Shoulder Pain & Rule Of The Hand
Hey everyone!
This is Dr. David Middaugh from El Paso Manual Physical Therapy.
Let’s talk about shoulder injuries today.
Common questions I get are,
“How do you fix a rotator cuff tear?”
“My shoulder hurts. What should I do about it?”
“What stretches should I do?”
“What exercises should I do?”
One of the most common exercises that I see people do is the typical rubber band exercises for the rotator cuff.
You know, the one where you keep your elbow at the side and rotate your hand out and in.
Most people get this exercise from google. Many times it is given to them by a physician, physical therapist or another medical professional.
You’ll feel a burn in the rotator cuff area doing this exercise, so it certainly does train/strengthen the rotator cuff muscles.
But coming from an expert, I look at things a little different….
….and I think that exercise is missing the point.
In cases where I see clients with rotator cuff tears, shoulder impingement, shoulder labral issues, shoulder bursitis….etc… they’re focused on the tissues right in the shoulder where it hurts.
Another issue is biceps tendinopathy or tendinitis. The bicep tendon runs up into the shoulder and that area is a choke point in the shoulder.
But in both of these conditions, it might not be the main area to focus on to fix the issue.
What we find is that many people actually need shoulder blade strengthening.
Look at the design of the ball and socket joint and the way the 4 rotator cuff muscles control it. that stabilize it. They all attach onto the shoulder blade.
The job of the rotator cuff is to hold together the ball and socket joint and pull the ball securely into the socket.
Now look at the design of the shoulder blade. It hardly has any bone attachments to the rest of the skeleton.
This means that the shoulder blade can move around a lot.
Just think of your shoulders for a moment – you can shrug up, you can roll them forward, roll them back, rotate them upward – there is a ton of movement that happens at that shoulder blade!!!
…and if that movement is not controlled very well – then you might start to get pain at the ball & socket joint.
That’s when the rotator cuff starts to become injured and painful.
So can you see how doing those rotator cuff exercises is missing some potentially huge problems?
You might get some short-lived relief but then you skip training the muscles that help to stabilize the shoulder blade.
Shoulder blade stability might be your BIGGER underlying problem…
This could be what needs to happen so you’re not constantly running into shoulder problems.
I hang around a lot of crossfitters and powerlifters because I love doing that stuff.
As a result, I hear a lot of the problems they have.
One of the most common things I hear people use to treat their shoulder problems is rest.
They’re doing a lot of overhead motions like thrusters, push press, strict press, and handstands (that’s also an overhead motion ).
They might have shoulder pain from this and then say “I’m going to take a week or 2 off”.
That shoulder pain comes on because the tissues have become inflamed. Think of all the shoulder tissues I mentioned earlier – the labrum, rotator cuff tendons, bicep tendon or the shoulder bursa – it’s all become inflamed.
Just like when you cut your skin – your skin is going to hurt….and it takes some time to heal.
Once you give it time to heal, you’re good to go. Your skin is fine and it’s not going to hurt anymore.
Well if you give the injured/irritated area in your shoulder some time – the inflammation will go down and you’ll feel good again.
….but then you go back into your exercise (overhead lifts) and then you run into the same irritation in the shoulder joint.
You may not be strong enough to move your shoulder blade correctly when you’re doing that overhead lift.
We see people stuck in this cycle of shoulder gets irritated and painful – then rest & feel better – return to exercise – then shoulder gets irritated and painful again.
We teach our all clients how to move appropriately so they can adapt it to any exercise they choose to do.
Rule Of The Hand
Here’s a basic concept that I teach my clients in order to learn how to use their shoulder blade effectively.
I call this the Rule Of The Hand.
Wherever your hand goes ->> your shoulder blade should follow.
So let’s say you’re reaching forward. Think of doing a bench press or pushing/punching motion.
Your hands are going forward so your shoulder blade should roll forward off your body.
When you’re moving your hands towards your body or behind your body ->>> your shoulder blades should pinch backward.
Think of a push-up or bench press, whenever you are pushing the bar forward or pushing yourself away from the ground, your shoulders should round forward for a moment. You need to set those shoulder blades forward.
(The reason for this is to get that socket part of the ball and socket joint to move with the hand. This puts less strain on the rotator cuff, shoulder labrum, bursa and bicep tendon.)
Same thing when you’re bringing the bar down or coming down on the push up bring your body down your shoulder blades should be pinching back a little bit.
The same applies when you’re reaching up overhead as you would in any sort of overhead lift.
An overhead press, thruster, handstand or anything where you’re pushing up overhead.
As your hands come up, your shoulder blades should also come up.
A lot of people don’t do that. Their shoulder blades only go up partially.
When you reach up your shoulders should shrug all the way so that you smash your shoulders into your ears.
If you think of the socket and ball as you’re shrugging up, the socket will move upward and allow you to stack your joints without straining tendons and cartilage.
We are bipedal animals. In other words, we stand on 2 feet instead of 4 (quadruped).
So our body needs to take advantage of stacking wherever possible to distribute forces efficiently. We stack our joints because it requires less effort from our muscles to fight gravity.
If you think of our spine it’s stacked up on our legs.
When we reach up overhead and move that shoulder blade up ->> you put all the weight going through your arm stacked on top of that socket.
….but if your shoulder is down at an angle that puts the socket at a bad angle and that causes it to put more stress on the rotator cuff tendons, bursa, labrum, and bicep tendon.
It’s important you follow the rule of the hand and you shrug it up all the way wherever you’re coming up overhead.
When you’re doing thrusters, make sure you push your shoulders up for a moment every time.
It’s almost like if you’re trying to hit your ears with your deltoid muscles.
If you follow that principle, you should be able to prevent a lot of problems from happening.
….and you should be able to avoid constantly irritating your shoulders.
If you’ve made this technique adjustment to your overhead lift and you’re still having issues, there maybe some specific things you should have an expert take look at.
You might have a restriction in your joints or maybe a severe muscle imbalance.
If you can’t quite get up all the way sometimes the collar bone joints get stuck. There are hands-on techniques we use in treatment to make sure you’re not being stopped by that.
Being able to reach up overhead effectively is a critical thing that everyone should be able to do.
I really don’t think you should avoid overhead exercises for the long term. If you’ve had a rotator cuff problem avoiding it in the short term is wise.
Make sure you learn how to move overhead safely.
Having strength in all those muscles that control your shoulder blade is so important to move forward in life.
People start to get the aches and pains up here and it starts to affect neck joints long term.
It is healthy for you to be able to reach overhead effectively.
If you’ve been told by someone to avoid overhead exercises, please talk to us about it.
We specialize in helping people in El Paso get off pain medication, avoid surgery and keep up active lifestyles.
Most of the time medical professionals that make that recommendation are using the “rest it” and “avoid it” technique.
It doesn’t solve the problem. It just creates another one later down the road.