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    Default Exercise and Shoulder Pain

    Introduction
    The human shoulder is an intricate system of bones, joints, connective tissues and muscles thatplace the arm and hand in a position that allows them to function. It derives its stability from agroup of four small muscles (known as the rotator cuff) and another five muscles that stabilizethe scapula (shoulder blade) and guide the entire shoulder joint along the rib cage during armmotions. Some experts state that the upper extremities can assume more than 1,600 positionsin three-dimensional space at the shoulder joint. When working properly, the shoulder makesactivities like throwing, hammering, shoveling, raking, painting, climbing, lifting, swimming andwaving possible. A painful shoulder can make routine activities like brushing your teeth, bathing,dressing, sleeping, and combing your hair extremely difficult.

    Chronic shoulder pain (lasting more than a few weeks to a few months or more) is the mostcommon upper extremity problem in recreational and professional athletes. According to theCenters for Disease Control and Prevention (CDC), approximately 13.7 million Americanssought medical care for shoulder pain in 2003 alone.

    Shoulder Structure

    The shoulder is a ball-and-socket joint and sacrifices some of the stability afforded the hip jointfor a higher level of mobility. It lacks a deep socket; instead, the ball-shaped humeral (armbone) head sits or adjoins a shallow, saucer-like socket (glenoid fossa), located slightly to thefront and side surface of your shoulder blade. The structural arrangement of the shoulder jointcontributes to its highly mobile and fairly unstable status. Because the head (ball) of thehumerus (arm bone) is two-thirds larger than the glenoid fossa (the narrow socket), theshoulder resembles a golf ball on a tee.

    Shoulder Function

    Raising your arm overhead requires a fine blend of shoulder mobility with dynamic stability.Adequate strength and endurance of both the rotator cuff and shoulder blade stabilizingmuscles (trapezius, levator scapula, rhomboids, pectoralis major and serratus anterior) isessential. Although each of the “rotator cuff” muscles has a separate function in isolation,together they enable the shoulder joint to produce its numerous characteristic motions whilemaintaining a balance between mobility and stability. The four rotator cuff muscles(supraspinatus, infraspinatus, teres minor and subscapularis) work in concert to allow the armrelatively free movement in numerous positions while pulling your humeral head (the ball)downward and inward within the glenoid fossa (socket).

    The scapula must move with the humeral head (the ball) in order to maintain a mobile yetsupportive base for the rotator cuff muscles to function within. Good posture, muscle strengthand endurance and proper exercise selection and technique can all contribute to enhancedshoulder stability and function. Poor posture (forward head with rounded shoulders and upperback), failure of stabilizing muscles, overuse of specific exercises, muscle strength and flexibilityimbalances and improper exercise technique can all contribute to shoulder pain and injuryduring overhead arm and shoulder movements.

    Common Sources of Shoulder PainCommon disorders contributing to shoulder pain include:

    • Arthritis: A degenerative process causing pain, swelling, stiffness, and disability
    • Fractures: A break in a bone
    • Dislocations/subluxations: Complete or partial separation of bones within the joint
    • Sprains: Stretch/damage to ligaments and connective tissue within the joint
    • Frozen Shoulder: Stiffness & loss of movement; a tight connective joint capsule
    • Diabetic Complications: Can cause frozen shoulder
    • Rotator Cuff Tendonitis: Irritation and swelling of tendons of rotator cuff muscles
    • Impingement: Compression/abrasion of rotator cuff tendons by bony and ligamentousstructures
    • Rotator Cuff Tears: Partial or full-thickness tears in the tendons connecting the rotatorcuff muscles to part of the humeral head (the ball portion of the joint)

    Exercise Precautions for Individuals with Shoulder Pain

    Individuals with ongoing shoulder pain should avoid exercising the painful limb and should seekimmediate medical attention. They should select other forms of exercise to maintain theirphysical fitness without using their painful shoulder. Shoulder pain lasting more than a weekshould be checked by a physician or qualified medical professional. Exercises or movementsthat cause pain should be avoided and new pain should be reported to a physician. Individualswho have successfully completed rehabilitation should be medically cleared to perform upperextremity exercises and should seek exercise guidelines from their healthcare professional(s).You should not try to “exercise through the pain.” The Arthritis Foundation cautions people toavoid exercise/activities that cause increased pain lasting an hour or more after exercise. Seekguidance from a qualified exercise professional.

