The shoulder joint is one of the most vulnerable joints in the human body. There is so much range of movement that it is surprising more shoulder injuries don’t occur.

If your shoulders are healthy, you must be doing the right things to strengthen them. If not, you are either performing compromising movements or are negligent on your strengthening protocols.

If you are experiencing shoulder pain during your training or competitions, it’s time to step back and determine the root cause. What follows are simple hands-on tests that can determine why your shoulders are in pain. A partner is recommended to assist with each test.

Impingement

1. While seated, have a partner raise the arm of your sore shoulder to the front and overhead as far as possible.
2. Your partner should use one hand on your arm and the other hand supporting your shoulder blade (scapula).

The space where your rotator cuff tendons and shoulder bursa reside (the sub-acromial space) becomes smaller when your arm is raised overhead and pushed to the limit. If pain is felt in your shoulder, the test is considered positive. The pain is likely caused by impingement of the tendons or bursa in that area of your shoulder.

Biceps Tendonitis Test

1. While seated, raise your painful arm (shoulder) forward to the front.
2. While holding your arm out straight in front of you, turn your palm up (e.g., forearm supinated).
3. You partner should then push your arm down, while you attempt to resist.

“There are multiple articulations (movements) at the shoulders, making it a challenge to directly pinpoint an injury. But proper assessment and movement tests to determine specific pain can narrow it down to specific injury issues.”

Pain felt in the front of your shoulder while resisting your partner’s arm push means biceps tendonitis is the probable cause of your shoulder pain.

Labrum Tear

The Labrum tear test has two parts: the apprehension and relocation tests.

The Apprehension Test:

1. Begin by lying on your back on a flat, elevated surface (e.g., a bench or table).
2. Move your arm out to the side perpendicular to the torso.
3. Flex your elbow to a ninety-degree angle.
4. Your partner should slowly rotate your arm so your hand moves toward your ear with the partner pushing as far as possible. Maintain the ninetydegree elbow flexion.

If you are apprehensive (hesitant) about shoulder movement beyond the joint, this test is considered positive for a possible labrum tear.

The Relocation Test:

You may feel your shoulder is unstable and potentially wants to move out of place – or relocate – especially when your shoulder is in extreme external rotation. If this is the case, have your partner gently press on the front of your shoulder to relocate the joint.

If you feel less relocation and your shoulder feels more stable, believe it or not this test is considered positive and a torn labrum is the probable cause.

AC Joint Separation

The test for an AC (acromial-clavicular) joint separation is called the AC joint compression test. The shoulder blade (scapula) connects to the collarbone (clavicle) at this joint.

1. While seated, have your partner place one hand at the front of your shoulder joint and one hand at the rear.
2. The partner should slowly, but firmly press on both sides of your shoulder to compress the AC joint.

“The aforementioned tests are simple protocol anyone can use to determine the possible cause of shoulder joint injuries.”

If there is a joint separation, pain will be felt at the joint between the downward pressing hands. In addition, pain while raising the arm upward and while sleeping are also indications of an AC joint separation.

Rotator Cuff Tear

1. While seated, have your partner raise the painful arm/shoulder to the side and parallel to the floor.
2. While you relax the arm, the partner lets your arm drop.

If your arm drops involuntarily and you are unable to maintain that parallel position you may have a rotator cuff tear. Some may compensate for a torn rotator cuff by elevating the scapula toward the ear. Be vigilant of this when performing the rotator cuff tear test.

Supraspinatus Tear

The empty glass test is used to assess the status of the supraspinatus, one of the four rotator cuff muscles. The supraspinatus is located on the upper part of the shoulder joint and is involved in abduction (arm raising).

1. While seated or standing, lift the sore arm forward and to the side about thirty to 45 degrees.
2. Pronate your wrist so the palm of your hand faces down to the floor (as if you were trying to empty a glass of water).
3. In this position your partner should gently push your arm down.

If pain or weakness prevents you from maintaining your arm position, you may have a supraspinatus tear.

Frozen Shoulder

A frozen shoulder is also known as adhesive capsulitis. It occurs slowly over time and can limit functional use of your arm. A frozen shoulder manifests in pain and tightness. This makes it difficult to reach overhead, press a dumbbell, or scratch your back.

“It is imperative to strengthen all participating muscles and shoulder articulations to enhance shoulder joint health due to the vulnerability of the body part.”

There is no special way of diagnosing a frozen shoulder, nor is there a diagnostic test to verify it (e.g., an X-ray or MRI). A frozen shoulder diagnosis is made by observing the specific shoulder moving through a range of motion.

Frozen Shoulder Procedure:

1. Stand in front of a mirror. A partner should observe you while moving the arm and shoulder. The partner should be noting the range and quality of motion of the shoulder joint.
2. Slowly raise both arms to the front and overhead. If you suffer from frozen shoulder, your painful arm may only come up to a point just past parallel with the floor. Additionally, as your scapula elevates towards your ear, you will feel general pain in the shoulder.
3. From this position, slowly lower the arm down, and then slowly lift the arm out to the side. Note the range of motion that occurs. If the arm only goes up to a point parallel to the ground – and it’s painful – then you likely suffer from frozen shoulder syndrome.

A final test for frozen shoulder is to stand with both arms at the sides and the elbows flexed at ninety degrees. Externally rotate the arms outward. If the frozen shoulder syndrome is present, the painful arm will not rotate outward in comparison to the healthy shoulder.

Assessing Your Shoulder Health

Shoulder joint injuries can be head-scratchers. There are multiple articulations (movements) at the shoulders, making it a challenge to directly pinpoint an injury. But proper assessment and movement tests to determine specific pain can narrow it down to specific injury issues.

The aforementioned tests are simple protocol anyone can use to determine the possible cause of shoulder joint injuries. You may discover one specific issue (e.g., only a rotator cuff tear) or multiple issues (e.g., biceps tendonitis and impingement).

Either way, multi-dimensional shoulder joint articulations can be problematic. It is imperative to strengthen all participating muscles and shoulder articulations to enhance shoulder joint health due to the vulnerability of the body part.

You might also like The Best Method For Talking To Your Doctor About Shoulder Injury and this list of articles how to prevent and treat shoulder injuries.

The post How to Self-Diagnose Your Shoulder Pain appeared first on Breaking Muscle.

I explained previously that just because an X-ray, CT scan, or MRI shows an “abnormality” does not necessarily mean someone needs fixing. Often, that abnormality is simply that person’s normal.

