How to Solve the AC Joint Riddle

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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!!!

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Comments for This Entry

  • bastien

    Hello Tony, First of all thank you for this article, I will try soon your advices but I have one question regarding a particular exercise which I'm not sure if it's good for me to continue practicing it in my working out routine : Pull-up. Will it hurt my ac joint ? I though It will be better to use a neutral grip. What are your thoughts on it ? Regards.

    February 5, 2015 at 8:36 am | Reply to this comment

    • TonyGentilcore

      That's going to depend on you Bastien. I've worked with a lot of people with AC joint issues, and oftentimes pull-ups are "okay" with them. It just depends. I know, not a sexy answer. If they hurt, don't do them....;o) Start with neutral grip and see how they go.

      February 5, 2015 at 9:08 am | Reply to this comment

      • bastien

        Ok, thank your for your reply, I thought the same

        February 5, 2015 at 10:54 am | Reply to this comment

      • bastien

        Hello again Tony. I though it would be a good idea to share with you some new ideas that I recently found on a book writed by Frederic Delavier. According to him, when people have to deal with AC join sprain, after a complete resting period for 2 weeks, when the athlete return to working out, he advises his readers to replace all "pushing down exercises" (like bench press / declined bench press / dips) by "pushing up execices" like incline bench press / overhead press because, I quote, "it tends to stabilises the joint" rather than stretching it (see the scheme in the following picture : http://postimg.org/image/ckoytoimd/ ). Do you agree with this statement and the explanation in the picture ? Kind regards.

        February 12, 2015 at 6:02 pm | Reply to this comment

  • Ned Brines

    Hi tony-thanks for the info. Three months ago I fell onto my left shoulder resulting in a grade 2 sprain of the A/C joint. The collar bone was sticking up appx. 3/4-1". I spent the past three months going through various phases of rehab (on my own)-daily ice, light movements, moving to bands, then light weights and now moderate weights. I have limited or eliminated a number of movements from my training. On Sunday at the end of my chest work I decided to try some push-ups and ended up doing 15, then 8, EXTREMELY slowly. I felt some slight discomfort during the second set and stopped. The joint is very tender again, the collar bone was slightly elevated yesterday/less so today, and some movements seems to create discomfort/pain. Did I blow it? Is it just part of the process? How long should this take to fully heal (I'm 54 and train six days a week)? Thank you

    June 14, 2016 at 11:56 am | Reply to this comment

    • TonyGentilcore

      Hi Ned - unfortunately, this is one of those scenarios where I can't offer much help. It's hard for me to make any concrete suggestions over the internet without coaching someone in person. Plus, this sounds like something that would be better suited for a physical or manual therapist. I don't feel you blew things - part of the process is teetering on the threshold of what the body can handle, and chances are, in a de-conditioned state, your work capacity is going to be low. So, if that much volume bothered you, I'd lessen it and see how you feel. Something else to consider would be a reduced ROM - perform in a PAIN-FREE ROM - and progress from there. But in all, I'd recommend seeking out a reputable PT in your area to help you on this front.

      June 22, 2016 at 11:29 am | Reply to this comment

  • Ken O'Byrne

    Hi Tony, Thanks for this article, I injured my AC Joint last week and I'm still waiting for an MRI to check how much damage is done so I've been looking for practical advice on how best to manage the injury and keep working in the gym. One question, when you say no dips, do you mean for an extended period after the injury or eliminate them completely from my workouts for good? Thanks, Ken

    October 26, 2016 at 7:51 am | Reply to this comment

    • TonyGentilcore

      Definitely no dips for the immediate future. Whether or not you'll be able to do them long-term remains to be seen. As a coach, whenever I see an injury (like an AC joint injury) I'm almost always operating under the assumption that exercises like dips may not be the best choice given the often precarious position the joint itself gets into during the exercise. This is more so if someone has a LONG history of shoulder issues. It just comes down to cost/benefit. However, only you and your coach/PT/physio can ascertain what will be the best fit down the road.

      October 26, 2016 at 8:45 am | Reply to this comment

  • Ken O'Byrne

    Hi Tony, Thanks for this article, I injured my AC Joint last week and I'm still waiting for an MRI to check how much damage is done so I've been looking for practical advice on how best to manage the injury and keep working in the gym. One question, when you say no dips, do you mean for an extended period after the injury or eliminate them completely from my workouts for good? Thanks, Ken

    October 26, 2016 at 8:51 am | Reply to this comment

    • TonyGentilcore

      Definitely no dips for the immediate future. Whether or not you'll be able to do them long-term remains to be seen. As a coach, whenever I see an injury (like an AC joint injury) I'm almost always operating under the assumption that exercises like dips may not be the best choice given the often precarious position the joint itself gets into during the exercise. This is more so if someone has a LONG history of shoulder issues. It just comes down to cost/benefit. However, only you and your coach/PT/physio can ascertain what will be the best fit down the road.

      October 26, 2016 at 9:45 am | Reply to this comment

  • Carlton Bennett

    Hi Tony, I first started having left AC joint problems 2 1/2 years ago after some dental work. Started working out again 4 months ago and both left/right sides are sore. I don't go over 10lbs in weight on machines, but it still hurts. Doctor took X-rays but said they didn't see anything. Pain also hurts on my collar bones. I did find a AC joint rehab program online a few months ago and that seemed to help some. Suppose to see an ortho to get a real view of what's going on. At this point I'm going to stop all upper body weights until I can figure things out. What I can't figure out is why it's not getting even a little better after all this time?

    January 28, 2017 at 10:18 pm | Reply to this comment

    • TonyGentilcore

      Possibly choosing the wrong correctives or exercises for YOU. There are many great programs you can find online, but they're not going to work for everyone; they follow the Bell Curve just like everything else. Something will work spot on for a certain % of the population, and be a disaster for others. Seek out a reputable physical or manual therapist in your area. Stop guessing and seek someone out who knows what they're talking about and can point you in the right direction. It's important to find someone who will show you what you CAN do, and not what you can't

      January 30, 2017 at 9:04 am | Reply to this comment

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