Preventing Shoulder Injuries
I titled this article preventing injuries, but that is a little of a misnomer. Contrary to popular belief, there are no perfect ways to prevent injuries. Fact of the matter is that injuries occur. Now what we can do is reduce the risk of injuries. So today I am going to focus on what we can do to reduce the risk of sustaining a shoulder injury.
First up, as always is strength. I like strength as a metric because it is undeniable, very easy to reproduce and trackable. Stronger individuals are always less likely to be injured for a couple reasons. First, with strength, the brain is able to pull the body out of bad positions without injuring passive tissues (ligaments). Next is the training to obtain and maintain strength. If an individual is strength training, they are less likely to fall into the category of overuse injuries that we often see pop up in athletes when a season starts. These are athletes that are coming into the season with a good fitness base or GPP (general physical preparedness), which allows them to ramp up sport specific activity and not sustain an injury. So how strong is strong enough? There is not an enormous body of literature on this but there are few metrics I found. For absolute strength, it is recommended that for a single arm dumbbell overhead press males be able to do 40% of their body weight for 1 repetition and females do 30% of their body weight. For a neutral grip pull up, it is recommended that males be able to do 140% of their body weight for 1 repetition and females do 100% of their body weight for 1 repetition. These are what is known as functional strength standards. There is always some variability in these, especially depending on sport. If you fall below it, don’t fret, it does not mean you are doomed for a plague of injuries, but you should be programming in some strength training. It also tells us that more strength above that point may not be beneficial, unless you are in a pure strength sport like olympic or powerlifting. We all have limited time and once you achieve adequate strength, it might be wise to start focusing on other aspects of athletic development and lifting enough to maintain the strength you already have. No pitcher won a Cy Young because he had the biggest bench, but many pitchers never won because their careers were plagued with injuries.
Next under the umbrella of strength is strength ratios. These ratios were developed after following high level baseball pitchers but they seem to apply pretty well across the board. They look at not how much strength someone has but how that strength is shared across a joint. When we have large imbalances in muscle strength across a joint, the way force gets transmitted can become altered and we often see mechanical break down and other structures start to wear out, think labrum in the shoulder. For the shoulder, the ratio of lifting your arm straight up to the side and turning it outwards should be at least .86. Anything below a .7 was indicative of a tear in the supraspinatus tendon. The ratio of turning your arm out vs turning it in should be 1.0 to .75. Anything below a .75 increased the likelihood of that athlete becoming injured over that season.
Skill/technique is the second major category of injury risk reduction. We are not going to go over all the differences in mechanics of all sports but I do want to say one thing about mechanics. Make sure the mechanics that an athlete is being taught match their body. If you ask a golfer to extend and rotate their mid back but they can’t do it, they will compensate and injure something. It is much better to teach them to swing in a slightly different fashion and avoid injury and allow them to be more consistent. For most sports, there are no perfect mechanics. Many greats in many sports play in different manners and all achieve great results. For any sport there are certain things that do have to happen. Randy Johnson pitched in a different way than Nolan Ryan and from Sandy Kofax. All legends at their position. They all do a couple things similar though, like they don’t start their upper body rotation until their lead leg makes ground contact. This allows them to be very efficient and transmit power from their lower body to their upper and into the ball. My whole point being, as long as the techniques learned respect the kinematic sequence and are very efficient for the athlete and they have the range of motion to do them, one is not better than others.
In an effort to keep this to a manageable length, I will close out this topic next week.
