How to Build Healthy Shoulders in Functional Fitness

The following is an excerpt about shoulder health in functional fitness from our P360 FCC Coach’s Certification Manual. We will be hosting our first FCC weekend, open to the public for the first time in five years, November 3rd – November 5th.

The shoulder is the most mobile, and also unstable joint in the body. This is a combination that means we must be on our A-game when it comes to training it.

Shoulders, their mobility, stability and health are a complex game as how well they function can be tied to a bunch of different areas. Our pecs, lats, traps, triceps and t-spine all play a role in how it functions, especially in the game of overhead lifting which everyone loves.

Today is going to be a rather in depth look at the shoulder, and ways we can keep it healthy and setting us to work overhead for a long, long time.

Shoulder Articulations

The shoulder complex is generally described as containing four joints:

The Glenohumeral (GH) Joint – Where your humerus (upper arm) meets your scapula (shoulder blade). This is the “ball and socket” joint that is the most mobile joint in the body. The GH joint is often the symptom of shoulder injuries, but rarely the cause.
The Scapulothoracic (STh) joint – Where the scapula moves on your ribcage. This is a very important area most commonly associated with injury prevention given its association with the scapula and all of the surrounding muscles.
The Acromioclavicular (AC) joint – Where your shoulder blade meets your collarbone.
The Sternoclavicular (SC) joint – Where your collarbone meets your sternum.

Requirements for Healthy Overhead Pressing

The ability to establish healthy pressing overhead requires the shoulder pass the following check points. As Kevin Bacon says in a Few Good Men, “These are the facts. And they, are undisputed.”

Have a Strong Foundation in the Lats and Core – Distal mobility requires proximal stability. A shoulder cannot function to it’s proper level without a strong core supporting it. This is priority number one. If the muscles around the mobile shoulder GH joint are tight or weak, the GH joint will try and overcompensate for them and this is when you see compromised positioning and shoulder injury.
Proper Thoracic Spine Mobility – Can’t be too flexed or extended, which will affect rib cage positioning, and ultimately limit shoulder mobility. With the shoulder, mobility comes first. Then, we add stability.
Stability in the Rotator Cuff – These muscles are critical for stabilizing the most unstable joint in the body (shoulder).
Balanced Scapular Muscles – The scapula and the humerus (upper arm) always move in coordination with one another. This is known as scapulo-humeral rhythm. They are a pair, so it’s important that balance in the musculature of the scapula exist, as to not create a faulty position of the scapular, which throws off shoulder movement and function. The scapula is also largely responsible for transferring force from the legs, to the upper extremities.

Major Movement Patterns of the Scapula

Elevation – ie, shrugging in weightlifting pulls. Upper Traps and Levator Scapulae.
Depression – the opposite pattern, a Farmer Walk. Lower Traps.
Retraction – squeezing the scapulae inward at the end of any row. Middle Traps and Rhomboids.
Protraction – The opposite pattern, rolling forward at the start of a row with the elbow extended. Serratus Anterior.
Upward Rotation – Arms moving overhead, lockout of a jerk. Upper and Middle Traps.
Downward Rotation – The opposite pattern, pulling the chest to the bar in a pull-up. Rhomboids and Lower Traps.

Certain gym movements are more dominant towards a specific action of the scapula.As you can see, if you are too dominant in a few areas without creating balance, you run the risk of hard-wiring only a few scapular movements, which will likely lead to an imbalance of muscle development in the scapula. This can work it’s way into the joints of the shoulder and cause injury or faulty movement pattern.

Beginners and Overhead Work?

One of the primary reasons we do not take beginners and immediately overhead press them with the fixed shoulder position of a barbell, is they often lack all four of those requirements (strong core, thoracic mobility, strong rotator cuff, balanced scapular stabilizers). In reality, we would love months and months to develop and reverse poor shoulder posture and function, but we do the best we can with what new athletes will give us. The best starting point is a set of dumbbells and an understanding of why taking it slow is king.

Let’s break down all four requirements.