An awareness is starting to trickle down to clients and the general public that an abnormal diagnostic image is not necessarily relevant to treatment. But for some reason, this logic seems to be isolated to the spine. An abnormal result in any other body part still seems to lead everyone to believe that it is also the reason for pain, injury, or dysfunction.

If people can have abnormal results in the spine but are otherwise completely asymptomatic, why can’t the same be true for other parts of the body, like the hip or the shoulder?

Diagnostic imaging can show abnormalities (like this rotator cuff tear), but those don’t always translate to dysfunction.

Who Has “Normal” Shoulders?

This question was the subject of a study published in the American Journal of Roentgenology. Researchers analyzed findings of shoulder ultrasounds to determine the prevalence of any “abnormality” in otherwise healthy, asymptomatic men. The study looked at 51 men ages 40–70 who had no symptoms in either shoulder.

An ultrasound of one shoulder per patient was performed by a sonographer according to a defined protocol, which included imaging of five areas:

1. Rotator cuff
2. Tendon of the long head of the biceps brachii muscle
3. Subacromial-subdeltoid bursa
4. Acromioclavicular joint
5. Posterior labrum

The scans were then analyzed by three radiologists in consensus, with subtle or questionable findings (mid tendinosis, bursal prominence, and mild osteoarthritis) being omitted.

When Problems Aren’t a Problem

Researchers discovered subacromial-subdeltoid bursal thickening in 78 percent of the subjects. Bursa are thin, fluid-filled sacs that reduce friction in joints and help facilitate gliding of muscles and tendons over and through them. Typically, thickening of the bursa indicates inflammation and has been thought to cause pain.

But the men in the study were completely asymptomatic. 

Further analysis showed the following:

• Acromioclavicular joint osteoarthritis in 65 percent of the men.
• Supraspinatus tendinosis (damage/degeneration of a tendon of one of the rotator cuff muscles) in 39 percent of the men.
• Subscapularis tendinosis (another rotator cuff muscle) in 25 percent of the men.
• Partial-thickness tear of the supraspinatus tendon (a third rotator cuff muscle) in 22 percent of the men.
• Posterior glenoid labral abnormality (an abnormality in the fibrocartilage ring that runs around where the upper arm bone fits) in 14 percent of the men.

All of these men had abnormal anatomy revealed in their ultrasound, but were asymptomatic. So are they really abnormal?

In Plain English, Please

To translate all the anatomy-nerd-speak, the study found that abnormalities were found in 96 percent of men who have absolutely no pain or issues with their shoulders. They are simply living their lives as usual, but an ultrasound shows an “abnormality.”

Just like we learned with MRI for the spine, results of ultrasounds for shoulders should be interpreted closely and combined only with clinical findings to determine the cause of symptoms. Seeing a skilled physical therapist who can assess the reason for shoulder pain is still required, regardless of what an ultrasound finds. Maybe you are one of the individuals who has a tear in your shoulder, but it is causing you no pain. If this is the case, imagine how upset you would be if you repaired the tear, only to find out that your pain came back because the root cause of your injury was never discovered or rehabilitated?

If It Ain’t Broke…

Always read results of imaging with an understanding that they do not mean you are broken. Imaging is a fantastic tool, and at times is incredibly important for injuries. As a physical therapist, there have been times when I have had to push for images to confirm clinical diagnosis. But the imaging results cannot be viewed in isolation from the bigger picture.

Just because the results of an X-ray, MRI, or ultrasound show something abnormal, please don’t take that as a reason to stop working on your strength, mobility, or range of motion. You are not “broken” or “abnormal.” Stay the course, keep working hard to rehabilitate your injury, and recognize the results for what they are: a single piece of the overall you.

More Training and Rehabilitation Science:

• You Are Not Normal – Here’s Why
• Myths About Disc Bulges: They Are Not Forever – But Training Is
• Get the Diagnosis Right: It’s Not Tendonitis, It’s Tendinosis
• New on Breaking Muscle Today

Image courtesy of Wikimedia Commons.

The post You Are Not Your Shoulder Ultrasound appeared first on Breaking Muscle.

In this article, I’ll address some of the worst repeat offenders when it comes to bad advice on the Internet and finally lay them to rest.

RELATED: How TV, the Internet, and Your Phone Are Hurting Your Fitness

Squat Depth Defines Your Quality as a Person

An enormous host of variables determine squat depth. The top contenders are hip mobility, ankle mobility and trunk stability. These are the things most often addressed because they’re easy to understand and modify. They’re also usually tissue dependent (muscles, tendons, fascia).

Then there’s the stuff that’s not so simple because it’s bony or structural. Factors like limb-length ratios and pelvic/femoral-acetabular structure. Luckily, these factors are usually the least significant. They may prevent you from touching your butt to your calves, but they won’t prevent most of us from getting to parallel.

Find the squat depth appropriate for yourself and your athletes. In competition, there is a necessity for universal, external depth cues for the sake of establishing a standard. If you aren’t competing, then those cues don’t matter. Go as low as you can with proper technique and stability. If you’re progressing and you’re pain free, that’s much more important.

RELATED: 4 Reasons You’re Not Getting Deep Enough in Your Squats 

A Butt-Wink Means Form Sucks and Numbers Don’t Matter

If you’re unfamiliar with the term, butt-wink is slang for the posterior pelvic tilt that occurs at absolute depth in a squat. Many of the same factors that affect squat depth contribute to butt-winking.

Sometimes that posterior pelvic tilt is just your body’s response to being forced to go lower even though it lacks proper hip flexion and ankle dorsiflexion. If both of those areas are under control, then the butt-wink is likely an issue of proper bracing and beginning the squat with a neutral spine.

“If your tilt doesn’t show up until you’re past parallel and you can squat without pain under a significant load, I’m comfortable saying it doesn’t matter.”

Some people seem to think tight hamstrings cause butt-wink, which is kind of silly. The hamstrings are a two-joint muscle – they cross the hip and the knee. As you descend, they lengthen at your hip, but they also shorten at your knee. The result is that the hamstrings probably don’t exhibit that significant of a change in length during a squat. Your adductors, on the other hand, could contribute. This is one of the many reasons goblet squats are a great technical exercise.

Some degree of butt-wink is acceptable. If your tilt doesn’t show up until you’re past parallel and you can squat without pain under a significant load, I’m comfortable saying it doesn’t matter. Is it ideal? Probably not, but we can’t all be perfect and there are bigger fish to fry.

