Preventing and fixing shoulder injuries can be sexy or at least allow you to work hard enough to get sexy.
Today is another interview. This time I am talking with with Taylor Weglicki, a fantastic DPT, that has helped me and many friends with a host of issues. And he has done this through the internet by analyzing specific movements on video and prescribing routines to fix the dysfunctions. Today we are talking about shoulders, one joint that seems to give many people a large amount of problems, especially since everyone's favorite movement is benching.
As interviews normally start give me a quick rundown of what you do and your path to get there?
I've been a PT since graduating with my DPT in May 2012. I originally was on a path towards Med School with my bachelor's in Biochemistry, but decided against it because I felt more of a pull towards physical therapy and patient-family centered care practices. I've worked in Outpatient Orthopedics, a 5 star Children's Hospital, have saved a clinic as it's director, started my own online PT consulting business with a biomechanics specialist as my partner, and currently work in skilled nursing/outpatient orthopedics in rural Mississippi. Pretty packed first few years of my career I'd say.
I currently manage my online business as well as consult with Complete Human Performance, while working the typical 40 hour work week at the hospital.
What's the biggest problem exercise you see with shoulder injuries?
Honestly the biggest issue I see with shoulder injuries is crappy movement patterns. People are probably sick of hearing about their posture, but it plays a major role in how you move. If your starting position sucks, how do you think it's going to look by the end, or under load for that matter? Unfortunately, not many people are familiar with the work of people like Sahrmann and don't look for these issues in the first place.
Benching: how do we keep our shoulder safe?
First and foremost, make sure you get someone to critique your form. Video will suffice, but traveling to see a local expert is your best bet. There are so many ways to bench depending on your individual limb lengths, and each person needs to tailor his setup and form to his individual needs. From a muscular standpoint, there are much better ways to engage pecs than the standard barbell bench, so for those not competing in powerlifting or a push dominant sport, I'd argue the lift isn't that important for you in the first place.
What can be done to avoid or prevent these shoulder injuries?
The best thing to do is start with the proper warmup. Now that I'm away from the amazing gym I had in Memphis (NBS Fitness, everyone should go once) I'm back training in a commerical gym. The most common warmup is 135 x5-10, 185x5, 225 x1-2 if they go any higher. Then they stand up and complain about how their shoulders hurt, but they have horribly internally rotated resting posture, and virtually no setup for the bench other than laying down and grabbing the bar.
One of the things about a competition bench setup is that with a reasonable grip width, your shoulder has a pretty safe movement pattern. This is easily ruined by super wide grips and crap mobility though, so make sure you have a professional check your movement patterns if you seriously intend to bench heavy. This may sound unreasonable to many, but otherwise I'll just see you in rehab once you injure yourself.
What is your Favorite warm up for shoulders?
We have a general warmup that the gym owner developed that I think is fantastic for multiple reasons: 1) it creates movement in multiple planes, 2) it follows a general cardio warmup, 3) it attempts to move the lifter in the planes that generally most people suck at. It goes as follows
1) 5 minutes general warmup on stairmill, treadmill etc
2) 25 Jumping Jacks
3) 15 Split Jacks (alternate legs forward/backward into lunge position)
4) 10 forward/10 backward arms circles palms down
5) 10 forward/10 backward arm circles palms up
6) Wall slides x207) Lifter specific mobility/soft tissue work
Which should we use: Stretches vs dynamic warmups? Where and when for both?
I prefer dynamic warmups prior to heavy work. If you are absolutely horrible mobility wise, I will sometimes prescribe some soft tissue work prior, but that is rare and in worst case scenarios. Typically do stretching and mobilizations afterwards to increased range, and focus specifically on dynamic warmups prior to prepare the tissues for loading.
If things go wrong what are your first assessments of finding whats hurt and what to do to fix it?
First thing is to find the mechanism of injury. Watching a person move as they come into my clinic and then finding the reason they're here is a great first step and usually eliminates a lot of work. Based on findings and a few special tests, I then develop a plan of action based on their needs/goals. Every shoulder injury is different, but most people benefit from postural awareness and correction in coordination with improving mobility and motor patterns of the shoulder complex.
It's complex to fix, but what are some insights people can use to do self correction? At what point is it time to go see a professional (other than always)?
Generally, if you take a week off all pressing and work on shoulder packing (setting scapula down and back with all daily activities, prolonged sitting, etc) and there's no improvements, it's time to consult a professional. Anecdotally, I'm finding that a lot of athletes with complaints of tendonitis symptoms over a prolonged period or with recurring symptoms tend to end up with tears of the same structures down the line. Scary to think about.
Behind the neck presses or pulldowns….dangerous?
This is a fun one. So, there are three types of acromion structures typically found in the human shoulder. Of note, only one of these will really allow you to perform behind the neck work safely, and less than 10% of the general population has them if I remember correctly.
Note that this is just a figure I remember from school, so I may be a bit off on the exact number, but suffice it to say that most people shouldn't perform these exercises. Training needs to be bang for your buck, and if the exercise has a more significant chance of hurting you than helping you achieve your goal, is it worth it? I do think you could likely implement these to ear level if you have decent mobility though. It's definitely person dependent.
If you could choose 1 exercise for the most help with shoulder health what would it be?
This is tough. Seriously. I wouldn't even choose an exercise per se. I'd have everyone work on packing the shoulders. An easy cue is to shrug up, then back then down. Hold that position with the shoulders down and recognize how it feels. That's a great place to start for any overhead pressing, and powerlifters will recognize the cue as something many do in their bench setups. It's basically the position for success in the shoulder and more people should be working on it, in my opinion.
Currently what does your own prehab look like for shoulders?
I've worked particularly hard on my own shoulders. The shoulder packing is something I do prior to every text and I have timers set to remind me when I have to be at a computer for a while. I have torn labrums in both shoulders, but they aren't symptomatic yet. I have to be very particular to limit mobilization of my shoulders so I don't compromise stability, all while working to ensure I do not get so tight that I end up injuring them further.
My warmup is exactly as listed earlier, but I also do some bodyweight pushups and 3-4x10 with the bar for any overhead/bench movement before moving up. I typically make smaller jumps as I move up on either lift as well to ensure my form doesn't break. I may not make as swift progress training as such, but my shoulders don't hurt. And honestly, training is all about longevity of the meatsuit you have, right?
I have to say meatsuit is new to me and I will be stealing that for ample use. In closing what is your final thought on shoulder injuries and prevention?
The biggest problem I see in regards to shoulder health is Ego. Everyone wants a bigger bench. But no one really wants to train their back. Think of how many spoonback looking lifters you see with halfway decent benches but awful balance in their physiques. If you train your back with the same intensity (or more) than you train your press, you will generally progress for a long time with far fewer issues. If you aren't sure, just look at the overall volume between pressing and pulling, and you'll have your answer.
This was a great interview and I hope this ends up helping you with either fixing your shoulders or better yet keeping them healthy. Major takeaways for me were shoulder position (packing the shoulder), which is a new position for many people considering the rampant horrible posture. Warmup up better. And then back sure to work the opposing musculature
Find more about Taylor and if you need someone to fix you up (like I do pretty much every couple of months as I neglect my body) find him here. And you can find out more here.
Personally I recommend looking into getting some bands. I get them from amazon and they can be used for both rehab and some different stretching techniques. Get a rumble roller, foam roller and or lacrosse ball to also work on your soft tissues.