So Your Shoulder Hurts……

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I’d say that at least once a week I open up my email and start reading something that sounds like this, “Hi Tony, this is (enter name of Victoria Secret model here). I was checking out your website and……..”

Just kidding – that’ll never happen.  But fingers crossed that it does someday.

Back in reality what typically happens is a receive an email that starts, “Hey man, so, uh, I have this shoulder thingie going on…………………”

And almost immediately the Darth Vader theme music starts echoing in my head.

Don’t get me wrong, I’m always honored when someone goes out of their way to reach out to me and ask for advice.  And, I’m always more than happy to respond.  It’s just sometimes I feel like I’m a broken record repeating myself over and over and over again.

Now shoulder injuries can be tricky, as no two shoulders are the same.  There’s a lot of “stuff” happening, which shouldn’t come as surprise given the shoulder actually consists of four joints (glenohumeral, scapulothoracic, acromioclavicular, sternoclavicular), as well as consists of 17 muscular attachments alone. This piece slides into that piece. This part rotates. BAM – it’s like it’s own little Transformer!

On top of all that, because the shoulder is such an intricate joint it lends itself open to injury fairly easily.  We have AC joint separations, labrum tears, SLAP tears, external (primary and secondary) and internal impingement, and a whole host of other words that end in ‘itis or “WTF my shoulder hurts!”

All that said, however, I’d say that 90% of the time when someone reaches out to me (or Eric for that matter) asking why their shoulder is flipping them the bird,  it usually comes down to a handful of common denominators. While the following shouldn’t be taken as the end all-be all list, I feel it does cover most people’s bases.

Lets get to it!

1. Programming Balance?

There’s a popular theme that a lot of coaches and trainers like to live and die by called programming balance.  Meaning, any well structured program should have a balanced approached between movement patterns.  Specific to the conversation at hand, with regards to upper body training, it’s often recognized that for every pushing exercise one performs (bench press), he or she should also perform one pulling exercise (seated row, etc).

This actually isn’t a bad advice.  The thing is:  We all know that Mondays are reserved for bench pressing.  So are Wednesdays, Fridays, and every other day that’s a prime number.

Basically, guys like to bench press.

As a result many develop muscular imbalances – short/stiff pecs, weak/inhibited upper back – which leads to protracted and internally rotated shoulders.

If we’re lucky, we may see a set or two of rows in there for good measure, but it’s safe to assume that for many, their pressing to pulling ration is skewed.

Program balance isn’t going to work for these people.  Using a 1:1 ratio ain’t gonna cut it.  In this sense we need to use an UNBALANCED APPROACH.

Which is why I’m not adverse to recommending that most people revert to a 2:1 or even 3:1 (pull:push) ratio to help offset their gross muscular imbalance and help their shoulder feel better.

To that end I typically let these guys know that their world won’t end if they don’t bench press for a few weeks, and that it would be in their best interests to implement more horizontal rowing into the mix.

2.  And Don’t Forget Push-Ups!

I’d say that 95% of the time any shoulder issue comes dow to it being a scapular issue.  One of the main reasons why I’d prefer guys nix the bench pressing for the time being is because it’s an open chained movement.

Speaking english, what this means is that the hands are able to move freely, but the scapulae are pinned against a bench.  Like, they can’t move.  At all. They’re “glued” in place, which doesn’t bode well for shoulder health.

Moreover, holding a barbell locks us into a pronated grip which leads to more internal rotation of the humerus, which closes off the subacromial space

On an aside: using DBs with a neutral (palms face one another) grip would be a more shoulder friendly option, as we can encourage a bit more external rotation and open up the subacromial space a bit more.

Push-ups on the other hand are a CLOSED-CHAIN exercise, where the hands don’t move and the scapulae have a bit more breathing room. This is a HUGE advantage, and something I feel many trainees dismiss because they deem push-ups too wimpy.

Of course push-up technique is going to enter the conversation as a huge reason why a lot of people’s shoulders hurt is because they have no idea how to perform one correctly.

For a primer I’d encourage everyone to check out THIS post.

3. Scaps, Scaps, and more Scaps

As I noted above, much of the time when someone’s shoulder hurts it can pinpointed to the scapulae.  The most cliched – albeit easiest – explanation to use here would be the shooting a cannon from a canoe analogy.

When everything is hunky-dory, the scapulae are hugged tight against our rib cage and our force couples are “balanced” and everything is in ideal alignment to allow things to run smoothly.  In other words our downward rotators (levator, rhomboids, pecs, and lats) and upward rotators (upper and lower traps, serratus anterior) are doing their jobs and everyone is happy.

Unfortunately, due to societal demands, lack of physical activity, and global warming (we can blame everything on that, right), most tend to be woefully weak in their upward rotators (especially lower traps and SA) and dominant in their downward rotators – leaving the scapulae abducted and anteriorly tilted.

Or……UNSTABLE!

Placing a premium on drills that target the lower traps and serratus anterior while stretching or addressing tissue quality  on the levator, pecs, and lats will go a long ways in helping the shoulder feel a ton better.

