Here’s what I discovered about the shoulder. It’s a dynamic and amazing joint and we need to keep it as strong, mobile, and stable as we possible can. We need to balance the extensive network of shoulder complex muscles effectively in order to minimize our risk for injury. I’m all for training hard and intense, but we also need to work towards bulletproofing our bodies as we work towards our goals. But before we discuss a few of the most common shoulder injuries, we need a quick crash course in basic anatomy.

Functional Anatomy of the Shoulder

The shoulder complex collectively consists of the glenohumeral (GH) joint, the acromioclavicular (AC) joint, the sternoclavicular (SC) joint, and the scapulothoracic joint (or articulation – this is not true a joint).

There are a large number of muscles involved in optimal shoulder joint function. The rotator cuff (RTC) muscles are vital for the normal joint mechanics of the shoulder. The RTC is also a common area of dysfunction. It consists of only four muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The supraspinatus is typically the affected muscle because of its anatomical location – it represents the superior aspect (top) of the RTC muscle group.

These important shoulder muscles allow for dynamic stability and mobility. This is a key concept to understand. What these four muscles essentially do is maintain the humeral head (ball) in the glenoid (socket) during arm movements. The ball and socket is the glenohumeral (GH) joint. Let me repeat, the RTC keeps the ball in the socket and is a major contributor to optimizing the joint mechanics, when healthy and strong. If there is muscle weakness, imbalance, or dysfunction of the RTC, the mobility and stability of the shoulder joint will be compromised.

I should mention the other major muscles that are important for optimal shoulder joint function. These are the deltoids, the long head of the biceps, the latisimus dorsi, the pectoralis major, teres major, coracobrachialis, and long head of the triceps. And, finally, there are the important scapular (shoulder blade) muscles, which include the serratus anterior, trapezius, rhomboids, pec minor, and levator scapulae. The role of the scapula is also critical in the stability and mobility of the shoulder joint because if the scapular mechanics are weak, the base of stability in the shoulder joint will be inefficient in it’s function.

A few other things to mention are the acromion and the coracoarcomial arch. You’ll see why these are important in just a minute. The acromion is a bony process on the tip of the scapula (shoulder blade). It forms the AC joint (acromioclavicular joint) and forms the superior bony aspect (top) above the supraspinatus. The coracoacromial arch is a protective arch formed by the smooth inferior aspect of the acromion and the coracoid process of the scapula with the coracoacromial ligament spanning between them.

Common Shoulder Injuries

Many shoulder injuries are preventable by strengthening the RTC and scapular musculature, while maintaining joint mobility and stability. But it’s important to perform the right types of exercises and avoid poor technique faults and training methods.

Rotator Cuff Injuries

The majority of shoulder problems in athletes and the general population are related to rotator cuff dysfunction. Repetitive trauma leading to inflammation is one causative factor in RTC injury, potentially leading to a tear of the RTC musculature. It should also be noted that RTC tears can be present and completely asymptomatic, meaning there is no pain. This was demonstrated in a large observational study in the general population.

Impingement

This is an encroachment of the subacromial space on the supraspinatus and often the biceps tendon, as well. RTC impingement can be a result of mechanical wear of the cuff under the coracoacromial arch. This has been described as a primary cause. Other contributing causes are degenerative changes to the RTC (which is inevitable as we age) and also an abnormal pathology of the acromion (structural defect).

Instability

This occurs when the shoulder joint deviates out of its normal position (the humeral head moves out of the glenoid). This can be a minor shift in movement, which is called a subluxation, or can result in a more severe dislocation in the shoulder. Individuals suffering from an instability problem will experience pain with active elevation of the arm and may feel as if the shoulder is slipping or moving out of place.

7 Key Exercises for the Shoulder

Here are what I believe are some of the best exercises performed with a kettlebell to prevent shoulder dysfunction and injury. The kettlebell is a wonderful tool for optimizing shoulder health. Many of these will help to improve or restore mobility, stability, and optimize RTC strength, as well as the entire shoulder complex. Listed below each exercise will be a recommended rep scheme to use as a pre-workout mobility program or warm up.

Any exercise listed here must be done in a pain-free range of motion. This should be obvious, but it’s worth mentioning that any exercise that induces pain is not a good exercise and should be avoided.

