Shoulder – Preventative Maintenance
Duane Godfrey has been Barefooting for 12+ years. He is a member of the Canadian National Open Mens Barefoot Team. Duane counts amongst his many accomplishments “recovering from injury.” Strangely enough, his column in BarefooterHQ is on that very topic!
What do Brian Heeney, Mike Holt, Joe Pressendo, Dave Miller, Terri Larson and yours truly have in common…besides being old farts (sorry Terri)? Before you can answer shall we pause for a commercial?
The mechanic says to his customer “You can pay me now or pay me later”
We are talking about preventive maintenance and recurring shoulder stress. The skiers above are world competitors who had shoulder surgery over the past few months…6 skiers under the knife and relegated to long and arduous rehabilitation. This is not just an infliction of the old; aggravation and injury can occur at any age. Why then, you might ask, are the best skiers unaffected? For one; they are in the best shape and two; they ski in perfect position, turn correctly and maintain perfect position. Therefore preventive maintenance comes from both skiing correctly and strengthening. Many of us are negligent on both counts though personally, the former attribute has eluded me.
I was diagnosed with a full thickness tear over 5 years ago and managed to keep it at bay through constant stretching and strengthening of the rotator cuff muscles; rehab and preventive maintenance definitely work. In the end I could not keep my arm pulled in hence contacted the local surgeon… 6 hr surgery and 3 mos later, I can now lift a 2lb weight above my head and do one pushup. You too can experience this fun filled atrophy … or you can be a proactive. I recommend “prehab” over “rehab” and will interject my opinions on ski fitness.
Please look at the following to increase your understanding of how the shoulder works and see what comprises the rotator cuff. Note the complex muscle and tendon system that keep the shoulder in its “socket” or the humerus head within the labrum. The shoulder is designed to be inherently unstable to achieve remarkable ROM (range of motion). The Amazing Amy, my athletic therapist, likens it to a golf ball on a tee where the rotator cuff muscles allow it to move and stay balanced in the tee. The goal here is to gain an appreciation of the shoulder’s fragile complexity and what it is you are trying to protect. Just watch a bit and take what you like out of it:
a bit lengthy but you can see how the humerus is moved.
An explanation of the Muscles attached to the Humerus,
…if only to see the complexity and potential for injury
When we ski, particularly whilst turning, there can be tremendous forces exerted on the shoulder(s), particularly when out of position. (Chest proud, look where you’ve been, trust the turning leg and keep the arm in…) are WBC mantra that will prevent being pulled out of position…(and note to self: don’t hang onto falls) Also, a windmill fall, where the limbs are flailing during the cart-wheeling water entry can whip the shoulder past its normal limits. A skier with better ROM has a better chance of surviving this intact.
A tear to one or more tendons, the labrum and other structures can be the result of one hard fall or cumulative repetitive strain and inflammation. The ensuing discomfort from repetitive strain can likely be relieved by icing and taking an anti-inflammatory and/or just laying off for a while. An inflamed supraspinatus tendon can rub on bone like little piranha teeth, gradually cutting a bigger and bigger tear until the only remedy is surgery… and quite a relief at that.
So, let’s get to the point: We all stay in decent shape and workout regularly…right? We know this is a physically demanding sport requiring a minimum threshold of strength and superior muscle tone and flexibility. We therefore know we need to prepare ourselves physically to meet the demands. The fitter you are, the more resistant you will be to the inevitable falls, forces and strains. Since shoulder pain/injury is perhaps the most common malady, why wouldn’t we spend just a bit of time strengthening and toning those structures that keep the shoulder secure?
Unfortunately, I feel this has been a neglected area of thought/exercise. So, find some time to do rotator cuff exercises and/or combine them with other exercises to save time. Here is my opinion/recommendation to get the best bang for the buck for overall fitness:
• Don’t lift heavy weights – strive for lean. You want a high strength to weight ratio for this sport. Do all exercises perfectly and isolate – you can’t isolate and achieve perfection with too heavy a weight as you will employ the “wrong” muscles while the “required” muscles undergo atrophy. The result of this will produce incorrect firing patterns that exacerbate the situation and create a habit that is very difficult to retrain. (This is a whole other issue that is prominent in arthritic knees where atrophy can cause complete shutdown of certain muscles hence compensation and an ingrained non-synchronous firing pattern…another battle I am fighting.)