#1. Strong Foundation in the Lats and Core

Remember the phrase distal mobility requires proximal stability. Refer to our article on both the lats and the core to better understand why they must be performing optimally for the shoulder to in turn perform optimally. If you don’t feel like reading them, then understand that weakness in your lats and anterior core will never produce a properly functioning shoulder. The best analogy is to think about trying to generate power and stability off an unstable surface. It’s not happening. It would be like trying to fire a hunting rifle one-handed.

The lats and the core must be strong for the shoulder to be healthy. This is non-negotiable.

#2. Proper Thoracic Spine Mobility

The human body is one large complex interaction and interdependence between various parts. This is very evident when looking at the shoulder complex and the thoracic spine. Healthy overhead positioning starts in the thoracic spine, particularly, whether or not the T-spine can extend will have great impact on rib cage position.

Rib cage position is very important to shoulder health, because if the rib cage position is faulty, then it is simply not possible for the scapulae, and the humerus (upper arm bone) to to avoid that line of fault when moving under load.

The humerus and the scapula always move in cooperation with one another, known as “scapulo-humeral rhythm”.

So, as we move forward remember the important connection between the rib cage, the scapula, and the shoulder.

Too Much Thoracic Flexion

You must be able to extend their T-spine in order to enjoy healthy overhead pressing. Think about it like this. If you cannot extend, it means they are “locked in” a position of too much rounded flexion (that upper bunch back look). It is only common sense to know that a shoulder, which sits on top of that rounded position, cannot move free and easy in its normal range, right? That flexed T-spine has messed with the natural order of the scapulo-humeral rhythm.

T-Spine Stuck in Flexion / T-Spine with Healthy Extension

When this flexed T-spine is left to persist, a few bad things may ultimately happen.

Upper Crossed Syndrome

This is the condition described above, commonly referred to as the “Computer Desk Disease”, but it has also been called “Bro Syndrome” because of it’s association with too much bench pressing.

Essentially, it is a condition where our pecs, biceps, and upper traps become tight/overactive (remember this concept from Lower Crossed Syndrome), and in combination with certain weak scapular muscles being weak/underactive (serratus anterior, rhomboids), our shoulders are “pulled” forward by our over-active muscles…and we become hunched.

Upper Crossed Syndrome results in the athlete resting in passive internal rotation of the shoulders and protracted scapula. This is the largest precursor to shoulder injury.

Once Upper Crossed Syndrome develops, the next step can be injury in the form of shoulder impingement and/or low back pain.

Upper Crossed Syndrome / Good Posture

Shoulder Impingement

When a weak rotator cuff is consistently overpowered by strong front deltoids (as is the case with too much pressing and not enough pulling, for example), the natural, healthy space between the acromion process and ball of the humerus shrinks. The bursa becomes “impinged” and the tendons underneath become inflamed and irritated. If unaddressed, this can lead to tears.

This is the most common shoulder injury in the gym setting. Clinical studies have shown that a fatigued rotator cuff can cause the humeral head to shift, which narrows the subacromial space and increases the likelihood of impingement.

Low Back Pain

If we somehow manage to escape shoulder impingement, it likely means our lumbar spine has becoming accustomed to going into hyperextension to “jump on the grenade”. In the absence of mobility in a joint, it is always the surrounding joints that come to aid and hypermobilize. In this case, because our thoracic spine would not mobilize, the lumbar spine right beneath it did so that our shoulder move free enough to complete the overhead motion.

We see this commonly when athletes will have an excessive arch in their low back when overhead pressing.

Upper Crossed Syndrome is the precursor to impingement and low back pain. We can help prevent that by establishing good posture during the day and by proper activation of the soft tissue of the shoulder, which we will address next.

Exercises for Thoracic Extension

Bar Pass Overs – This will not train thoracic extension directly, but the act of lengthening the pec minor and major will reduce that forward hunch and pull on the humerus. This will result in more extension ability in the T-spine.

Overhead Squat – At just a PVC pipe, the OH Squat can be a great tool even for those who cannot get into the position safely under a barbell.

Foam Roller Extensions – We prefer to support the head of the athlete with a vertical foam roller placement.
Keeling Thoracic Rotations – Try to keep the pelvis squared to the floor and only rotate in the thoracic spine. We do not want the lumbar to do the rotating here (or really, ever).

