You could boast shoulders as wide as Dwayne Johnson’s or arms as buffed as Ronda Rousey’s, yet still be at high risk for sports injury until you give some correct and loving care to a couple of your more hidden structures: your rotator cuffs.
Located below the showier bulges of “pecs, delts and traps” (pectoral, deltoid and trapezius muscles), your rotators are muscles and tendons that snug a ball on the big bone of your upper arm against a shallow socket at the end of your shoulder blade.
This arrangement awards your arms a wondrous mobility, yet surrenders some of the stability that can be found in the body’s more encompassing ball-and-socket joint – the hip. The shoulder’s more-vulnerable version has been compared to a golf ball sitting on a tee. To fully round out this picture, imagine four rubber bands (the cuff) securing that ball in place. Pop, stretch or strain these bands to their breaking point, and you might need to visit a place like The Stone Clinic in San Francisco or the Sports Medicine Center of the Palo Alto Medical Foundation.
Dr. Kevin Stone of The Stone Clinic is an orthopedic surgeon, inventor and medical technique innovator who specializes in treating sport injuries to ankles, knees and shoulders. Much of the severe shoulder trauma he sees results from falls, particularly cyclists tumbling off bikes, or skiers and snowboarders taking a hard dive onto the slopes.
“We perform surgical repair when it’s needed,” Stone says. “But we also have a rehabilitation team that teaches exercises to do before and after surgery, or sometimes instead of it. Preventing injury in the first place means learning how to take a fall. Don’t fling out an arm to brake yourself. It’s far better to tumble and roll.”
Skillful patterning of body movement to maintain your shoulder health includes training exercises to improve the tone, strength and flexibility of the rotator cuff muscles.
“A useful thing to bear in mind is that as soon as you raise an arm above your shoulder, you begin to impinge some of the cuff muscles,” says Stone. “Overall, I favor exercises that keep the hands below the shoulders, ones that involve keeping your whole body in an athletic stance. The best exercises are not workouts on gym machines, but performing your sports in a thoughtful manner.”
However, what if your most beloved sport requires sticking your arms up above your shoulders a whole bunch? Whenever you swing a racket to serve a tennis ball, make a basketball jump shot, spike a volleyball, hurl a baseball, dig deep on a crawl or butterfly swim stroke, raise a dumbbell over your head, or perform any similar moves, you put your rotator cuffs at risk. If you don’t strain them by making too strong an effort, you can wear them down via too many repeated moves – especially moves that a skilled trainer or physical therapist might frown upon.
There are ways to prevent or at least reduce a chance of injury. The first is to learn grace.
That particular bit was hard for me. For many years when doing my sports, I would mightily surge, over-exert and force myself past a pain signal. If anyone wants to call that macho, I won’t object. When I began trying to rehab my highly compromised rotator cuffs, I was fortunate to meet Dr. Warren King, an orthopedic surgeon at the Palo Alto Medical Foundation’s Sports Medicine Center.
King explained to me that research done with sensors placed on the shoulders of athletes showed that the cuff muscles experience their highest electrical discharge when an arm movement nears completion, as you try to guide an arm through slowing and stopping. Consequently, attempting an abrupt, jerky or violent halt to your movement is an error, one worsened by constant repetition. Much better is learning to apply smoothness and grace to all exertion and follow-through.
I ripped a ligament of my collarbone just above my shoulder by making a bad roll in Aikido. I also tore my left rotator cuff during an ill-advised high brace with my paddle while kayaking an infamous whitewater run on the Eel River. If that wasn’t enough, I tore my right rotator cuff by catching a ski edge and taking a hard fall on a slope at Squaw Valley.
The good news is that I was able to fix all this damage and restore operational health without surgery. I did that by assiduously following a physical therapy program suggested to me by King, as well as therapists at Kaiser Permanente. The key elements were correct movements against mild resistance, which was provided by elastic bands and light weights. A short list of three such exercises accompanies this story; many additional ones that are potentially beneficial can be learned.
More good news comes from the fact that not only did my cuffs eventually heal, but since I continued the healing exercises long past obvious need, my shoulders became fitter than ever before, and I can now perform in my main sports about as well as I ever could. However, I did boot a few particularly stressful activities off my athletic menu. From now on, for example, I proclaim myself entirely content to merely observe beach volleyball!
And a final blast of good news is that, should you need it, surgery in some locations uses techniques so advanced they would have seemed like fantasy a few decades ago.
Stone was a pioneer in the use of cleansed animal collagen scaffolds (trellises of protein) to support re-growth of cartilage and ligaments in human knees. Now he says similar methods can be used in shoulder repair, with the added element of deploying amniotic stem cells to restore the tissues in a manner similar to the way they originally developed. He dubs this method “bioware.”
King believes the science isn’t settled on stem cell use, and consequently he has not adopted the technique. Yet both orthopedists fully concur on one point: If you take steps to protect and strengthen your original factory equipment, hopefully, you won’t need to avail yourself of surgical solutions.
“About half of the shoulder problems I see derive from ‘attritional’ injury,” King says, meaning sheer overuse, especially if coupled with stressful movement. “But if everybody engaged in proper strengthening and conditioning, our number of such problems would go way down.”
How to avoid rotator cuff injuries
The owner’s manual for human rotator cuffs has two major tips: Avoid severe stress with your arms raised above your shoulders; and take in robust natural nutrition, including adequate protein. “The best things to consume for your health are not made in factories,” Dr. King says. “They’re made by God and the earth.”
The four muscles (and their tendons or bone attachments) of the rotator cuff run from the scapula (shoulder blade) to wrap the knobby head of the humerus (arm bone). At the top of the scapula in the back is the supraspinatus, at the bottom is the infraspinatus. At the top of the scapula in the front is the subscapularis, at the bottom is the teres major.
To work the supraspinatus: Stand erect, hold very light weights, such as unopened soup or soda cans (OK, beer bottles work, too!) in both hands, with your thumbs angled up. Bring arms slightly forward, in a “Vee” pattern (as seen from above). Slowly raise the weights to shoulder level, then slowly lower to waist level, and repeat. The supraspinatus is the frailest of the cuff muscles and most easily damaged, so be gentle with yourself, and halt at any sign of pain.
To work the infraspinatus and teres major: Stand erect, and put a knot of elastic band (or surgical tubing, bungee cord or bike tire inner tube) behind a closed door or loop around a door handle. Stand with left shoulder pointing at the door, right elbow tucked to abdomen, elbow bent 90 degrees, right hand grasping the other end of the elastic. Start with some tension on the elastic. Increase tension by rotating the right hand outward until it is aimed away from the door. Hold for two seconds, then gradually allow the hand to move back until the forearm is pointing directly away from your abdomen again. Repeat. Reverse body position, and work your opposite arm the same way.
To work the subscapularis: Set up the elastic band as above, but this time utilize your arm and hand closest to the door. With elbow planted firmly against the side, rotate your hand and forearm inward against resistance until it lies across your abdomen, hold two seconds, and allow it slowly move back. Repeat. Reverse body position, and work opposite arm.
In general, begin by doing two to three sets of a dozen repetitions of each exercise, and perform them two to three times weekly. Be alert to any signals of pain, and respond to them by lightening the regimen. If there are no signs of pain, repetitions and frequency of exercises may gradually be increased.