Shoulder Maintenance

What training techniques are people/climbers out there using to maintain their shoulders in good health,i.e. shoulder tendonitis prevention, shoulder impingement prevention, muscular imbalance prevention and maintaining a healthy rotator cuff?

From a personal standpoint...every time I get on the steep stuff, the shoulder impingment/tendonitis issues start-up and knock me down.

Check this out:

dpmclimbing.com/articles/vi…

I agree with what ShaunG says about balance and rest. Working antagonists is really important, do some press-ups and shoulder press (overhead press) since these target muscles mostly neglected by climbing.

However, I was advised by a physio (who also climbs) not to work rotator cuffs while doing a lot of climbing. She said climbing works them really hard so you don't need to be loading them any more than you are already. Her advice was to do rotator cuff exercises if you have a layoff from climbing to keep them strong.

I've had mild to moderate shoulder problems for the last 12 years, including two shoulder subluxations. Despite these injuries, I've consistently progressed and can train and climb harder each year. My shoulders take lots of maintenance, most of which I can do on my own, but I've benefitted from a lot of guidance and treatment from great PTs along the way.

It seems that most shoulder problems in climbers come from poor mobility and stability, not weakness. Sure, there are imbalances, but it's not like just strengthening the weak muscles will fix the problem. The problem, like the DPM article says, is movement patterns.

First off, I (and nearly all the sports medicine folks I trust) don't think rotator cuff training is really all that important for mild shoulder problems in climbers. Our RCs are plenty strong, just poorly functioning due to other muscle issues.

Second, the way the DPM article describes shoulder problems seems sound, but many of the exercises it suggests probably don't help. Some of them are fine, like the warm-up exercises. Two of the exercises, the plange push-up and pull-up retraction, are problematic because they force you to destabilize your shoulder. Our shoulders are the strongest and most stable in a "packed" position, that is, back and down with the traps engaged. If shoulder stability is paramount, why would I practice a movement to put my shoulders out of the stable position? So, I don't do those kinds of exercises.

With that in mind, here's what works for me:

1-2 general strength training work outs per week, with a focus on pushing, pulling, and core muscles (i.e. climbing and non-climbing exercises). Rather than trying to get much stronger, I try to do exercises that are less stable, like push ups on a ball, pull ups on rings (maybe combined with leg lifts), or curls while standing on one leg. The movements should be slow and controlled and always with packed, stable shoulders. These workouts are on top of climbing workouts. I do them during training cycles for 4-6 weeks at a time.

Shoulder mobility/stability. There are two exercises that I have used extensively and that have worked really well. The first is the "Turkish Get-up." The second is the "cross-body one-arm single-leg dead lift." They're both on Youtube and are two of the four exercises highlighted in the "4-Hour Body" book. Again, the focus is on doing these with a well-packed shoulder. Also, there's no need to make these super heavy - it's about the right level of stress to activate the shoulder muscles for stability. I do these frequently, at least a few times a week, often as part of warming up or cooling down.

Stretching and massage. I stretch out my chest, arms, and hips. I use a tennis ball on a wall to massage my back/shoulders/arm pit. I do this all the time, especially massage, before, during, and after climbing.

There are some other more complex ways of improving shoulder stability that involve functional movement exercises. They're hard to explain, maybe see a PT for that kind of stuff. I'm a big fan of getting dry needled every month or two around my shoulders.

Best of luck.

Hope this is not too late, but I found some of these exercises to be very helpful in relieving shoulder tendonitis pain.

idoportal.blogspot.com/2009…

lay on your side tuck your elbow over a towel against your side torso and bend arm at 90 degrees. Lift 5-10lb DB externally rotating it for high reps for multiple sets.

This is the only thing that will keep my shoulder (which has been in the past problematic) happy.

I agree with a lot of what's being said here. We always need to be in balance, yes. Climbers generally are stronger in the lats and pull muscles, tight across the chest and weak in the muscles that retract the shoulder blades. This leads to a stooped posture for many, where the chest drops/caves in, the shoulders round forward, the neck flattens and the head drops forward.

What Christoper Barlow says is absolutely true, the shoulders are safest when they are back and in the socket (he used the word "packed"). I've been in the therapeutic yoga industry for 14 years, before that for 6 in pilates, and a climber for nearly 20. What I've seen over the years is that the posture created by the above mentioned imbalances is what causes problems for everyone, especially climbers. Our problems come because we load our shoulders and crank when they are forward and unstable, not "packed."

What I've seen work in all people, myself and my husband (both serious climbers) included, is these three components which return us to better overall alignment.

1. The sides of the body need to lengthen to release downward pull and tension on the neck, levator scapulae, upper trapezius, etc. This actually feels like a slight lift in the whole shoulder girdle.

2. The head of the humerus (shoulder at the socket) needs to go back.

3. Shoulder blades need to retract. (I think this is what they are trying to get in the retraction pull-up in DPM) This is done by engaging both in-between the bottom tips of the shoulder blades (rhomboids & lower trapezius) and along the sides of the ribs (serratus anterior). NOTE: in a push up position this would be shoulder blades FLAT on the back NOT the plange position mentioned in the DPM article.

To achieve all of this most climbers need
1. To stretch their chest muscles. Try yoga’s shoulder clock. Here's a link I found: youtube.com/watch?v=_sJ4rSN…

2. To strengthen the shoulder blade retracting muscles (rhomboids and lower trapezius). Here's a link to a post I wrote on how to find and engage that area: paisleyanne.com/2013/12/18/…

3. To stretch the arms and hands. Tightness here pulls on the whole line of connection to the shoulders and affects the wrists and elbows as well as the neck and shoulders. The classic extensor stretches and finger stretches are a must.

