All About Shoulder Strength & Stability

How to maximize your shoulders’ ability to move in a safe and injury resistance manner.

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You have a choice. You can either move around in almost any direction, but be at a high risk of injury, or you can be strong, stable, and at a low risk of injury, but you can only move around a little bit. Which choice sounds better to you? Well, if you’re the joints of the hands and feet you chose the latter. But if you’re the shoulder joint, you chose the former. Being such a dynamic joint with a very low level of stability, the shoulder is  naturally very prone to injury. That’s why today’s post is all about how to maximize your shoulders’ ability to move in a safe and injury resistance manner.
How It Works
There’s a lot of moving parts when we talk about getting the arm overhead. There are 12 ribs and their spinal attachments, 10 of which have attachments at the chest. You also have scapular motion through 3 dimensions (to the side, to the front, and rotations), humeral rotation and alignment within the glenoid fossa, AC and SC joint motions or limitations, spinal motion of, at minimum, the 12 thoracic spine segments, and 24 muscles that attach through the thoracic spine, scapula and humerus. In total, there’s motion from 38 joints, making for a whole lot of potential for things to get wonky. By simply raising your arms overhead, a trained eye can tell a lot about what’s going on in the upper body. Take a look at the table below, or this video, to see how important it is for the muscles and the joints of the upper body to be in sync (1).
Inline image 1
What’s The Worst That Could Happen?
One thing that drives the issues seen above is the ever-growing tendency for us to sit! Putting other health issues aside, sitting is bad for us because it drives poor posture. Sitting drives the head forward and bends the spine in a way that makes it difficult for the shoulders to allow the arm to get overhead. It also decreases the flexibility of the big Lats and reduces the strength of the lower traps, rotator cuff, and serratus anterior (2). You may not care about those muscles, but what you probably care about is the fact that these issues can cause problems that include subacromial impingement, rotator cuff tears, glenohumeral inferior instability, sternoclavicular joint pain, acromioclavicular joint pain, glenohumeral osteoarthritis, frozen shoulder syndrome, scoliosis, lateral epicondylalgia, kyphosis, thoracic outlet syndrome, headaches, neck pain, and upper crossed syndrome (3,4). YIKES! 
 
Inline image 2
 
What’s The Best Solution?
The best solution always depends on the problem. So what’s your problem? Well, if you have to ask, you may want to seek out a professional to help you find out. In general, most people should work on a few things in particular. If you are fit and looking to do overhead or military presses to get big strong shoulders, you need to work on technique and changing up your mode of training (i.e. using resistance bands with dumbbells, bottoms up training, or changing the plane of motion). If you’re not quite ready for that level of intensity, you should be working on some basics. Essentially, you need to get some scapular (shoulder blade) positional stability and glenohumeral stability. Try to resist rotating the torso, and use a little bit of abs to hold it all together. Here are some great exercises to work on basic shoulder stability (5,6):
 
Inline image 3
 
Prone extension – Lie face down with the shoulders resting in 90° and raise the arms up off of the ground
Forward flexion in side lying – While lying on your side with your top arm straight, raise and lower your arm off of the ground
External rotation in side lying – While lying on your side elbow flexed 90°, rotate your arm upward with a towel between the elbow and trunk to avoid compensatory movements
Prone horizontal abduction with external rotation – While lying face down hands by your hips, raise your arms off of the ground and squeeze your shoulders together
Push up plus – While in a push up position against a wall or on the ground, perform a full push up and emphasis on an extra push once the arms are fully extended (bonus points for using an unstable surface)
Plank walking – Hold a push-up position with the feet together and walk the hands sideways while keeping the feet in place making an arch
Bottom Line
To have healthy shoulders, good posture, and lower chances of upper body pain and injury, you need to work on the basics. External rotation exercises are underappreciated by almost everyone. Whether you like to lift heavy weights, or if you simply want to place a can of beans on the top shelf without pain, you need to be working on shoulder health. And while there are many ways to achieve happy shoulders, simply working on the muscles of the back is a good place to start. So, sit up in your chair, roll your shoulders back a few times, and take a deep belly breath. See how easy it is to get started?!
References
1. Howe, L., & Blagrove, R. (2015). Shoulder function during overhead lifting tasks: implications for screening athletes. Strength and Conditioning Journal, 37(5). 
2. Weon, J., Oh, J., Cynn, H., Kim, Y., Kwon, O., & Yi, C. (2010). Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork & Movement Therapies, 14(4), 367-374. doi:10.1016/j.jbmt.2009.06.006
3. Nagai, K., Tateuchi, H., Takashima, S., Miyasaka, J., Hasegawa, S., Arai, R.. . Ichihashi, N. (2013). Effects of trunk rotation on scapular kinematics and muscle activity during humeral elevation. Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology, 23(3), 679-687. doi:10.1016/j.jelekin.2013.01.012
4. Fayad, F., Roby-Brami, A., Yazbeck, C., Hanneton, S., Lefevre-Colau, M., Gautheron, V.. . Revel, M. (2008). Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder. Journal of Biomechanics, 41(2), 326-332. doi:10.1016/j.jbiomech.2007.09.004
5. De Mey, K., Danneels, L., Cagnie, B., & Cools, A. M. (2012). Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: Effect of a 6-week training program on muscle recruitment and functional outcome. The American Journal of Sports Medicine, 40(8), 1906-1915
6. de Araújo, R. C., de Andrade, R., Tucci, H. T., Martins, J., & de Oliveira, A. S. (2011). Shoulder muscular activity during isometric three-point kneeling exercise on stable and unstable surfaces. Journal of Applied Biomechanics, 27(3), 192.

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