1. Turkish Get Up

Arguably, the Turkish get up (TGU) is the most important of these exercises. The TGU enhances and optimizes RTC function by moving through a broad range of motion, while the RTC is firing and stabilizing the entire time. The TGU and its component parts are what I consider to be the staple for maximizing shoulder joint health and function. Not only does it fire the RTC the entire time, but the weight bearing positions are outstanding for scapular stability and strength. The important thing is to get this exercise right and not rush it as you’re moving through each transition in a slow, controlled motion.

Perform 2-5 reps, either unweighted or with light weight, prior to beginning your training session.

2. Windmill

Performing the kettlebell windmill requires a dynamic range of motion, mobility, and stability. While it’s also great for the hip and spine strength and stability, I include it on this list for the same reason as the TGU. As you move throughout the windmill, the RTC must constantly fire and stabilize the humeral head through the wide range of motion.

Perform 3-5 reps per side with a light sized kettlebell.

3. Armbar

The kettlebell armbar has similar benefits to the exercises above, but there are some differences. The shoulder mobility is not as dynamic as with the TGU and windmill, but the stability and proprioceptive benefits (knowing where your arm is in space) are outstanding. Also, it really opens up the anterior portions of the shoulder complex (anterior glenohumoral joint, pecs, and rib cage). For tight pectorals and forward rounded shoulders, this is a fantastic mobilization. The armbar is also outstanding for thoracic mobility, which is something we all need to maintain or potentially improve.

5-10 reps or mobilizations per side with a light to moderate size is acceptable.

4. Military Press

The kettlebell military press is excellent for total shoulder strength, but has the mobility and stability elements to it, as well. The key is to perform the shoulder press in the plane of the scapula, which is approximately thirty to 45 degrees anterior to the frontal plane (see picture). Basically, your arm is not positioned straight out to the side and it’s not straight out in front of you.

Keeping the press in the plane of the scapula is not only safe, but is the most functional and biomechanically efficient position for the shoulder to effectively press. For example, think of a barbell press in which your shoulder is taken back out of the plane of the scapula to hold the barbell in position and press overhead. In contrast, you can press the kettlebell in the natural groove. The kettlebell press is excellent for the shoulder complex and incorporates not only the RTC, but also all shoulder musculature for stability, mobility, and strength.

Perform 2 sets of 5 per side with a light kettlebell prior to your session to set the groove and properly activate the shoulder complex muscles.

5. Swing

This may come as a surprise, but the kettlebell swing is fantastic for the RTC. The entire time you are swinging the kettlebell, the RTC is firing to stabilize the shoulder joint and maintain the humoral head in the glenoid. And, it’s doing this is a non-stressful, non-aggressive way. Remember, in the Russian style swing the shoulders (especially the deltoids) aren’t really active, but there is demand on the upper extremities and the RTC muscles to contract continuously to hold the shoulder in place. From a standpoint of strengthening the RTC, the kettlebell swing is an excellent exercise to optimize shoulder health, even though we don’t typically think of it that way.

Perform 2-3 sets of 5-10 one hand swings prior to your training session. Consider this part of your warm up program to activate the shoulders.

6. Halo

The halo is a very effective mobility exercise for the shoulder (GH joint) and the thoracic spine. It’s also easy to do. The halo should be considered a standard mobility exercise for the shoulder complex. While it doesn’t offer the strength benefits of some of the other exercises listed here, it’s outstanding for the GH joint mobility, with the added benefit of opening up the thoracic spine.

5-10 halos each direction with a lighter size kettlebell.

7. Snatch

The kettlebell snatch is a high-level exercise, not just for the shoulders, but also for the entire body. There can be no argument that the snatch is an extremely powerful and dynamic exercise for the shoulder complex when properly performed. Assuming there is no shoulder injury or dysfunction, snatching a kettlebell overhead is a proven way to develop the shoulders and improve shoulder joint mobility and stability.

2-3 sets of 5 reps per arm with a light to medium sized kettlebell prior to a training session is an excellent way to prime the shoulders.

Putting It All Together

I’ve found these types of exercises are some of the best ways to improve shoulder function, improve RTC strength, and minimize risk for injury, when executed with proper technique in combination with smart programming. To maximize shoulder health, we could also add more scapular stabilization work in addition the exercises above. Things such as planks, TRX scapular retraction, bat wings, and push ups with scapular protraction are a few examples. This would be necessary if scapular weakness or dysfunction was noted.

To minimize our risk for injury, we need to keep our RTC and all of our shoulder stabilizers strong and healthy. These are seven great examples of shoulder stability and mobility training. If you had to pick one, I would consider the TGU as the mother of all shoulder exercises because of the unique benefits it offers, in terms of mobility, stability, and strength. But you should pick the exercises that are appropriate for you. I hope this serves you well as a simple guide for optimizing the health of your shoulders.

