By Elena Voropay

Some say that if you never felt a pain in your shoulder, you can't call yourself a bodybuilder. Shoulder Pain is so common among all who get their fix on wearing the tank top, that they have accepted the torment of moving the arms and shoulders as the norm of daily living. But you don't have to follow the same path. By getting to know the Shoulder Joint actions and functions and applying the protective measures, you will join the club of the lucky pain-free bodybuilders. The biggest problem with any shoulder injuries in the extreme mobility of the joint. This makes proper diagnosis not an easy task. From Dislocation and Subluxation (partial dislocation), to Tendonitis and Bursatis, figuring out why you can't work your Traps with Upright Row may be a true challenge.

From all shoulder injuries, Shoulder Impingement is one of the most common causes of the aggrevating pain. If you never thought of it before, you will when you find yourself helpless on the Bench Press, or the Lat Pull-down, or the Shoulder Press, basically any machine that tells the shoulders to move. The unpleasant feeling usually arises from the Rotator Cuff muscles - the supraspinatus, the infraspinatus, the subscapularis, the teres minor and their musculotendinous attachments. These muscles cover the "ball" of the shoulder, or the head of the upper arm bone known as humerus in the special compartment, or glenoid fossa. The Rotator Cuff muscles work together to lift and rotate the shoulder by pulling the ball centrally into the socket and down from the shoulder roof. Individually, each muscle also has micro-managing tasks which becomes problematic.

Precisely, the supraspinatus muscle helps hold the head of the humerus in the glenoid fossa of the scapula. When you workout your upper body too often, you force the muscle to work over time irritating it by repetitive abduction or upper arm elevation to 90 degrees. As a result, you call upon the Shoulder Impingement syndrome with almost all chest, back, and shoulder exercises known for compressing all shoulder structures, such as tendons, bursae, and the long head of the biceps tendon. Since the shoulder-holding tendons are located under the “shoulder roof” called the acromion process, every time you lift your arm the acromion rubs or "impinges" on the surface of the Rotator Cuff causing pain.

Causes of Shoulder Impingement

Any repetitive overhead arm movements may wear down or even rupture tendons laxing the shoulder joint. This is a fool-proof way to Shoulder Impingement. The narrow space between the undersurface of the acromion and the superior aspect of the humeral head is called the impingement interval. With every arm abduction the space narrows setting up a fertile ground for Shoulder Impingement syndrome.

To get a good picture of what's hidden behind your skin, try this demonstration: Curl one hand with the palm facing the ground, make a fist with the other hand and put it in the cupped hand. Your cupped hand is your glenoid fossa and acromion process. Your fist is your humeral head. When the Rotator Cuff muscles are not strong enough to keep the humeral head in its place, your arm starts moving everywhere. Your tendons have to do their own job plus the work of muscles keeping your upper body in one piece. Eventually this repetitive stress inflames the tendons and bursa located under the acromion – the very part that actually impinges these structures when the space between them narrows.

Weak shoulder muscles, tendons and ligaments steal your padded poise making Shoulder Impingement an effortless task. The most common exercises that contribute to the Shoulder Impingement are Upright rows, Lateral and Front Arm Raises (with palms facing the ground). These internally rotate and then elevate the shoulder driving the 'ball' of humerus up into the acromion process, or the shoulder “roof”.

Symptoms of Shoulder Impingement

Impinging your shoulder may not initiate any pain or inflammation straight away – the biggest reason why most don't seek timely treatment. But you can't fool your body – as the time goes by, the radiating pain in movement and rest springs from the front of the shoulder to the side of the arm. Now you know that you've done something wrong with the Rotator Cuff. But what you may not know, is that you've got yourself into a double trouble.

The first trouble is that you have to deal with physical joint torture and emotional pain of not working out. Your second problem is to get the correct diagnosis. Many conditions can mimic Shoulder Impingement, such as Calcific Tendinitis (deposition of Calcium in the supraspinatus tendon),and Acromioclavicular Arthritis.

Shoulder Impingement initially causes edema and/or hemorrhage, all quite common for youngsters under 25 years of age. Generally, at this stage the condition is reversible. If you miss the early stage of injury and don't get appropriate treatment of the damaged joint, your shoulder pain may worsen progressing to eternal never-ending pain, day and night. Pretty soon you won't be able to zip your pants or button your shirt – every snap screams “pain”. In this second stage of Shoulder Impingement, typical for 25-40 year-olds, there may be fibrosis and irreversible tendon changes. The loss of motion may progress to a "Frozen Shoulder” with evident pathologic changes. Stage III generally occurs in patients over 50 and frequently involves a tendon rupture or tear.

