Role of the muscle mass in injury prevention?


Original Post
Nivel Egres · · New York, NY · Joined Dec 2014 · Points: 130

So first the statement itself: It's not only the strength but also the mass of the muscles that plays a role in injury prevention. The context was that if you want to reduce the chances of acute injuries (tears and dislocations) to your shoulders, you should try to "beef up" pectorals, deltoids and the neck muscles. Not only strengthen, but also add some mass.

Any thoughts/comments from training/PT-involved members of the hive? Does that make sense?

PS. This comes from an orthopaedic surgeon but he said it after Nth glass of wine...

JCM · · Seattle, WA · Joined Jun 2008 · Points: 95

Protective layer of neck meat? Mnnnnhmmmnnnn.

JNE · · Unknown Hometown · Joined Apr 2006 · Points: 1,940

Agree 100% (except that IMO with respect to the shoulders and chest one wants to focus on the front delts, with any weight on the chest and neck then being largely incidental) because it is the mass of the muscle which creates a physical volume which in turn forces the joint into the desired balanced position. Aesthetically, this means you want the front of the shoulder as massive as the back, the top of the forearm as massive as the bottom, etc. and so means you want to try and look very similarly to an olympic sprinter, swimmer, or gymnast.

Brent Apgar · · Out of the Loop · Joined Oct 2007 · Points: 90
Nivel Egres wrote: This comes from an orthopaedic surgeon but he said it after Nth glass of wine...
Is he a shoulder specialist?

I would love to hear his argument for this position.

As someone who has rehabbed a lot of shoulders from various traumatic injuries I can honestly say that, at least anecdotally, I haven't seen any evidence that would lead me to believe that this is true.
Nivel Egres · · New York, NY · Joined Dec 2014 · Points: 130
Brent Apgar wrote: Is he a shoulder specialist? I would love to hear his argument for this position. As someone who has rehabbed a lot of shoulders from various traumatic injuries I can honestly say that, at least anecdotally, I haven't seen any evidence that would lead me to believe that this is true.
He is, though I know him only socially. He works with the pro ball players of various sorts a lot, but has no experience with climbers.

PS. This has something to do with his brand new research project, but we, unfortunately, have an agreement not to talk about work.
JNE · · Unknown Hometown · Joined Apr 2006 · Points: 1,940

I have a separated clavicle on my right shoulder from a ~3 ft awkward bouldering fall. I used to have bad shoulder tendonitis as a result, which survived all manner of theraband and small weight high rep "shoulder cuff muscle strengthening" exercises. It finally responded when I put a bunch of extra mass on my front delts, enough that when looking at my profile in the mirror there was visibly the same mass on the front of the shoulder as on the back. I now go all out on that shoulder with frequent foot-loose limit bouldering, often involving hard latches with the right arm. I do this so thoughtlessly I never even think of this now roughly decade old 'injury'. IMO the "shoulder cuff muscles" were not anatomically designed to stabilize the shoulder through the kinds of forces induced through hard rock climbing. I might add that had my delt been built like that in the first place, I find it highly unlikely my shoulder would have had the range of motion (with all that muscle suddenly tensed as tends to happen in such situations) necessary to have sustained that injury from that fall. One only need look at the delts attachment points across the clavicle and front of the shoulder to see how it is used to hold down the clavicle and thus help limit and dampen the range of motion of the shoulder, which is a bit like a basketball sitting on a dinner plate.

Brent Apgar · · Out of the Loop · Joined Oct 2007 · Points: 90
JNE wrote:I have a separated clavicle on my right shoulder from a ~3 ft awkward bouldering fall. I used to have bad shoulder tendonitis as a result, which survived all manner of theraband and small weight high rep "shoulder cuff muscle strengthening" exercises. It finally responded when I put a bunch of extra mass on my front delts, enough that when looking at my profile in the mirror there was visibly the same mass on the front of the shoulder as on the back. I now go all out on that shoulder with frequent foot-loose limit bouldering, often involving hard latches with the right arm. I do this so thoughtlessly I never even think of this now roughly decade old 'injury'. IMO the "shoulder cuff muscles" were not anatomically designed to stabilize the shoulder through the kinds of forces induced through hard rock climbing. I might add that had my delt been built like that in the first place, I find it highly unlikely my shoulder would have had the range of motion (with all that muscle suddenly tensed as tends to happen in such situations) necessary to have sustained that injury from that fall. One only need look at the delts attachment points across the clavicle and front of the shoulder to see how it is used to hold down the clavicle and thus help limit and dampen the range of motion of the shoulder, which is a bit like a basketball sitting on a dinner plate.
I debated on how to best respond to this. I'm going w/ something that may come across as slightly dickish as it saves me a lot of time going into a detailed scientific explanation of the the physiology involved.

