Shoulder Injuries, Prevention and Treatment
Shoulder Injuries: Prevention and Treatment - FREE Delivery Worldwide
"Extremely useful! I've not been able to use it as much as I would have liked because I made the mistake of lending it to one of the rugby players at the club and it is now making it's way around the team. Keep up the good work!" - Charmaine Johns, Physio
There is perhaps no joint in the human body as complex, fascinating, or baffling as the shoulder. It can leave clinicians scratching their heads, wondering why a problem they have solved many times before is so stubborn.
And shoulder problems can certainly be stubborn! That' s why, in every case, prevention is so much better than cure. Rarely is a pain that has surfaced a simple matter of applying some ice - it is more likely to be the tip of an iceberg…
This is a groundbreaking book in more ways than one. I was surprised to discover so many shoulder problems are due not only to bad habits of technique, but to the unbalanced upper-body workouts many athletes undertake in the mistaken belief they are doing themselves good.
Click here to get all the latest sports injury research!
For these poor souls, injury and pain lie just around the corner. Read on to find if you are among them!
Shoulder Injuries - Prevention and Treatment is a ground-breaking book from Peak Performance for all athletes who rely on their shoulders. You can get this great training guide for 33% off the recommended retail price of $59.99! You pay only $39.99! Prepared by the combined experts of Peak Performance and Sports Injury Bulletin, it looks at every aspect of shoulder care and injury prevention:
Shoulder overview: the five main ingredients for keeping shoulders injury-free
Rotator-cuff protection: a specialist in treating sports injuries explains how overhead athletes can prevent chronic shoulder pain
Preventing injuries: a sports fitness expert suggests further exercises to help you avoid shoulder pain
A surgical view: an orthopaedic surgeon explains why shoulders go wrong and what can be done to repair them
Case study: how a keen club golfer was cured of a nagging shoulder pain
Technical review: two surgeons discuss the diagnosis and treatment of acromioclavicular injuries in athletes
Prehab guide: an assessment of the latest research into shoulder problems and with practical advice on achieving balanced upper-body development
The amazing shoulder joint
Consider what the shoulder does, and how many athletes - swimmers, tennis players, bowlers, baseball pitchers, javelin throwers - take it for granted. The shoulder can assume no less than 1,600 different positions! There is more movement at the shoulder joint than at any other joint in the body.
The shoulder joint actually comprises four joints - see if you can feel them on yourself:
- Sternoclavicular (SC) joint (between the sternum and the collar bone) - this is actually the only bony connection that the shoulder has with the main skeleton
- Acromioclavicular (AC) joint between the collar bone and the point of the shoulder called the acromion, which is part of the scapula or shoulder blade
- Glenohumeral (GH) joint between the glenoid part of the scapula - the socket - and the head of the humerus (HOH) - the ball
- Scapulothoracic (ST) joint (the ' false joint' between the scapula and the rib cage that it rides over).
Clearly, the shoulder joint is truly remarkable invention -- until it goes wrong! Shoulder Injuries - Prevention and Treatment looks at the most common cause of shoulder pain and provides a number of illustrated exercises designed to treat and prevent them.
For those with a shoulder injury they would like to try to treat themselves, we provide a checklist for ruling out structural damage. The seven chapters include a number of canny DIY ideas for improving performance and avoiding injury.
"Shoulder Injuries is a must have for your library"
Robert Whynot, Canadian Sports Massage Therapy Association
Treatment, prevention and performance enhancement
The measures outlined in this new workbook for the prevention and treatment of overuse injuries of the shoulder are guaranteed to improve your performance. They will genuinely improve the way your shoulder works, and thus it will be stronger, more co-ordinated, reach further and last longer before fatigue sets in.
All the experts say it: injury prevention equals performance enhancement.
First, we give the big picture of injury prevention and performance enhancement for athletes who depend on their shoulders for playing their sport. The information is presented to help you decide which issue you might need some more work on. Advice includes home exercises, and when to seek professional help to maximise the results of your efforts.
Prevent shoulder injury, enhance performance! It's that easy!