1-Arm Prone Trap Raise

Forearm Wall Slide w/ Lift Off

Shoulder W’s

Hand Switches w/ Push-Up

Actually Doing Your Rows Correctly

Pec Release w/ Ball

4.  Learning to Breath Correctly

While I’ve always felt this was important, I generally steered clear of it because I felt there were more pressing (HA!  Pun intended) issues that people should work on – technique, program modifications, soft tissue quality, etc.

But when we consider that everyone takes roughly 20,000 breaths per day, incorrectly, firing our accessory breathing muscles (upper traps, scalenes, levator) and completely neglecting the diaphragm – it’s no wonder we have an epidemic of pissed off shoulders!

I won’t go into too much detail here, other than to say to check out THIS post on breathing patterns I wrote last year as well as check out Mike Robertson’s much more detailed post HERE.

5.  Watch Predator

This really has nothing to do with shoulders, but it’s a crime if you haven’t watched this movie.  I’m pretty sure watching the Predator Handshake on repeat increases T-levels by 286% instantly.  Subsequently your shoulder will feel better!

6.  Hammer T-Spine Mobility

I don’t think I need to belabor this point.  If you’re rocking a Neanderthal posture, chances are your shoulder hates you.  This ties in hand-in-hand with the section on scapular stability above.  When we’re stuck in a overly rounded/kyphotic posture, the scapulae are going to be abducted and anteriorly tilted.  Tossing in some daily t-spine mobility drills will work wonders on how your shoulder feels.

Some of my favorites include:

Quadruped Extension-Rotation

Side Lying Windmill

Yoga Push-Up Complex

Also, because I’m sick of typing now, I’d HIGHLY encourage you to check our Dean Somerset’s 3-part series on All Things Thoracic Spine HERE.

That’s That

And that’s that.  Seriously, stop benching.

Did what you just read make your day? Ruin it? Either way, you should share it with your friends and/or comment below.

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  • Bob

    Me again Tony, last few little questions and I’m done, promise.
    1 – Is there a reason why the PTR is done with the arm at 45 degrees and not straight out? I seem to feel it a bit better with the arm straight out in front…
    2 – Prone trap raises done with a cable machine (heard of them called scarecrows) – good or bad?

    Thanks Tony, as you can probably tell I’m rehabbing a shoulder injury just now…

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  • kedric93

    Tony,

    Fantastic post on the shoulder. I love learning about it. One execise I find problematic is actually forearm wall slide at 135 degrees.

    I am able to slide my arm up but find it difficult to retract my scapula during the lift off without going out of neutral. Could this be a lower trap weakness since 135 degrees set up the line of pull for the lower trap?

    Thanks,
    -kedric

  • Tim

    Great article Tony. I have a client I recently started working with and I have no clue what her last trainer was thinking in regards to her shoulder. She can’t get her arms up overhead and her trainer had her overhead pressing twice per week. Yikes!!

    Been using a lot of corrective exercises/warm-up drills I see on your and the Cressey Performance youtube page that’s helped a lot. Post Rehab Essentials has been great as well.

    Thanks for the post!

    • TonyGentilcore

      Well that’s unfortunate! Glad to see that she finally started working with someone who knows better….;o)

      • Tim

        Well, your posts/videos helped me with her, so thank you!

  • Augie S

    Thanks Tony, question on rows. Any advantage/preference on grip, e.g. overhand vs. neutral?

    • TonyGentilcore

      I like to change the grip on rows every so often just to break the monotony. For those with more depressed shoulders, however, I’d probably lean more towards a pronated grip with the elbows flared slightly (so that they won’t recruit lats so much).

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  • Kieran

    Hi Tony. I was just wondering if you ever do planche push ups or recommend them? I tried them for the first time the other day and they’re awesome! It’s essentially a push up with the hands supinated and pointing towards your feet. They might require a bit more wrist flexibility but I think they’re great for when push ups get a bit easy. The fact that it puts your shoulders in external rotation might mean they’re more stable too (but I don’t really know what I’m talking about). It’s also awesome for the upper chest due to the supinated hands and even the biceps!

    • Kieran

      Also forgot to say – love number 5. Dillon you son of a bitch, what’s da madda, CIA got you pushin’ too many pencils? Excellent

    • TonyGentilcore

      Can’t say I’ve ever done them Kiernan, and to be honest, probably not going to add them in anytime soon.

      I just think from a realistic standpoint, not many people will be able to do them properly and I also feel they’d place certain joints in compromising positions that most people wouldn’t be able to handle.

      Thanks for chiming in though!

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  • Michael Lebrun

    Hello, Tony. I’ve suffered from sore shoulders from a while, to the point where it is difficult for me to even put a dress shirt on by myself. Reaching behind me for that second sleeve is painful. My wife had to stand behind me to hold the shirt behind me to a level where the sleeve openings would just engage my hanging hands and she would then pull it up to shoulder level where I could then take over. Necessity being the mother of invention, I’ve come up with a device that now allows me to put that shirt on all by myself. If anyone would like some info, I’d be happy to share it. Just email me at mlebrun1539@yahoo.com.

    • TonyGentilcore

      Sorry to hear about that Michael. Hopefully you get it looked at if you haven’t already.