I sent off an email to my good friend Alwyn Cosgrove about our new Optimal Shoulder Performance DVD set , and he asked me what I thought were the three most important things that folks - from fitness professionals to regular ol’ weekend warriors - ought to know with respect to the shoulder. Here were the first concepts that came to mind:
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.