Balance through control: the five ingredients
Exercises and guidelines are given for the five most essential ingredients for an athlete whose main weapon is the shoulder:
- Sports-specific technique
- Flexibility
- Core stability
- Rotator-cuff control
- General strength
Sports-specific technique: poor performance and shoulder pain commonly originate in bad habits of technique. Often they are only clearly seen when muscle fatigue sets in.The variety of overhead movements required for each sport gives rise to very subtle and unique technique faults. We give examples of what to look out for.
Flexibility: the purpose of flexibility varies for the different muscles around the shoulder. For the major power muscles, it is important that flexibility allows freedom of movement for the pelvis, trunk, scapula, and humerus. For the rotator cuff, the critical issue is the balance of forces centreing the head of the humerus, and to a lesser degree, freedom of movement. As we explain, it is more critical that the internal and external rotators are equally flexible, rather than how flexible they are.
Stretching: learn why stretching to increase flexibility should never be done prior to training or competition -- and when it should be done.
Core stability: core stability has become a whole science in itself in the last decade as all manner of sports professionals have realised how critical it is for the inner core of the body, namely those joints closer to the spine, to be supported by the postural muscles designed to do so. For the shoulder, the critical areas are the lumbar and cervical spine and the scapulothoracic joint. Discover why, if these areas are not stable, significant extra loading and strain is passed on to the shoulder joint
Rotator-cuff strength and control: the rotator-cuff muscles are dependent on the good positioning of the scapula for effective control. If the scapula is angled too far forward or downward, for instance, while the tennis player reaches overhead to smash, the rotator-cuff muscles are biomechanically disadvantaged and may result in failure of the prime mover muscles to generate power.
General muscle strength: once the foundational issues of technique, flexibility, core stability, and rotator-cuff control are being implemented, we then look at the bigger picture of the ' outer core' . What is the rest of your body like - does it help or hinder the performance of your shoulder?
Avoiding the common mistake of imbalance
Most athletes believe that a gym routine needs to include strengthening work for the deltoids (three heads), latissimus dorsi, pec major, upper trapezius, and the rectus abdominis because they are the prime movers of the shoulder.
What is often critically overlooked, however, is the imbalance that can develop between the front of the shoulder and the back. In those athletes that are carrying an overuse injury in the shoulder, nine times out of ten they have overdeveloped pecs and lats relative to their trapezius, rhomboids, posterior deltoids, and posterior rotator cuff.
In these situations, flexibility must often be improved, scapular setting must be taught, and the focus of gym exercises changed towards the back. We explain how it' s done.
How to prevent the damaging cycle of chronic shoulder pain
Any overhead activity that involves the arm being taken often enough from below the shoulder level to above shoulder level has the capacity to damage the rotator cuff. With repeated impingement, a poorly conditioned cuff can become damaged, and a cycle of cuff damage, impaired function, further impingement and worsening cuff damage is initiated.
We look at how such repetitive damage is caused, how the athlete may be able to prevent it occurring in the first place and why a co-ordinated action of this group of muscles is needed to provide a stable base for pain-free overhead activity. Here are the symptoms:
- The shoulder aches after overhead activity
- It gets worse and restricts the activity
- Periods of rest apparently resolve the problem only for the pain to recur when you returned to sport
Chronic shoulder pain is an all-too-common consequence of repetitive ' overhead activity' , such as serving and smashing in tennis, freestyle or butterfly swimming, bowling in cricket, javelin, or baseball throwing and above-shoulder weight-training exercises.
Keep your shoulders in peak condition!
Injury prevention strategies
Most cuff injuries can be prevented relatively simply, and we provide shoulder-injury prevention strategies to focus on improving shoulder stability.
Isolated rotator-cuff strengthening exercises can be very effective as part of a pre-participation conditioning programme. These can be done with our three simple exercises of single sets comprising a minute of either external or internal rotation exercises. The exercises strengthen these areas:
- Internal rotator (subscapularis)
- External rotators (infraspinatus and teres minor)
- Abductor (supraspinatus) muscles of the shoulder
Three to-five minute sets over the course of a day will produce a conditioning effect.