RELATED: How to Unlock Your Athletic Potential Through Good Posture

Face Pulls Are a Magical Swolixir for All Shoulder Problems

I don’t know where this started, but I’ve seen it in many places. On one hand, I’m glad people are concerned with their shoulder health. On the other, I don’t understand how someone chose this exercise as the messiah of AC joint integrity. I have over 10,000 hours of clinical experience and you know how often I’ve seen the face pull used? Never. Not even once.

If you’re world-class powerlifter Chris Duffin, then you can do face pulls.

It’s not the face pull’s fault. It’s not a terrible exercise in and of itself, but it tends to activate muscles that don’t need help. Most athletes’ upper back and shoulder musculature are just fine. It’s the muscles responsible for scapular motion and stability in the mid-back that don’t get enough love. Face pulls aren’t helping with their loneliness.

Face pulls might seem cool because they’re fancy and different, but that’s probably exactly why I hate them so much. Keep it simple. Neutral-grip, shoulder-width rows will help activate the poor, disused muscles in your mid-back and give your scapulae a whole new lease on life.

“You can do all the cuff “strengthening” you want, but if your scapulae don’t move properly, then it won’t make a difference.”

People are so concerned with improving rotator cuff strength that they overlook the most important aspect of cuff function: scapular positioning. You can do all the cuff “strengthening” you want, but if your scapulae don’t move properly, then it won’t make a difference.

On the flip side, once your scapulae do move properly, then you’ll probably find you don’t need to do much cuff-specific work. Hell, if you’ve got the proper scapular motion, you can strengthen your rotator cuff with push ups and overhead presses. How about that?

Rounded-Back Deadlifting Equals Disc Herniation and Death

Back-rounding is the butt-winking of the deadlift. It’s one of those biomechanical issues that’s obvious and thus an easy target. The thing is – it’s not that big of a deal.

RELATED: Why It’s Sometimes Totally Okay to Lift With a Rounded Back

First, if your back doesn’t round at all during a max effort, then the effort probably wasn’t a true max. Don’t believe me? Go watch videos of the best pullers in the world. They all exhibit some degree of lower-back rounding at max. As long as you’ve followed the proper progression and you know how to brace yourself, rounding is not gong to kill you. Just like butt-winking, there is an acceptable amount of lower-back rounding in a pull.

Second, intentionally rounding your upper back is a common technique used by competitive lifters to decrease ROM and increase their numbers. I’m not really a fan because I mostly lift for healthy function, but it is a tried-and-true tactic of some of the world’s strongest.

Bar Position When You Squat Is Extremely Important

No. Not really. If you’re an Olympic lifter, then a traditional high-bar, Olympic-style squat is more conducive to your goals. If you’re trying to set records, a low-bar, wider-stance powerlifting squat is a better choice. If you’re not competing, then the only things that matter are progress and injury avoidance. 

“It’s all about specificity and goals here, because frankly, squatting is squatting for 90% of athletes.”

Do what comes naturally to you. It’s all about specificity and goals here, because frankly, squatting is squatting for 90% of athletes. Bar position just isn’t that big of a deal.

Overtraining Is a Myth

I think we can all agree that training hard is good and necessary. I want to believe that’s why people love reciting that overtraining is a myth. Other people like to use overtraining as an excuse to skip workouts or go light when they should be going heavy.

RELATED: Overtraining Can Kill You: The 3 Stages of Overtraining

But overtraining is most definitely not a myth. It’s a serious medical condition with symptoms far beyond simple fatigue and soreness. It can compromise your immune and nervous systems and even, in extreme cases, lead to death. Luckily, unless you’re working out multiple times a day seven days a week, it’s probably not an issue for you.

Overtraining is something professional athletes whose lives revolve around working out need to be concerned with. It does exist. But although we may like to sometimes train like the pros, we aren’t them. So let’s not make their problems ours.

I’m sure there are plenty of other bits of common advice that more qualified professionals would take issue with. What are some of your biggest pet peeves? Let us known in the comments below. As always, thanks for reading. Now go lift something heavy. 

Photos courtesy of CrossFit Impulse.

The post The Worst Strength Training Advice on the Internet appeared first on Breaking Muscle.

The general “solutions” for this are to rest and avoid these movements for a while. Maybe you were told to do “cuff strengthening” with some fancy rubber bands or a series of questionable stretches that just seemed to piss off your shoulder more. Or maybe you’re one of those no-pain, no-gain individuals and you soldier on despite the crippling pain, completely ignoring the fact you’re doing irreparable damage to your shoulder.

All of these options are terrible. The shoulder is a complex joint, to be sure, but in my experience this fact has been used to justify overly complex courses of treatment that yield lackluster results. Simple interventions deliver better, more reliable outcomes. The following are the five simplest interventions that will give you the largest return on investment.

RELATED: Understanding the Shoulder and Bulletproofing It From Injury

1. Stop Half-Repping

An often-overlooked downside of partial reps is that when done to avoid a problematic portion of your range, they tend to reinforce the mechanics responsible for the pain. Partial-repping tells your body you don’t need those parts of the range and it’s perfectly acceptable to become tighter and weaker in those positions.

This is not to say that partial reps don’t have any place anywhere in any path of treatment. They’re actually a rather important part of reclaiming full range of motion post surgery, but that’s not what we’re talking about. If you’re sacrificing range for more reps or higher weight on non-surgical shoulders, you’re doing yourself zero favors. Stop. Now.

“Partial-repping tells your body you don’t need those parts of the range and it’s perfectly acceptable to become tighter and weaker in those positions.”

If your mechanics suck, you need to focus on mechanics, not intensity. Lower the weight to a workload that allows you to perform the movement with proper technique. Once you work your way back up, you’ll likely feel stronger and more stable in every portion of the range, including the part you were already good at.

2. Pull Before You Push

Regarding end range, particularly in the bottom portion of a push up, your shoulder is in an extended position that forces your humerus to angle forward. Passively, this isn’t an issue, but when force is applied many athletes will experience intense anterior shoulder pain.

Sometimes this is caused by actual soft tissue damage or inflammation. More often, I find it’s caused by weakness or poor activation in the muscles of the back that stabilize the shoulder. If your traps and rhomboids aren’t strong enough to hold your shoulders back, your upper arm will pitch forward and compress the tissues on the front of your shoulder. Boom, anterior shoulder pain. This can happen even if you don’t start from extension like you would in a bench press or push up. It can even happen when rowing if you’re upper-trap dominant.

