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Shoulder Injury Prevention and Treatment

There is perhaps no joint in the human body as complex, fascinating, or baffling as the shoulder. It can leave clinicians scratching their heads, wondering why a problem they have solved many times before is so stubborn.

And shoulder problems can certainly be stubborn! That' s why, in every case, prevention is so much better than cure. Rarely is a pain that has surfaced a simple matter of applying some ice - it is more likely to be the tip of an iceberg...

The amazing shoulder joint

Consider what the shoulder does, and how many athletes - swimmers, tennis players, bowlers, baseball pitchers, javelin throwers - take it for granted. The shoulder can assume no less than 1,600 different positions! There is more movement at the shoulder joint than at any other joint in the body.

The shoulder joint actually comprises four joints - see if you can feel them on yourself:

• Sternoclavicular (SC) joint (between the sternum and the collar bone) - this is actually the only bony connection that the shoulder has with the main skeleton

• Acromioclavicular (AC) joint between the collar bone and the point of the shoulder called the acromion, which is part of the scapula or shoulder blade

• Glenohumeral (GH) joint between the glenoid part of the scapula - the socket - and the head of the humerus (HOH) - the ball

• Scapulothoracic (ST) joint (the ' false joint' between the scapula and the rib cage that it rides over).

Clearly, the shoulder joint is truly remarkable invention -- until it goes wrong! Shoulder Injuries - Prevention and Treatment looks at the most common cause of shoulder pain and provides a number of illustrated exercises designed to treat and prevent them.

For those with a shoulder injury they would like to try to treat themselves, we provide a checklist for ruling out structural damage. The seven chapters include a number of canny DIY ideas for improving performance and avoiding injury.

Treatment, prevention and performance enhancement

The measures outlined in this new workbook for the prevention and treatment of overuse injuries of the shoulder are guaranteed to improve your performance. They will genuinely improve the way your shoulder works, and thus it will be stronger, more co-ordinated, reach further and last longer before fatigue sets in.

"Injury prevention equals performance enhancement".

Flexibility: the purpose of flexibility varies for the different muscles around the shoulder. For the major power muscles, it is important that flexibility allows freedom of movement for the pelvis, trunk, scapula, and humerus. For the rotator cuff, the critical issue is the balance of forces centreing the head of the humerus, and to a lesser degree, freedom of movement. As we explain, it is more critical that the internal and external rotators are equally flexible, rather than how flexible they are.

Stretching: learn why stretching to increase flexibility should never be done prior to training or competition -- and when it should be done.

Core stability: core stability has become a whole science in itself in the last decade as all manner of sports professionals have realised how critical it is for the inner core of the body, namely those joints closer to the spine, to be supported by the postural muscles designed to do so. For the shoulder, the critical areas are the lumbar and cervical spine and the scapulothoracic joint. Discover why, if these areas are not stable, significant extra loading and strain is passed on to the shoulder joint.

Rotator-cuff strength and control: the rotator-cuff muscles are dependent on the good positioning of the scapula for effective control. If the scapula is angled too far forward or downward, for instance, while the tennis player reaches overhead to smash, the rotator-cuff muscles are biomechanically disadvantaged and may result in failure of the prime mover muscles to generate power.

General muscle strength:once the foundational issues of technique, flexibility, core stability, and rotator-cuff control are being implemented, we then look at the bigger picture of the ' outer core' . What is the rest of your body like - does it help or hinder the performance of your shoulder?

Avoiding the common mistake of imbalance

Most athletes believe that a gym routine needs to include strengthening work for the deltoids (three heads), latissimus dorsi, pec major, upper trapezius, and the rectus abdominis because they are the prime movers of the shoulder.

What is often critically overlooked, however, is the imbalance that can develop between the front of the shoulder and the back. In those athletes that are carrying an overuse injury in the shoulder, nine times out of ten they have overdeveloped pecs and lats relative to their trapezius, rhomboids, posterior deltoids, and posterior rotator cuff.

In these situations, flexibility must often be improved, scapular setting must be taught, and the focus of gym exercises changed towards the back. We explain how it' s done.

How to prevent the damaging cycle of chronic shoulder pain

Any overhead activity that involves the arm being taken often enough from below the shoulder level to above shoulder level has the capacity to damage the rotator cuff. With repeated impingement, a poorly conditioned cuff can become damaged, and a cycle of cuff damage, impaired function, further impingement and worsening cuff damage is initiated.

We look at how such repetitive damage is caused, how the athlete may be able to prevent it occurring in the first place and why a co-ordinated action of this group of muscles is needed to provide a stable base for pain-free overhead activity. Here are the symptoms:

• The shoulder aches after overhead activity

• It gets worse and restricts the activity

• Periods of rest apparently resolve the problem only for the pain to recur when you returned to sport

• Chronic shoulder pain is an all-too-common consequence of repetitive ' overhead activity', such as serving and smashing in tennis, freestyle or butterfly swimming, bowling in cricket, javelin, or baseball throwing and above-shoulder weight-training exercises.