Further exercises to help avoid shoulder pain
We offer more exercise suggestions and give further practical guidelines to help athletes avoid shoulder pain.
Balance your upper-body workouts: a good way to avoid shoulder injuries is to make sure your upper-body strength sessions are balanced.
Too many athletes and weight trainers focus on developing the ' mirror muscles' , the upper trapezius, anterior deltoid and pectorals. As a consequence, the ' non mirror muscles' , lower trapezius, rhomboids, latissimus dorsi and rear deltoid are underdeveloped.
This leads to a muscular imbalance about the shoulder. Redressing this imbalance is very important for the prevention and rehabilitation of shoulder impingement injuries.
We give a balanced upper-body workout for various muscle combinations:
- Pectorals, anterior deltoid
- Rhomboids, mid-trapezius, latissimus
- Pectorals
- Rhomboids, mid-trapezius, rear deltoid
- Anterior mid deltoid, upper trapezius
- Latissimus, lower trapezius
Limit your range of movement and take it easy: rehabilitation from a shoulder impingement injury should focus on rotator-cuff strengthening. We explain why it' s important to remember that when it comes to re-introducing your weight-training exercises, you must progress slowly.
It' s also important to avoid certain ranges of motion where the shoulder joint sub-acromial space is compressed the most.
Details are given for the impingement zones to avoid, which muscles to start the training with, and once the pain is completely gone, which exercises to introduce.
Correct scapula positioning when performing exercises: the correct position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a good ' military posture' , with shoulders back and chest out. A round shouldered or hunched posture is to be avoided at all times.
To achieve the correct position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down. You' ll learn the correct position and exercises to keep your scapula back and down while you move your arms.
Sports-specific exercises - plyometrics for the shoulder: just as rehabilitation training for leg injuries requires a functional progression from simply strength exercises to sports-specific exercises, so does rehab for the shoulder.
This means that for the athlete, eg a thrower or tennis player, conventional resistance exercises in the gym may not be enough to allow a full return to competition. Often what are needed to bridge the gap are plyometric exercises for the shoulder that mimic sports-specific movements.
Plyometrics for the shoulder usually involve medicine balls of various weights. Plyometric exercises have two advantages. First, they are performed fast, and second, they involve stretch-shortening cycle movement patterns.
This means they are much more sports-specific than conventional resistance exercises. In particular, plyometric exercises for the rear-shoulder and external rotator muscles are very useful because they provide eccentric training for these muscles. This improves their ability to control the shoulder during the powerful concentric actions of the pectorals and anterior deltoid involved in throwing or serving.
Two suggested exercises are given for the pectorals and anterior deltoids and external rotators.
Surgery: why shoulders go wrong and what can be done to repair them
The shoulder joint is often injured in the throwing athlete because it has a greater range of movement than any other joint in the body, and because its stability depends upon intact muscles and ligaments rather than supporting bony structures.
The five phases of throwing are wind-up, cocking, acceleration, deceleration and follow-through. The forces generated during these phases are considerable and the resulting stresses generated around the shoulder joint make it prone to acute and chronic inflammatory conditions and injuries. A poor throwing technique will exacerbate the potential for chronic inflammatory shoulder conditions.
An orthopaedic surgeon lists the various approaches to treatment including:
- Clinical examination
- Imaging
- Other diagnostic tools
- Non-operative treatment
- Operative treatment
Case study
How a keen club golfer was cured of a nagging shoulder pain
An avid club golfer with a handicap of 4 and a right-handed stroke asked for help with his nagging left shoulder pain that had recently become markedly worse and finally was threatening to stop him playing. He said he knew he should have asked for help sooner, but he thought it would just go away (This is one of the most commonly heard statements by treating practitioners!). It had now been hanging around for about six months in total, despite regular coaching.
Assessment: examination showed all the signs of rotator-cuff tendinitis (inflammation and microscopic breakdown of tendon), with accompanying weakness of the muscle itself, leading, over time, to extra shearing of the ball in his socket joint on follow-through.
