Wednesday, June 8, 2011

Shoulder Abuse and Recovery

Even though I am really too old and frail to be taking up Olympic weightlifting as a serious sport at my age, I have a hard time not doing things I really enjoy.  As a coach of some rather talented young lifters, I also decided that it would probably be a good idea to have first hand knowledge of competing on the platform and so entered a competition in February.

This is not me.
Well, if I had taken a good hard look at my training log, I would have realized that my shoulder issues from the year before had not really resolved.  And maybe I would not have ignored the pain and horrible sounds when I put the bar overhead.  I might have also realized that there was a problem when three weeks out from the comp, both lifts had decreased by about 30 pounds.  Oh, and there was something about falling off a horse and having an injured hip as well.  You can probably tell by now that I don't really exercise caution, restraint, or common sense when it comes to training myself.

Coaching one's self can be a challenge, especially with levers like these.

Long story short, I lifted at the competition, but after it was over, I had such pain in my left shoulder  that I could not only no longer go overhead with the bar, I couldn't go overhead with anything.  I couldn't even shoot a basketball or throw my laundry in the hamper.

Off to the ortho I went and was ordered to get an MRI to rule out a possible tear in the labrum, a band of connective tissue that helps the shoulder stay together.  When the labrum is compromised, two things happen:  The ball does not stay in the socket and the ligaments that attach to it to maintain the integrity of the shoulder can't do their job.  A torn labrum would have been pretty bad news.

http://healthandfitness101.com/?p=776

Fortunately, mine was only frayed, as were the rotator cuff tendons.  Not terrible news, but not great news.  I now had to figure out what to do about it.  I did qualify for Master's Nationals after all and can't pass up my chance at a mediocre performance next year.  Lucky for me, I happen to have a few friends who are even better at not practicing restraint than I am, but are smart enough to be just as aggressive about rehabilitation.  If you want to know how to fix a problem like this, your best source is going to be those who hurt themselves even worse and came back to lift another day.

Healing tendons can be tricky business.  They don't typically get a lot of blood flow and the inflammation process which can lead to healing is extremely painful.  The trick is to find ways to increase the blood flow, allow inflammation to do its job, and strengthen the weak spots that may have lead to the injury to begin with.

The shoulder is a particularly delicate joint that is held together largely with tendon, muscle, and connective tissue.  It is the most freely moving joint on the body and therefore is subjected to stress from multiple directions.  Weak spots, tight muscles, strength imbalances, and ignoring pain can all lead to a serious shoulder injury.  The rotator cuff is the most likely victim of all of these abuses.

Most of us who train regularly know the importance of the rotator cuff in supporting the shoulder joint, but don't always take the extra steps to keep it healthy.  Exercises such as external and internal rotations, Y's and T's, scapular retraction and protraction, as well as moving the shoulder in multiple directions are necessary to strengthen and stabilize the joint.  Unfortunately, if you can lift a lot of weight overhead, off the bench, or do multiple pullups, your larger muscles take over and the rotator cuff does not get utilized in a way that keeps it strong.  It is necessary to specifically address all the muscles of the shoulder in a way that keeps the ball tracking properly in the socket and the tendons from taking the brunt of the force.  It is also necessary to stretch the muscles in the chest that tend to pull our shoulders forward.  Anyone who works at a computer or drives a lot (uh, that would be me) is going to have exaggerated tightness in the upper chest simply from daily activities.

So, to summarize, shoulder health requires quite a few things:
1. Keeping the internal rotators and upper chest muscles flexible and not overly tight.
2. Strengthening and stretching the external rotators and stabilizers of multiple scapular positions.
3. Encouraging proper tracking of the ball and socket joint with high repetition, lighter resistance exercises that target the multiple planes of movement.

So, what to do about it?  Good news is, there's a lot, thanks to my friends (Bob and Dave) for sharing.

First of all, this video of shoulder rehab circuits from Diesel Crew is invaluable.  Pick what works and make your own circuits.



A lot of these exercises include shoulder retraction, protraction and scapular positional changes.  Other exercises include waiter's walks (holding weight stable overhead) with plates or kettebells.  One armed heavy overhead kettlebell presses, push presses, or jerks can be beneficial as well.  The goals is to stabilize the joint and allow the movement to occur with proper tracking.  Bar presses and pullups do not allow for the joint to move freely.  Incline dumbbell bench presses, band press downs, pull aparts, curls, and face pulls are good as well.  The idea is to choose exercises that do not hurt, but allow you to move the joint stably in multiple direction.

As I mentioned previously, its not just strength work, but stretching as well that is of particular importance. One of my friends was kind enough to send me another piece of equipment called "The Rotator" which is useful for both strengthening and stretching the internal and external rotators.  I found this particularly useful for stretching and use it both before and after workouts.  It has a built in resistance band and so you can also strengthen the rotators both internally and externally in multiple planes.  There are multiple points of attachment for both the wrist harness and resistance band so even skinny small people like me can use this relatively easily.

http://therotater.com/wp/


This is a video demonstrating stretching of the external rotators using this piece of equipment.



Stretching the muscles of the chest that pull the shoulder forward is important as well and can easily be done in a doorway or by laying across a stability ball.  A lacrosse ball can be used to specifically target tight spots via self myofascial release around the front and back of the shoulder.  Its not comfortable, but it works.

Good news is that by implementing all of these things, I have started to get overhead again without pain.  And barring any other competitors in my age and weight class (which is a real possibility), I might just be a Master's National weightlifting champion after all.

There are a lot of things we do in every day life that will contribute to the decline of our shoulder health.  However, there are a lot of simple things that we can do to offset or even reverse the damage.  Pay close attention to what your body is telling you and don't discount the simple lighter exercises that support the joint and will keep you lifting heavy much longer and much more safely.