So, if you notice swelling and tenderness in the front of the shoulder, pain and stiffness when you lift and lower your arm should be your alarm to see the doc.

Treatment of Shoulder Impingement

To help you solve the problem, go to an Orthopaedic Surgeon – he or she will give a proper diagnosis of Shoulder Impingement by careful symptom review and examination of the joint. X-rays may be essential – a special view on the picture is called an "outlet view" which will show a small bone spur on the front edge of the acromion. The doctor may even request further imaging studies, such as an MRI (magnetic resonance imaging) to note any fluid or inflammation in the bursa and rotator cuff. If your problem is severe enough, partial tearing of the rotator cuff will be identified.

When all diagnostic procedures are over, the initial treatment should focus on minimizing pain. The simplest way is to stop or at least limit all overhead activity. Applying ice to the affected area may help lessen inflammation, but if it sounds like a joke to your inflamed and mutated shoulder, the use of nonsteroidal anti-inflammatory medications may be necessary.

Once you feel better, you may start strengthening and stretching shoulder and forearm muscles . If you follow the instructions to the letter, you may return to the gym without further treatment. And you better take it easy, mate, otherwise your Rotator Cuff will start hurting in no time. You rather see yourself lying on the Bench Press in the gym and not on the operation table in the surgery.

Prevention

Always remember that a repaired Rotator Cuff is an easy one to tear again if you become too ambitious in your training and push your shoulders just a bit more than they can really handle. Patience, patience, my friend, will help you through the rehabilitation period. This is the only way to get back to 'normal' activities and build the picture-perfect upper body you want.

Simple rules of training still apply to all, whether you care about Shoulder Impingement or just want to stay injury-free. They are as important as 'eating vegetables' - everyone knows the are good for you, but this is not enough to put theory to action. Sometimes, these are just things we ought to do regardless of desire. So, just stop contemplating and start doing:

• Warm up all soft tissues before you start training
• Cool down and stretch your arms, shoulders, back and chest after workouts
  
• Watch your form, especially in Lat Pull-Down
• Come to full stops at the top and the bottom of each repetitions to shift the load from the muscles to tendons and ligaments
  
• Progress with your training slowly and steer clear from overtraining
  

 Simple techniques may help you ease the symptoms of Shoulder Impingement

In the meantime, do whatever is in your power to minimize the risk of getting Shoulder Impingement by following these tips:

• Stay away from all exercises that guide the bar behind the neck, such as as pull-downs and shoulder presses (just do these with the bar in front of you). These may also cause neck problems because they require the neck to flex forward in order to get your head out of the bar way
  
  

• Religiously strengthen and stretch the external rotators (infraspinatus and teres minor), scapular retractors (rhomboids and middle traps), internal rotators (chest, anterior delts, and lats) to restore normal biomechanics to the entire shoulder
  
  

• Always balance muscle work – if you work the front, do the same for the back of the joint to maintain stability. For example, if you workout anterior delts with Front Raises, don't forget Bend-Over Lateral Raises for your posterior deltoids. Obsessed with Pecs? Get same pre-occupation with Lats, and so on
  
  
• Dedicate more time to training smaller upper-body muscles. Research has shown that most athletes have overdeveloped pecs and lats relative to their trapezius, rhomboids, posterior deltoids, and posterior rotator cuff (nine times out of ten, to be precise)
  
  
• Try plyometric exercises for your shoulders with medicine balls of various weights. When performed correctly, these are the greatest and much more specific for your Rotator Cuff than conventional resistance exercises. Ball lifts and throws in various directions provide eccentric stretch-shortening cycle movement patterns teaching your muscles to control the shoulder during the powerful concentric actions of the pectorals and anterior deltoid, all involved in throwing or serving Add the following joint-supporting supplements to your regular mountain of pills and powders: Glucosamine, Chondroitin Sulfate, MSM (Methyl Sulfonyl Methane), Hydrolyzed Collagen Protein (Gelatin), Essential Fatty Acids (EFAs)

Before your joints weaken and have a chance to break, fuel them with high quality nutrients from whole foods and additional supplements. These small additions have shown the most promising results in strengthening the connective tissue.

• Glucosamine
• Chondroitin Sulfate
•  MSM (Methyl Sulfonyl Methane)
  
• Collagen Hydrolysate (Gelatin)
  
• Essential Fatty Acids (EFAs) from fish, flax, primrose and borage oil
  
• Green Tea Extract
  
• Curcumin
  
• Humulus Lupulus
  
• Vitamins C, E, B12 Niacin

References

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