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Shoulder Injuries - Prevention and Treatment



Dear colleague,

There is perhaps no joint in the human body as complex, fascinating, or baffling as the shoulder. It can leave clinicians scratching their heads, wondering why a problem they have solved many times before is so stubborn.



And shoulder problems can certainly be stubborn! That’s why, in every case, prevention is so much better than cure. Rarely is a pain that has surfaced a simple matter of applying some ice – it is more likely to be the tip of an iceberg…



This is a groundbreaking book in more ways than one. I was surprised to discover so many shoulder problems are due not only to bad habits of technique, but to the unbalanced upper-body workouts many athletes undertake in the mistaken belief they are doing themselves good.



For these poor souls, injury and pain lie just around the corner. Read on to find if you are among them!



This new workbook from Peak Performance is for all athletes who rely on their shoulders. Prepared by the combined experts of Peak Performance and Sports Injury Bulletin, it looks at every aspect of shoulder care and injury prevention:



Shoulder overview: the five main ingredients for keeping shoulders injury-free



Rotator-cuff protection: a specialist in treating sports injuries explains how overhead athletes can prevent chronic shoulder pain



Preventing injuries: a sports fitness expert suggests further exercises to help you avoid shoulder pain



A surgical view: an orthopaedic surgeon explains why shoulders go wrong and what can be done to repair them



Case study: how a keen club golfer was cured of a nagging shoulder pain



Technical review: two surgeons discuss the diagnosis and treatment of acromioclavicular injuries in athletes



Prehab guide: an assessment of the latest research into shoulder problems and with practical advice on achieving balanced upper-body development


Pre-publication discount

Shoulder Injuries – Prevention and Treatment is available today at a special pre-publication discount. As a registered visitor to our website, you qualify to receive this new workbook before it goes on worldwide sale. Please click on any of the links in this message to order your preview copy. The Peak Performance guarantee means any of our workbooks fails to live up to its promise you can claim a full and immediate refund.


Click here to order Shoulder Injuries – Prevention and Treatment at a pre-publication discount, or read on for more editorial extracts:


The amazing shoulder joint

Consider what the shoulder does, and how many athletes – swimmers, tennis

players, bowlers, baseball pitchers, javelin throwers – take it for granted. The shoulder can assume no less than 1,600 different positions! There is more movement at the shoulder joint than at any other joint in the body.



The shoulder joint actually comprises four joints – see if you can feel them on yourself:



* Sternoclavicular (SC) joint (between the sternum and the collar bone) – this is actually the only bony connection that the shoulder has with the main skeleton

* Acromioclavicular (AC) joint between the collar bone and the point of the shoulder called the acromion, which is part of the scapula or shoulder blade

* Glenohumeral (GH) joint between the glenoid part of the scapula – the socket – and the head of the humerus (HOH) – the ball

* Scapulothoracic (ST) joint (the ‘false joint’ between the scapula and the rib cage that it rides over).



Clearly, the shoulder joint is truly remarkable invention -- until it goes wrong! Shoulder Injuries – Prevention and Treatment looks at the most common cause of shoulder pain and provides a number of illustrated exercises designed to treat and prevent them.

For those with a shoulder injury they would like to try to treat themselves, we provide a checklist for ruling out structural damage. The seven chapters include a number of canny DIY ideas for improving performance and avoiding injury.



Treatment, prevention and performance enhancement

The measures outlined in this new workbook for the prevention and treatment of overuse injuries of the shoulder are guaranteed to improve your performance. They will genuinely improve the way your shoulder works, and thus it will be stronger, more co-ordinated, reach further and last longer before fatigue sets in.



All the experts say it: injury prevention equals performance enhancement.



First, we give the big picture of injury prevention and performance enhancement for athletes who depend on their shoulders for playing their sport. The information is presented to help you decide which issue you might need some more work on. Advice includes home exercises, and when to seek professional help to maximise the results of your efforts.

Click here to order Shoulder Injuries – Prevention and Treatment at a pre-publication discount, or read on for more editorial extracts:

Balance through control: the five ingredients

Exercises and guidelines are given for the five most essential ingredients for an athlete whose main weapon is the shoulder:



* Sports-specific technique

* Flexibility

* Core stability
* Rotator-cuff control
* General strength



Sports-specific technique: poor performance and shoulder pain commonly originate in bad habits of technique. Often they are only clearly seen when muscle fatigue sets in.The variety of overhead movements required for each sport gives rise to very subtle and unique technique faults. We give examples of what to look out for.



Flexibility: the purpose of flexibility varies for the different muscles around the shoulder. For the major power muscles, it is important that flexibility allows freedom of movement for the pelvis, trunk, scapula, and humerus. For the rotator cuff, the critical issue is the balance of forces centreing the head of

humerus, and to a lesser degree, freedom of movement. As we explain, it is more critical that the internal and external rotators are equally flexible, rather than how flexible they are.



Stretching: learn why stretching to increase flexibility should never be done prior to training or competition -- and when it should be done.



Core stability: core stability has become a whole science in itself in the last

decade as all manner of sports professionals have realised how critical it is for the inner core of the body, namely those joints closer to the spine, to be supported by the postural muscles designed to do so. For the shoulder, the critical areas are the lumbar and cervical spine and the scapulothoracic joint. Discover why, if these areas are not stable, significant extra loading and strain is passed on to the shoulder joint



Rotator-cuff strength and control: the rotator-cuff muscles are dependent on the good positioning of the scapula for effective control. If the scapula is angled too far forward or downward, for instance, while the tennis player reaches overhead to smash, the rotator-cuff muscles are biomechanically disadvantaged and may result in failure of the prime mover muscles to generate power.



