Should you experience an upper extremity injury, the chances are good that it will be your shoulder and the chances are even better that it will be your rotator cuff-and it is highly likely that it could have been avoided.
The job of the rotator cuff is immense. The shoulder joint is capable of over 16,000 positions and the functional shoulder is sensitive to within 1 degree of motion (Donatelli R. Physical Therapy of the Shoulder, 3rd edn. Churchill Livingstone, 1997). Our arms are in constant use in feeding ourselves, taking care of personal hygiene, driving a car and on the job-most of which are activities that require that the arms be fully engaged all day long. On top of that, many of us go to the gym in pursuit of physical goals, often performing exercises that are traumatic to the shoulder joint complex and the intricate rotator cuff.
In this article, I would like to briefly highlight several considerations that we all need to take in order to remain free of rotator-cuff injury.
The shoulder girdle is greatly influenced by the posture of the feet, pelvis, spine, rib cage and head. Being placed between the pelvis and head, it is at the mercy of these other structures, which commonly exhibit poor alignment.
The first step in the prevention of a rotator-cuff injury-which is also a critical step in the treat-ment of rotator-cuff injury-is to identify the source(s) of poor postural alignment and to correct them. The two things that can make the biggest difference are a sound postural education and a scientifically based core-condi-tioning programme. For more information on such a programme, see my website.
Faulty motor sequencing
Today, there are a few 'experts' telling people all over the world to 'adduct their scapulae' (shoulder blades) before and during exercises such as the lat-pull-down, bench-press and low-row. However, this technique is not only incorrect, but it also causes an error in motor sequencing-the natural timing of muscle recruitment during an action (Chek P. Controversy and Current Concepts of Pulling (video). C.H.E.K Institute, 1995).
In the case of the shoulder, the scapulothoracic joint (STJ) is such a major contributor to overall shoulder motion and to positioning of the glenohumeral (GH) joint, that altering the natural timing of the STJ results in excessive loading of the acromioclavicular (AC; the joint linking a small projection near the outer top of the shoulder blade with the collarbone, or clavicle), sternoclavicular (SC; the joint that links the breastbone, or sternum, to the clavicle) and GH (the joint linking the upper arm bone, or humerus, with the outer border of the shoulder blade) joints.
The end result is rotator-cuff strain and/or injury. The very best thing you can do when training is to train with good static and dynamic alignment. Let your central nervous system do its job-it is much smarter than you are.
Abuse of wrist straps
The use of wrist straps is much more common among bodybuilders than among those training for athletics, Olympic lifters, power lifters or strong men.
Bodybuilders use these wrist straps to extend a set beyond the capacity of their current level of grip strength and endurance. This kind of use can be detrimental to the rotator cuff.
Clinical experience has cultivated a 'clinical pearl of wisdom' that states that, when the grip is tired, the rotator cuff is usually tired.
But this is not always true of fixed or supported actions such as standing in the customs line at the Los Angeles Airport with your briefcase in your hand. However, I do find it to be quite true of dynamic work and in training situations such as performing chin-ups or bent-over rowing.
In my Level III internships, I speak of a principle called 'overflow, or irradiation' (Hall CM, Brody LT, eds. Therapeutic Exercise: Moving Toward Function. Philadelphia, PA: Lippincott Williams & Wilkins, 1998; Voss ED, Ionta MK, Myers BJ. Proprioceptive Neuromuscular Facilitation: Patterns and Techniques, 3rd edn. Philadelphia, PA: Harper & Row Publishers, 1985). Overflow is a principle in which neurological energy spreads from the prime agonist to complementary agonists and antagonists.
To help you understand what this means, there's a little experiment you can do with your rotator-cuff and shoulder-fixator muscles.
Hold hands with a partner as though you were going to shake hands. Place your free hand on their infraspinatus (the deep muscle lying below the scapula) and rhomboid (in the upper back, connecting the inner edges of the shoulder blades) muscles on the side they are using to shake hands.
Then, ask your partner to progressively increase the force of his grip. You should note that, as they apply more grip force, 'overflow' takes place, with an increase in the contraction of the infraspinatus and rhomboid muscles, among other muscles in the region.
When holding a heavy object that requires significant grip strength, the brain is forced to step up rotator-cuff recruitment to stabilize the shoulder girdle and GH joint, thereby providing the arm and hand with a working platform.
But now, if you have overflow due to an increased grip force to the shoulder, what do you think will happen if you use wrist straps while deadlifting or performing heavy bent-over rowing?
As your grip fatigues-or even before that point-you will need to down-regulate your grip to the point at which your minimal grip force is able to prevent the wrist straps from slipping. This point, however, will be far below that required to lift the same weight without the use of the wrist straps.
As your set continues past the point of grip fatigue with straps, the rotator cuff will then often fail to perform its job of stabilizing the GH joint and maintaining its intricate timing with the STJ. This is due to the lack of 'irradiation' from the distal grip to the proximal rotator cuff and shoulder girdle. This then sets the lifter up for an increased incidence of rotator-cuff injury, as the often heavy loads and inertial forces begin to 'dismember' the GH joint.
In fact, if you watch carefully, at the end of a set of chin-ups, deadlifts or bent-over rowing, you can often see a positive sulcus sign (a depressed groove just below the acromion, or highest point of the shoulder) in a lifter's shoulder. This means that the humerus is being pulled away from the joint under load.
If you (or your athlete) feel that they can't get a good training session without using wrist straps, it may be an indicator that you need to indulge in grip training.
One of the best forms of grip training is simply to exercise without straps. In the real world, if your grip fails, it doesn't matter how strong the rest of your muscles are because whatever you were holding is gone. This is why the use of wrist straps with combative athletes such as wrestlers, football players, martial artists and moto-X racers is not a good idea: when their grip fails, they fail.
In addition, when considering the principles of 'overflow', if you use the straps at the beginning of a set, when you are feeling fresh, your rotator cuff is potentially understimulated due to the lack of irradiation from the grip muscles.
This means that you may spend the entire set training with faulty shoulder mechanics, which will certainly increase your chances of a rotator-cuff injury.
In fact, I have treated athletes who have experienced repeated shoulder injury while using straps, yet they were not able to recall ever being hurt while not using them. Again, if you can't hold the bar because of fatigue, you will be less likely to injure yourself.
The inability to extend the thoracic spine is common, particularly among those who have a history of performing abdominal exercises from the floor. Repeatedly flexing the spine forward of the mid-frontal plane encourages shortening of the rectus abdominis muscles-the 'six-pack' muscles-which leads to restriction of extension in the thoracic spine.
Restricted thoracic extension is critical for the shoulder and rotator cuff because shoulder flexion (movement toward the midline) and abduction (move-ment away from the midline) beyond 140 degrees are dependent on the cooperation of thoracic extension for optimal mechanics.
However, it is very common to find thoracic extension restriction in patients with rotator-cuff injury. To prevent unwanted shoulder injury secondary to insufficient thoracic mobility, I suggest a well-designed comprehensive core-conditioning programme (again, see my website).
There are a number of other issues that ought to be considered in the prevention or treatment of rotator-cuff dysfunction, but these are beyond the purview of this brief article. Nevertheless, I feel sure that if you implement the few, but important, suggestions that I've offered here, you will significantly improve both your shoulder health and physical performance.
Paul Chek is founder of the C.H.E.K Institute in Encinitas, CA. He has served as a consultant to professional and college sports teams, equipment manufacturers and professional athletes world-wide.
For more information about Paul Chek, his internship programme and up-coming UK seminars, or to request a catalogue of his books, videos and products, please call 0208-874-6942 (UK) or visit his website at www.chekinstitute.com.