Why Fitness Keeps Getting Shoulder Pain Wrong

Jessica Bento, Physical Therapist (Creator DVRT Restoration Certification, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)

This past weekend I had the great opportunity to present at the National Strength & Conditioning Associations Nevada State clinic for the third time. I always love any opportunity to share with such a diverse group of professionals. From physical therapy students, fitness professionals, chiropractors, strength coaches, and clinicians, it can be difficult to make a single presentation relevant for everyone. 

That is why I had chosen a topic like “Beyond The Rotator Cuff: The Evolution Of Shoulder Training”. While issues like low back pain usually get the attention of being major problems in our society, they are, we often don’t realize shoulder pain is an all too often issue for most people. One in five Americans alone will experience low back pain and shoulder pain has been found to impact almost 30% of the population.

Maybe the most frustrating stat though is that at least 50% of people that experience shoulder pain AND get treatment will end up having pain 18 months later. That means we aren’t actually that good at helping shoulder pain and issues. 

If you have followed my writing and what we do at DVRT though, you know that we do things VERY differently. Not to be different, but because we actually do know through research better strategies in how to help shoulder pain but that often doesn’t leaked down into the practical aspect of training or rehab. It leads both my physical therapists and fitness pros to often chase the wrong issues when it comes to shoulder pain and function. Where do we get off track?

We Focus TOO Much On EMG

Most of these mistakes, to be honest, are mistakes I made myself as a young physical therapist. Yet, over 20 years later, I see THIS one as a major place so many people go wrong into trying to help shoulders. EMG is used to see how active a muscle is and is a useful measure in research for very specific things. However, it has been misinterpreted when it comes to things like “what is the best shoulder exercise”. 

Many of my fellow therapists will proclaim that this or that exercise is the best to help the rotator cuff, the serratus anterior, and so forth because the EMG is high. As renowned physical therapist (also often thought as one of the father’s of functional training), Dr. Gary Gray explains in the video we have to ask if the muscle is singing or screaming in these tests.

(Adrian, Michigan is where Dr. Gray is from so that was the reference) 

As someone who use to use many of these drills with patients, they often are painful and don’t really solve the root causes of what caused the shoulder issue in the first place. What Dr. Gray points too is that we shouldn’t see super high EMG Activity of one muscle or another because there has to be great balance of muscle activity to be efficient and strong in a real world movement. 

That takes us to our next point. 

We Need Strength 

During this past weekend’s conference, I was asked if EMG isn’t a reliable measure for predicting hypertrophy (it isn’t based on the research I shared “Hip thrust and back squat training elicit similar gluteus muscle hypertrophy and transfer similarly to the deadlift”) is EMG good for strength? 

This is actually a tricky question because if a muscle is activated to a great level, it may become stronger for sure. HOWEVER, that isn’t what I think most of you are interested in and you may not realize it. Such a question is an accidental fault in thinking that an individual muscle is what causes our shoulder pain to develop. As renowned physical therapist, Gray Cook explains, motor control, not typically strength are the issues we need to address. 

However, most people don’t talk about motor control on social media or fitness articles. You won’t have anyone really compliment your motor control in the gym, at least not on purpose;) Motor control refers to the timing and sequencing of muscles that are helping create a movement. This means no ONE muscle is more important than how the chain works and training a singular muscle doesn’t mean that the chain works any more effectively. Such thinking is the flawed application of a machine model to a complex organism like the human body. 

That is why we have to look at the entire chain. The lower body, the core, are EXTREMELY important for the function and ability to help shoulder pain. You can train the shoulder ALL day, but if you don’t make sure the lower body and core are functioning properly you will not only see your strength come to life, but you also will probably keeping having shoulder pain again and again. 

Exercises like I show below are far more effective in addressing these issues, but there is one more idea to address….

But Will I Get Stronger? 

When I show how I address not only shoulder pain, but also shoulder training people can often wonder how they are going to get stronger? After all, I’m not like everyone else online telling you to work on this shoulder muscle and then this shoulder muscle. I MUST seem like the crazy one EXCEPT that research largely supports what I am sharing with you. 

I get it, people not only are surprised by the movements themselves, but the loads that are used. Often I use diagonal patterns in the form of various lifts/chops and because of the nature of the movements one can’t use the same type of weight. The thought HAS to be that you won’t get as strong. However, research doesn’t support that idea. 

When manual PNF (diagonal pattern movements) were used in upper body and lower body patterns and compared to a leg press and bench press the results were shocking! Those that performed PNF patterns got STRONGER and performed better in some athletic tests that the leg press and bench press group. The crazier part was that the measures of strength were on leg and elbow extension, the VERY thing that a leg and bench press train with much higher loads. 

Trust me, I understand that this often flies in the face of what the person with a million followers and a buffed out body will tell you on social media. I’m not just sharing with you what has worked with a diverse patient population for over 20 years for me, I am sharing with you what top experts and research tells us about shoulder pain. If we choose to continue to ignore these ideas chances are we will still struggle to help shoulder pain and keep getting frustrated with the results we can offer. 

I hope by understanding the issue of shoulder pain more effectively and what science already has taught us about what works that we will start to have programs that lead to more people being stronger and pain free.

Learn more of the science and how we bring in to life in our DVRT Rx corrective exercise programs and Restoration Online Certification you can get 40% off this week only with code “40edu” HERE

 

View this post on Instagram

 

A post shared by Ｊｅｓｓｉｃａ Ｂｅｎｔｏ (@jessbento_physiotherapist)