Avoid upper cross syndrome and maintain rotator cuff stability

We're going to address one of the most neglected and important areas of the body: the shoulder joint.

Overuse can occur through repetitive motions, as in swimming, or in static overuse -- for example, the position held on a bike. What's the result? Tight anterior and weak posterior musculature creates imbalances, poor posture, discomfort and possibly injury. This area needs to be trained and maintained to avoid these issues, promote good posture and solidify your performance.

There's so much information related to form and function of the shoulder that three-time World Ironman Champion Peter Reid would have no trouble finishing Ironman Hawaii twice, and recover completely from both, before we could even scratch the surface of relevant information.

So, in order to keep you awake and interested, we'll address one of the most common faulty upper body imbalances, along with shoulder joint integrity.

What is upper cross syndrome?

Although you may not be familiar with the term upper cross syndrome (UCS) you've probably seen it. All of us have seen that little old lady who's standing up, but appears to be falling over; her head shifted forward, shoulders rounded, and her upper back between the shoulder blades looks like the head of a cobra poised to strike.

Now, just so you don't think we're picking on the elderly, the same condition can exist in the young. Picture the gym rat that does 10 sets of 10 with 225 lbs, three days a week, year after year. Eventually he too will develop the same condition as the little old lady.

Both examples are a result of muscular imbalances between the flexors and extensors of the upper torso and regardless of age, if you suffer from these imbalances you'll have a higher risk of injury and will be less efficient in your training and racing.

How do you develop UCS?

UCS is simply the weakening and lengthening of the posterior upper-back and neck musculature, and the tightening and shortening of the anterior and opposing musculature. Remember your mom telling you to stand up straight? Well, poor posture, such as slumping over a computer or slouching, contribute to UCS.

If someone with UCS swims, bikes, or runs, it will exacerbate the faulty mechanics and cause excessive wear to the skeletal system, muscles, and tendons and ligaments. Additionally, UCS will also hinder performance by depressing the sternum; meaning you can't breathe, which is rather important for endurance athletes!

How do you correct it?

You can correct UCS by strengthening what's weak and stretching what's tight. Let's discuss the muscles that make up the rotator cuff and their function and relevancy to the stability of your shoulders and posture.

The shoulder allows for a great amount of mobility, at the sacrifice of stability, which is why you must be forever vigilant and adhere to the commandments of shoulder stability.

Commandment 1: Know thy structure. Unlike the hip joint, which has the protection of surrounding bone to help stabilization, the shoulder heavily depends on four small muscles, ligaments and tendons to establish joint integrity. The muscles are: the subscapularis, teres minor, suraspinatus, and the infraspinatus. The stabilizing ligaments are the glenohumeral, coracohumeral, and the transverse humeral ligaments.

Commandment 2: Know thy movements. Shoulder movements include abduction, adduction, lateral and medial rotation, flexion, extension, and circumduction (combination of these movements). Because of the mobility of the shoulder, exercise selection must encompass all of these movements through a safe and full range of motion, which we'll cover shortly.

Commandment 3: Know thy anchor. Shoulder movement and the four muscles that perform stability are anchored to the scapula, so you must stabilize the scapula to further establish joint integrity.

The major players are the levator scapulae, upper trapezius, and rhomboid major and minor. You use your lower trapezius and the serratus to lift your scapula, and your latissiumus dorsi, pectoralis major and minor, and subclavius to lower it.

The exercises

Although there are many exercises that assist in shoulder stability, most of which are covered in The Next Level Strength Training for Endurance Athletes, here are a few to get you started.

To determine weight, use the weight that allows you to complete 10-12 repetitions correctly, using a full range of motion. Bands may also be used instead of cables for these exercises. Do three sets of each exercise.

Internal/external rotation with elbow bent at 90 degrees

This exercise is great for the medial and lateral rotators of the shoulder. Use the towel as pictured to help ensure your elbow is in the proper place.

Internal rotation: Position the cable in line with your hand as you grasp the handle. As shown in Figure 1, start with your hand out to the side of your body (keep elbow against towel) and then pull toward the mid-line of your body; your forearm horizontal to the ground as you rotate out and in. Always activate the transversus and pelvic floor by pulling your belly button in while performing the movement.

Figure 1.

External rotation: Begin with your hand at the mid-line of your body and then rotate the hand out to the side, as shown in Figure 2 below. If you don't have cables or they're beyond your level of ability, you may substitute bands or rubber tubing instead, or use dumb bells while lying on your side on a bench.

Figure 2.

Internal rotation top to bottom/external rotation bottom to top

Perform these exercises in the order as shown.

Internal rotation top to bottom: Start with the cable at the top of the column system with hand as shown in Figure 3. Pull your belly button in as you pull your arm down, keeping your hand in line with the cable angle (at the start), to the mid-line of your body with only a slight bend in the elbow. Return to start position and repeat.

Figure 3.

External rotation bottom to top: As shown in Figure 4, move cable down to the bottom of the column and grasp handle as shown at thigh height. Raise your arm at an angle in line with the cable with minimal bend at the elbow to a height just above the ear, lower and repeat. As with the other exercises, activate the TVA and pelvic floor muscles by pulling your belly button in.

Figure 4.

Internal rotation bottom to top: Start with the cable at the bottom of the column with your hand as shown in Figure 5. Pull the cable up with your hand in line with the cable angle and arm bent slightly at the elbow. Lower and repeat.

Figure 5.

External rotation top to bottom: Place the cable at top of column and hold your hand as shown in Figure 6. Pull the cable across your body with your hand in line with the cable angle and a slight bend in your elbow. Raise your arm to start position and repeat.

Figure 6.

Remember, if you feel you have any UCS symptoms, make sure you stretch properly beforehand and place extra emphasis on the movements that involve external rotation -- this will help correct the imbalances caused by UCS.

We hope that you've learned a bit about maintaining the structures that support your body and your performance, no matter what sport you participate in. A little effort will go a long way, so do your best to make time for the maintenance work that will keep you pain and injury free and performing at your best all season long.

All exercises shown in this article can be found in The Next Level, Strength Training for Endurance Athletes. For more information, visit www.endurofit.com.

All images are property of Endurofit, LLC. Images and the content of this article may not be reproduced or disseminated without the express written consent of Endurofit, LLC.

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