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Default Shoulder Imbalances - Causes & Solutions
by MVP 02-20-2012, 04:35 PM

I've decided since I joined the board, to share some of the articles I have written. This one has probably been the most helpful amongst lifters since it is about a very common condition. Read and enjoy.

Shoulder Imbalance- Causes & Solutions

by Will "MVP" Riggs

Personal Trainer- ACE, NASM; Nutrition Consultant- AFPA

Last week we discussed the importance of horizontal and vertical pulling in relation to horizontal and vertical pressing. Protracted shoulders can be a nasty condition; what makes it even worse is 70% of the people that have it aren't even aware that they have it nor of the condition itself! And people wonder why rotator cuff injuries are the most frequent injury in the fitness center.

First off, lets again analyze the posture and its cause. Protracted shoulders and internal humeral rotation comes from overactive pushing muscles and underdeveloped pulling muscles; it is a condition of the internal rotators overpowering the external rotators. The internal rotators of the shoulders are the lats, pectorals and anterior deltoids. The external rotators are the trapeziums, rhomboids, posterior deltoids, infraspinatus and teres minor. The shoulder protractors are the pectoral muscles, serratus anterior and anterior deltoids. The scapula retractors are the rhomboids, lower trapeziums, and posterior deltoids. Most of which are utilized during transverse extension style movements.



If there is an significant imbalance in the external and internal rotators, the head of the humerus will elevate in the socket of the shoulder and rub against the acroniom and impingement of tendons and the result is a shoulder bursitis (rotator cuff tendonitis). After a while the result of impingement of the shoulder results in significant tearing of the rotator cuff. The image of the condition - bursitis is below.



The main cause of the condition in terms of movement specificity is performing bench presses and overhead presses without working their opposites: the row and pullup. Bench presses and overhead presses, however, are not the only cause of the condition. Infact, there are some people that do not even lift weights with protracted shoulders!

Driving and office seated jobs (those including secretaries, bus drivers and general computer works all the way to a regular school student) are prone to and often do suffer from the condition. When their internal rotators tighten up and their external rotators get long and weak from sitting and slouching forward for the majority of the day, the result is your body and posture naturally leaning the way.



The solution to this condition is to stretch the shoulders internal rotators (pecs, lats, anterior deltoids) and strengthen external rotators (rhomboids, lower traps, infraspinatus, teres minor). The question you're probably wondering is - HOW! The answer? Horizontal pulling. Barbell rowing has an important aspect that most other pulling movements do not compromise of - and that is scapula retraction. You must contract the scapula to perform a proper bent over barbell row.







Now, lets give an activity to you to see if you have this condition. Go to the nearest room and grab a pencil. Hold that pencil and ball your first up with the tip of the pencil facing forwards. If the pencil tip faces inward (towards you) then your humerus is internally rotated and the result is protracted shoulders. If the pencil tip faces directly forwards, then you have health shoulders.

Internal Humeral Rotation:



Healthy Shoulders:



The shoulder consists of the deltoids muscles: anterior deltoids (front of the shoulder), lateral deltoids (side of the muscle), and posterior deltoids (rear of the shoulder). All deltoids need to be strengthened in order to overcome the condition. We should, as weightlifters, work every aspect of the shoulder. The rotator cuff muscles consist of SITS: Supraspinatus, infraspinatus, teres minor and subscapularis.

Deltoid Muscles:



Rotator Cuff Muscles:



Overhead pressing focus on development of the protractors of the shoulder more specifically then the retractors, on top of that you're already bench pressing. Overhead pressing gives slight work to the rotator cuff but is by no means a solution to protracted shoulders. It works different parts of the shoulders differently and if protracted does not allow specific muscles to fully contract. The external rotators are used isometrically during an overhead press, but are stimulated nowhere near as heavily as the internal rotators which only further influence the imbalance. Furthermore, the posterior deltoids, which are needed for strengthening of the shoulder retractors are not worked heavily during an OHP.

Quote:
During the early phase of upward rotation, the scapula and the clavicle move together around an axis through the sternoclavicular (SC) joint, the only joint where the scapula and shoulder girdle attach to the axial skeleton. The SC joint's antero-posterior (AP) axis is somewhat oblique and passes near the base of the scapular spine.

Around this axis, serratus anterior (SA) and upper trapezius (UT) produce upward rotation moments.
As you read from this source (What drives upward rotation of the scapula?) the OHP focuses on development of some of the main causes of the protraction.