An easy way to address this is to perform some type of resisted row during your warm up. I’m not talking about hopping on the erg or doing band pull-aparts either. Those things have their place, but the best way to activate the oft-neglected muscles of your mid back is to do some type of horizontal pull where your body is stable and the only movement is occurring from the shoulders down.

You want to try to isolate the muscles that help retract your shoulders so less accessory movement is always better. The resistance should be moderate. Enough to feel it in your mid back, but not enough to exhaust those muscles. We’re trying to activate them, not tire them to the point they can’t do their job.

“If your traps and rhomboids aren’t strong enough to hold your shoulders back, your upper arm will pitch forward and compress the tissues on the front of your shoulder.”

3. Row (a Lot)

If the muscles of your mid back are weak, all the activation work in the world won’t magically make them strong enough to stabilize your shoulders. Sometimes you just need to get stronger.

Seated cable rows are ideal for this purpose. Use a handle that allows you to have a neutral, shoulder-width grip. Close-grip handles (the triangle-shaped ones where your hands are inches from each other) actually cause your shoulders to internally rotate, which we don’t want.

Start with a weight that allows you to perform 4-5 sets of 12-15 repetitions with perfect form and shoulders pulled down and back for the duration. I realize that’s a fair amount of volume, but the idea is to establish some muscular endurance in the muscles that hold that position.

In terms of return on investment, you can’t beat the row for overall shoulder stability. If you’ve been plagued by shoulder pain, try doing a few sets of rows two or three times a week for the next month. You’ll be surprised at the results.

RELATED: 7 Exercises to Optimize Shoulder Health With Kettlebells

4. Learn How to Pack Your Shoulder

This is one of the most common problems I see and should be the easiest to fix. When your shoulders start in a bad position and have a movement demand placed on them, it’s unlikely they will be able to transition into a good position while doing the work.

Packing your shoulders mostly just means exaggerating your neutral posture. Pull your shoulders down and back and lightly squeeze your scapulae together. Congratulations, you shoulders are now braced and the stabilizers are activated. Doing this before any type of shoulder work, either pulling or pressing, will significantly increase proper muscle activation and joint stability.

It bears mentioning that it’s actually physically impossible to get your arms completely overhead while squeezing your shoulders down and back. Your scapulae need to upwardly rotate to allow the humerus to move into an overhead position. Even so, if you start with your shoulders down and back, it’s more likely that the lower trap, upper trap, and serratus anterior will work together properly to upwardly rotate your scapulae than if you started with your shoulders rounded.

“When your shoulders start in a bad position and have a movement demand placed on them, it’s unlikely they will be able to transition into a good position while doing the work.”

You should also focus on your posture. All the rehab in the world won’t change much if you continue to spend most of your time in a crappy position.

5. Stretch Your Upper Trap

A common issue with anterior shoulder pain is upper trap overuse. An easy way to combat this is to stretch the upper trap before you try to strengthen the muscles of your mid back. Stretching the upper trap will inhibit it a bit, and therefore prevent it from taking over for your mid and lower traps when trying to retract your shoulders.

For the record, I’m not recommending you just stretch your upper trap in the absence of other exercises. I’m saying you can stretch your upper trap immediately prior to some pulling activity to emphasize proper muscle activation. Do this two or three times on each side, for thirty to sixty seconds. The pull should be strong enough that you feel it, but you’re not trying to rip your trap off. Don’t go crazy.

I’ve personally dealt with a lot of shoulder problems and of all the things I tried these were the most useful. Hopefully they can help you too. Now get out there and get to work.

Photo 1 courtesy of Shutterstock.

Photo 1 courtesy of Jorge Huerta Photography.

The post 5 Simple Solutions to Shoulder Pain appeared first on Breaking Muscle.

My Shoulder Has a Complex

While the term “shoulder” most commonly refers to the ball and socket mechanism, the shoulder complex actually consists of multiple joints:

• The first, and only “hard” connection between our arms and axial skeleton (skull, spine, ribcage, and sternum) is the costoclavicular joint, or where the collarbone meets the sternum.
• Following the clavicle away from midline – distally – the next union is our acromioclavicular joint (AC). Here the clavicle sits on top of a projection from the scapula called the acromion process. When the shoulder is “separated,” this is where that dislocation occurs.
• No introduction is necessary for the next joint in line, the ball and socket, or glenohumeral joint (GHJ).
• Although not technically a real joint, the final articulation in the shoulder complex is the scapulothoracic joint (STJ), or the “connection” between the shoulder blade and the thoracic spine and associated ribs.

Together, this intricate cluster of joints creates the incredible shoulder – the cornerstone of movement through the upper extremity. But like any great team, many do the work while few get the credit. Ask Jordan or Pippen.

The Roles of the Joints in the Shoulder Complex

The glenohumeral joint is the MVP of our shoulder complex. It’s flashy, makes the big plays, and scores all the points. The GHJ joint is the single most mobile joint in the body. But, thanks to the laws of physics, mobility exists at the expense of stability. Picture a golf tee and a golf ball – this is the age-old analogy that best describes the dimensions of the GHJ joint. When the tee is set just right, the ball can sit perfectly centered in the shallow support of the tee. As long as the ball doesn’t keep falling off the tee, you can now step up to the box and drive the ball in just about any direction you want, with the exception of straight down. Works great for golf, but how can such an unstable joint work in our body? Simple. The glenohumeral joint can only be so amazing with the help of the scapulothoracic joint.

The scapulothoracic joint is the bread to our PB&J, our Phil Jackson to Jordan and Pippen, and the fuel to Cheech and Chong’s fire (or should I say smoke?). Without the scapulothoracic joint, the glenohumeral joint would be rendered useless. The relationship between these two joints is all too often overlooked when addressing the shoulder as focus is instead shifted to the ball and socket (alone) or the scapula (alone). The coupling of the GHJ and STJ effectively links the arm to the thoracic vertebrae meaning dysfunction of the spine can compromise the shoulder – and vice versa.

The Scapula and Stability

Here’s how the dots connect. Starting from midline, the thoracic spine forms a column from which twelve ribs attach. These ribs wrap around in a barrel-like fashion, creating the rib cage. Consider the thoracic vertebrae the foundation under a building and the ribs the floors sitting on top. The triangular-shaped scapula sits on top of the ribs, just as a rug would lay flat on a floor.

