Shoulder pain and rotator cuff injuries can be very painful, debilitating and can take a long time to heal if you do not initiate a good program early. This can have a negative on your daily life, in particular if your dominant arm is the affected arm. A very common injury in sports like Tennis, Baseball and various sports requiring a throwing action. Focus for this type of injury is typically about the shoulder, but I have found from over 15 years as a trainer specializing in rehabilitation and sports is that there is a lot more to the problem than meets the eye. I have found that poor posture, lack of movement skill and leg strength, mainly the lunge movement, coupled with poor rotation and twisting, is where the real problems lie. In this article, I am going to show you our 6 step process for identifying the cause and then how you go about using stretches, mobilizations and exercises to get rid of pain and restore function to the shoulder. But most importantly, you will learn how you can prevent it from coming back.

What Is The Most Common Injury And How Does It Happen?

The most common shoulder injury is known as impingement syndrome,  when the long arm bone (humerus), smashes into the top of the shoulder (acromion).  This is due mainly in part to poor posture and poor movement mechanics. The rotator cuff’s job is to hold the top part of the arm in the socket as such regardless of the speed of movement. This is done by applying compression to the joint in combination with what is referred to as a glide and roll action. When someone has impingement syndrome, they lose the ability to roll, not allowing the arm to stay down in the joint.

As mentioned already poor posture and movement skills play the most significant role in this starting in the first place. For a successful long term outcome, there needs to be careful program design and a significant amount of time to create the necessary change.  However most people are prescribed a few shoulder stretches, given a massage and told to do some external rotation exercise with rubber tubing and told you will be right in just a few weeks. Just because the pain has gone away does not mean you are “all fixed”. This is where most people stop, but what I will show you in this article this is where you have the most work to do!

In every sport that relies heavily on the shoulder, it is vital to see the shoulder as only one piece of the puzzle – all the other pieces must also be correctly and carefully trained in order to create the needed rotational power, otherwise the shoulder will be overloaded. There is a ‘winding up’ and an ‘unwinding’ that takes place at a rapid speed starting from the legs, progressing through the hips, pelvis, lumbar spine, thoracic spine, shoulder, elbow, and wrist. And each must be taught to absorb its fair share. Both Tennis and Golf are sports where to use as a clear example of this transfer of rotary power – a series of wind-ups finally being unwound as the stable base of the hips whips back in the opposite direction.

Any weakness in this chain will create compensation and problems somewhere! 

The following 6 steps provided are in order of most important, so make sure you do not skip a step as the program will not be completed correctly if you do. The exercises I show are to give you an idea of how we go about helping someone with this type of injury. In order to find your solution it needs to be tailored exactly to you.

Shoulder Pain Special Report

Before getting straight into the 6 Important Steps, if you are struggling with an injury right now I encourage you to get a copy of our detailed report on Shoulder Pain. While I am going to share a lot of stuff with you in this article it is very difficult to tell you that this is exactly what you need! Without completing a thorough assessment and looking at your body and trying to find the weaknesses you could end up using a corrective exercise that makes you worse. In our detailed report we take you through ALL of our assessments, tests, drills, stretches and advanced methods we use in our studio every day, and this has over 95 pages of information complete with exercise instructions, pictures and a 6 month program to walk you through the steps of overcoming this injury once and for all.

Click here to see more information about this or click the image below to get your copy straight away.

Okay let's take you through the 6 steps and give you some examples of how to do this.

6 Step Process For Preventing Rotator Cuff Injury

Step 1: Assess Posture

I cannot stress to you enough how important this step is. The body is designed to have the head, rib cage, and pelvis perfectly balanced upon one another in both the front and side views. If the posture is deviated from normal, then the spine is also deviated from the normal healthy position. Unfortunately, abnormal posture has been associated with the development and progression of many spinal conditions and injuries including back pain, neck pain, headaches, carpal tunnel symptoms, and various other conditions. I have found this to be particularly true for shoulder problems. The poor position the shoulder has been forced into, will now create all types of muscle imbalance and compensation. Before going any further you must find out where to start by completing a thorough postural assessment.