General muscle strength: once the foundational issues of technique, flexibility, core stability, and rotator-cuff control are being implemented, we

then look at the bigger picture of the ‘outer core’. What is the rest of your body like – does it help or hinder the performance of your shoulder?


Click here to order Shoulder Injuries – Prevention and Treatment at a pre-publication discount, or read on for more editorial extracts:




Avoiding the common mistake of imbalance

Most athletes believe that a gym routine needs to include strengthening work for the deltoids (three heads), latissimus dorsi, pec major, upper trapezius, and the rectus abdominis because they are the prime movers of the shoulder.



What is often critically overlooked, however, is the imbalance that can develop between the front of the shoulder and the back. In those athletes that are carrying an overuse injury in the shoulder, nine times out of ten they have overdeveloped pecs and lats relative to their trapezius, rhomboids, posterior deltoids, and posterior rotator cuff.



In these situations, flexibility must often be improved, scapular setting must be taught, and the focus of gym exercises changed towards the back. We explain how it’s done.


How to prevent the damaging cycle of chronic shoulder pain

Any overhead activity that involves the arm being taken often enough from below the shoulder level to above shoulder level has the capacity to damage the rotator cuff. With repeated impingement, a poorly conditioned cuff can become damaged, and a cycle of cuff damage, impaired function, further

impingement and worsening cuff damage is initiated.



We look at how such repetitive damage is caused, how the athlete may be able to prevent it occurring in the first place and why a co-ordinated action of this group of muscles is needed to provide a stable base for pain-free overhead activity. Here are the symptoms:



* The shoulder aches after overhead activity

* It gets worse and restricts the activity

* Periods of rest apparently resolve the problem only for the pain to recur when you returned to sport



Chronic shoulder pain is an all-too-common consequence of repetitive ‘overhead activity’, such as serving and smashing in tennis, freestyle or butterfly swimming, bowling in cricket, javelin, or baseball throwing and above-shoulder weight-training exercises.


Injury prevention strategies

Most cuff injuries can be prevented relatively simply, and we provide shoulder-injury prevention strategies to focus on improving shoulder stability.



Isolated rotator-cuff strengthening exercises can be very effective as part of a pre-participation conditioning programme. These can be done with our three simple exercises of single sets comprising a minute of either external or internal rotation exercises. The exercises strengthen these areas:



* Internal rotator (subscapularis)

* External rotators (infraspinatus and teres minor)

* Abductor (supraspinatus) muscles of the shoulder



Three to-five minute sets over the course of a day will produce a

conditioning effect.


Click here to order Shoulder Injuries – Prevention and Treatment at a pre-publication discount, or read on for more editorial extracts:


Further exercises to help avoid shoulder pain

We offer more exercise suggestions and give further practical guidelines to help athletes avoid shoulder pain.



Balance your upper-body workouts: a good way to avoid shoulder injuries is to make sure your upper-body strength sessions are balanced.



Too many athletes and weight trainers focus on developing the ‘mirror muscles’, the upper trapezius, anterior deltoid and pectorals. As a consequence, the ‘non mirror muscles’, lower trapezius, rhomboids, latissimus dorsi and rear deltoid are underdeveloped.



This leads to a muscular imbalance about the shoulder. Redressing this

imbalance is very important for the prevention and rehabilitation of shoulder impingement injuries.



We give a balanced upper-body workout for various muscle combinations:



* Pectorals, anterior deltoid

* Rhomboids, mid-trapezius, latissimus

* Pectorals

* Rhomboids, mid-trapezius, rear deltoid

* Anterior mid deltoid, upper trapezius

* Latissimus, lower trapezius





Limit your range of movement and take it easy: rehabilitation from a shoulder impingement injury should focus on rotator-cuff strengthening. We explain why it’s important to remember that when it comes to re-introducing your weight-training exercises, you must progress slowly.



It’s also important to avoid certain ranges of motion where the shoulder joint sub-acromial space is compressed the most.



Details are given for the impingement zones to avoid, which muscles to start the training with, and once the pain is completely gone, which exercises to introduce.

Correct scapula positioning when performing exercises: the correct position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a good ‘military posture’, with shoulders back and chest out. A round shouldered or hunched posture is to be avoided at all times.



To achieve the correct position, you need to use your rhomboids,

mid and lower trapezius muscles to retract the shoulder and pull the scapula down. You’ll learn the correct position and exercises to keep your scapula back and down while you move your arms.



Sports-specific exercises – plyometrics for the shoulder: just as rehabilitation training for leg injuries requires a functional progression from simply strength exercises to sports-specific exercises, so does rehab for the shoulder.



This means that for the athlete, eg a thrower or tennis player, conventional

resistance exercises in the gym may not be enough to allow a full return to competition. Often what are needed to bridge the gap are plyometric exercises for the shoulder that mimic sports-specific movements.



Plyometrics for the shoulder usually involve medicine balls of various weights. Plyometric exercises have two advantages. First, they are

performed fast, and second, they involve stretch-shortening cycle

movement patterns.



This means they are much more sports-specific than conventional resistance exercises. In particular, plyometric exercises for the rear-shoulder and external rotator muscles are very useful because they provide eccentric training for these muscles. This improves their ability to control the shoulder during the powerful concentric actions of the pectorals and anterior deltoid involved in throwing or serving.