At rest, the superior border of the scapula runs horizontally from shoulder to spine and then turns down at a ninety-degree angle continuing parallel to the spine as the medial border of the scapula. A little more than midway down the spine the scapula turns up, becoming the lateral border as it heads up and out toward the armpit where it meets the superior border to complete the triangle. This junction of the superior and lateral border creates a projection called the glenoid fossa, which you know as the socket. The glenoid holds the ball, which is the rounded end of the humerus bone, to form the glenohumeral joint.

Say we are moving furniture into a building. We require that a solid foundation provide the base for our building. Then, flooring would need to be installed so that we can lay down a rug. Only after these steps are taken – in this order – furnishings can be brought in. Similarly, we must ensure a stable spine and ribcage for the scapula to sit on so that it can in turn be a reliable support for the arm. Stability at each and every link along this kinetic chain is necessary for function as a whole. Without Jordan bringing his A-game, Pippen performing to full potential, and Phil Jackson calling all the right plays there is no three-peat championship for the Chicago Bulls.

The Muscles Involved With the Shoulder Complex

The good news is that we are much more like the Bulls than a building. While we ideally have “good bones” like a building, that’s where the similarities end. We are more than a skeleton. We don’t sit idly. We don’t break and not bend. We are dynamic. We act and react. We can take our sturdy foundations and move them in all kinds of ways, producing amazing feats – like drilling the game winning three-pointer at the buzzer. But, as important as our bones are, we can only control what they do with our muscles. When it comes to operating the shoulder complex, the rotator cuff, scapular stabilizers, and core muscles are in charge. Without these muscles, we are just an idle structure.

Stability of the glenohumeral and scapulothoracic joints occurs in a specific order. First, the thoracic spine moves (or doesn’t) thanks to our core muscles. Then, our scapula is anchored to the spine and ribcage via several different stabilizing muscles. Lastly, the rotator cuff travels from the surface of the scapula, crossing the glenohumeral joint to hold the ball into the socket. Centered around the scapula, these three groups of muscles work together as a kinetic chain connecting the core to our upper extremity. The scapulothoracic joint, as a result, is the key to the shoulder. Insufficient stability of the STJ is the main ingredient in the recipe for disaster – and not just at the shoulder. Inability to control the scapula can lead to neck pain and headaches. Weakness of the shoulder blade not only decreases the ability for the arm to function, but it can also bring us down, literally. A slouched posture and overextended spine can both result from weakness at the scapulothoracic joint.

Control your scapulothoracic joint, and you control your ability to make gains with strength and power, abolish or avoid pain and dysfunction, and most importantly, take a huge stride toward mastering the complexity of human performance. I’ll show you how controlling your STJ is easy.

Photos courtesy of Shutterstock.

The post The Scapula: How It Can Make or Break You appeared first on Breaking Muscle.

And Super D should know better than anyone. After six years playing football, he turned his hand to powerlifting, and was the first human to ever total 3,000lbs! Super D has eight all-time world records in professional powerlifting, including three bench press records, two squat records, and three total records. His 3,000lb powerlifting total still stands today.

Super D now specializes helping other athletes be strong and mobile, and to prevent or recover from injury. Here are four videos to help you do just that.

The post 4 Videos to Help You be Strong, Mobile, and Injury-Free by Donnie Thompson appeared first on Breaking Muscle.

One of the most common shoulder problems is impingement. This is when the bony structures of the shoulder move slightly out of place (usually through years of neglect and desk-sitting) and begin to rub against the delicate tendons and ligaments that move the shoulder. Over time these soft tissues become inflamed and even torn.

An upcoming study in the Journal of Strength and Conditioning Research examined shoulder impingement in recreational weight trainees. Researchers asked, “Can we identify any common movements done by athletes with shoulder impingement? Can we identify movements done by the healthy athletes that could prevent shoulder impingement?” They examined 77 men between the ages of 19 and 56. They quizzed these men about their exercise programs and whether they suffered from shoulder impingement.

The researchers identified two exercises tightly correlated with shoulder impingement. First, lateral deltoid raises accompanied the group with shoulder impingement. Upright rows (a high pull with a narrow grip) were also a staple of the group with shoulder impingement. Both of these exercises involve pulling the elbows to shoulder height with the shoulders internally rotated.

But the researchers also found one group of exercises that may prevent shoulder impingement – strengthening the external rotators of the shoulder. These are the muscles that hold your shoulder blades in place and keep them from rolling forward and causing problems. This means performing band pull-aparts, seated rows, Kroc rows, active hangs, and even overhead squats if they can be done with correct technique. Stretching the internal rotators through the sleeper stretch should also provide a nice addition. Here’s how to do the sleeper stretch correctly:

But before we completely poo-poo shoulder raises and high pulls, let’s remember that these exercises didn’t necessarily cause shoulder problems, but rather everyone with shoulder problems was doing those exercises. Indeed, if you have terrible shoulder mobility and you high pull heavy loads with internal rotation, then you’re asking for trouble. Someone with excellent shoulder mobility and scapular stability can probably do those exercises with zero problems, but is that you?

Talk with your coach about shoulder exercises that are appropriate for you. Hold your shoulder blades back and down (think about trying to put them in your back pocket) when you pull anything in the gym. Most importantly, never perform an exercise that is going to set you back because it’s not right for your ability level right now.

References

1. Morey Kobler, et al. Characteristics of Shoulder Impingement in the Recreational Weight-Training Population.” Journal of Strength & Conditioning Research. POST ACCEPTANCE, 25 September 2013. doi: 10.1519/JSC.0000000000000250

Photo courtesy of Shutterstock.

The post Research Provides New Insights Into Preventing Shoulder Impingement appeared first on Breaking Muscle.

I feel like most people follow a three-stage journey in their pressing. The first starts with just loading as much weight as they can on the bar and doing whatever is needed to get that bar up. The second phase strikes when their shoulder begins to hurt and they start looking around for other alternatives. It’s at this stage where dumbbells and kettlebells tend to appear in training, as well as the possible migration away from lying pressing exercises to standing variations. The final stage is one that sees the virtual total elimination of all pressing exercises from people’s routines as they try to avoid surgery.

The biggest issue I see for many people in regards to pressing is that most – as in, two-thirds of people – aren’t actually built for it. You see, the AC joint comes in three different variations, not surprisingly called type I, type II, and type III, and it’s only type I that is actually set up to allow most people to press pain free. Those with types II and III have an issue in that they are likely to lose acromium space during pressing and put their rotator cuff at risk. The problem is that most people will only learn what types of acromium set up they have once they’ve actually hurt themselves and need an X-ray or MRI. Without X-ray vision there’s just no way to tell.

