In November of 2009, just over 40 rehabilitation specialists, fitness professionals, and athletes gathered at Cressey Performance to spend the day learning about “everything shoulder.”  This seminar bridged the gap between injured athletes looking to get healthy and those performing at high levels and looking to stay healthy. Optimal Shoulder Performance: From Rehabilitation to High Performance draws upon the expertise of two industry professionals, Mike Reinold and Eric Cressey, who have devoted countless hours to this commonly injured joint.
Eric has been kind enough to share three key things every personal trainer should know about the shoulder:

1. You should NEVER be intimidated when you hear/see the words “rotator cuff tear” or “labral tear.” Why?  Because if you are training clients, you are absolutely, positively already training people who have these issues but are 100% asymptomatic.  Some interesting research:

Miniaci et al. (2003) found that 79% of professional baseball pitchers – the people who put the most stress on their shoulders on the planet – actually had “abnormal labrum” features.  They concluded that “magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of ‘nonclinical’ findings.”

Meanwhile, rotator cuff tears often go completely unnoticed. Sher et al. (1995) took MRIs on the shoulders of 96 asymptomatic subjects, and found cuff tears in 34% of cases, and 54% of those older than 60.  Meanwhile, another Miniaci study (1995) found ZERO completely normal rotator cuffs in those under the age of 50 out of a sample size of 30 shoulders.

What’s my point?  Both the people who are in pain AND those who have absolutely no pain can have disastrous looking shoulder MRIs.  So, in many cases, it is something other than just the structural deficit that causes certain people to experience pain.  To me, that difference is how they move.

A torn labrum may become symptomatic in a thrower with poor shoulder internal rotation.  Or, a partial thickness cuff tear my reach the pain threshold in a lifter who doesn’t have adequate scapular stability.

In short, a MRI report doesn’t tell you everything there is to know about a shoulder – and you need to assume that a lot of your clients are already jacked up.

2. When assessing a shoulder, everything starts with total motion. In healthy shoulders, total motion – which comes from adding internal rotation and external rotation – should be the same on the right and left side.  This “arc” may occur in a different place on each shoulder, but as long as it’s symmetrical from side-to-side, you’re off to a good start – and that’s when you work further down the chain to see what’s going on with scapula stability, thoracic spine mobility, etc.

3. 100% of all shoulder problems involve scapular dysfunction. The interaction of the glenoid fossa of the scapula (socket) and humeral head (ball) is what allows the glenohumeral joint (shoulder) to do what it needs to do.  However, most individuals have some form of shortness (e.g., pec minor, levator scapulae) or weakness (e.g., serratus anterior, lower trapezius) of muscles working on the scapula.  These inefficiencies alter glenohumeral alignment and increases stress on the rotator cuff, biceps tendon, labrum, and glenohumeral ligaments.  Identifying and addressing scapular issues is a key step in preventing shoulder pain.

I personally have learned so much about training the shoulder through these 2 guys and know that this 4 DVD set is jam packed with information that will be beneficial to everybody that helps people realize their physical and athletic goals.

Be sure to check out Optimal Shoulder Performance so you can help your clients and athletes get better.