Sunday, July 25, 2021

4 Exercises To Avoid If You Have Shoulder Pain

We've seen quite a few patients in our clinic recently with shoulder injuries after exercising at gyms. Often, the patients will ask how soon they can get back to their regular gym exercise routine. 

I haven't found any published evidence for what I'm suggesting. They are based purely on my personal observations, treating many patients with shoulder pain and of course doing the same exercises myself.

So here are a few exercises to avoid in the gym (at least until the pain ceases) if you currently have shoulder pain.

First up is the behind neck Lat (Latissimus Dorsi) pull downs. The bar behind the head position potentially creates a situation where the humerus (arm bone) can move too much in front. Majority of the time, it is due to lack of scapular retraction. This creates a scenario whereby they need more than average shoulder extension to get their elbows behind the body so the bar  can clear the back of their head. This places high loads on the front of the shoulder  and can potentially damage the anterior glenohumeral ligaments and the Biceps Brachii tendon. 

Next is behind the neck shoulder press. This is similar to the Lat pull down, but more damaging. When pressing up, the Deltoid muscles have to work, whereas during a pull, the Latissimus Dorsi works. The Deltoid abducts the shoulder and also elevates the humerus into the acromion process. So a pulling movement with the Latissimus Dorsi will pull the humerus away from the acromion and reduce shoulder impingement. However, the behind the neck shoulder press can potentially cause shoulder impingement.

The upright row. A lot of people 'cheat' by extending their lower back to get the bar up when the weight is too heavy for them. At the top of the pull, the elbows are in a higher position than the arms putting the shoulders into abduction and internal rotation. This position can cause or worsen shoulder impingement since our shoulder should naturally externally rotate with shoulder abduction. 

Dips. I used to do lots of parallel bar dips as a kid, but I hardly do them now. Try it yourself, when dipping, there are super high tensile loads on the front of the shoulder at the bottom of the dip. The Biceps tendon, anterior shoulder capsule, and Subscapularis tendon are all under huge loads. The scapula is also tilting anteriorly at the bottom of the dip. Much worse if you add weights attached to the waist.

If you do the above exercises occasionally, I'm fairly certain no harm or damage is done. But if done regularly, with high load and especially if you have a pre-existing shoulder dysfunction, they can definitely make your shoulder worse.

Don't get me wrong, the above mentioned exercises are not bad exercises to do at the gym. It's just that some of us do not have the perfect joint placement for certain exercises, due to imbalances and underlying movement restrictions, that makes those exercises damaging.

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