You're talking about an injury to the A/C joint, whereas the OP is talking about the GH joint. I may be wrong and perhaps the OP can add some insight here. (But if you can dig up anything reliable that shows the ant delt head or the trapezius contributes a significant amount of force closure to the AC I'd be psyched to see it.)

Your convoluted reasoning of how having more muscle mass in the anterior delt would effect all the variables you talk about makes no sense biomechanically or physiologically. But hey, I only graduated from a medical school program and have 10 years of clinical experience... so what the fuck do I know.
Brent Apgar · · Out of the Loop · Joined Oct 2007 · Points: 90

To at least contribute to the discussion (and again maybe the OP can comment on this)

I'm curious why the research wants to look at muscle mass vs fascial density? Or are they looking at both since chances are there's going to be a direct relationship between them.

Are you just looking at the muscle structures or are you going to factor in the passive fascial structures around the shoulder girdle?

Anyhow, a boat load of questions on how this would potentially be setup to reliably isolate the one variable of increased muscle mass to determine it's effect on preventing injuries to the shoulder girdle.

By the way, if the research does happen I would love to see the results.
cheers,
BA

normajean · · Reading, PA · Joined Jun 2015 · Points: 100

The way I took OP and the surgeon's statement, he is making a distinction between the size and the strength. Is he stating that more muscle mass does not mean more strength and vice versa and that it is the muscle bulk that basically protects from injury?

JNE · · Unknown Hometown · Joined Apr 2006 · Points: 1,940
Brent Apgar wrote: I debated on how to best respond to this. I'm going w/ something that may come across as slightly dickish as it saves me a lot of time going into a detailed scientific explanation of the the physiology involved. You're talking about an injury to the A/C joint, whereas the OP is talking about the GH joint. I may be wrong and perhaps the OP can add some insight here. (But if you can dig up anything reliable that shows the ant delt head or the trapezius contributes a significant amount of force closure to the AC I'd be psyched to see it.) Your convoluted reasoning of how having more muscle mass in the anterior delt would effect all the variables you talk about makes no sense biomechanically or physiologically. But hey, I only graduated from a medical school program and have 10 years of clinical experience... so what the fuck do I know.
You don't know a anyfuckingthing ;)

The A/C joint being damaged will cause the GH joint to be unstable, leading to tendonitis, which is what happened to me. You need to work on either your reading comprehension, your ability at giving me the benefit of the doubt, or your personal intellectual honesty.

Regardless of the cause of the GH joint instability, it will be addressed by adding muscle to the front delt, which according to every anatomy reference I have looked at in fact attaches to the clavicle, and maintaining the integrity of the clavicle structure will, in fact, contribute to stability in the shoulder. I'm sorry this comes as such bad news for you.
T Roper · · DC,VA,NM,UT,CT,MA · Joined Mar 2006 · Points: 860

its funny that it takes a Dr a few drinks to think/speak out of the box.

my experience is the medical world is out of touch with proactive medicine, they focus on reactive medicine way too much which is one reason this country and its health care system are so fucked up.

what this buzzed Dr said as well as JNE and myself works, it may not work for everyone and every problem but it works.

fuck, if I had a dollar for every time some greedy nitwit Dr(who owes a ton for their training) suggested surgery for an injury that could easily be fixed with quality PT I'd be fucking rich!

Nivel Egres · · New York, NY · Joined Dec 2014 · Points: 130

OP knows Jack Shit, he just heard an off-hand remark and got interested. It all started with my statement about low correlation of mass to strength in beginner athletes (you can guess which book I am reading) and he responded that he's actually doing a study on it with regards to shoulder injuries.

He said exactly that he aims to correlate injuries "not only to strength gains, but also to an increase in mass". Since we have a strong agreement not to talk about work, I did not ask for any details.

Brendan N · · Salt Lake City, Utah · Joined Oct 2006 · Points: 378

It's hard to speak to such an ambiguous target but anecdotally, the climbers with more mass are more frequently injured.

Carla R · · San Jose, CA · Joined Mar 2016 · Points: 110
T Roper wrote: fuck, if I had a dollar for every time some greedy nitwit Dr(who owes a ton for their training) suggested surgery for an injury that could easily be fixed with quality PT I'd be fucking rich!
Pretty much.
Brent Apgar · · Out of the Loop · Joined Oct 2007 · Points: 90
JNE wrote: The A/C joint being damaged will cause the GH joint to be unstable, leading to tendonitis.

You state this with such authority. Please show us something, other than your wild assumptions, that conclusively shows an injury to the AC joint will cause a glenohumeral instability. I've personally seen several climbers w/ at least grade 2 or worse AC injuries that have had zero issues with the GH joint.

JNE wrote:Regardless of the cause of the GH joint instability, it will be addressed by adding muscle to the front delt, which according to every anatomy reference I have looked at in fact attaches to the clavicle, and maintaining the integrity of the clavicle structure will, in fact, contribute to stability in the shoulder. I'm sorry this comes as such bad news for you.


