Stretch and Strengthen to Prevent Shoulder Pain | Sports Medicine Sept/Oct 2012

We can all remember days of endlessly and effortlessly throwing rocks into water, playing catch, paddling boats, or performing any other overhead activity with no thoughts of shoulder pain. As kids, we could do this all day without any thought to warming up, stretching, or staying strong. Unfortunately for most of us those days are now a distant memory. I know for me, those first few strokes or throws are often accompanied by tightness and pain in my shoulder.

Shoulder issues have long been a problem for the “overhead” athlete. This traditionally meant baseball players, tennis players, and quarterbacks, for example. These same shoulder problems exist for the nontraditional overhead athlete (kayakers, Nordic skiers, rock climbers, swimmers), all of whom repetitively use their arms overhead as part of their sport.

Pain experienced in the outside part of the shoulder during these activities has long been referred to as “impingement.” This impingement occurs as the result of the rotator cuff rubbing against a part of the shoulder blade (scapula) called the acromion.

It is not uncommon for patients to experience this type of pain soon after restarting an activity that they have not done for a while. For example, the kayaker who is getting back into paddling after a winter off, or the Nordic skier restarting double-poling during fall training.

Normal shoulder motion involves a coordinated rhythm between movement of the shoulder blade on the chest wall and movement of the ball in the shoulder socket. This is called the “scapulohumeral rhythm.” If the muscles around the shoulder blades are strong, the shoulder blade has a solid connection to the rest of the body and acts as a solid base for the arm during overhead motions. In addition to this, a flexible shoulder— especially one that is not tight in the back—is less likely to impinge.

If you experience shoulder pains with overhead activities, it is possible that your shoulder blade is not stable or that the back of your shoulder is tight.

Baseball trainers have developed special stretching and strengthening exercises to treat and prevent shoulder troubles in pitchers. Two important components of this program are stretching the back of the shoulder and strengthening the muscles around the shoulder blade.

Scapular stabilization refers to a set of exercises that strengthen the shoulder girdle muscles to restore normal scapular motion. These exercises also aim to facilitate energy transfer from the trunk through the shoulder blade to the arm.

One simple example of each type of exercise

Sleeper stretch:
1. Lie on your side with the painful shoulder down. Similar to the position you might be in when sleeping on your side (hence the name).
2. Place the affected arm directly in front of you, with the elbow bent 90 degrees.
3. Using your other arm, push your hand down toward your feet, internally rotating your shoulder.
4. Hold for 20 to 30 seconds. Repeat 2 to 3 times.

Scapular stabilizing exercise:

1. Lie face down on the floor or exercise mat with a large pillow under your stomach. Rest your forehead on the floor.
2. Bend your elbows at a 90 degree angle, and place your forearms on the floor.
3. While keeping your forehead on the floor, slowly raise your arms as high as you comfortably can and hold this position for 5 to 10 seconds as you continue to breathe. Slowly return to the starting position.
4. Build up to 8 to 10 repetitions.

You can perform this exercise either with dumbbells or wrist weights, or without weights. Start by using very light weights.

Most of this shoulder pain will improve with a simple approach. Try to warm up before exercise. Build up to things if you’ve been away from a sport for a while. If it’s your first cross-country ski of the season, consider going for 20 to 30 minutes instead of starting with the 90 minutes that you had built up to at the end of last season. If simply warming up and starting slow doesn’t fix the problem, try the above exercises.

Dr. James Ames

James Ames, MD, MS, Sports Medicine, Dartmouth-Hitchcock Medical Center, lives near the Connecticut River in Hanover, New Hampshire, with his wife, Beth, and their three boys. He enjoys outdoor activities including cycling, trail running, swimming, kayaking, and hiking.