ANATOMY OF SHOULDER
The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.
Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.
The shoulder also relies on strong tendons and muscles to keep it stable. Some of these muscles are called the rotator cuff. The rotator cuff is made up of four muscles that come together as tendons to form a covering or cuff of tissue around the head of the humerus.
The biceps muscle in the upper arm has two tendons that attach it to the shoulder blade. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process. These attachments help to center the humeral head in the glenoid socket.
In addition to the ligaments and rotator cuff, muscles in the upper back play an important role in keeping the shoulder stable. These muscles include the trapezius, levator scapulae, rhomboids, and serratus anterior, and they are referred to as the scapular stabilizers. They control the scapula and clavicle bones — called the shoulder girdle — which functions as the foundation for the shoulder joint.
The articulations between the bones of the shoulder make up the shoulder joints. “Shoulder joint” typically refers to the gleno-humeral joint, which is the major joint of the “shoulder,” but can more broadly include the acromioclavicular joint . In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, the head sitting in the glenoid fossa. The shoulder is the group of structures in the region of the joint
The shoulder must be mobile enough for the wide range actions of the arms and hands, but also stable enough to allow for actions such as lifting, pushing and pulling. The compromise between mobility and stability results in a large number of shoulder problems not faced by other joints such as the hip.
THE OVERHEAD ATHLETE EPIDEMIC
Any amateur or professional athlete who participates in an overhead sport is at risk of traumatic or degenerative injuries to the shoulder girdle. Due to the nature of overhead throwing biomechanics, the passive tissues consisting of ligaments, fascia and tendon-bone insertion points of overworked musculature are placed in a precarious position for injury, especially as frequencies and training loads are increased. This, in combination with year round specialty sport training, causes a cascade of hazardous chronic inflammation and mechanical breakdown of tissues, especially those still developing in younger athletes. Although throwing injuries in the shoulder most commonly occur in baseball pitchers, they can be seen in any athlete who participates in sports that require repetitive overhand motions, such as volleyball, tennis, swimming and some track and field events.
Over training isn’t something surgery can fix. It is something that needs to be monitored and controlled under the watch of coaches, trainers or therapists, before it ever puts athletes at increased risk.
The shoulder girdle is one of the most anatomically complex and biomechanically advanced regions of the human body. The synergistic movement, rhythm and stabilization of multiple joints in unison are needed to maintain a high level of performance while also decreasing unwanted stress when it comes to throwing and hitting from an arm overhead position.
One of the most effective and efficient ways to bulletproof the shoulder girdle and elbow against chronic and acute sport specific injuries is through the implementation of dynamic warm-up routines preceding any training or competition. Intelligently designed progressive dynamic activations and warm-up routines are essential for high-level athletics.
DYNAMIC NEUROMUSCULAR RECRUITMENT
Arm care and preparation for the overhead athlete is an absolutely pivotal aspect of both performance and health, especially under heavy and frequent training schedules. Turning on the right muscles at strategic times, while positioning the active joints to function at their highest possible levels are necessary for long term function and success.
An often-overlooked aspect of a dynamic warm-up is the neurological training adaptations that it produces. Without primed neurological conduction capabilities, complex motor tasks become less precise, thus increasing the risk for unwanted stress and forces through joints and soft tissues.
Enhancing neuromuscular recruitment can be achieved through activating reflex stabilization properties of active joints and positioning those same joints in a spiral loaded position.
REFLEXIVE STABILIZATION
The true shoulder joint, also known as the gleno-humeral joint, is comprised of a ball and socket surrounded by both active and passive stabilizers. Arguably the most important gleno-humeral stabilizers is the rotator cuff complex. This group of four intricate shoulder stabilizers enhances both the position and function of the entire upper extremity.The rotator cuff muscles consist of the supraspinatus, infraspinatus, teres minor and subscapularis muscles. Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles particularly in sports which involve a lot of shoulder rotation. The cuff plays two main roles: it stabilizes the glenohumeral joint and rotates the humerus outward. The cuff centers the humeral head in the glenoid cavity via passive effects and, more importantly, via active multidirectional effects. In other words, the cuff prevents upward migration of the humeral head caused by the pull of the deltoid muscle at the beginning of arm elevation. Functioning ideally, these muscles can create an incredible amount of stabilization through the shoulder joint by sensing both position and mechanical pressure of the joint itself .This phenomenon is known as reflex stabilization. Reflex stabilization provides the most precise real time adjustment of bodily position and secondary muscle recruitment patterns.
The shoulder works best when the ball and socket of the humorous (upper arm bone) and scapula (shoulder blade) are centered and balanced and thus the optimal joint position with maximal surface area contact between the humeral head (ball) and gleaned fossa of the scapula (socket). The scapula serves many roles in order for proper shoulder function to occur. These roles include providing synchronous scapular rotation during humeral motion, serving as a stable base for rotator cuff activation, and functioning as a link in the kinetic chain. Each role is vital to proper arm function and can only occur when the anatomy around the shoulder is uncompromised. The presence of bony and soft tissue injury as well as muscle weakness and inflexibility can alter the roles of the scapula and alter scapular resting position and/or dynamic motion.
PREHABILITATE TO PERFORM
In order to rise above the injury rates, pre-habilitation must be practiced and mastered on a daily basis.
