Sports Medicine: More Ball-and-Socket Sensibilities

Shoulder pain is one of the most common problems in the gym, along with low-back pain, knee pain and elbow pain. There are many causes of shoulder pain. Shoulder instability is certainly a major cause. Overstretched ligaments become more uncomfortable during key movements such as bench presses, pecs deck flyes, dumbbell flyes and behind-the-neck presses. Pain can be generated from the stress on the capsule and from the excessive work of the rotator cuff, which is trying to keep the ball centrally located in the socket so it can move properly. There can also be a tear of the cartilage ring around the socket, which is known as a SLAP or Bankart tear. That cartilage ring serves several purposes: It deepens the shallow socket a bit, and it serves as an additional anchor point for the capsule and biceps tendon.

You may be thinking, 'That's interesting, but what do I do about it?' First, if your shoulder is painful, you need to see a physician. Go to an orthopedic surgeon (preferably one with sportsmedicine experience) or a board-certified sportsmedicine-trained chiropractor (preferably one with shoulder and weight-training clinical experience). There are many causes of shoulder pain, and you need a diagnosis to determine if you require additional tests or treatment before you resume training.

Once you return to training, you must strengthen the rotator cuff muscles, stretch the posterior capsule (back of the shoulder) and strengthen the muscles around the scapula. The rotator cuff consists of four muscles that originate on the shoulder blade (scapula) and insert onto the upper-arm bone (humerus). Their function is to pull the ball down away from the roof of the shoulder (acromion) to provide enough room for the ball to move. They also pull the ball to the center of the socket for optimum movement of the shoulder. If the rotator cuff is strong, the ball slides forward less, and it can also help protect the ball from stretching and pushing against the cartilage ring. Sometimes, just strengthening the rotator cuff alone is enough to enable a trainee to keep training without surgery.

You can easily strengthen your rotator cuff with a few key exercises. All three can be performed by lying on your side on a bench. The first is a rear-delt exercise. While lying on your side and holding a light dumbbell in your free hand, point your nearly straight arm up at the ceiling. Lower your arm across your chest, and then raise it to the starting position. (That's also known as a lying flye.)

For the next exercise, lie on your side again, but this time keep your upper arm against your side with your elbow bent at 90 degrees. Hold a light dumbbell. Start with your forearm against your abdomen and then try to raise the dumbbell while keeping your upper arm anchored. Your forearm won't rise very far, as it's limited by the shoulder anatomy. Return the weight to the starting position.

For the third exercise put your arm down against your side as if you were trying to place your palm against the outside of your thigh. Keeping your elbow straight, raise your arm a quarter of the way (45 degrees), as if you were performing half of a lateral raise. Once you reach the halfway point, lower your arm back to your side.

Perform three sets of 10 reps and add weight on each exercise every two weeks or so. It's not necessary to do high reps. As you become stronger, you will actually lower the reps to six to eight. The rotator needs to be strong. It is often mistakenly said that it needs endurance. The cuff needs to be able to contract powerfully (for a small muscle group) at the time of demand on the shoulder. I'll have more on shoulder rehabilitation, including stretching for weight trainees, in future columns.

Editor's note: Visit www.softtissuecenter.com for reprints of Horrigan's past Sportsmedicine columns that have appeared in IRONMAN. You can order the book, Strength, Conditioning and Injury Prevention for Hockey by Joseph Horrigan, D.C., and E.J. 'Doc' Kreis, D.A., from Home Gym Warehouse, 1-800-447-0008 or at www.home-gym.com.