shoulder

Shoulder Injuries: Rehab, Prevention and the Big Picture

So it looks like shoulder injuries are the most common injury affecting all EricWongMMA readers and subscribers, so that’s what we’re going to talk about.

I gives the peoples what the peoples wants, just like the People’s Champ:

But I’m not going to show you the same old shit of some wimpy little rotator cuff exercises with a rubber band that is somehow supposed to get your shoulder back into shape so you can knock mofoz out with a big right hand.

Oh no. We do things different ‘round here.

I’m going to give you the BIG PICTURE of the shoulder, why it gets hurt, how to fix it when it does and most important of all: how to prevent it.

Shoulder Injuries - The Big Picture

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One caveat – all the talk about injury prevention is great, but the reality is that in a combat sport like MMA, you’re going to get hurt sooner or later. If you don’t, you’re probably doing something that can be better described as Cardio Kickboxing rather than MMA.

What I’m going to show you is how to minimize the amount of stress on your shoulder and ensure the muscles around the shoulder are all working as they should to minimize non traumatic injuries. Ya dig?

This is going to be a 2 part series on shoulder injuries.

Part 1 (what you’re reading here today) is all about the big picture so you’ve got an idea of my total approach.

Part 2 will be shoulder injury exercises and programming. There will be video. That will be coming later this week.

NOTE: If you’re not on my email list yet, get on the damn thing so you don’t have to waste time coming back to my site every few hours, hoping, just hoping that I’ve made an update. OK?

 

Now, let’s get started…

There are a couple of basic acute injury principles that I’ve got to remind you of, in case you’ve recently hurt yourself or if you do in the future.

Basic Acute Injury Principle #1 – If you hurt yourself, icing it as soon as possible is generally a good idea. Ice for 10-15 minutes on, 5-10 minutes off for an hour once or twice daily for a few days after you first hurt yourself. Ice again after anything that aggravates it.

Pain in your shoulder due to inflammation is a great way to screw up motor patterns and timing because your body will compensate to avoid the pain. Icing helps minimize pain and compensatory patterns, so do it.

Basic Acute Injury Principle #2 – If a movement hurts, stop. If you tweak your shoulder and it hurts to throw a punch, stop. You’re only screwing yourself up more. The 2, 4, 8 or 12 weeks of avoiding these painful activities is a drop in the bucket if you want to be fighting or training for the long-term. I know “no pain no gain” and all that but there’s a difference between being tough and being stupid. Be tough, don’t be stupid.

I just hit the heavy bag for the first time since mid-January because of my messed up hand (first MCP joint) and while it’s sucked, it would suck more hurting my hand repeatedly and having to have surgery and be out for 6 months. I have been able to work on other aspects of my game, such as conditioning, footwork, head movement, etc – so there is always something else you can do and probably need to be doing more of anyway. Spend your time on those things and stop wasting time and energy worrying about what you can’t do.

To understand shoulder injuries, rehab and prevention, you’ve got to know a bit about the shoulder. I’m not going to give you a boring anatomy lesson, I’m just going to break down the important info for you in a way that you understand. That’s how I do.

When we think of the shoulder, we usually think of the ball and socket joint. While this is the main part of the shoulder, other areas are important, including:

  • The scapula
  • The clavicle
  • The thoracic spine

Shoulder Injury Anatomy

Everything must work together properly to keep your shoulders healthy: joints must have necessary mobility, muscles must have proper balance of length and strength and good activation patterns. These things all work to ensure the ball moves smoothly in the socket. If something’s not working, nerve impingements, grinding out the capsule or wear of the ligaments occurs. Nasty stuff.

This is a big reason why shoulder injuries happen
so often - there’s a lot of range of motion and a lot
of muscles are needed to control the motion properly.

One common misconception about the shoulder is around the area of the rotator cuff. Because of the name, people think that these muscles are designed for rotational movements. While they do perform these movements, their main job is control and stability of the ball in the socket as you go through real-world movements. So isolating these muscles all the time won’t help train them for the function they are built for, although isolation is needed when imbalances are present (as we’ll talk about in a second).

With respect to direct joint mobility, thoracic spine mobility is the most important to work on and needs to be worked on regularly by anyone who uses a computer, drives a car, watches TV or participates in a sport like MMA or boxing. That means YOU.

Chronic Shoulder Injuries: Practical Demo

Here’s an example of the importance of the thoracic spine on shoulder mobility, particularly shoulder flexion (raising your arms up overhead):

  1. First, hunch over like you’re depressed because your wife or girlfriend just told you, “Sorry honey, it’s true, I have been faking it all this time.”
  2. Next, slowly raise both arms up overhead as far as you can, keeping arms straight and close to your ears.
  3. Now, stand up tall and proud and do the same thing.

