Why do I hurt? Anterior Shoulder

 

 The shoulder is one of the most injured areas of a golfer’s body. Only the low back and elbow experience more occurrences of pain than the shoulder. But why is this the case? Is it that the shoulder joint is just a weak area of the body? The short answer is no. Is it because the muscles are small and have to handle lots of force? Maybe. However, we have to look more globally than just the shoulder joint to figure out what might be going on. 

 

Many people know what the rotator cuff is. They are the 4 muscles that attach the arm bone to the shoulder blade, allowing for dynamic control through range of motion. They help support the shoulder, and prevent impingement by depressing the arm bone within the shoulder joint to create space. However, many times when a golfer experiences shoulder pain (it is likely our lead shoulder) it is in the front of the shoulder, generally not in the area of the rotator cuff. However, this is where the biceps tendons and labrum often will cause pain. 

https://www.uptodate.com/contents/image?imageKey=PI%2F74486The biceps tendons and labrum also act to provide stability to the shoulder joint. The biceps has two heads, hence BI-ceps. The short head of this muscle attaches to the coracoid process on the shoulder blade, while the long head of the biceps (which most people are referring to when they speak of the biceps tendon) attaches into the labrum surrounding the glenoid fossa (shoulder joint). This glenoid fossa is also on the shoulder blade. As we elevate our arm up this long head of the biceps is likely going to pinch between the arm and the acromion, something we call impingement. Depending on the shape of your acromion this might happen at shoulder level or higher as you bring your arm above your head. If you do this often there is a likely chance that you will experience some pain in your biceps tendon. 

As stated before, the rotator cuff should be depressing the arm bone in the shoulder joint, leading to more space in the joint as you raise your arm up. Therefore it is important that you have a rotator cuff that works well and has good endurance to keep your biceps tendons as healthy as possible. However, it is possible to pinch or shear the biceps tendons by bringing your arm across your body as well. A move we call horizontal adduction. As you bring your arm bone across your chest the tendon will be pinched between your arm and the acromion, or the soft tissue will experience shearing forces from being compressed

As golfers we perform this movement every single backswing we make. As we bring our lead arm back, we bring it towards our chest. If we have poor thoracic mobility it will not rotate well and we will still try to get into these leveraged positions at the top of our backswings. This will cause even more shear and pinch to the tendon. At the same time, if the shoulder blades (especially on the lead arm) cannot slide forward on the back of the rib cage (protraction) even more pinching in the anterior shoulder will occur. The only other option for the shoulder at this point is to shrug which has also shown to cause more pinching of the biceps tendon on the acromion. Sounds like have a mobile thoracic spine and flexible muscles around the shoulder blade are pretty important to preventing this or making it feel better if it already hurts. To alleviate or prevent this pain from occurring we need to be sure that our thoracic spine and shoulder blades possess good mobility. This will allow our biceps and rotator cuffs to work efficiently and our joints can stay in positions that help create powerful movement while also reducing the amount of detrimental forces on the muscles and tendons.  

The following three drills can help open up your thoracic spine, mobilize your shoulder blades, and help stave off pesky shoulder pain. 

 

Stable Hip Trunk Rotations (with reach) - watch video below

 T4 Rotations (low hand)

2-4 sets of 8 each side
  • Start in quadruped with your hands under your shoulder and knees under your hips.
  • Place your right hand on your low back - palm up to ceiling
  • Now make a big left turn and try to point your left elbow at the ceiling. 
  • At the same time push yourself away from the ground with your right arm.
  • Return to start and repeat. 

 

Pec Stretch 

2-4 sets of 60 sec each side
  • Stand in a doorway.
  • Place your right elbow on the doorway at approximately ear high. 
  • Step through the doorway with your right foot and rotate to the left, while keep your right hand where you started. 
  • You should feel a stretch through your chest and bicep on the right.
  • Remember to keep your ribs down to prevent arching your lower back.

 


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