During the concentric phase of your bent over barbell row, make sure your body is parallel to the floor. Once you make sure of this: keep your elbows flared out and pull the external resistance towards you and pause at the top focusing on the retraction phase of the scapula. Before each workout, incorporate cuban rotations and the poor mans shoulder horn to focus on development of the rotator cuff. You should also include scapular depressions (reverse shrugs) three times per week (after each workout) and eventually begin adding weight to those.

Pullups are often believed to be "all you need" for back development and this is a false statement. Pullups specifically target the lats and do not target the inner back muscles and external rotators: posterior deltoids, rhomboids, trapeziums as specifically a barbell rows do. The lats are part of the internal humeral rotators, which in this condition are overactive. The barbell row is dominant through lat stimulus just like the pullup, but involves a greater dependence on the scapula retractors and external rotators, balancing protraction movements like bench presses.

Solutions: incorporate rotator cuff work pre-workout before each session, incorporate doorway stretches to stretch the internal shoulder rotators, incorporate horizontal pulling to a 2:1 ratio of horizontal pushes and vertical pulling with a 1:1 ratio of vertical pushing. Incorporate scapular depressions if you have access to a dip station and if necessary, incorporate face pulls and bent over lateral raises.

Workout 1:
Cuban rotations
Squat
Bench Press
BB Row
Chinup
Pectoral Stretches

Workout 2:
Poor mans shoulder horn
Squat
OHP
deadlift
BB Row
Face Pull

Workout 3:
Cuban Rotations
Squat
Weighted Dips
BB Row
Pullup
Scapula Depressions
Wall Stretches


Other movements that people are often trying to barbell rows with and are not being put into focus for development of the scapula external rotators and depressors such are: power cleans, deadlifts and overhead presses. First off, none of the movements put focus on external rotators specifically and deadlifts and cleans certainly do not work the upper back muscles better than a row. Deadlifts are not an example of retraction, the obvious solution for protraction; they are an example of hip extension (posterior chain) dominant exercises that utilize force that is dominated through movement of the gluteus maximus and hamstrings, which are far more demanding those specific movements themselves than the stimulus that acts to isometrically contract at the top of the scapula. People often make the argument that the primary function of the external rotators is stabilizing the humerus in the shoulder during overhead pressing movements - incorrect. The primary function of the external rotators of the humerus is external rotation.

OHP, on the other hand, is not an example of retraction of the scapula either; it is an example of upward rotation and is dominated through the more demanding prime movers (the internal rotators) than it is through its stabilizers (the external rotators and scapula retraction). To fix or avoid a common injury - you must give the muscle or movement attention through specialized training, which is worked with horizontal pulls. All four rotator cuff muscles have different purposes that serve as separation from belief that they all serve the purpose of stabilizing a resistive force held overhead; for instance, the infraspinatus and teres minor serve a function of externally rotating the scapula, while the scapularis is an internal rotator. The supraspinatus is located at the top of the shoulder and abducts the shoulder. Essentially, what we can conclude is the rotator cuff muscles that externally rotate should be given direct external rotation and retraction of the scapula in order to strengthen as much as the prime movers to pushing motions that cause protraction.

The higher the poundage increase on a flat bench press and overhead barbell press the more work the external rotators will require to keep up with the internal rotators. I suggest once you can bench press more than 1.5x your bodyweight to incorporate face pulls and scapular depressions and horizontal pulling at a 2:1 ratio with your horizontal pushes. I also suggest incorporating direct rotator cuff stability movements like cuban rotations, doorway stretches (stretches of the internal rotators) and the poor mans shoulder horn before EACH workout (except for the stretches that should be incorporated post-workout).

Examples of these exercises are listed below.

Poor Mans Shoulder Horn:



Face Pulls:



Cuban Rotations:



Scapular Depressions:



Barbell Rows - Properly Executed



Wall Stretches:



Performing these stretches and motions for the rotator cuff can result in a higher bench press, as well as a longer progressing bench press without pain to the anterior deltoids in the future. You want to develop the shoulder evenly, something that occurs with working your opposite motion of the shoulder.
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Old 02-20-2012, 04:39 PM   #2
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Nice article and thanks for sharing.
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Old 02-20-2012, 04:40 PM   #3
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Old 02-20-2012, 04:56 PM   #4
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