Again, I'm not sure WHY you assume this to be true. (As I asked before please show me some reliable proof that the delts or the traps can create an appreciable amount of force closure at the AC)

Yep you're right, the Anterior head of the Delt does in fact have an insertion on the distal end of the clavicle.
But unless those handful of fibers are stronger than say, the Acromioclavicular and Coracoclavicular ligaments I'd suggest not looking at one anatomy picture and making a statement like you're an expert on something as complicated as the shoulder girdle.
Brent Apgar · · Out of the Loop · Joined Oct 2007 · Points: 90

Just one last thing on what's turned into a bit of an interesting thought experiment.

The OP said that the Doc works on various pro ball players. It would be interesting to know if he intends to do the study on a demographic of athletes from various sports or just one?

OP also said that the doc was talking about acute shoulder injuries (tears and dislocations)
I haven't looked up the stats but it's not hard to imagine that in something especially like football where players are using their shoulders like a battering ram that increased muscle mass may in fact help decrease the chances of injury.

I'm just doubtful that this would translate to climbing where the athlete is grabbing a fixed object with their hand and then applying a shit-ton of torque to the shoulder girdle as the climber manipulates his/her body around that point.

My suspicion is that having full range of motion and exceptional stability at end range (which strength would certainly help) would be more advantageous to decreasing shoulder injuries than muscle mass.

Thanks to anyone still listening.

JNE · · Unknown Hometown · Joined Apr 2006 · Points: 1,940
Brent Apgar wrote:My suspicion is that having full range of motion and exceptional stability at end range (which strength would certainly help) would be more advantageous to decreasing shoulder injuries than muscle mass. Thanks to anyone still listening.
Your suspicion is correct. What you don't seem to get is the fact that the shoulder joint, or any other body joint, sits where it sits largely due to the relative physical size (mass) of the involved muscles, and that there is no work around to this. If the joint is in the wrong position, then it can generate excessive forces, especially if there is heavily recruited muscle present which has to simultaneously set the joint into position as well as deal with the applied force. One need not be a professional to be able to visualize that and the ensuing wreck you are recommending to people. The world does not obey your solipsism.

Also, it is a well accepted fact that a separated clavicle will lead to instability in the shoulder. I believe an athletic trainer for a D1 college football team told me this. He also said it was a weak connection that overall did not do too much, and that it was a pretty common sports injury. He is the one who diagnosed the whole thing, and gave me the typical exercises, which did nothing remarkable. Adding muscle to the front delt fixed it completely. The people you know must not put the same kind of forces on their shoulders that I do, or they have balanced musculature.

Brent Apgar wrote:I'd suggest not looking at one anatomy picture and making a statement like you're an expert on something as complicated as the shoulder girdle.
Thanks. I was just stating my experience. While we are on the subject, what is your experience in these things? How many shoulders have you made gone from shaky and unstable to bulletproof by virtue of the theories you yourself thought up?
Aerili · · Los Alamos, NM · Joined Mar 2007 · Points: 1,970

Nivel, it is entirely possible that an orthopod making a statement after nth glass of wine is less a statement of fact but rather his hypothesis for his study related to a specific athlete group. The two are very different things. Er, maybe you were trying to say this already though.

Increased muscle mass to prevent injuries vs rehabbing existing/previous ones are also totally different topics. Some people in this thread are confusing the two.

To answer your question, I do not think it is known exactly what role muscle mass plays in injury prevention. It is possible that your doctor friend is interested specifically in looking at cross sectional area of the rotator cuff muscles; I read one study that said football players with low CSA of the multifidus (a deep spinal stabilizer similar to the RC in a way) were more at risk of back injury. If mass of joint stabilizers is what he alludes to, this type of mass is nothing you would notice with the naked eye. (Edit: nvm, I see you said he wants to look at large primary movers....hmm)

I wonder how he plans to measure muscle mass? Computed tomography scans? Additionally, there are factors like the material properties of muscle and other soft tissues which could play a huge role in injury/lack thereof which may have no relation to mass itself. Things like stiffness, compliance, energy absorption, and failure strength contribute just as much to a muscle's properties as size does.

Brent Apgar wrote:I'm just doubtful that this would translate to climbing where the athlete is grabbing a fixed object with their hand and then applying a shit-ton of torque to the shoulder girdle as the climber manipulates his/her body around that point. My suspicion is that having full range of motion and exceptional stability at end range (which strength would certainly help) would be more advantageous to decreasing shoulder injuries than muscle mass. Thanks to anyone still listening.
This is a good point. In essence, many sports like baseball, volleyball, swimming and so forth require the shoulder to mostly function in an open chain method. Whereas climbing is mostly closed chain (minus the time our hands are off the rock - which I ignore because they don't present a stress to the joint). Forces are different because in open chain you have most of the time spent under intrinsic forces acting on the joint created by the muscles, whereas in closed chain you have both intrinsic and extrinsic forces acting on the joint for much of the time. These two scenarios will create very different net joint moments (or torques).

