Injury Tips

Shoulder Do's and Do Nots
By Kathleen Anderson, OTR, LCHT; President/Therapist, Physical Therapy and Upper Extremity Specialists

Many athletes perform certain stretches and exercises that are harmful to their shoulders. There are also certain grip positions in the gym that can damage the shoulder joint, and can lead to arthritis in and around the shoulder.

First, a brief anatomy lesson. Let's start with the scapula, which is located on the back of the shoulder. The scapula has a ridge running horizontally across its surface, and this ridge wraps around to the front of the shoulder. The terminal end of that ridge is called the acromion process. The acromion process floats just over the insertion of the four rotator cuff (RC) tendons. These tendons attach on a piece of bone called the greater tuberosity, located on the top of the upper arm bone (humerus). The primary purpose of the RC muscles is to provide stability to the shoulder complex.

When you raise your arm up with the palm facing downward, the acromion process lines up directly over the (RC) tendons and often pinches either those tendons or the bursa (a sac of fluid which acts as a shock absorber between the acromion process and the greater tuberosity). In contrast, if you turn the palm inward or upward, the greater tuberosity will rotate to the outside of the arm and away from being positioned under the acromion process. This way you avoid impingement of the rotator cuff tendons.

Another way to avoid pinching the RC tendons and/or the bursa, is to drop your scapula toward your waist while you raise your arm overhead. When you avoid hiking the shoulder while raising the arm, you prevent the acromion from gliding forward towards the RC tendons and bursa.

When in the gym, keep both the two major tips in mind to avoid RC impingement. For example, when a piece of equipment such as the chest press provides two options to grip the chest bar, choose the positioning with your palms turned inward, and be sure to drop the shoulder downward to avoid pinching the RC tendons and bursa.

Symptoms of rotator cuff impingement include a sharp pinching sensation in the top and front portion of the shoulder when the arm is placed in certain positions. The pain often radiates down the arm and across the top of the shoulder towards the neck.

With bursitis, there is usually tenderness when you press on the outside of the shoulder, and the pain often radiates down the middle deltoid. Each of these diagnoses are commonly treated in physical therapy. If they go untreated, you may develop a frozen shoulder, or have chronic pain and stiffness.