Weight lifters often put an emphasis on targeting the larger muscle groups of the upper extremity (deltoids, pecs, trapezius), but often neglect the RC muscles. This can create an imbalance of strength between the global muscles and local stabilizing muscles of the shoulder. This miss match, in combination with repetitive loading, biased exercise selection, and training errors precipitate RC tendinopathy.
Our main goal is to always keep our athletes in their sport/activity during rehab whenever possible. However, depending on the intensity, irritability and duration of symptoms, a short period of time off from weight lifting may be necessary to offload the tendons. This offloading phase is closely followed by a gradual graded tendon loading program and eventual return to weight lifting. Upon return to weight training there are important modifications to consider to reduce the risk of re-injury.
We will use the bench press for example. Modifying the hand spacing and grip when returning to bench press from RC injury are instrumental in reducing the risk of re-injury. Hand spacing should be no wider than 1.5x the biacromial width (AC joint to AC joint). The narrower hand space reduces the peak shoulder torque and therefore reduces the RC and biceps tendon stabilization requirements of humeral head stabilization3,4. The narrower hand space also allows for a shoulder abduction angle less than 45 degrees and extension less than 15 degrees. These modified angles put the pec major and biceps brachii at a mechanical advantage resulting in less stress on the RC and distal clavicle3.
In addition to hand spacing, grip type is also an important consideration in the return to lifting. The underhand grip (supination) rotates one of the RC tendons, supraspinatus (SSp), out from under the acromion, reducing the risk of impingement during the pressing motion. Whereas the overhand (pronated) grip draws the long head bicep tendon out from under the acromion but places the SSp under the acromion5.
As you can see from the literature, simple consideration of hand spacing and grip type can be instrumental in the successful return to lifting of an athlete dealing with rotator cuff tendinopathy/shoulder impingement.
Anterior Shoulder Instability
An athlete may develop anterior shoulder instability as a result of previous shoulder dislocations/subluxations or a gradual insidious onset. In the athlete with previous shoulder dislocation it should be noted that a conservative management plan may not always be successful. The presence of a bony lesion to the humeral head called a Hill-sachs lesion or Bankart lesion to the glenohumeral labrum may result in chronic instability of the shoulder joint that will result in discomfort and disability under high loads. Surgery may be indicated for this individual if their goal is to continue to lift heavy weights.
The lifter with anterior shoulder instability will present with poorly localized pain in the ‘high five’ position under load and commonly has an athletic history of overhead sports (volleyball, tennis, baseball, swimming) or previous shoulder dislocation/subluxations.
The ‘high five’ position refers to the position of the shoulder when high fiving another individual. In this position the shoulder is placed in 90 degrees of shoulder abduction and 90 degrees of shoulder external rotation. This is considered a high-risk position for individuals with anterior shoulder instability as it puts stress on the main passive primary stabilizer of the shoulder, the inferior glenohumeral ligament (IGHL)6.