Athlete Question #1: How Do I Fix My Shoulder?
“I separated my shoulder 20 years ago in a cycling accident and it’s never been the same. How do I fix it?”
This is a loaded question. And it came directly from my first meeting with a new in-person athlete last week. An early 40’s former college rower. In this AQ I’m going to walk you through a three step process:
Assess - this will first be done through dialogue, gaining more information about the injury first and then learning more about how he’s impacted in the present day. The second phase is physical testing to get more information about what's going on in and around the joint.
Address - Taking everything we found in step 1 i’ll walk through the methods we’ll use in the program and share the actual program itself.
Reassess - This is an ongoing process that happens within the training sessions when this gets specifically addressed and over the course of his training program.
#1 Assess
The first thing I want to do is learn more. So I ask more specific questions about the incident and injury, like:
> Do you know what grade separation it was? Answer: No
> Do you know if anything else was damaged besides the AC ligaments? Answer: I don’t think so
Here’s the deal → this happened 20 years ago, in his young 20’s so I didn’t expect detailed answers, but every detail is helpful in building a more specific plan…if they are available. And if not we move forward with what we have in front of us.
Second we’ll move into questions about present day, like:
> Do you experience pain in the shoulder? Answer: No
> Tell me more about what you mean when you say “it doesn’t feel right…” Answer: It just doesn’t move like the other one, I can tell when I do pressing overhead that something is off.”
What did we learn? 1. No pain → that’s great. 2. There is something different about the left shoulder in overhead positions. Time to move onto testing. We want to figure out what ranges of motion he has access to and the control he has through those ranges. I start with two tests:
Standing Back to Wall Overhead Reach Test: This is one I learned from Eric Cressey who specializes in Baseball and overhead athlete performance training. Its a quick and simple test to see. He was able to get his right thumb to the wall, but was missing about 3-5inches of range on his left shoulder.
Shoulder Adduction & External Rotation: There are three separate tests I went through for this:
Supine Passive External Rotation: He laid on his back on the table, I manually took his shoulder through both internal and external rotation from a 90 degree angle at the armpit and elbow. He hit normal ranges in both tests. So he has passive access, which tells me the flexibility in his internal rotators is not an issue.
Supine Active External Rotation: With the athlete laying on the ground, knees bent, feet flat, abs engaged and low back flat to the ground, he performed the same abduction external rotation with the goal of getting his wrists to the ground. His right made it, his left was a few inches short. Which tells me he is lacking strength in his external rotators.
For good measure I moved him to the Standing Back to Wall External Rotation test: and found the results to mimic the ones from the floor.
So now we have some data to confirm what he said: The left shoulder, indeed, does not function like the right. We know he lacks access to full range of motion in flexion and external rotation, both important positions for overhead pressing and pull strength work. While he is not an overhead athlete per se he does mix in swimming occasionally and just completed a sprint triathlon. So I think it’s important to get this cleared up before placing any direct overhead pressing into program, especially with a barbell.
#2 Address
External Rotation: Here is the 6 step protocol we used for addressing this limitation…
Test: We used a Back to Floor External Rotation Test. Passing would be to get the wrists and back of hands to rest on the ground.
Soft Tissue Work: Using a foam roller and/or lacrosse ball you’ll roll out the lats, teres group, and pecs.
Take Space: Goal is to isolate the external rotators of the shoulder. We used a Face Down External Rotation, one side at a time.
Create Space: This is stretching. We used a Back to Floor Weight Assisted Goal Post Stretch.
Take Space: Repeat the Back to Floor External Rotation Test.
Re-Test: Goal here was to see improvement from the first test. If we see measurable improvement in this 5-8 minute process then we know this is a protocol to stick too.
Shoulder Flexion: Here is the 6 step protocol we used for addressing this limitation…
Test: We used the Standing Back to Wall Overhead Reach Test. Passing is getting the thumbs to the wall with back flat and elbows fully extended.
Soft Tissue Work: Using the foam roller we rolled out the lats and teres group.
Create Space: We used the Straight Arm Prayer Stretch
Take Space: We used lift offs from the Straight Arm Prayer Stretch bottom position.
Create Space: We went right back into the Straight Arm Prayer Stretch
Re-Test: Goal here was to see improvement from the first test. If you see improvement in this 4-6 minute process then we know it's a protocol to stick to and progress.
If you are dealing with limited access in external rotation and/or shoulder flexion you can join The Evergreen Outpost [HERE] for access to the full program (for free) with video. And if you’re dealing with something else, let me know how I can help. You may just be the next Athlete Question feature.