Notice how hard it is to get your arms overhead when you’re hunched over and how much more range you have in good posture?

This is what happens when you’ve got chronically bad posture, specifically a hunchback, or the more scientific term “excessive thoracic kyphosis”.

When you’re hunched and your arms are overhead, the ball is getting jammed up in the socket, grinding the capsule and impinging nerves. Not good.

One exercise to address T-spine mobility isthe extension exercise over the foam roller that I show you here, in this classic era EricWongMMA video:

A better exercise for this that I’ve been using now is the Bench Extension warmup exercise, (found in the Mobility Warmup of the Olympic Lifting Mastery Course).

The other joints are controlled more by the active and passive muscle activation patterns at the shoulder vs. limitations in the joints themselves.

I mentioned earlier that “muscles must have proper balance of length and strength and good activation patterns.”

The balance of length and strength across a joint determines the resting position of the joint.

Just like with the thoracic extension example, if your shoulders are rounded forwards (protracted), the same problems at the shoulder will occur: grinding of the capsule and nerve impingements.

This problem is commonly due to something that world-famous therapist Vladimir Janda coined Upper Cross Syndrome.

Upper Cross Syndrome is when the pecs and some posterior neck muscles are strong and tight, while the opposing muscles groups, the deep neck flexors, serratus anterior, rhomboids, lower and middle traps are long and weak.

Upper cross syndrome is commonly associated with shoulder injuries

So what’s the cure?

Lengthen and loosen the strong and tight muscles while activating and strengthening the weak muscles.

Simple, but effective.

Doing so will put your shoulder girdle back into a neutral resting posture, which makes for one happy shoulder joint and one sad orthopedic surgeon.

So far, we’ve talked about the importance of thoracic mobility, addressing muscular imbalances and ensuring that the muscles are activated.

Specific exercises and strategies covering all of these topics to come in Part 2…

You also need gross strength balance across your shoulder joint. Again, the concept is simple. You’ve just got to put it into play. Simply equalize the amount of weight you can lift in a flat dumbbell bench press with the 1-arm dumbbell row. So if you can dumbbell press 80 lbs for 3 reps, you should be able to do at least the same with the 1-arm dumbbell row (if not more). If you’re pressing a lot more than you’re pulling, you’ve got an imbalance that may contribute to a shoulder problem down the road.

The other type of strength you need is absolute strength. In particular, I’ve found that people with shoulder injuries are extremely weak in the Side Lying External Rotation exercise.

First, you need super strict form. Any cheating totally negates the benefit of this exercise and shifts the emphasis on other muscles.

Here’s a video of something I see a lot with this exercise – a lack of ROM:

The big dude is doing the exercise OK, but notice his total lack of ROM. You need more than that – at least 60 degrees, like this girl here:

Important points: go slow, keep your wrist straight throughout and do your first set with a light weight, like 3-5 lbs, so you can see what kind of ROM you can get with a light weight before challenging yourself. You’ll find form quickly deteriorates if the weight used is even slightly too heavy. Any guy who fights should be getting 15-20 lbs for 8-12 reps if they want to bulletproof their shoulders. Girls should be in the 7.5-10 lbs range for 8-12 reps.

The final topic I want to talk about in this article is specificity.

Because we’re mixed martial artists here, we need to address punching and joint locks.

Let’s start with punching.

The first thing that you have to understand is why you don’t do exercises like this:

Punching with bands is the fastest way to a shoulder injury...

Fastest way to a shoulder injury…

The full scoop is here: One of the WORST Exercises for MMA.

For punching, the highest risk for the shoulder is at the very end of your punch when you change directions from throwing it out to bringing it back in. At the end (of a good punch) you turn your fist (internal shoulder rotation) to add that last bit of power. Bringing your fist back is reversing all of the power you put into the punch, starting with external shoulder rotation, which means you need to brake (eccentric) then pull it back.

To train this, you can use an exercise like this:

While it doesn’t look like a punch, it trains the specific strength of the external shoulder rotator muscles needed for when you’re punching hundreds of times a day to prevent throwing your arm out of its socket or overloading the muscles and causing a strain.

Finally, with respect to joint locks, if you’re training and rolling, what I said earlier applies, “Be tough, don’t be stupid.”

One tip that can help is to roll more relaxed. When you’re fighting and grinding away with your training partner, your muscles tend to be more tense. When your muscles are tense, you lose flexibility and if you get caught in an omoplata or something and you’re all tense, you can easily strain or sprain something.

So chill out, work on technique and if you get caught, try to escape but if you’re stuck, tap early, especially with things like shoulder locks.

Phew, that was a long one.

Any feedback, thoughts, comments or questions?