This would likely cause an impingement of his already thickened tendon under the bony acromial arch of the shoulder, giving him the sharp stabs of pain he complained of. Full details of the treatment are given, which include:
- Systematic stretching regime by the patient
- The ' release' of muscle tightness by deep-tissue massage
- Trigger-point therapy
- Heat
- A home programme of self-pressure massage with a tennis ball
- Mobilising of the tight parts of the capsule of the shoulder with seat-belts
This regime resulted in the golfer achieving one of his best-ever scores in the Queensland Open Tournament three months later.
"A comprehensive introduction to shoulder injuries, the pathogenesis, treatment and rehab. Good examples of approaches from current specialist."
Dominic Lakeland, GP.
The diagnosis and treatment of acromioclavicular injuries in athletes
Acromioclavicular (AC) joint injuries most commonly occur in athletic young adults involved in collision sports, throwing sports, and overhead activities such as upper-extremity strength training. They account for 3% of all shoulder injuries and 40% of shoulder sports injuries. Athletes in their second and third decade of life are more commonly affected and men are injured more commonly than women are.
The athlete who sustains an acromioclavicular injury commonly reports either one of two mechanisms of injury: direct or indirect.
Direct force: This is when the athlete falls onto the point of the shoulder, with the arm usually at the side and adducted. The force drives the acromion downwards and medially. 70% of acromioclavicular joint injuries have been found to be the result of a direct injury.
Indirect force: This is when the athlete falls onto an outstretched arm. The force is transmitted through the humeral head to the acromion, therefore the acromioclavicular ligament is disrupted and the coracoclavicular ligament is stretched.
Treatment: the treatment of acromioclavicular joint injuries varies according to the severity or grade of the injury. AC joint injuries are an important source of pain in the shoulder region and must be evaluated carefully.
The management of these injuries is nonoperative in the majority of cases.
No matter what form of treatment is chosen, the ultimate goal is to restore painless function to the injured AC joint in order to return the athlete safely and as quickly as possible back to their sport. This is possible in the majority of acromioclavicular joint injuries.
Practical advice on achieving balanced upper-body development
Chronic shoulder injury is a common problem, and not just for athletes. Among the population at large, day-to-day activities such as DIY or gardening can produce chronic pain, as can resistance work in the gym, when enthusiasts pile on the weight without paying heed to the need for balanced strengthening. Adults beyond the age of 50 are more vulnerable in general to rotator-cuff tears, the incidence increasing with age.
Among sportspeople ' overhead athletes' are at increased risk of chronic shoulder injuries. The overhead group covers a broad range of sports including swimming, tennis, cricket, javelin and baseball, all of which involve variations on the generic throwing action where the arm moves above the head.
The throwing movement recruits a large number of muscles and combines a large range of arm motion with high forces or speeds at the shoulder joint. All overhead athletes tend to perform many repetitions of the movement, usually with a dominant arm only, as part of their sports training. Here' s our strategy:
Step 1: equalise front and rear strength: the starting point is a balanced programme for front and rear shoulder muscle development. Opposing muscle groups are trained equally. While exercises for the anterior shoulder and pectorals develop power, to train just these muscles will unbalance the shoulder.
Step 2: develop good pulling form: it is essential to perform pull or row exercises with correct technique in order to ensure that the middle trapezius, rhomboids and lower trapezius muscles are properly recruited.
Step 3: isolate the rotator cuff: the small but crucial muscles of the rotator cuff are targeted alongside the lower traps to avoid developing dysfunction or weakness.
To achieve the above strategy, four exercises are given to target the following muscle groups:
- Subscapularis and pectoralis minor, the shoulder' s medial rotators
- Infraspinatus and teres minor, the shoulder' s external rotators
- Supraspinatus (top of the rotator cuff), assisted by the deltoid and infraspinatus
- Lower trapezius, focusing on scapular depression
Shoulder Injuries - Prevention and Treatment is one of a new series of workbooks from Peak Performance, the sports science newsletter. It is not available through any other source.
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Shoulder Injuries - Prevention and Treatment is published by Electric Word plc, publishers of the Peak Performance newsletter, Sports Injury Bulletin and Successful Coaching.
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