#3: Stability in the Rotator Cuff

The rotator cuff provides the necessary soft tissue help to stabilize a very unstable structural set-up in the shoulder.

The rotator cuff consists of four small muscles that originate from the scapulae and connect the humeral head to the shoulder socket.

The rotator cuff consists mainly of four small muscles and is very important to the shoulder’s function.

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

The reason why a strong rotator cuff is important, is because a weak cuff will easily become overpowered by a strong front deltoid. Over time, this leads to the exact imbalances we want to avoid (internally rotated humerus, protracted scapula).

In addition, there is what’s called the weakest link theory at play, and that is, once a muscle group becomes your limiting factor, progress stops. Your body will literally not allow itself to continue to get stronger and develop when a weak leak persists, as a way of protecting itself from injury. And in a lot of instance, weak muscles responsible for joint stability are the biggest culprits, ie. the rotator cuff.

There are training anecdotes from renowned strength coaches who claim to increase an athlete’s bench press by up to thirty to fifty pounds simply by including external rotation into their program, as a way to remove the limitations of strength stability in the shoulder that was inhibiting progress.

So, the rotator cuff plays a very big role in maintaining law and order in the scapulo-humeral rhythm.

Strengthening the Rotator Cuff

External Rotations – Try to keep the elbow pinned by the side as close as possible.

Handcuff Pulls

Scapular Plane Raises – This is the natural plane of the scapula, about 30–45 degrees in front of the frontal plane (side raise). Maintain a thumbs up, neutral grip. As with any raise, make sure not to shrug at the top. Shrugging turns it into a trap exercise.

#4: Balanced Scapular Muscles

Remember, we want to keep the scapula out of passive protraction and the shoulders out of hunched internal rotation (Upper Crossed Syndrome). Most of the abnormal biomechanics and overuse injuries that occur within shoulder girdle can be traced to alterations in the function of the scapular stabilizing muscles.

When we say “balanced”, what we mean is avoiding the dysfunctional development of the Tight/Overactive muscles dominating the antagonist Weak/Inhibited muscles.

The muscles of scapular stability that we want to focus on are:

Serratus Anterior – The primary role of the serratus anterior is to stabilize the scapula during elevation (overhead pressing) and to protract the scapula (push-up, bench press). This is considered to be the most commonly weak muscle of the group because it is very difficult to target.
Rhomboids – The rhomboids are very active in scapular retraction (rowing). We cannot achieve full scapular retraction with weak rhomboids.

Weakness/Inhibition of the Serratus Anterior and Rhomboids is closely associated with Upper Crossed Syndrome.

Trapezius – The traps are a large muscle group in three parts: upper, middle, and lower traps. The upper part is responsible for elevation (hang clean). The middle traps retracts the shoulder blade (rowing). The lower trap contributes to scapular depression, drawing it down and in toward the spine (pull-up). Because they are so big, overdeveloped upper traps can often take over movements and create scapular imbalance, as well as low back pain.
Levator Scapulae – Scapular elevation. This muscle gets tremendous overwork for athletes who focus on “shrug” heavy movements like weightlifting, and who allow their shoulders to elevate on movements where they shouldn’t.

Pressing overhead is a coordinated effort between the upper trap, lower trap and serratus anterior. An over-activation of the upper trap when moving overhead has been shown to be a major contributor to shoulder dysfunction.

Activating the Scapular Muscles

These drills will help target the underdeveloped rhomboid, middle and lower trap.

Banded Retractions – Focus on initiating and finishing the row with retraction of the scapulae.

Wall Slides – With the feet about 8-12” away from the wall, place your hips, T-Spine and head in contact with the wall. Then, in a W position, establish contact with the elbows and wrists. Slide them up the wall until the elbows extend, keeping wrist and elbow contact the entire time. If the athlete cannot maintain contact, complete ROM up until contact is lost.

Protracted Push-Ups – Slight protraction at the top of every push-up rep is a good habit to establish, as it will target the serratus anterior. If we focus on retraction of the scapulae the whole time, the serratus won’t get worked.