References:

1. A. Yamamoto et al., “Prevalence and risk factors of a rotator cuff tear in the general population,” Journal of Shoulder and Elbow Surgery 2010 Jan;19(1):116-20.

Photos 1-3 courtesy of Shutterstock.

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Later that night and into the next day my back was really bothering me. Thinking it was just “muscular strain” and being a young kid, not knowing any better, I was in the gym the very next day squatting. Needless to say, this was a big mistake. What exactly was the mistake? Well, there were several. Not listening to my body, pushing through pain, and being too stubborn to take any time off from my training, just for starters.

About two months later, I ended up having surgery on my low back at level L4-L5. Surgery is not fun and injuries are not fun. I had a quick surgery because I had an extreme disc herniation that required immediate action. Here I was a nineteen-year-old kid and I was totally immobile within a few weeks of sustaining the initial injury. To be transparent, it was hell.

I can’t tell you how hard that was, because not only did I kiss my training goodbye for the entire summer, but all I could do was lie flat on my back for the next several months due to the worst, most constant pain you could imagine. I had sciatic scoliosis with pain in my back that radiated into my right leg. I couldn’t even stand up straight because of the pressure on the nerve root causing constant, severe pain, regardless of body position. It was one of the worst things I’ve ever gone through, but there were actually many great things that came from a really bad situation.

The surgery was successful and I came back strong to compete in bodybuilding again. Today, I’m fitter, stronger, and train at a higher level than I ever have in my life. I also demand proper biomechanically efficient lifting technique – from myself and the people I work with. It was out of that bad experience that I eventually became an orthopedic physical therapist and have many helped others to successfully rehab from and prevent injuries like mine.

It was through that experience that I always teach that the most important goal of every single training session must be to minimize the risk for injury. Preventing injury has to be the primary goal of each and every training session, because if we injure ourselves, there is no training, especially with spine related injuries.

How do we minimize risk of injury? There are several ways to do this, but here’s three simple strategies to use:

The most obvious way (excuse the bluntness here) is to not do “dumb stuff.” What does that mean? It means really focusing on ourselves, knowing our limits, and listening to the signals our bodies tell us when there’s something going wrong. Be honest with yourself and don’t do things you know you shouldn’t do. Yes, train hard and push it to the limit, but understand and really know that limit. Something I have asked myself in the past is, “Would my injury have been as bad if I had not been in there the next day squatting?” That’s something I’ll never know the answer to, but what is important is that I learned from it. I totally admit that’s an example of doing “dumb stuff.” These days, I am extremely focused on paying attention to how my body responds to each training session and making sure my technique is rock solid.

The next thing we need to do is to make sure we understand what good movement is. Not only do we need to understand good movement, we need to make sure we have a baseline of good movement before we do certain lifts like squatting, snatching, or pressing. By understanding proper movement and the biomechanics of exercise technique, whether with a barbell, kettlebell, our own bodyweight, or anything else, we will minimize risk for injury. If we understand the physiology of human movement and apply that to our lifts, so that we lift with maximal safety and efficiency, we will optimize our training in every way possible. We must assess if we have a proper baseline of movement and pre-requisite mobility, stability, and motor control to perform certain lifts. In other words, we have to establish a baseline of quality movement before we lift heavy things or our risk is increased.

And, finally, we need to be constant learners. We need to constantly refine our techniques and improve our skills. Injuries are very common, but surprisingly very avoidable by using proper technique and not getting sloppy with our form. Whether it’s spine, shoulder, knee, ankle, or wrist, we need to make sure we understand how our bodies work and how to use key principles during training sessions. Key principles such as spinal stabilization, muscular tension, and optimal joint positioning, to name a few.

Each of these areas goes much deeper and requires much more education and training, of course. Ultimately, good and safe movement requires fundamental understanding and the best way to do this is to obtain good coaching. Then, constant practice will be required to reinforce and build motor control patterns that become conditioned and automatic over time. A great coach can help you to improve your skills and see the things you can’t. This is invaluable. You can constantly refine and improve your skills to train safer and more efficiently, no matter your level of experience.

So, no matter what you’re training goals are, whether you’re training for competition, strength, conditioning, weight loss, fat loss, muscular gain, or whatever it is, the most important thing to remember is that minimizing the risk for injury is the most important training goal in every session.

