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Jan 24, 2013

Growing Pains: The Rotator Cuff and Your Paddling Shoulder UPDATE Part II

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.

Coach BK post-op labral tear (from a fall)
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?"

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 (part 2):
Supraspinatus 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. Lie on your side like you're lounging at the beach with your back leg bent (knee up) and head propped up with your arm (see fig. 1.1 below)
  2. With your arm out palm facing down, elbow extended, bring palm up to the level of your knee (see fig. 1.2 below).
  3. Slowly lower and return your arm back down to start position over three seconds, taking note not to rush or rest at the bottom.
  4. Try 3 sets of 15, each side, 1-2 times/day.
  5. Add light weight as needed (2-3 lbs but no more as you will be firing off those "big muscles" mentioned prior)
Fig. 1.1
Fig 1.2

Scapular Stabilizing Exercise ("Straight Elbow Push-ups")--
This exercise works the scapular stabilizers which include the middle and lower trapezius, rhomboid major and minor, and serratus anterior. They are found in the back of the shoulder. This exercise has an added bonus of improving your posture as well.
  1. Kneel on all fours with your hips over your knees, and your shoulders over your hands. Keep your elbows straight like you're prepping to do a push-up.
  2. Increase the space between the floor and your chest by protracting your shoulders forward.
  3. Decrease the space between the floor and your chest by retracting your shoulders back by squeezing your shoulder blades together.
  4. Keep your lower back in a curved position, do not tuck (not a "cat pose" for my yoga peeps).
  5. Try 3 sets for 15-30 reps, 1-2 times/day.

       Option 2. (for you peeps looking for a challenge)
  1. Kneel on all fours but this time, increase your lever by assuming the "knee push-up" position; harder, planked "full push-up position;" hardest, "pushup position with feet on a gym/Swiss ball" 
  2. Repeat steps 2-5 on the above Scapular Stabilizing Exercise ("Straight Elbow Push-ups")
"Harder" full push-up position
Field Goal Exercise--
This exercise uses the teres minor and infraspinatus muscle of your "cable system" which helps develop stability and control in your shoulder motion. These muscles help you externally rotate your shoulder.
  1. While lying prone over a bed or couch, hang your shoulders and arms over the edge of whatever surface you are lying off of (bed, couch, treatment table, etc.). 
  2. Squeeze your shoulder blades by bringing them together. Bring your elbows up at 90 degrees as you do this.
  3. Make a "field goal" by bringing your thumbs forward and up and level with the posture of your head.
  4. Reverse by rotating hands back down with elbows still to the side at 90 degrees and relax by bringing the shoulder blades all the way back down.
  5. Try 3 sets for 12-15 reps, 1-2 times/day.
Step 1
Step 2
Step 3
For more tips on form and common mistakes check out this handy video presented by Dr. Brant Pedersen, DC, CCSP

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 2-3 pounders if you're a sexy Space Dragonette like Arlene or Joanna, 3-5 lbs if you're a strapping Space Dragon man-stud like David or Henry. Any more weight will activate the "big muscles" of your body and your ever so important rotator cuff muscles will feel sad and left out.
  • 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.

Paddle hard Space! But, no more injuries please (ahem, Bruno). =P