Brent Apgar wrote:I've personally seen several climbers w/ at least grade 2 or worse AC injuries that have had zero issues with the GH joint.
Yes, I've also trained 2 individuals with full A/C separation and they did not have GH instability. One of these individuals had had a separation for years and I was working with him for arena football tryouts.

JNE wrote:Regardless of the cause of the GH joint instability, it will be addressed by adding muscle to the front delt
Actually GH instability is addressed by strengthening the rotator cuff, the serratus anterior, and the middle and lower traps/rhomboids. Frequently a too large/too strong anterior delt is a contributing cause of GH instability, not the opposite.
JNE · · Unknown Hometown · Joined Apr 2006 · Points: 1,940
Aerili wrote: Things like stiffness, compliance, energy absorption, and failure strength contribute just as much to a muscle's properties as size does. ...In essence, many sports like baseball, volleyball, swimming and so forth require the shoulder to mostly function in an open chain method. Whereas climbing is mostly closed chain (minus the time our hands are off the rock - which I ignore because they don't present a stress to the joint). Forces are different because in open chain you have most of the time spent under intrinsic forces acting on the joint created by the muscles, whereas in closed chain you have both intrinsic and extrinsic forces acting on the joint for much of the time. These two scenarios will create very different net joint moments (or torques).
Not sure how this then makes it logical to have climbers looking like Quasimodo but I'm willing to learn something new.

Aerelli wrote:Yes, I've also trained 2 individuals with full A/C separation and they did not have GH instability. One of these individuals had had a separation for years and I was working with him for arena football tryouts.
Cool. An athletic trainer for D1 football, who IMO has a stronger professional credential than yourself and certainly better and more relevant experience, diagnosed things otherwise. His female colleague/replacement years later had the same train of thought. I will take their diagnosis over yours.

Aerelli wrote:Actually GH instability is addressed by strengthening the rotator cuff, the serratus anterior, and the middle and lower traps/rhomboids. Frequently a too large/too strong anterior delt is a contributing cause of GH instability, not the opposite.
Done right working the front delt will also get the rotator cuff, the serratus anterior, and the middle and lower traps/rhomboids. It is basically impossible to not work these muscles (in addition to various heads of the pectoral muscles) while targeting the front delt, though I am sure with all your knowledge you already knew that. If not just ask nicely and with respect and I will give you a really useful workout, and it is a hormone trigger on the level of a deadlift. As far as the rotator cuff is concerned, I am not sure how you can't see the importance of the front delt in saving that structure from big forces, but if you want to keep your eyes wide shut go right ahead.

I'm sure there are cases where people have over-developed their front delts, and that these are the people you prefer to work with. Nonetheless, that does not change the fact that this is a chronically underdeveloped muscle in climbers, that strengthening it will lend a great deal of stability to the shoulder, and that the enlarging and subsequent strengthening of the muscles is the final step to truly recovering from any injury caused from any joint imbalance.
kenr · · Unknown Hometown · Joined Oct 2010 · Points: 10,394

Three problems I see:
a) The "shoulder" is a rather complicated joint with many articulations and many attaching muscles. If you want to get serious about "building mass", you're going to have to do lots of different exercises. Which is going to take substantial time per week. Perhaps also some space in your home for equipment.

I will bet that the increased "mass" on a majority of those muscles will be irrelevant to preventing climbing injuries. The extra mass on those muscles will be relevant to reducing the difficulty level of your climbing.

Even for the minority of muscles which are relevant: How will you know when to stop? How much "extra mass" is enough?

b) My limited experience as a patient showed that a significant percentage of Orthopedic Surgeons know little about soft tissue (except specific ones that they cut or re-attach), little about rehabilitation exercise, little about prevention exercise.
I guess because just being good at the "carpentry" and "plumbing" is enough to engage them and enough for them to succeed in their career. I further guess that they like control. The carpentry and plumbing is under their control. Exercise is way out of their control.

So for exercise, many of them just keep repeating whatever they remember some professor at medical school saying, or what somebody said at some conference last year. Even though there's no solid clinical evidence.

c) Actually it's rather difficult (and expensive?) to do really careful well-designed studies on soft tissue and injury prevention.
So it might well be that best current answer about "muscle mass" is: Nobody really knows.

Ken

P.S. Myself I've got more important things to do with my time.

Nick Sweeney · · Spokane, WA · Joined Jun 2013 · Points: 650

This is the exact reason that Aleks Zebastian can avoid injury and proceed with bold flash, myah.

Guideline #1: Don't be a jerk.

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