So what should the vast majority of people be doing if they want some pressing in their training? Firstly, ditch exercises that lock the hands into a single position. Yes, that means that barbell pressing, as well as handstand push ups, will be off the menu. That’s a small price to pay for not needing surgery.

The second step is to increase thoracic spine mobility. If you haven’t heard of the joint-by-joint approach let me give a summation here. The body flows from a joint that needs stability to a joint that needs mobility. If that gets messed up, then the entire system upstream is compromised.

1. The foot – needs to be stable to deal with landing forces.
2. The ankle – needs to be mobile and move in all directions.
3. The knee – requires stability. (Imagine if your knee moved like your ankle? That’s called an ACL tear).
4. The hip – like the ankle need to be able to move in all directions.
5. Lumbar spine – needs to be stable
6. Thoracic spine – needs to be mobile.
7. Scapulae – stable.
8. Shoulder – mobile.

However, what usually happens is that we get things mixed up in our daily lives. Because we spend so much time sitting we turn our hips from mobile to stable. That means our lower back has to become more mobile to deal with the lack of movement from the hips. Because the lower back is hypermobile the thoracic spine stiffens up. And if the thoracic spine becomes immobile then the scapulae are forced to become mobile, then the shoulder itself becomes stiffer in an effort to take on some of the stability missing lower down.

I’m not going to go into all the different methods of mobilizing the thoracic spine here, as there are plenty of great articles all over the Internet about that. But what if we came up with a different solution? One that still allowed us to put weight overhead?

I had a conversation with Primal Move creator Peter Lakatos quite a while ago regarding pressing versus snatching. Like me, Peter is middle aged and has a body that bears the marks of a life well lived, so I was wondering how he balanced pressing and snatching? He told me that he felt the shoulders had only so much ability to be used and if he focused on one then the other wasn’t used much. That concept fits quite well into the RKC training template, as it means if you press then you get your conditioning from swings.

More recently I had a conversation with Mark Reifkind, another battle-hardened iron warrior, and we were talking about how my shoulders were holding up during Ironman swim training with the addition of strength work. At that stage I was down to get ups and handstand holds (support and straight-arm strength versus bent-arm and press strength). But what I was finding was that the faster lifts didn’t put a strain on my shoulders. My exact words were, “Swimming plus pressing equals shoulder impingement, but swimming plus kettlebell ballistics are fine.”

The kettlebell ballistics usually are thought of as being swing and snatch, but really they should include push press and jerk as well. What Mark and I talked about was that these lifts bypass the AC joint and allow you to still train overhead movements, just not the press. The added benefit of these movements, when done with kettlebells (although you could use dumbbells for the same benefit) was that having two hands operating independently didn’t tie you into a single-hand position, freeing up some wiggle room in your shoulders. And if you’ve got really bad shoulders, then maybe a single kettlebell is an even better idea as the single overhead position allows even more wiggle room.

That was when my ballistic shoulder complex was born. I decided that I liked all those movements equally and that if one was good, then all three combined must be better. The result is a simple three exercise complex, done with a single kettlebell – snatch, push press, jerk. The order is actually important because if you try to snatch last in that group you’re probably in for a big surprise, if you’ve used a decent-sized bell. My two favorite variations go like this:

Complex #1: 5-3-2 Increasing Weight

• 5 reps kettlebell snatch 24kg, then 5 reps push press 24kg, 5 reps jerk 24kg.

• Switch hands and repeat.

• 3 reps snatch 28kg, then 3 reps push press 28kg, then 3 reps jerk 28kg.

• Switch hands and repeat.

• 2 reps snatch 32kg, 2 reps push press 32kg, 2 reps jerk 32kg.

• Switch hands and repeat.

Repeat this process for 2-3 total waves.

Complex #2: 1-2-3 Ladder

• Perform 1 snatch, 1 push press, 1 jerk before switching hands and repeating.

• Perform 2 snatches, 2 push presses, 2 jerks, before switching hands and repeating.

• Perform 3 snatches, 3 push press, 3 jerks, before switching hands and repeating.

Repeat for 3-5 ladders. The difference here is that I would use the same weight for each rung of the ladder, with the focus on more time spent with a heavier bell.

These single bell ballistic complexes are great for those with shoulder problems who still want to do some upper body work while saving the fragile AC joint from either further damage or for other activities such as swimming. While there is a large chance that you will need to stop pressing at some point due to the shoulders you inherited from your parents, there is no need to stop overhead work all together.

Photo 1 courtesy of Shoulderdoc.co.uk.

Photos 2&3 courtesy of Shutterstock.

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In a perfect world we’d all be able to do everything and training sessions would consist of performing freestanding handstand push ups, lifting more than Klokov, and finishing with a conditioning run that involved backflips off buildings parkour style. But that’s not reality.

Reality is most of us are messed up in some way and there are just some things we shouldn’t do. That doesn’t mean don’t train, nor does it mean we spend all of our time on correctives. There’s always a way to work around a problem, avoid injury, and keep edging our way forward.

Here’s what some of us just shouldn’t do, and what we can do instead:

Tall Guys

Tall guys have some unique issues that shorter folks don’t have. Sure, it’s great to be able to reach the top shelf without a stepladder and it’s good not having everyone’s armpits in your face on the train, but some lifts are going to be difficult.

Many top strength coaches, like Mike Boyle, suggest that taller lifters shouldn’t train off the floor, but from either the hang or off blocks.

One of my clients has found, through injury-laced trial and error, that when we deadlift off the floor his back locks up. But start a few inches off the floor, courtesy of resting the bar on a couple of plates, and he’s fine.

The same goes for squats. That super deep, working-in-a-rice-paddy squat just isn’t going to happen for taller lifters.

Rob Shaul of Mountain Athlete suggests that taller trainees need only worry about going to parallel and no deeper as the risk of the tail tucking under becomes more pronounced.

I know people will say these athletes just need to get stronger through the abs, but in taller lifters there’s simply a lot of spine to stabilize and sometimes the answer is to slightly shorten the range rather than risk injury by going deeper.

People With Shoulder Issues

A lot of shoulder issues aren’t due to bad shoulders but to bad movement somewhere else in the chain, usually the thoracic spine.

At my gym, when we have new clients come in one of the first things we teach them is the get up.

The reason is that during the get up all kinds of things become obvious and one of them is what we’ll simply call “bad shoulders.”