Making Sense of it All

To simplify, an athlete with unhealthy shoulders might fit the following profile.

Pushes more than they Pull.
And/or, Pushes with bad mechanics.
- i.e., doesn’t activate the scapula in push-ups by briefly “rounding at top”
- Overhead presses with bad thoracic mobility
And/or, Pulls with bad mechanics.
- Always start any row with retracting the scapula BEFORE flexing the elbow. This will turn on the rhomboids.
- Always start pull-ups by depressing the scapula (aka finding “Giraffe” position)
- Never shrug at the top of a deadlift.
- Think “row low” and depressing the scapula, not shrugging and elevating it. Rowing should not involve a shrug.
Allows their Upper Traps to take over when they shouldn’t.
- i.e. elevating the shoulders on rear delt raises, deadlifts, kettlebell swings, and barbell rows
Develops and reinforces bad posture (aka thoracic flexion) on a daily basis.
- i.e. sits at computer, looks down on phone

Beneficial Movements in the Gym

The following are part of our daily training that are opportunities to improve shoulder function, generically speaking.

Landmine Work – Because of the friendlier angle, landmine pressing is probably the single best thing you can do for your shoulder.
Unilateral DB Work – Dumbbells are your shoulder’s friends. Only a fool sees these as an inferior tool to build strength.
Bottom’s Up Work – Bottom’s up KB work is great at bridging the gap between strength and stability. Athletes who are very strong in the overhead press family should also be able to move relatively impressive weight in the bottom’s up press, where stability and motor control reign supreme. When performing unilateral pressing, always “swing out” a bit (middle image). It will put the scapular and shoulder into a better position.
High Plank Side Bridges – An excellent movement for scapular stability.
Push-Ups (Correctly) – Make sure all push-ups end with slight scapular protraction to ensure the scapula is playing a role in stability.
Turkish Get-Ups or Turkish Sit-Ups – Builds strength and stability in the rotator cuff.
Farmer Walks & Deadlifts – This is literally your rotator keep keeping your arm in its socket. They also both retract and depress the scapula, something most of us want more of.
Rear Delt Raises w/ Pronated Grip – This builds the underactive rear delt that often gets bullied by the biggers, stronger traps.
Quadruped Movement – Helps build shoulder stability.
Ring Rows and Banded Rows – Our easiest and most basic form of scapular retraction.

In Conclusion

Here are the take home notes of what you the athlete can do to ensure your shoulders keep you in the game long-term.

Proper positioning in the thoracic spine, core strength, rotator cuff stability, and balance in the scapular stabilizers are pre-reqs for successful shoulder function.
Stand more. Too much sitting and hunching, in combination with bad gym movement can lead to Upper Crossed Syndrome.
Do not cherry pick. It’s important to include all forms of scapular function across multiple planes of movement.
Do push-ups properly. Take advantage of any band or body weight movement in class that focuses on shoulder function.
Lighter with better function is ALWAYS better than heavier with poor function. Do not add strength to dysfunction.
Avoid overhead pressing with poor thoracic mobility (as usually evidenced by an elevated rib cage).
Row a lot, in any format. And, row properly.

Hopefully this provided a glimpse into the world of the shoulder and how you can better set yourself up to be healthy and successful.

-Dave Thomas
@VirginiaDave

PS. Coaches, our FCC certification will be open to the public for the first time in our gym’s history this November. For more information, and how to apply for this knowledge filled 3-day weekend, visit the official FCC page.

Suggested Reading

Banded Rows for Healthier Shoulders

References:

Moseley JB Jr, Jobe FW, Pink M, Perry J, Tibone JE. EMG analysis of the scapular muscles during a scapular rehabilitation program. Am J Sports Med. 1992;20:128–134

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Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg. 1995;3:319–325

Paine, Russ, and Michael L. Voight. “THE ROLE OF THE SCAPULA.” International Journal of Sports Physical Therapy. Sports Physical Therapy Section, 1 Oct. 2013. Web. 31 Jan. 2017.

Paul, Andrew. The Strength Coach’s Guide to Shoulder Training (n.d.): n. pag.Www.thestrengthcoach.com. 2009. Web.