How to Solve the AC Joint Riddle
Q: Tony, I have a friend who is having shoulder issues, namely along the lines of AC joint problems. Besides just rest and surgery, what can she do, if anything, to help, and what exercises should she absolutely avoid?
A: To keep this as succinct as possible, with regards to your friend’s AC (Acromioclavicular, for the non-nerds out there) joint issue – it could be any number of things, really. As it stands, the AC joint itself is a fairly complex and “dense” area encompassing several muscles, ligaments, and bones all coming together in a small space.
The first (and obvious) question to ask is: what hurts? For many, they’ll typically have pain or discomfort with direct palpation, horizontal ADD-uction (pulling arm across the body), full extension, and/or approximation (compression of the joint). I’ll expound on this a little below when discussing training modifications; but for now, it’s just something to keep in the back of our minds.
Furthermore, as noted above, it’s important to recognize that the coracoid process is an attachment point for three separate muscles: pec minor, coracobrachialis, and short head of the bicep. Almost always, the pec minor is going to be the main culprit, which shouldn’t come as a surprise given the vast majority of us are stuck in flexion all day sitting in front of our computers. And bench pressing far too often, but I digress.
When the pec minor is restricted (or adaptively shortened), you’re typically going to see a few things happen:
– Scapular protraction.
– loss of posterior scapular tilt (scapular winging).
– and a decreased width of the subacromial space (impingement).
All of which are going to lead to an ouchie. The simple solution? Getting some aggressive soft tissue work would be a great start. Unfortunately, the pec minor is a nasty little bugger to get to on your own, so finding a really good manual therapist who can get his or her fingers in there would be your best option. A far second would be taking something like a tennis or lacrosse ball, and performing the following drill against a wall. Granted, this drill mainly targets the pec major, but it’s better than nothing.
As well, there are a few simple stretches that you can do to help lengthen the pec minor. Rather than re-invent the wheel, though, I’ll just direct you to THIS article by Eric Cressey which describes, in detail, some of the stretches we perform at the facility with our athletes and clients.
Additionally, soft tissue work on the levator scapulae as well as the infraspinatus has worked well with many people. Really, when you think about it, improving upward rotation in general would be a smart way to approach things. To that end, utilizing exercises that will strengthen the lower traps as well as the serratus anterior would be ideal.
A few of my BFFs in that regard include the supine no-money drill with band:
Note: Be sure to keep your scapulae DOWN when performing the exercise (no shrugging). Too, make sure you keep your elbows against your sides throughout the duration of the set. You won’t need to use a lot of resistance with this exercise, so I suggest starting with a LIGHT band.
For the serratus anterior, I like to use hand switches. A word of caution, however. Whether or not to use this exercise will be dependent on the comfort level of the individual. Remember, approximation stress can be problematic for some with AC issues.
Of course there are dozens of other exercises we can utilize to help improve upward rotation, but the two above should be a good start for most people.
As far as any training modifications I’d make; I like lists, so here’s what I’d do:
1. Scarlett Johannson is now single. Just sayin……
2. Front squats are more than likely going to make them hate life – since the bar lies directly across the AC joint. Here, I’d be inclined to either use specialty bars if you have access to them (safety squat bar, giant cambered bar, or maybe even a front squat harness), or just stick to back squats.
3. You can go to town with all the single leg work you want. The only caveat would be placing a bar in the front squat position (see above).
3. Never, ever, never, never, ever, under any circumstances, do another dip. I mean it!**
4. Push-ups are probably going to be iffy for most people in this case. As such, I’d be more inclined to have him or her perform push-up ISO holds in a pain free ROM; or, at the very least, elevate the push-up on pins to a pain free ROM.
5. Moreover, full-range benching is probably going to be out of question for the time being. Given that most guys only go down half way anyways, this shouldn’t be an issue (HA!). That said, board presses would be an ideal substitute here.
From there you can progress to floor presses, and then full-ROM presses.
6. Pulling exercises (horizontal rowing in particular) may need to be modified so as to avoid full extension. Again, because the pec minor is pulling the scapulae forward and out (anteriorly tilted), many people will compensate scapular retraction/posterior tilt with glenohumeral hyper-extension (and forward head lean). Kind of like this:
Just be cognizant of the fact that you’re probably doing your rowing movements wrong, and that you need to fix it for the love of god!
So, will this certainly isn’t an exhaustive list I think it should at least get the ball rolling in the right direction! For those interested, I’d HIGHLY recommend checking out Eric Cressey and Mike Reinold’s Optimal Shoulder Performance dvd. Much of what I discussed above is covered in a lot more detail there. Also, in case you missed it, SCARLET JOHANNSON IS NOW SINGLE!!!!!!!!!!!
** I swear to god, I’ll take away your Xbox for a month if you do one!!!