For gym goers, there is no bigger annoyance than a muscle injury.
A strain or sprain doesn’t just set back a workout plan, and potentially undo hard-won ‘gains’, but left untreated it can start to interfere with day to day life and function.
As a physio, I encounter countless patients and friends who report that they will avoid working a particular muscle group for fear of aggravating an historic injury.
It appears that the most common injury amongst gym goers, and particularly weight lifters, is shoulder injury.
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What’s Going On In The Shoulder Joint?
Before we discuss why gym goers are particularly vulnerable to shoulder injuries, it’s important to first briefly consider the anatomy of the shoulder.
The shoulder is the most flexible joint in the body, with the ability to move through multiple planes of movement.
Whilst this is obviously a vital element in the multifunction of the arm, the joint unfortunately tends to sacrifice stability in favour of flexibility.
The shoulder socket itself is very shallow, which means that movements within the shoulder structure rely heavily on the smooth running relationship of a great number of ligaments and muscles.
The most important of these is a group of internal muscles known as the rotator cuff, which plays an important role in holding the arm firmly in place within the shoulder socket.
Imbalance within one of the sets of structures within the shoulder can lead to injury (what was once known as ‘shoulder impingement but is now known by the much catchier name ‘sub acromial pain syndrome’).
Why Are Gym Goers Vulnerable To Shoulder Injury?
There are three main reasons why gym goers are particularly vulnerable to shoulder injury:
• They are too big and strong for their own good!
When a gym goer focuses their routine on building hypertrophy in the ‘glamour muscles’ such as the pecs and deltoids, they are inadvertently creating an imbalance within the shoulder, leaving the intricate internal rotator cuff muscles straining to balance against the big and strong shoulder and chest muscles. In physiotherapy, this is known as a load intolerance of the rotator cuff.
• Muscle tightness
In large part, this comes down again to the emphasis placed by many gym goers on particular groups of muscles, in this case the pecs and lats. Focused training on both of these groups of muscles can lead to tightness which disrupts the natural positioning of the shoulder, pulling the shoulder blade (aka the scapula) forward and down into an internally rotated position.
Unfortunately, this is the opposite of what is required for a smooth and healthy range of movement. (As a test for this at home, try rounding your shoulders down and forwards, and then raising your arms – you’ll see that your movement is substantially restricted. Now imagine adding weight to that movement in the gym, for example trying to do a shoulder press. It’s no surprise that this can lead to injury!)
• Weakness (gym goers won’t like to hear this)
On shoulder elevation (think of the shoulder press motion), in order to raise the arm above shoulder level, the shoulder blade needs to tilt backwards and externally rotate in order to make way for the arm, whilst holding the shoulder blade in place.
The muscles required to make this movement are sadly often neglected and therefore too weak to handle the load of the weights, and the pull of the tight muscles explained above. In clinic, I often find that gym goers are surprised by how weak these muscles are when tested.
How To Prevent Shoulder Injury
The most appropriate method of injury prevention for the shoulder will depend on which of the issues above are at play.
The best way to find this out will be to visit a qualified physiotherapist (although, as a physio, I would say that!)
In terms of general advice for preventing shoulder injury, I’ve set out below my top three tips.
• Pay more attention to the rotator cuff
On shoulder day, have a rotator cuff sandwich. This might sound mad, but I simply mean that you should be sure to give this group of muscles some attention both before and after your usual shoulder routine.
Before you start, incorporate some rotator cuff activation exercises into your regime prior to exercising the shoulders. Grab a resistance band or spend some time on the cable machine.
An example exercise would be rotating the hand away from the body against resistance, with the elbow tucked in at the side. For activation, you want to repeat this enough to feel the muscles warming up but not to the point of fatigue.
At the end of the shoulder sesh, give your rotator cuff a workout of its own in order to build strength within this group of muscles.
In order to do this, one example exercise would be for you to repeat the exercise above but with increased resistance and to the point of muscle fatigue.
• Test yourself
Lying down on the floor with your hands cradling the back of your head, can your elbows touch the floor? Someone with pec tightness would find this difficult, and their elbows would be raised off the ground.
Still lying flat on the floor with your knees bent, are you able to raise your hands above your head, and touch the floor, without arching your lower back? If not, you may well be suffering from lat tightness.
In both cases above, the solution to muscle tightness is to stretch the relevant muscle group! Repeat the stretches daily with multiple 30 second holds in order to really see the benefit.
• Strengthen the scapula muscles
Remember, the job of the scapula muscles is to stabilise the shoulder blade and facilitate movement through a healthy range of motion. In order to strengthen these muscles, we need to use them.
Two examples are set out below:
The “Saturday Night Fever”. Using a band or a cable machine, with your fist down in front of you and across the body, channel your inner John Travolta and pull your arm upwards and back across the body and over your head.
The “Superman”. On all fours, holding a light dumbbell in one hand, lift your hand until your arm is in line with your body (into the superman pose). Hold this position for five seconds and repeat. Strength dependent, you may be able to lift the opposite leg simultaneously with this movement.
About The Author
Sam Kelly is a Senior Musculoskeletal Physiotherapist in the NHS, and runs his own physiotherapy service called The Home Physios. The Home Physios is a service which specialises in providing musculoskeletal physiotherapy treatment to patients in their own homes.
Sam first completed a Bsc in Sport and Exercise Science before completing an Msc in Physiotherapy. As a junior physiotherapist he experienced a wide range of physiotherapy disciplines before deciding to specialise in Musculoskeletal physiotherapy. His specialist interest areas include post surgery rehab, treating back and shoulder pain, and injury rehabilitation focused on returning people to sport or exercise.