A skilled CHEK Practitioner or Chiropractor is a great place to get this done. I also use some very cool apps these days to help me which you can read about in more detail here in this article. Why Posture Is Everything To The Sporting Athlete

Below is some videos of the most effective stretches, mobilizations and some of my favourite postural corrective exercises I use with most clients. Again I stress you should find a skilled Therapist, Exercise Physiologist or CHEK Practitioner to prescribe the right exercises for you. 

Step 2: Assess Lunge Movement Skill and Strength

Before we go any further you must get the concept of focusing more on movement and less on muscle to effectively rehabilitate or prevent injury. The body only knows movement, it does not know muscles. So train yourself this way and you will never have any problems. Why do I choose the lunge over just any leg exercise? Why not a squat? Well the reason is, the split stance or lunge position is the position that is involved when you perform most rotator cuff actions such as throwing a ball. This is referred to as activating the slings of the body. Read this article to see more about Slings and Core Strength.

The speed and force needed to perform a powerful throw is generated from the ground up, so it makes sense to ensure your legs are working exactly as they are supposed to. There are two things to consider here. Firstly I would always check your technique to make sure you have good form. Secondly you should have enough strength to provide the amount of power needed. 

Watch the video below for ideas on how to improve your lunge movement pattern. This includes everything from mobility to strength and power.

Step 3: Assess Rotation Skills

Again this is an extremely important step that is often missed by most therapists and personal trainers as people are always looking at the area in pain instead of where the problem is coming from. Poor trunk rotation plays a key role in providing the power that has been created by the legs. We see this all too often in our Sports Specific program and also with many elbow related injuries. The lack of rotation now forces the arms to try and make up for the loss of force and power, creating huge loads going through the elbow, shoulder and lower back!

Watch the video below of how to do improve your rotational power. As with the video above for improving the lunge movement, this video shows you several ways to improve mobility, strength, and power with rotation.

Step 4: Include Stability & Isolated Rotator Cuff Exercises

This is a complicated step and to be honest there are a multitude of ways I may go here depending on the person. I could use another 10,000 words and provide over 50 different videos if I was going to explain the different things I might explore at this point.

The role of the rotator cuff muscles is to maintain the position of the top part of the upper arm while the prime mover muscles generate power. As you improve your scapula control, the stabilizer muscles are able to act more efficiently and independently of the scapular control muscles. Meaning you should be able to hold the scapula quite still in the neutral position while you complete various actions with your arm. This is usually where you see the external rotation exercises used, but BEWARE! These exercises can create more pain and dysfunction to the shoulder joint if not correctly used. I will regularly prefer to use scapula exercises like the serratus anterior wall slides before using strength exercises like external rotation.

The video below will give you a better understanding of what I am talking about here.

Great articles to read with additional information and exercises for improving scapula stability are shown below

• The 3 Key Factors To Healthy Shoulder Function
• Why I love the serratus anterior wall slides exercise
• 5 Ways to improve scapula stability
• How good is external rotation for the rotator cuff?

Step 5: Develop Dynamic Rotator Cuff Skills With An Emphasis On Braking

This section of exercises looks very risky to many people and because of that it is rarely used. This is where you begin to throw and catch loaded medicine balls at high speeds in various angles and positions. Why? Think about how fast you throw a ball or use your shoulder for exercises requiring the rotator cuff. Are they performed slowly or fast? Fast is the correct answer.

Now knowing this, it means you must teach the body how to stabilize the shoulder when it encounters this fast speed. When you throw a ball, something has to slow your arm down after you release the ball or you would throw your arm out! This role is performed by the stabilizers of the shoulder.

I also occasionally use tools like the Body Blade to provide rhythmic stabilization of the joint and body. This is very challenging and highly co-ordinated and can be very useful for developing strength later on. 

Step 6: Use Integrated Full Body Exercises With Pushing Movement Pattern

The pushing pattern is the riskiest of all the shoulder exercises. It is in this pattern of movement you can create severe pain and impingement if the previous steps are not performed correctly. The anterior capsule of the shoulder is the most vulnerable and weakest part. Exercises like the bench press and chest press place huge stretch on this capsule and if it is not stable enough or in the right position pain is inevitable. During chest press the gleno-humeral joint may ‘lurch’ forwards, while the scapula moves into downward rotation and anterior tilt – a deadly combination for the supraspinatus tendon and other fragile shoulder tendons and ligaments.