Don’t do “dumb stuff,” understand and practice good movement skills, and constantly learn and refine your techniques. Train hard, but always train smart and continue your journey safely.

Photos courtesy of Shutterstock.

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When I finally decided to purchase my first 16kg kettlebell to see how this tool could possibly help me, I was blown away. I was even more blown away when I took my first workshop taught by a phenomenal, high level RKC Instructor (Andrea DuCane). This is when I found out what I had been doing for the last few months on my own was completely wrong. I was very humbled, to say the least.

Now, after numerous workshops, kettlebell certifications, and countless hours of practicing, teaching, and training, I know there is something very special about kettlebell training. You could say I’m on a mission to help other people learn about how to use it the right way to get the results I have.

Today, people ask me all the time, “Why kettlebells? Is this type of training really any different from a dumbbell or other gym exercises?” Every time I’m asked that question, I start to feel the passion build and I have to contain myself. Kettlebell training is radically different from any other form of training I’ve personally experienced in my thirty years of weight training.

Kettlebells are kaizen. Kaizen is Japanese for continuous and never-ending improvement. There’s really something “magical” about kettlebells when you learn how to perform the key exercises correctly. It’s a very different type of training from other modalities.

The kettlebell swing is a perfect example of the uniqueness of kettlebell training. Why? As Tracy Reifkind, RKC and author of the great book The Swing puts it, it’s a two-for-one exercise. It combines the benefits of resistance training and cardiovascular conditioning in one very powerful exercise. There isn’t an exercise that addresses so many things at once as does the kettlebell swing.

The magic of the kettlebell appears to have something to do with the cannonball shape and the offset handle, which allow you to manipulate the kettlebell much differently than you could with a dumbbell, barbell, or any other training device. The shape and the handle allow you to perform ballistics and grinds. Ballistics are fast, explosive movements, while grinds are slow and deliberate. This allows for a different type of training experience for faster results.

While there are many great things about kettlebell training, one of the biggest benefits is that all of the exercises are essentially total body exercises. This means you get total body strengthening and conditioning with one single tool. Virtually every fitness goal you want could be accomplished with a kettlebell, but don’t mistake me saying that this is the only thing you should do. It’s a tool, just like a barbell is a tool, and other training methods certainly have utility and benefits, as well.

What I have found is that the kettlebell has become central to my training programs. While I still use bodyweight exercises and barbell programs, kettlebells are an essential part of my training and what I teach today because they offer better results in less time. The time efficiency of training is another huge advantage of kettlebell training, as you can get amazing workouts in a very short time period.

What about the “movement advantage?” The movement advantage is learning to move better through the use of kettlebells. This is something I feel very strong about as a former physical therapist, because kettlebells actually teach you to move in a way that is better, stronger, and safer. Unfortunately, many of us today lose some of our basic movements as a result of sedentary occupations and lifestyles. When you don’t use it, you lose it. That’s exactly what happens when we don’t move with full range of motion or become habituated to certain postures (like sitting all day at a computer).

Kettlebells help us to reclaim our true movement and flexibility again. The Turkish get up is a great example of an exercise that teaches us to move better. I’ve had many clients say how well they move and function again, after learning how to perform this exercise correctly. It’s a very powerful, dynamic, and fundamental exercise, like the kettlebell swing.

If you learn the proper way to use a kettlebell, I can guarantee you’ll discover for yourself, what’s so special about kettlebells. The best way to get started is to find a certified instructor and get qualified instruction from the beginning, if you can. This will ensure you get started off the right way and get results, faster and more safely than trying to figure it out on your own. For total body strengthening and conditioning, kettlebells are definitely a very special fitness and performance training tool to incorporate into your program.

Photos courtesy of Shutterstock.

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“You can’t put fitness on dysfunction.” – Physical Therapist, Gray Cook

Have you heard of the expression “fundamentals first?” All top-level coaches, professionals, and experts advocate the simplistic approach of having the fundamentals before anything else. One of the challenges today is that many of us want progress to the next level without having our fundamentals down first. This is a problem. In regards to exercise, this is critically important if we want to minimize our risk for injury.

The number one goal we should all have with an exercise program is to prevent injury. This comes before any goal of fat loss, weight loss, muscle building, or performance enhancement. If you get hurt, then none of those goals even matter because you can’t train.

