet? What food are we designed to eat?  This book gives a lot of background on the new ideas out there about restructuring our food pyramid "ideal", and I totally agree with him.  I have been doing a lot of other reading and research about this topic over the past few months and am hoping to share some info on my blog at some point.

100 Best Gluten-Free Recipes
Eating gluten free is tough.  Gluten is in almost every grain and in preservatives and thickeners... so almost anything you buy with a sauce on it contains gluten.  Besides eating salads and Asian food every single day, its a great idea to have some sure bet recipes.  This is one of the better cookbooks I used when I was strictly gluten free.  I'm such a foodie!

The Hepatitis C Handbook
Anyone that gets diagnosed with HCV should read this book first.  I bought literally all of the reference manuals on the subject on amazon.com when I first found out, and there is so much fluff, so much outdated research, so much of the same old things you could just quickly look up on mayoclinic.com.  This book is detailed.  It also gives a lot of research about every single supplement, vitamin, or other medication that might be good or bad for someone with HCV, which is great to have all in one place.  A good resource!

Silent Storm: Finding Spiritual Shelter During Hepatitis C
This is about a semi-famous TV newsman, who was a healthy (non druggie) family man who describes everything from his diagnosis, to his sickness, to his suffering with the side effects of Ribaviron and Pegylated Interferon.  Out of the several memoirs I read, his was by far the most helpful for me.  He included his spiritual growth and the effect it had on his relationships openly, and he wasn't too much of a wet blanket.




Reading Rainbow. I read a lot, can't you tell? I am currently in between books, so if anyone has any recommendations for me... I'm listening!

M

A long time coming

It has been almost a year since I had the idea to start this blog, but for some reason I have been inspired to sit down and write over the past few weeks and get this going :)  I first wanted to share my story with all of you.  It's a pretty honest, quick run down of the things I have been through:

 http://mysickgirlstory.blogspot.com/


However, the purpose of this blog for me is a little different.  I want to share thoughts on various health and wellness topics that I am passionate about or find quirky/interesting enough to share. Recipes, preventative health for all of the runners/volleyball players/competitive drinkers I know, great exercises that I want to share... anything!

It's still in the bare bones stage... I'll make it prettier soon :)

Enjoy,

M