From the point where you are in a kneeling lunge position, your arm that is holding the kettlebell should be completely vertical, with your bicep in line with your ear, and you should be looking straight ahead. The same goes as you stand up – if you can see your hand when you’re completely upright you’re doing it wrong.

If you can’t stand with your arm vertical it usually is a sign of some tightness in your upper body that is quite fixable in most cases.

The same holds true for any exercise from kettlebell snatch to barbell press or jerk. If you can’t stand upright with arms in line with ears then you have shoulder issues and should address them now before the surgeon needs to. Some solutions include kettlebell armbars, Brettzels, bridging, and stretching the lats, pecs, and triceps.

There are ways to adapt the get up in the short term too, while you’re working on your mobility.

You could do half get ups, which have you sit up from the floor and return down, with your hips never coming off the ground. (Think of this as a sit up, but done as a get up.)

This position allows the arm to never need to be near vertical, yet still gives many of the great benefits of the exercise from the rolling and crawling patterns to shoulder and trunk stability.

When it comes to people’s much-loved pressing there are plenty of options that don’t require you to go overhead such as bench press and many push up variations.

Most people with troubled shoulders find if they stick with the exercises that are below shoulder height, they do fine.

People With Knee Issues

I love squats. I know the deadlift is all in vogue these days, but squats are my favorite. But not everyone can cope with squats and there are plenty of people around with glass knees.

One of the things that sets off problem knees is how far from vertical the shin travels while performing an exercise. So a weightlifting front squat, which often sees the knees travel so far forward that they end up in front of the toes, will be hard on the knees (pictured right).

On the other hand, a powerlifting squat where the shins are nearly vertical and the butt is pushed back will be more likely to be acceptable.

But there are even more ways you can train the legs and avoid knee issues. Reverse lunges are a great way to attack all parts of the legs and make sure to keep a vertical shin. I personally find heavy sled work to be a huge benefit – all concentric muscle action too, so there is little associated muscle soreness.

But the easiest way to train maximal strength and maintain vertical shins is the deadlift. While it won’t develop the same leg strength as squatting, it will be an alternative that you can use for the rest of your life.

People With Wrist Issues

Many people these days suffer from wrist issues. Part of the problem is tightness due to a flexed working position and a lot of time spent on a keyboard. Others may suffer from arthritis.

Whatever the root of the problem, there will be many lifts that cause the injured athlete issues. Barbell work such as front squats, presses, push presses, and jerks will all be uncomfortable, as will many bodyweight exercises like push ups and handstands.

This is a great place to use kettlebells in your training. Done properly, there isn’t a single kettlebell exercise that has a bent wrist position.

While you may not be able to get the same load on the body from a kettlebell variation compared to a barbell movement, because of the offset nature of the load and the lack of stress on the inflamed joints you’ll still be able to get an equal training effect.

Try replacing your damaging barbell work with kettlebell front squats, presses, and jerks for a while and see how little stress there is on the wrist if you keep it neutral – something neither bars or dumbbells allow for.

People With Calf, Achilles, or Foot Issues

While I’m a relative beginner in endurance training myself, I guess I’ve had my fair share of issues over the last eighteen months.

Now my clients are starting to get into some endurance work of their own, and issues of the calf, Achilles, and foot are the most common problems I see people have from starting running.

The most important thing to do if you start getting flare-ups in the lower limbs is to stop doing the thing that is hurting it.

If running is the issue, and it often is, then try riding, rowing, swimming, or another form of cardio training like kettlebell swings that allows your foot and ankle to be under less stress.

While running fitness is specific to running to a degree, you’ll be surprised how much running fitness you can maintain by working hard at other disciplines. But you have to stop the cycle of inflammation before it can get better, so lay off the activity causing the problem.

Be smart with your training. Injuries and the issues associated with them are part of training if you push hard, or if you sit for a job.

In other words, everyone is likely going to have an issue of some kind sooner rather than later.

But modifying your training to minimize that issue is smart and allows you to keep training rather than take a full hiatus when you’re forced to have an operation.

We’re all in this for a long time. Don’t worry about winning a battle today to lose the war in the long term. In other words, take it easy now if you need to, so that you can train for life – not just for the immediate future.

Photos courtesy of CrossFit LA.

The post Do This, Not That: What People With Shoulder, Wrist, Knee, or Calf Issues Should and Shouldn’t Do appeared first on Breaking Muscle.

The shoulder is a relatively fragile joint compared to its lower body cousin, the hip. The shoulder only attaches to your skeleton via bone in one place: the clavicle. All the other connections via your upper arm and scapulae are floating in a sea of muscles, tendons, and ligaments. Many of the stupid things we do in life and the gym contribute to shoulder instability – when you can’t effectively keep the humeral head centered in the shoulder joint.

A recent study from the Journal of Strength and Conditioning Research asked, “What causes shoulder instability? What can be done to avoid it? Can anything be done to prevent it?” The study examined 123 participants who trained recreationally about three times per week. The average participant had about nine years of weight training experience and was about 28 years old.

The study identified two movements in particular that accompany shoulder instability: military press and behind the neck pulldowns. The frequent use of both movements together was also particularly correlated with instability. But the study also found some good news. Strengthening the external rotators of the shoulder makes the shoulder more stable and can help prevent the above problems.

To get some practical advice from these findings, I reached out to Dr. Ryan Davis, a doctor of chiropractic and a rock star manual therapist. Dr. Davis says, “Too often rehab professionals confuse strength and stability. Strength is simply one component of stability. Just as important for stability are timing and neuromuscular control.” He goes on to describe how rhythmic stabilization drills, such as the one in the video below from Eric Cressey, can aid someone recovering from shoulder pain. For advanced patients he prescribes functional movements that can strengthen the external rotators such as Turkish get ups, pull ups, and deadlifts.

If you suffer chronic shoulder pain, shoulder instability could be part of the problem. My advice is to lay off the strict presses for a while and work on strengthening the muscles that externally rotate your shoulder. I also recommend seeking out a therapist who can help solve the problem at the root of your shoulder pain, and not a family doctor who will simply prescribe two weeks of rest and Ibuprofen.

References:

1. Morey Kolber, Melissa Corrao, and William Hanney. Characteristics of Anterior Shoulder Instability and Hyperlaxity in the Weight-Training Population. Journal of Strength & Conditioning Research. May 2013. Vol 27. Issue 5. p1333-1339. doi: 10.1519/JSC.0b013e318269f776

Photo courtesy of Shutterstock.