We like to use single arm cables again using the split stance to allow leg strength and rotation of the trunk. Remember steps 2 & 3! For the chest press exercise I always use a Swissball to encourage activation of the entire body and to ensure I recruit the stabilizers effectively I add rubber tubing into my hands.  The tubing will directly activate the subscapularis, thereby improving muscle balance and preventing injury to the supraspinatus tendon.

You can see me do this in the videos below.

There is so many more exercises and variables to consider, that this article is just scratching the surface of what you really need to do. Again if you have a shoulder injury grab a copy of our report as it covers all of these variables. The main point I wanted to drive home here is that you need to start looking at the legs, even though the pain is in the shoulder it is really just where the pain has settled, not where the problem is!

Want Proof That This Exercise Program Works?

Below is an amazing story below of Christian Haider who came to see us for a severe neck and shoulder injury in early 2017.

" After years of coping with pain I had finally crashed hard in January 2017. I was lost in deep depression and pain that was hard to describe. I spent every waking moment focused on the pain and the disability it was inflicting in my life. Couldn't sit, couldn't run, couldn't lift, couldn't do anything without paralyzing fear. I had tried massage, chiropractor, osteo etc. I was all out of options and truly lost and hopeless.

Finally I came across the No Regrets testimony page and after reading some of the stories I decided to drop in and have a chat to Nick. Straight away everything he was telling me made sense, I had put my trust in so many heath professionals however so i was naturally a little pessimistic that what he was talking about could actually fix me. 

The pain I was experiencing in my neck was so strange that I felt no one could possibly understand what it was or how to fix it, I had been convinced it was a herniated disc, or a bulging disc, or maybe even a dodgy spine that would inevitably cause tremendous pain for the rest of my life.  After 3 months of hard work and listening to the team at No Regrets, I was finally experiencing a reduction in pain and had regained hope.

Fast forward 2 more months and here I am now, doing Jiu Jitsu again, sitting for hours again, running again, doing whatever I want! The pain no longer rules my life. It's not until now, 5 months later that I realize that what really saved my life was the fact that the team at No Regrets were not entirely responsible for fixing me, they were teaching me how to regain my freedom myself. They simply showed me what I needed to do and the rest was up to me. I had to to lift the weights, I had to put in the hard work. Thank you Nick and Nathan for showing me there wasn't anything wrong with me that I couldn't fix with time and hard work. You have given me hope that has truly saved my life. If you're reading this and you're in pain right now, you have come to the right place.

The team at No Regrets will change your life." - Christian Haider.

Conclusion

The purpose of this article is to educate the community that you MUST apply strength, stability and postural correction principles to solve your problem. Just going to get a massage or a physiotherapy treatment to “fix the problem” is not enough! You must take responsibility for what happens to your body and that begins with exercise. Having worked with over 1000 people in my 12 years as a Personal Trainer in Melbourne there is a real lack of knowledge in this area, even from the so called experts. I did not intend to specialize in rehabilitation, core strength and functional movement, when I started my career this came about accidentally. Firstly I had sustained several injuries myself and the treatment and exercises I was given rarely helped me and in many cases made it worse!

Secondly when working with clients using the mainstream method that is used everywhere today I was struggling to help anyone overcome their problem. I eventually came to the realization that addressing just the area that was in pain was futile. There was a lot more to it than what we are told, and from 15 years of formulating programs and methods I have learned in many courses, and from working with so many various conditions, I have now developed a method that works. There is no magic pill, and there is no one size fits all either, there is only the way that works for you and you must use assessments and intelligent decisions on what to do in order to have a long term successful result.

And if you would like to know more about our programs and various services fill in the contact form below and I will be in touch within 24 hours to schedule a Free Consultation and Postural / Movement Assessment. 

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program. International readers can request a Zoom call.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Shoulder & Scapula Injuries in Athletes - By Sports Injury Bulletin
• Fixing Your Shoulders & Elbows - by Rick Olderman 
• Movement - By Gray Cook
• Corrective Exercise Solutions for the hip and shoulder - by Evan Osar
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek
• Twist Conditioning Sports Strength - By Peter Twist
• Twist Conditioning Sports Movement - By Peter Twist
• Functional Training For Sports - By Mike Boyle