Lastly, the blogspot link videos are pretty good, but I'd just be really careful and not go so deep into the rounded back positions... And, the rolling with balls and rollers from the UK article is something I do a couple times a week to stay limber and in balance.

Just my 2¢!

^ wow valuable 2 cents thanks for sharing!

Do you think "scapular retraction pushups" have a place in a climber's prehab/rehab strategy for dealing with rounded shoulders/posture issues from repetitive climbing?

I hope you know what I mean by that exercise (slight bend in elbows resting weight on pectoral muscles and retracting and pushing with scapular muscles (rhomboids mainly?).

While bordering on obnoxiously "bro-brah", Kelly Starrett is a doctor of P.T. and has an amazing collection of videos on mobilitywod.com on maintenance of your structures and tissues. Some people hate him and some love him; I've followed it since it started and have gained a lot of valuable knowledge. Either search shoulder or start at day 1; a lot of the content is pay now, but the archives have a lot of free stuff. Here's a start

mobilitywod.com/2010/08/epi…

“Do you think "scapular retraction pushups" have a place in a climber's prehab/rehab strategy for dealing with rounded shoulders/posture issues from repetitive climbing?”

Not sure I exactly know what you mean, but I personally, would stay away from anything that protracts/wings the shoulder blades off the back, especially when weight bearing.

I think it would be most helpful to work range of motion and strengthening while keeping the shoulder blades retracted and the head of the arm bone back.

I allow my shoulder blades to relax and wing off when I'm working passively on a roller or a ball. I feel it allows me to get deeper into the muscles and fascia. Also, I will get the ball or roller on a trigger point and stay there, then move the arm/shoulder all around so the fascia and muscle loosen up. When I do these I'm lying on or leaning against something and letting my weight compress/push on the muscles, so it's not weight bearing in the joint...

Hope that answers your question!

Why would you not strength build in a winged position with the shoulders? We end up in that position all of the time doing dead points to distant holds. What is your reasoning for not strength building in that position?

Again thanks for the thoughts is obvious you've thought about this a lot.

:)

Every time we raise our arms overhead the shoulder blades wing out, but the key is to keep the head of the arm bone back and protected in the socket.

What I'm trying to articulate is that I wouldn't train in the dangerous positions (arm bone forward, upper back rounded) but try to strengthen to get and stay in the safer positions (head of the arm bone back, upper back flat/shoulder blades on the back).

Yes, we dead point to reach holds and the shoulder blades will wing off, but the clarification is that we want to keep the head of the arm bone back and the upper back from rounding. I'm not saying don't train with your arms overhead -- that would never work! -- but I am saying the training should be about keeping good alignment and/or returning to it when we lose it.

Paisley Close wrote:Every time we raise our arms overhead the shoulder blades wing out, but the key is to keep the head of the arm bone back and protected in the socket. What I'm trying to articulate is that I wouldn't train in the dangerous positions (arm bone forward, upper back rounded) but try to strengthen to get and stay in the safer positions (head of the arm bone back, upper back flat/shoulder blades on the back). Yes, we dead point to reach holds and the shoulder blades will wing off, but the clarification is that we want to keep the head of the arm bone back and the upper back from rounding. I'm not saying don't train with your arms overhead -- that would never work! -- but I am saying the training should be about keeping good alignment and/or returning to it when we lose it.

This is a good article if you want to better understand packing shoulders and correct overhead arm movement (ie. no winging)

bretcontreras.com/guest-blo…

I have gone through multiple rehab cycles for the left shoulder (5 years) and finally figured out (after doing too much stretching, wasted time on rotary cuff strengthening) that my issues were hypermobile shoulders, poor movement patterns due to inactive lower traps and poor Lat contraction. My suggestion is that make sure your t-spine mobility is good. I think this is the beginning point of anyone suffering from shoulder issues.

great article and very clear! thanks for the link...

Being a poor climbing bum, I'm looking for help to treat a shoulder issue without a doctor/PT appointment. I've got some pain in my shoulder, towards my neck, maybe my trapezius? But then I have some pain in my underarm that extends into my bicep/triceps when i extend my arm above my head?

I thought that it might be related to a minor ski accident? or digging of a quinzee? I've climbed with the pain once, and noticed there was no loss of strength and the pain is tolerable.

Thoughts?

Generally pain = misalignment. (Even tolerable pain). Get a roller, a tennis ball, lacrosse ball, a theracane or even your thumb to work out the tight spots in the armpit, lateral side of shoulder blade and down the posterior deltoid. I'll bet it helps your neck and traps, too. PS: I'm no Dr. so the risk is yours! Good luck :-)

say a climber came into some disposable income and she could afford some regular massage therapy. What type of massage would you suggest that would be most beneficial for somebody that has had past shoulder issues and is actively working on correctly muscular misalignments throughout shoulder girdle, pectoral, thoracic muscles?

Depends on your sensitivity. You're going to have to shop around. Some people like really hard, deep, trigger point style work, while others like work that is more gentle and holistic but still has a deep and profound effect. In either case I'd look for an HHP (Holistic Health Practitioner) --or that's what its called in California anyway -- which is someone with more training and experience. I'd look for a Rolfer, or someone who knows about the fascia, not just the muscles. It would also be a bonus if the person were athletic or a climber and understood what it meant to be active.

A busted old bike inner-tube makes a pretty good resistance band for shoulder rehab. Fatter MTB tubes are higher resistance, skinnier road tubes are lower in resistance. Tie a knot in one end and jam the knotted end in a door frame and you have a quick and dirty setup without having to buy overpriced workout gear. Local bike shops can probably hook you up with old tubes that are beyond repair if you're not a cyclist and don't have them readily available.

Checkout the American Academy of Orthopedia Surgeon's page for resistance band shoulder workouts (first PDF):
orthoinfo.aaos.org/topic.cf…