Shoulder injury treatment and prevention

Shoulder injuries are the most common injuries from weight lifting related activities. These are typically the result of bench pressing or overhead lifting.

The shoulder is a complex joint that is stabilized by many muscles holding it in place against the shoulder blade. The optimal position for the shoulder joint means that all muscles must be balanced in strength and length. When there is an imbalance, this means there are muscles that are overpowering the others and pulling on the shoulder joint more than it should. In the short term you may experience tendinitis and shoulder pain, but in the long term this may lead to tendon ruptures, impingement, nerve injuries and rotator cuff tears. Most weight lifting related activities focus on exercises that build strength and size in the large muscles such as the pecs and deltoids.  The most common exercises are bench press, shoulder presses and dips. While it is important to train these muscles, unfortunately the smaller, less noticeable stabilizing muscles are forgotten. 

One of the first symptoms is pain in the front of the shoulder or top of the shoulder and the pain may travel towards the neck. You may notice the shoulder is rolled forward and the upper back may look somewhat hunched over as a consequence. There is typically less range of motion with internal rotation. You may also notice loss of power or performance from certain lifts. Depending on how long the shoulder imbalance has been occurring, there may be a shoulder blade instability, or what is known as “winging”. Since the shoulder blade stabilizing muscles have been pulled and weakened, the shoulder blade is no longer sitting flat on the rib cage and it takes on a winging appearance.

(photo credit to physiotherapist Torben Blenstrup in Denmark)

To rehab the shoulder, first began with myofascial release and stretching of the pec, front deltoid and biceps. Taping the shoulder blade may also help. The next step would be to strengthen the stabilizer muscles with specific isolation exercises. Some basic stabilizing exercises are called Blackburn. This video shows how to do them at home:

The most important time to do scapular stabilizing exercises is when you aren’t experiencing any pain or do not have any shoulder instability issues. This will ensure you are less likely to experience an injury. In addition to the Blackburn exercises, other important exercises are those that target specific rotator cuff muscles, such as internal and external rotation movements with light weight.

It’s important to not let the shoulder instability go on too long. Shoulder instability not only can cause pain, and lead to tears, but can negatively affect your physical performance.

References:

Deepak N Bhatia, Joe F de Beer, Karin S van Rooyen, Francis Lam, Donald F du Toit . The “bench-presser’s shoulder”: an overuse insertional tendinopathy of the pectoralis minor muscle. British Journal of Sports Medicine 2007;41:e11.

Kolber, Morey J; Beekhuizen, Kristina S; Cheng, Ming-Shun S; Hellman, Madeleine A. “Shoulder Joint and Muscle Characteristics in the Recreational Weight Training Population”.  Journal of Strength and Conditioning Research: January 2009 - Volume 23 - Issue 1 - p 148-157.

Kolber, Morey J; Beekhuizen, Kristina S; Cheng, Ming-Shun S; Hellman, Madeleine A. Shoulder Injuries Attributed to Resistance Training: A Brief Review. Journal of Strength and Conditioning Research: June 2010 - Volume 24 - Issue 6 - p 1696-1704.