The post A Quick Look at Preventing and Treating Shoulder Instability appeared first on Breaking Muscle.

The balance of front and back shoulder strength is one thing, but attention must also be given to the other movements that occur at the shoulder joint and girdle. Neglecting a muscle group or movement can create potential issues over the long term.

As compared to another vulnerable joint – the knee – the shoulder joint/shoulder girdle is unique because of the wide range of articulations at the glenohumeral (ball and socket) and scapular-clavicular (shoulder blade and collar bone) areas. The knee involves mostly flexion (heel to the butt) and extension (straightening the leg). Pretty simple. The shoulder area is more complex and thus requires attention to properly strengthen and develop all the musculature surrounding it.

Let’s begin with the shoulder (glenohumeral) joint. These are the gross movements that occur there:

With the arm at your side:

• Raise it forward out in front (flexion), then back to your side (extension).
• Raise it laterally to the side (abduction), then down to the side (adduction).
• With the arm moved out in front (flexion):
• Move it backward parallel to the ground (horizontal extension).
• Move it forward from horizontal extension (horizontal flexion).
• Combine all of these movements by rotating the upper arm in a circular manner, clock-wise and counter clock-wise (circumduction).

With the arm held statically down at your side or abducted (raised laterally):

• Rotate the upper arm inward, turning the thumb to the front or downward (internal rotation).
• Rotate the upper arm outward, turning the thumb to the back or upward (external rotation).

Let’s now look at the shoulder girdle (scapula and clavicle). Movements there possess a shorter range of motion. Think “shrugs.”

With the arms down at your sides:

• Shrug your shoulders upward (elevation).
• Shrug your shoulders downward (depression).
• Shrug backward, pinching the shoulder blades together (retraction).
• Shrug forward, spreading the shoulder blades apart (protraction).

Because of the multitude of articulations at the shoulder, a greater risk of trauma exists. Don’t think so? Check out the list of shoulder joint/girdle potential malfunctions:

• Acromial-clavicular (AC) joint separation
• Adhesive capsulitis (frozen shoulder)
• Arthritis
• Biceps tendon tear (where it originates at the shoulder)
• Bursitis
• Chronic shoulder instability
• Clavicle fracture
• Dislocated shoulder
• Labrum tear
• Rotator cuff strain
• Rotator cuff tear
• Scapula fracture
• Tendonitis
• Winged scapula

Gosh! A lot can go wrong here. So, what can you do to eliminate or at least minimize shoulder issues? The primary controllable precaution you can take is to implement a sensible shoulder joint/shoulder girdle strengthening program. Employ these movements and applicable exercises:

Glenohumeral joint:

• Flexion – front raise or front press.
• Extension – close grip pulldown, pull up or pullover.
• Abduction – side lateral raise or overhead press to the front (not behind the head).
• Adduction – wide grip pulldown or pull up to the front (not behind the head).
• Horizontal flexion – chest/bench press or chest fly.
• Horizontal extension – seated/bent-over row or rear delt fly.
• Internal rotation (upper arm down at the side or raised [abducted] to the side) – cable, band, or dumbbell internal rotation.
• External rotation (upper arm down at the side or raised [abducted] to the side – cable, band or dumbbell external rotation.

Scapular-clavicular joint:

• Elevation – dumbbell, barbell, or machine upward shrugs.
• Depression – dip bar downward shrugs.
• Retraction – seated or bent-over row shrugs (move the shoulders backward to pinch shoulder blades together).
• Protraction – chest or bench press shrugs (move the shoulders forward to increase the distance between the shoulder blades).

A program that incorporates the aforementioned movements and exercises should at the least minimize debilitating or nagging shoulder issues and allow you to train and compete consistently for a long time. Therefore, for a sturdy and functional shoulder joint/shoulder girdle, do this:

• Work all joint articulations – if it moves that way, strengthen it.
• If you do a pushing exercise, counter it with a pulling exercise.
• Always use proper exercise form – control the resistance.

And don’t neglect the smaller stabilizing shoulder muscles that make up the rotator cuff. Spend time fortifying them via internal and external rotation exercises with the upper arm at various positions.

Photos courtesy of Shutterstock.

The post Understanding the Shoulder and Bulletproofing It From Injury appeared first on Breaking Muscle.

Probably the most common questions are about rotator cuff injuries. Injuries to the rotator cuff are fairly common and the shoulder is a complex series of joints that can be difficult to understand. As a result, many rotator cuff injuries are self-diagnosed and are likely to be something else entirely. In the event a legitimate rotator cuff injury rears its ugly head, staying informed on how to deal with it is paramount. A recent review in Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology aimed to do just that. In the review, researchers looked at numerous studies to piece together a comprehensive understanding of rotator cuff tears and suggested treatments.

First, let’s describe what the rotator cuff is, which may be confusing all by itself. The rotator cuff is what we call four of the muscles in the shoulder that are responsible for some of the shoulder’s motion. A lot of that motion involves the rotation of the humerus, the long bone in the arm, which is why the group of muscles is referred to as rotators. Another major role these muscles play is the stabilization of the shoulder, which is a series of joints that requires muscular stabilization to allow for greater range of motion.

When one of the muscles, or the tendons that connect the muscles to the bones, becomes torn, either partially or completely, you have a rotator cuff injury. In the review, they found that in the general population most rotator cuff injuries actually occur in older people, typically as a result of disuse and poor range of motion. However, amongst athletes, we can see this phenomenon occur as a result of trauma.

More critical to that finding for athletic readers, is that the research indicated that only 10% of partial tears heal completely, and another 10% heal partially. 53% of tears will actually worsen and 28% will progress into full tears, which do not heal on their own. In some cases these tears can cause long term changes to the joint itself.

The first recommendation on dealing with a tear is immediate treatment, but the suggested treatment is something in need of further study. Unless the tear is full, mild therapy and rest is suggested over surgery for at least 6 weeks and as long as 3 months. A longer period of conservative treatment will actually increase the risk of the tear worsening, perhaps in part due to atrophy and worsening blood flow. If possible, the athlete should resume activity after that time and work up to previous strength levels over time.

If avoiding surgery is not possible, the good news is that the surgical success rate is good. The research tends to indicate what is called a “double row” repair of the muscle as being stronger and less likely to tear again.

References:

1. Nicholas Clement, et. al., “Management of degenerative rotator cuff tears: a review and treatment strategy,” Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, 4:48

Photo courtesy of Shutterstock.

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