Let me have it in the Comments section below, but first remember to hit ‘Like’ or any of the other fancy sharing buttons below. Thanks for reading and your feedback!


UPDATE

Part II has been published. Check it out before I regain my wits and actually charge for this:

==> INDESTRUCTIBLE: Shoulder Injuries – Rehab & Prevention

I promise that this ebook and the videos will be the most comprehensive yet practical on shoulder injuries you’ve ever seen.

12 Comments

  • Nick

    Reply Reply Mon, March 19, 2012

    I really like the eccentric strength for the external rotators!!! Very creative!

  • darren

    Reply Reply Fri, March 16, 2012

    Hi Eric
    Whats you thoughts on Turkish Get Ups with kettlebells for shoulder stablization exercise

  • Choobie

    Reply Reply Wed, March 14, 2012

    Thanks for this, I have had discomfort in my shoulders for the last 4 months (winter…surprise surprise) from the strain of boxing. I stopped training for a while and then focused more in bjj as I thought I could give my shoulders a relative rest but after a day of getting caught in omaplatas the burning in the shoulders returned. Acupuncture here in china successfully cured most of the soreness and stiffness in the shoulder but the exact exercises you gave here were recommended to me from a bunch of professionals so it is good to see their methods validated by yours. Thanks, you run a great site, your “spam” is the only newsletters I dont delete lately. One question though, you recommend seated rows (such as rowing machine?) over the TRX inverted rows or “lawn mowers?”

  • wayne

    Reply Reply Wed, March 14, 2012

    Great article Eric thanks heaps.I’m sitting in Auckland New Zealand with a ripped rotator cuff – missing my boxing and feed up! Physio has recommended the same style of exercises to rebuild the muscle and strentghen it without surgery. It was good seeing how well that matched your info. Thanks Wayne

  • Josemm

    Reply Reply Tue, March 13, 2012

    Great thanks Eric, I did got caught in a triangle choke but from my knees which means the guy jumped to my shoulders trapping me and with his weight going down to the mat with mine trapped there at the same time well yeah of course I got fucked up at the shoulder I think is called supra spinatus but yeah I have used this exercises since I have them in your programs with the ice and stretching and is all working again now and as you said i also started training other aspects and exercises but with out using that shoulder so i could keep improving other aspects of conditioning in a nutshell all you are saying here is true I have experienced myself.

  • Bruce

    Reply Reply Tue, March 13, 2012

    Hi Eric, another great and very informative post, i am 43 now, work hard in the dojo for 16 – 20 hours a week, always picking up tweaks and looking for ways to keep Fighting Fit and strong. Shoulders and lower back issues are always prevalent and take a lot of work. Thanks

    Bruce

  • Alex

    Reply Reply Tue, March 13, 2012

    Very good article..
    I practice external and internal rotation standing up on a pulley, i find it much better because you can do both and the strength curve is also better.. what do you think about it ?

  • JC

    Reply Reply Tue, March 13, 2012

    I understand what you said about the resistance band punching but I was wondering what you opinion would be of instead of resisting the punch how about if it was being pulled? Such as in this video at :13 sec

    http://www.youtube.com/watch?v=sJnVAJoUrL0

    Also yeah I’ve had shoulder problems for about 3 years now due to relying too much on my natural shoulder flexibility. So having you write an article about this is a true blessing.

    Thanks Eric you

  • ace

    Reply Reply Mon, March 12, 2012

    Awesome info ,this will help me heaps with my shoulder problems
    Thanks man!

  • Steve VB

    Reply Reply Mon, March 12, 2012

    Eric as normal awesome info and ya hit the nail on the head, yet again. Q’s for you, that nerve pinching your talking about is that likely to cause tingling in the hand, specifically the thumb and first two fingers?

  • chris

    Reply Reply Mon, March 12, 2012

    hey Eric, firstly thank you for all this amazing info. im 34, i have had a shoulder injury 15 years plus, i slipped on ice & took the full fall on the outside of my elbow, obviously my shoulder didnt thank me for it. i was in a lot of pain for a few days but never got medical advice as i was “young & invincible” haha, anyway it nags me if i lift a heavy shopping bag or if i lift things above my head, some days its hardly noticeable at all, some days it nags a bit. it doesnt stop me doing anything in general, ive been to boxing, jeet kune do..etc in the past & its never really bothered me but im considering going to my local mma gym & this is my concern. sorry for the long winded explanation but my question is…can i sort this out myself with some of the exercises mentioned (although ive lifted weights & done bodyweight exercises ive never done any of the above) or does it sound like surgery is my only option?? thank you for reading…chris.

  • Paul

    Reply Reply Mon, March 12, 2012

    Thanks for the tips Eric :)

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