Healthy Shoulders – a few simple rules

Plain and simple, healthy shoulders make life better. Nobody wants to have a bummed up shoulder.

Injuries suck in general, but shoulder injuries just make everything hard. A shoulder injury can obviously limit upper body training, but it can derail lower body training too. For those involved in strength sports, it derail the ability to snatch, clean, jerk, squat, deadlift, and so much more.

While good lifting mechanics from lift to lift differ, I’m going to lay out some “rules” for healthy shoulders. These are not set in stone, but from experience these have shown to help people ward off issues.

Shoulder mechanics

The shoulder is a complex system of multiple joints – glenohumeral, scapulothoracic, acromioclavicular, sternoclavicular (and debatably the thoracic spine) – that interact to produce movement. When we have excessive motion of one joint (typically the glenohumeral) without enough of other joints (like the scapulothoracic) then we can have movement deviations that may lead to irritated tissues. Learning how to integrate all of the joints together in a fluid manner will encourage less strain on the shoulder.

For a lot of people, moving their shoulder blade purposefully can be a new concept. From experience, people tend to over utilize their glenohumeral joint and don't utilize their scapulothoracic joint fully. This is particularly evident in movements like rows, pull ups, push ups, etc.

Learning how to move through the various joints and gain control of them be a challenge for people. My preference is to use exercises where we can focus on primarily one joint at a time, go nice and slow, and feel good control of it.

A few that I like to have people use for their shoulders are:

  • Quadruped Scapula circles

  • Great exercise for people to start feeling out their scapular motion in a pressing mechanical position

  • Inverted Scapular circles

  • Similar to above, but now we are working on more of a pulling mechanical position

  • Quadruped Thoracic windmill

  • This will begin to incorporate the thoracic spine more in a rotary plane, as well as take the glenohumeral joint through a greater motion

Push:Pull ratio

When is the last time you met someone who was awesome at pulling motions (strict pull ups/rows) and had a lot of shoulder pain? Pretty rare. Typically people who are monsters at pulling (with good mechanics) have strong and durable shoulders.

In general for people with current shoulder issues, look at the ratio of your push to pull training.

Using a 1:3 push:pull ratio, where for every set of pushing you do 3 sets of pulling can do wonders for people. This is a great way to start getting the shoulders healthier relatively quickly. Over time as your shoulders get healthier you can transition to 1:2, and finally 1:1.

A few of my go to pulling motions to help individuals progressively get stronger at pulling motions are:

  • 3 point DB row

  • Single arm row variations are great for people who are just getting started with feeling out a proper row. When using both arms a lot of people struggle with controlling their shoulders, but with one arm at a time they can focus a lot better.

  • Inverted row

  • A great exercise to fluctuate difficulty with, walk down or walk back as you need more/less challenge. Few exercises allow you to change the difficulty mid set like this does.

  • Chest supported row

  • When it comes to loading up row variations, this should be a go to movement for you. We can go to this exercise and not worry about overly challenging the low back or worry about body momentum.

  • Half kneeling 1 arm pulldown

  • Progressing to overhead pulling mechanics can be a battle for some people. I like using the variation as we can have better control of the low back and rib cage with half kneeling, while utilizing a single arm again for better proprioception of the shoulder.

It's important to notice in all of these movements are not "pinning" our shoulder blades down, but reaching and forward/up and then coming back. The aspect of reaching out controlling the shoulder through a range is what really makes these gold.

The little guys

Some muscles just don’t get the love they deserve. People want pecs, delts, abs, triceps. From a health and performance perspective, ignoring any muscle is not a great idea. Particularly, ignoring muscles like the serratus anterior and lower trap is going to lead to what is traditionally called “movement impairments” or “muscle imbalances.” If we want to optimize the shoulder position throughout pressing/pulling/throwing/etc. we want to have each muscle play its part effectively.

This isn’t to say that all of the muscles of your shoulder should be equally strong, but each muscle should have an appropriate level of strength to do its job. As well, people need to have a good level of proprioception for the muscle. This is the area where I’ve found a lot of people struggle with for their lower trap & serratus anterior.

When we look at athletes like weightlifters or crossfitters, people who put a big demand on their shoulders overhead, there is a huge requirement for adequate upward rotation of the scapula. From experience, these people rarely adequately upwardly rotate their shoulders and instead find ways to get around it – excessive lumbar extension, scapular retraction, excess glenohumeral motion, etc. For these people, getting more lower trap and serratus anterior involvement will help a ton with shoulder positioning and health. While training doesn’t need to focus on individual muscles/muscle groups, there are certain groups that don’t get as much attention as they deserve and when these are playing their role, its good to focus on them for a bit.

Along the same lines, the posterior cuff does not get very much diligent attention in training. External rotation is a very important action for the shoulder, especially if taking your arm above your head. This can get trained fairly well if you do a lot of pulling motions with good shoulder mechanics, but if you struggle with it, then it can limit pulling motions and shoulder movement in general. Doing a few sets of external rotation work can really help improve the strength of these muscles.

A few simple exercises for people to start to get more involvement of these muscles are the:

  • Quadruped Serratus Punch

  • This will help encourage more serratus anterior activation while also working on control the trunk.

  • Quadruped Serratus rotations

  • This exercise teaches how to get more involvement of the serratus anterior on a single arm while rotating the thoracic spine

  • Prone Y

  • Integrating more low trap work now! To get a good upwardly rotate shoulder blade, the serratus anterior and low trap work together - driving the shoulder blade forward and then rotating upwards. In general, the angle of the arm will be about 135 degrees, so we use the "Y" to start working on this.

  • All fours 1 arm serratus slide w/ roller + lift off

  • This is a perfect drill to help teach individuals to get better upward rotation. Using the roller allows people to have a more controlled reach, being on a single arm allows for more proprioception, and the lift off can be more controlled from the quadruped position.

  • Side lying external rotation

  • Arguably the best posterior cuff exercises. This has some of the best EMG research supporting it, and it can help to teach people to move through their shoulder.

  • No money drill

  • This is a great way to work on bilateral external rotation, while integrating scapular motion.

Consider these three "rules" when evaluating your program and training to help address any shoulder issues you have. Whenever utilizing any of the exercises shown, remember that the priority is on movement quality – not how many reps can you crank out. If you have any questions or need assistance, feel free to reach out.

Move well, lift heavy, stay healthy,

The Strength Therapist Crew

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