Now that we have our number one goal established, we must have strong fundamentals in our exercise program. Digging down deeper, we must have sound fundamental movement patterns before we put a fitness program on top of baseline movement. I really hope that makes sense because this is so important in exercise progression.

There is a need to appraise “human movement” with a proven system to precede physical training and performance. Without a quality appraisal and determination of whether baseline movement is acceptable and symmetrical, there is risk for injury.

The Functional Movement Screen (FMS) is the appraisal system. It is essentially a quick and easy way to screen fundamental movement before you train it. If you train with a baseline of a poor quality of movement, the risk for injury is significantly increased. If, however, you correct baseline movement in a methodical corrective exercise strategy prior to advancing performance training, the risk of injury is significantly reduced.

There are three basic outcomes of the FMS:

1. You will have an acceptable screen after which it is safe to proceed with full activities.
2. Next, you may have a screen that is not acceptable, but you simply may require a corrective strategy in place before advancing.
3. Or you may have pain with movement, in which this will require appropriate referral to a health care provider.

It should be noted that just because you have good movement patterns, this does not guarantee you won’t get hurt. It does suggest that the risk is much less than a dysfunctional movement pattern. And, “normal motion” does not mean “normal movement.”

WHAT IS AN FMS AND WHO SHOULD GET IT?

The FMS looks at fundamental movements, motor control within movements, and a competence of basic movement patterns. Its job is to determine movement deficiency and uncover asymmetry. Further assessment can be conducted, if revealed in the FMS. The evaluation is done by a simple grading system, without judgment.

The system was developed by Physical Therapist, Gray Cook in approximately 2001. The goal was to use the screen to add insight to movement problems that would ultimately lead to the best exercise choices and program design for individuals that would minimize risk of injury.

The FMS is designed for all healthy, active people and for healthy, inactive people who want to increase physical activity. It is designed for those that do not have pain or injury.

The FMS itself is a series of seven different movements and three clearing tests that are combined into a movement screen. By screen, this does not mean it’s a diagnostic tool. The FMS is not diagnostic at all. It is a proven tool that looks objectively at quality of movement. It is extremely objective, reliable, and reproducible. It used by a wide range of fitness and health care professionals.

The seven tests require a balance of mobility and stability. Mobility and stability are the essential elements of the movement patterns in the FMS. If there are limitations in either, the FMS will reveal them.

The purpose of this information is not to go into the details of each of the seven movements, but to explain the practical application and utility in the athletic and recreational exercise population. With the increased desire to be fitter, stronger, and more athletic, people need to realize the importance of having fundamental movements before advancing into higher-level activities. What often happens is people are putting exercise and performance on top of dysfunctional movement, which can impair performance and cause injuries.

There is a saying that “something is only as strong as its weakest link.” The FMS strives to identify the weak link and correct it. The FMS looks at fundamental movement patterns, which are the foundation for fitness and performance.

Once the FMS has revealed a dysfunction, if there is one, an appropriate exercise strategy can be implemented to correct the problem. This is part of the magic of the FMS and corrective exercise system.

WHAT SHOULD YOU DO NEXT? HOW TO GET A SCREEN

I highly recommend getting an FMS for the reasons I mention. The screen may score completely “normal” and that’s a great thing if it does. If it does not, that’s not bad either, as the next step is in building an appropriate corrective exercise strategy, which is easily built into your program to correct the underlying dysfunction.

If you’d like to get a movement screen, the next step would be to search the FMS website to see where the closest local certified expert is to you to perform the FMS. There are many functional movement certified experts that can perform the complete screen, which will only take about ten to fifteen minutes.

I strongly believe in the effectiveness and value of the FMS. The last thing any of us wants is to sustain an injury while exercising. While the FMS does not guarantee that won’t happen, it does significantly cut that risk. The FMS is a great evaluation tool to reveal a movement dysfunction or asymmetry that could be the crack in your exercise foundation.

In summary, the FMS is simple, but highly reliable and effective.The main benefits for getting a screen include:

1. Identifying individuals at risk for injury.
2. Implementing a corrective exercise strategy to improve or normalize functional movement patterns.
3. Providing a tool to monitor progress in dynamic or changing fitness programs.
4. Establishing a functional movement baseline for appropriate exercise programming.

The important consideration to remember is that proper functional movement precedes performance and may ultimately lead to an injury reduction. If you haven’t had a screen and you are beginner or experienced exerciser, this is something you should give strong consideration.

Remember, you can’t put fitness on dysfunction. Unfortunately, this happens much too often in today’s fitness climate.

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