    The American College of Sports Medicine’s certification credentials recognize exerciseprofessionals demonstrating high levels of competence in exercise plan development andsupervision. They can help you develop a balanced exercise program to enhance your physicalfitness and help you make sound exercise selections.

    Common Exercise-Related Shoulder Injuries

    Common injuries to the shoulder include rotator cuff impingement (squeezing and abrasion oftendons beneath joint structures and surfaces), rotator cuff tendonitis (inflammation, pain andswelling), and rotator cuff tears (either partial or complete tears of the rotator cuff tendons).These injuries are most common in people over the age of 40 . Shoulder (scapular) instability(excessive motion) is found in 68 percent of individuals with rotator cuff problems. Factorsleading to rotator cuff impingement tendonitis and tears include:

    • Sudden trauma: A fall on the shoulder or arm
    • Repetitive microtrauma: Overuse of overhead activities with improper form
    • Poor posture: Round shoulders, forward head and rounded upper back; rotator cuff andscapular stabilizing muscle fatigue and weakness and muscle imbalances; changes orvariations in shoulder anatomy
    • Connective tissue (capsular tightness or looseness)
    • Improper exercise selection and technique

    Strategies to Enhance Shoulder Stability and FunctionShoulder stability and function can be enhanced by practicing good posture, maintaining abalance of flexibility and strength in all shoulder muscles, and selecting appropriate exercisesand performing them correctly. Pressing the chest out while pulling the bottom of the shoulderblades and elbows downward (towards the back pockets) and together can help improveshoulder stability and function. Hold this position for a count of five, release and repeat it astolerated throughout the day.The following exercises are often considered “contraindicated” forpeople with swollen and irritated shoulders:

    • Shoulder (overhead) presses
    • Dumbbell side raises with thumbs pointing down
    • Upright rows above shoulder height
    • Incline bench press
    • Lateral pull-downs behind the neck

    Some preventative shoulder exercise modifications may include:

    • Shoulder press: Keep bar/dumbbells slightly in front of shoulders and above ear level.
    • Bench press: Keep bar a few inches above chest when lowering and keep arms close to thebody.
    • Pectoral Chest Fly Machine: Keep arms slightly in front of the shoulder and body whenlowering the weights. Do not try to stretch your arms below your torso level.
    • Lateral pull-down: Pull bar down in front of head and use an underhand grip.

    SummaryRotator cuff injuries are the most common upper-extremity problem experienced by recreationaland professional athletes. They can be painful and debilitating, yet are often preventable. Goodposture, proper exercise selection and technique, and consultation with an exerciseprofessional are all strategies that can enhance shoulder stability and function. Exercise-relatedpain that limits shoulder function should be reported to a physician immediately. Previouslyinjured exercisers should get medical clearance from their physician and/or physical therapistbefore starting a new exercise program. Recurring pain warrants cessation of exercise andmedical follow-up.

    Written for the American College of Sports MedicineBy Peter Ronai, M.S., RCEP
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    Thanks for the article. I know shoulder pain plagues us all given enough time.
     

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    Especially me! I've had THREE rotator cuff surgeries.
     

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    stay away from standing upright rows and behind the neck presses and pull downs

    just my opinion, I have tight shoulders and already had one rotatory cuff tear
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    Quote Originally Posted by dorian123 View Post
    stay away from standing upright rows and behind the neck presses and pull downs

    just my opinion, I have tight shoulders and already had one rotatory cuff tear
    I agree with not doing these exercises especially the behind the neck stuff... it puts a very large strain on the shoulders and neck and the thing is u can get just as good a workout going infront..
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    C'mon!.. give me two more! .. lets get serious!"

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