Warm-up
1. Unilateral External Circular Rotations – 10x each arm 2. Unilateral Internal Circular Rotations – 10x each arm 3. Bilateral External Circular Rotations – 10x 4. Bilateral Internal Circular Rotations – 10x 5. Corkscrew Shoulder Twists – 20x 6. Squat Position Unilateral Thoracic Mobility Reach – 10x each side 7. Band Shoulder Dislocates – 10x – GLENOHUMERAL DISTRACTION 8. Band Diagonal Shoulder Dislocates – 5x each way 9. Band Pull Aparts – 10x 10. Diagonal Band Pull Aparts- 10x each way
Recommended Stretch #1 – Door Frame Stretch for the Pectoral Group
Stand at doorway with forearm on doorframe. Elbow bent to 60-90 degrees. Step through the door. A good stretch should be felt along the anterior chest, not the shoulder joint. If you are stretching the right shoulder, step through with the right leg. Complete 3 x 30 seconds each side. The angle of the arm can vary depending on which fibers of the pectoral group you wish to stretch. A combination of angles can be added to the stretching routine to incorporate the different fibers.
Recommended Stretch #2 – Two Part Latissimus Dorsi Stretch
Arch your back up like an angry cat to round out your back. Keep your back rounded and drop your rear to your heels. Reach out with your hands and then reach to a side to specify the stretch and address each of the Latissimus Dorsi. Hold each stretch 30 seconds and repeat three times, alternating sides.
Recommended Stretch #3 – Upper Trapezius / Levator Scapulae Stretch
Sit on a chair and grasp the seat with the hand on the side of the tightness. Place your other hand on your head as outlined below and gently pull down and diagonally to the other side. Two versions of this stretch are shown below. The first version is to turn your nose towards your armpit and gently pull down. The second version is to look straight ahead and gently pull down. Hold for 30seconds and repeat three times, alternating sides.
Active Warm-Up #1 – Place your arms by your side, bend your elbows to 90° to assume the start position. Externally rotate your arms to the end range at a comfortable pace and then return to the starting position. As you externally rotate, pinch your shoulder blades together. Do not force the end range. Complete 2 sets of 15 repetitions.
Active Warm-Up #2 – Place the back of your hands on your back at the belt line and bring your elbows forward to assume the start position. Squeeze your elbows and shoulder blades together and then return to the start position. Complete 2 sets of 15 repetitions
Active Warm-up #3 – Forward elevate your arms to 90° and then bend your elbows to 90° to assume the starting position. Horizontally abduct your arms to a “goal post” position, squeezing your shoulder blades together at the same time. Then return to the starting position. Complete 2 sets of 15 repetitions
Active Warm-up #4 – Abduct your arms to 90° and bend your elbows to 90° to assume the starting position. Then externally
rotate your shoulders to achieve the “goal post” position. Return to the starting position. Complete 2 sets of 15 repetitions.
SHOULDER STRENGTHENING DB EXERCISES-
Perform consecutively for 6-8 reps each—NO REST!
Do 1-3 sets.
Use LIGHT dumbbells (1-10 lbs.) so you can maintain form. 10 pounds would be “very heavy” for this series of exercises.
- Windshield Wipers With ½ Circle –From shoulder height, circle arms in, down, then out as you retract shoulders back & down
- Side Raise Thumbs Up –From legs to ears
- Shoulder Extension- Bend over 30-45°; kick arms straight back
- Scare Crow- Elbows square @ 90° then rotate
- .Reverse Fly -Bend over 30-45°; lift arms up; retract shoulders
“Y-T-W-L” SHOULDER MATRIX
- Lie face down on a stability ball (SB) with your navel on top of the ball and feet split wide for a stable base of support. OR ON A INCLINE BENCH
- Perform consecutively for 6-8 reps each—NO REST! Do 1-3 sets according to ability.
- Use LIGHT dumbbells (DBs) of 1-8 pounds so you can maintain form. 8 pounds would be “very heavy” for this series of exercises. Be careful to lift and lower with control and proper form so you optimize each repetition. Keep head and neck in neutral position.
- 1. ‘Y’ –
- Hold DBs with thumbs up & wrist straight. Extend arms overhead in front of SB into ‘Y’ with straight elbows then lower towards floor & lift. Lift DBs from the “shoulders” while leaving elbows locked
- 2. ‘T’
- Hold DBs with thumbs up & wrist straight. Extend arms straight out to each side into ‘T’ with straight elbows. Maintain a 90° with arms to body as you lower DBs towards floor. Lift DBs from the “shoulders” while leaving elbows locked.
- 3. ‘W’
- Hold DBs thumbs up & wrist straight. Bend elbows & pull upper arms down slightly until arms & body resemble the ‘W’ shape. Lift & lower arms like a bird slowly flapping its wings. As you lift retract or “pinch” your shoulderblades together in upper back.
- 4. ‘L’
- Hold DBs thumbs in towards the SB as you place each hand close to floor directly to side of shoulders. Lift DBs up until elbows are even with shoulder height & 90° then rotate DBs forward until they are horizontal and parallel with floor. Rotate arms back down so hands point to floor then lower. Maintain the ‘L’ shape throughout rotations with a 90° bend in elbows. Also keep upper arms at 90° to body. If you cannot maintain the form and 90° “square” angles then use lighter DBs.