• Balance while exercising and try off balance exercising to get the proprioceptors firing
• Perform explosive exercise – plyometrics…leaping, lunging etc
• Take care of your frame – strengthen the core, commit to yoga or another regime for flexibility and calm. Take all stretching and rotator cuff exercises to the full ROM and hold for 30s. Many of the yoga poses increase ROM and strengthen the rotator cuff hence it is a very good form of exercise for barefoot water skiing.
• Do regular rotator cuff exercises and stretches with a cane or dowel, Theraband and very light dumbbells. Combine with leg exercises.
I have 18 exercises done in 3 sets that take around 40min performed 3x/day…keeping in mind that 3 tendons were re-attached and the labrum was fully lacerated. You would only require a few because prehab is a lot easier than rehab! I also do a lot of stretching and exercise of the shoulder while walking. At completion of rehab and embarking on prehab maintenance, it will probably take 5-10min a couple times/day or, stretch before and exercise after skiing. Or just do something for the shoulder whenever it crosses your mind – you don’t have to be in a gym, at a set time and place, to shoulder strengthen. The following exercises are pretty simple to do however it is imperative to stretch and exercise to absolute full ROM:
• Inner and outer rotation at varying angles – be creative here
• Flexion (forward), Extension (behind), 45degree plane and abduction (side) with thumbs up, thumbs down and palms down. I prefer exhaling going up and exhaling going down. At the top, strain for every last 2.54 cm upwards.
• Small, controlled arm circles or alphabets at all angles and writing the alpahabet on the wall rolling a tennis ball in front mid and high and to the side mid and high and behind.
There are lots of examples on youtube that illustrate the above. The following is just one example of a few exercises. I like the method except for the last exercise where it should be done a lot slower and to full ROM…probably requires a lighter weight. Do this while rolling your IT band and this can be one of your greatest hits!
The following has some good stretches
All the above can be done, anytime anywhere, with or without very light weights and/or using a $5 Theraband or tubing. I have never lifted more than 5lbs doing rotator cuff exercises and the band can be taken anywhere. One needs to constantly remind oneself to pull the shoulders back and down and hold them there while concentrating on being still/statuesque and using the back to derive and increase the movement to the full ROM. The rhomboids will become stronger and you will be using/strengthening the rotator cuff muscles properly since they attach at the scapula. In other words, do all the exercises with concrete posture and really isolate. Watch and learn from others who exercise incorrectly ie see someone doing arm circles or lifts by throwing their shoulder using the large muscles and momentum to get the arm around…do it yourself incorrectly then do it controlled by not moving the shoulder or traps – notice and feel the difference in your lats– see that your better way takes a lot more effort and tires your back; realizing that your method is correct and actually exercises the small rotator cuff muscles. Why not balance on one leg whilst doing this and rip off one legged squats for good measure?
Bring shoulder awareness and posture into your constant conscious thought. What I mean by constant is to always think when raising your arm to do so without raising the shoulder using your scapular muscles to achieve the movement. When you reach maximum height, stretch for more and you will be further using the rotator cuff muscles to achieve “accessory movement” of the humerus head to the limit of the cuff. It takes conscious effort but it will become habit. Constant would also mean doing the exercises while walking and/or exercising the legs in your gym.
Shoulder exercises when done properly have the bonus effect of forcing correct posture; better posture makes for better resistance to the pull. The goal while skiing would be to ski relaxed yet hold posture while positioning the shoulders as indicated above. This positioning will greatly relieve forces on the rotator cuff. When I get back in the late spring, I will be doing my absolute best to keep my shoulders secure and not allow being pulled out of position….and really; this is in fact exactly what is instilled at WBC. I don’t want to throw away all this hard work!
Do you love barefoot skiing? Want to do it for a long time? Want to ski your best and avoid the knife? Performing shoulder prehab will minimize chance for injury and make you a better and more durable skier.
Good luck. Hope to see you soon on the dock warming up those shoulders.