Shoulder Savers part 1, by Eric Cressey

“Over the past few years, I’ve become known as the shoulder guy on the list of T-Nation contributors.

Nobody ever really asked why this became an area of interest for me; all they care about is how to recover from impingement, labral tears, bicipital tendonosis, AC joint sprains, and the occasional accidental amputation. (I usually recommend a bottle of whiskey, some duct tape, and a glue gun for that last one.)

Truth be told, my shoulders have taken a beating during my career as a competitive athlete, so I’ve got a pretty good frame of reference. Would you believe that this powerlifter was an all-state tennis player in high school?

Let’s just say that my kick serve wasn’t exactly conducive to shoulder health, so before I ever picked up a weight, I’d lost a chance to play in college due to internal impingement — a hypermobility condition that led to a partial thickness tear of my right supraspinatus and enough bone spurs to sink a battleship.

Surgery was scheduled for December of 2003, but rather than just wait for the ‘scope, I buckled down, read everything I could find, and experimented in my training to find what I could and couldn’t do in an attempt to avoid the surgery.

The end result? I canceled the surgery in October of 2003 and took up powerlifting, where I’m on the brink of bench pressing 400 pounds at a body weight of 165.

Unfortunately, it wasn’t always smooth sailing between 2003 and now. I dealt with a frustrating acromioclavicular joint problem in the other shoulder for a good four months this past year. As a result, I spent an entire 12-week training cycle spinning my wheels and dealing with a lot of pain. Rather than have my distal clavicle cut off, I ultimately managed to figure out a way to correct the issue, and recently hit a 34-pound personal best bench press in competition.

Along the way, I’ve helped to fix a few hundred T-Nation shoulders and those of athletes and clients I see in person. It seems to have just become part of a normal day for me.

My intention here isn’t to just blow some sunshine up my own butt, but rather to show you that I’ve got a pretty good perspective for what I’m going to write below.

Very simply, there are certain mistakes that many lifters with shoulder problems share in common. With that in mind, I decided to take a proactive approach and present to you my top sixteen recommendations for avoiding the problems in the first place. These aren’t exhaustive, but I guarantee that if you take them to heart, you’ll be much less likely to email me or, worse yet, give your orthopedic shoulder surgeon enough business to pay off his new Mercedes.

Shoulder Saver #1: Avoid what hurts.

It seems logical, but we all know how tough it is to resist the exercises we’ve grown to love. Face the facts; you just might not be able to overhead press or bench with the straight bar.

Not all bodies are created equal in the first place; a good example would be the different types of acromions, a portion of the scapula. Those with type III acromions are more likely to suffer from subacromial impingement due to the shape of this end of the scapula:

These are the 3 types:

Type I Acromion: flat, minimal impingement risk, normal subacromial space

Type II Acromion: curved, higher rate of impingement, slight decrease in subacromial space

Type III Acromion: beaked, highest rate of impingement, marked decrease in subacromial space

Now, ask yourself this: when someone universally recommends overhead pressing, how often do you think they’re consulting x-rays to determine if it might not be the best thing for you?

Moreover, not all bodies are equal down the road, either. If you’re a type I or type II acromion process, you can “acquire” a type III morphology due to reactive changes. These changes may be related to a specific activity (e.g. weight-training) or just a case of chronically poor movement patterns (think of a hunchbacked desk jockey who’s always reaching overhead).

There’s almost always going to be something else you can do to achieve a comparable training effect without making things worse. So, the next time your shoulder starts to act up in the middle of a training session, put down the weights, take a deep breath, and walk over to the water fountain.

Use this stroll as an opportunity to recognize that something is out of whack and determine an appropriate course of action — including an alternative exercise. You might need to experiment a bit, but it’ll come to you.

Shoulder Saver #2: Serratus Anterior Activation Work

The serratus anterior is a small muscle, but it’s of profound importance when it comes to scapulohumeral rhythm and, in turn, shoulder health.

Essentially, this muscle locks the scapula to the rib cage to prevent the scapula from winging out. It assists the pectoralis minor with protraction, but most importantly, it’s involved in a delicately-balanced force coupled with the upper and lower trapezius for scapular upward rotation, a movement in which you need to be perfect to function safely with overhead movements.

The Serratus Anterior

Unfortunately, the serratus anterior will always be the first muscle to “shut down” in the face of any sort of scapulohumeral dysfunction, and activating it is a crucial component of all rehabilitation programs for the shoulder girdle.

I could literally give a day-long seminar on all the different pathologies in which serratus anterior dysfunction is involved in some way. So, why not take care of it ahead of time? Two great exercises are the scap push-up and supine 1-arm dumbbell protraction:
(…)”

Continue reading the article on tmuscle.com

Shoulder savers part 2
Shoulder savers part 3

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