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Jan 12, 2011

Growing Pains -- The Rotator Cuff and my Paddling Shoulder

Have you ever wondered why your shoulders sometimes hurt after a long, intense paddle session on the water? Whether minor or major, odds are that if you paddle you or someone you know has experienced a fair share of shoulder issues. This post is to help educate you on the fact that this doesn't have to happen. With a little knowledge and some preventative know-how, you too can paddle like Rod (injury-free of course)! In many strength and training programs, pulling movements such as chin-ups and rows are given backseat emphasis, if any. The simple reason? "They're just too hard" (insert obligatory Space Dragon "that's-what-she-said" comment here). Most athletes instead focus on lat pull-down or push-ups for the muscles of the upper back and chest with the assumption that this is sufficient and all they'll need. The key to a good training program however is balance. Balancing your muscle development is the recipe for preventative maintenance of your shoulders. Paddlers with injuries typically have overdeveloped muscle groups while others remain relatively underdeveloped. The problems are common because the "big muscles" tend to overpower the smaller ones such as the rotator cuff and stabilizers.

What's a "rotator cuff" you ask? Stabilizers? First, it helps to have a general idea of what the rotator cuff does. Imagine one huge antenna tower on top of a skyscraper. The tower is held in place by several high tension guy wires that pulls the pole in all directions. Now imagine that as the wind blows the tower in certain directions, the opposing cables pull back, keeping the tower from swaying too far and ultimately falling over. Imagine further that that tower is your arm and the cables are your rotator cuff. Still confused? In order to move effectively while still keeping in place, other muscles (or "cables") have to pull back as well to keep your arms from straight falling off your body. As you can imagine, if one of the guy wires holding your tower in place is weakened or damaged, then your tower (aka shoulder) is then unstable and much more susceptible to injury. At this point, you're probably wondering, "so what do cables and towers have to do with my shoulder and it hurting?"

Coach BK post-op labral tear (from a fall)
The response is that while there are a myriad of reasons why your shoulder hurts--from poor paddle technique and posture, overtraining, unilateral (one-sided) paddling, long paddles (longer paddles = more load forcing upon the shoulder), etc--working the posterior (back) shoulder, back muscles, and stabilizers that hold the scapula in the correct position will be the keys to avoiding problems like shoulder instability, strains/sprains, impingement, or the dreaded scary words...rotator cuff or labral tear! 


The Exercises:
Shoulder Abduction--
This exercise is initiated by the supraspinatus muscle. This "cable" is located at the top of the shoulder. Its purpose is to raise the arm and move it away from the body.

  1. Hold arm down by your side with palms facing in.
  2. Grab the resistance band or dumbbell and, keeping your elbow straight, exhale and lift the band out to the side with your thumbs facing up.
  3. Lift the band to about shoulder level and do NOT lift the band above shoulder level.
  4. Hold for a few seconds, taking care not to shrug the shoulders and slowly lower back down to starting position at your sides.
  5. Try 1-3 sets at 10-15 reps, each side.
External Rotation--
This exercise works upon the teres minor and infraspinatus muscles that externally rotate the shoulder. They are found in the back of the shoulder.
       Option 1. (with resistance band)
  1. Attach resistance band to a stationary object.
  2. Stand with left side to the attachment point.
  3. Hold resistance band with your affected hand and keep wrist straight.
  4. Begin with the right hand directly in front of the body with elbow bent at 90-degrees.
  5. Keep your elbow close to your side as you slowly stretch the band by moving your arm outward until back of hand faces backward. Keep wrist neutral and unbent. Shoulders kept square with minimal rotation at the trunk.
  6. Try 1-3 sets for 10-15 reps, each side.
       Option 2. (sidelying with light dumbbell)
  1. While lying on your side in a fetal-type position, keep your shoulders square.
  2. Hold one dumbbell in your outside (top) hand with elbow at side and bent at 90-degrees. Keep wrist straight.
  3. While remaining on your side, with elbow in, raise dumbbell towards the ceiling and up to your side. (Motion resembles opening a sliding glass door with a newspaper wedged between your elbow and side)
  4. Try 2-3 sets for 10 reps, each side.
Internal Rotation--
This exercise uses the subscapularis muscle of your "cable system."  The subscapularis is at the front of the shoulder and it internally rotates the shoulder.
     Option 1. (with resistance band)
  1. Attach resistance band to a stationary object.
  2. Stand with left side to the attachment point.
  3. Hold resistance band with right hand.
  4. Start with right hand out in front of the body, elbow bent at 90-degrees.
  5. Slowly stretch band away by moving arm outward until back of hand faces backward. Keep wrist neutral and unbent as well. Shoulders also kept square with minimal rotation at the trunk.
  6. Try 3 sets for 10 reps, each side.
Overhead view of option 1
    Option 2. (with dumbbell)
  1. While lying on your side in a fetal-type position like in external rotation exercise, keep shoulders square.
  2. Hold one dumbbell in your inside (bottom) hand with elbow at your side and bent at 90-degrees. Keep wrist straight.
  3. While keeping on your side and elbow tucked in next to the body, raise the dumbbell up towards the opposite top shoulder.
  4. Try 3 sets for 10 reps, each side.
A Couple Points:

  • Because the rotator cuff muscles are smaller muscles compared to your legs and back, leave the 45 pound kettlebell at home (*ahem Rod) and instead grab for the 3-5 pounders if you're a sexy Space Dragonette, 5-8 lbs if you're a strapping Space Dragon man-stud. Exercise bands like Therabands are great substitutes in this situation!

  • Know your body, and start low and slow. You should be going for "the burn" in repetition, as opposed to "the pump" gain in higher weight.

  • Pain does not equal gain. If it truly hurts, listen to your body and stop.

More tips to follow. Stay tuned! 

Remember train hard, win easy!