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The Importance of Protecting Your Shoulders
Hunting, fishing, raking leaves, and shoveling that early season snow are all activities this time of year that make us think of fall.  These are also activities which can lead to overuse shoulder injuries.  There is a common misconception that lifting weights or strengthening your biceps, triceps, and deltoid muscles can keep your shoulders from suffering injury.  While each of these muscle groups is important when it comes to fall activities don't forget that smaller supportive muscles can be injured as well.  Even NFL football players routinely report to training with shoulder pain in spite of spending all summer long improving the strength of the overlying muscles.  Knowing the anatomy, reviewing injury types, and preventative exercises and activities is key to better understand why these injuries still occur.

The shoulder joint is considered a ball and socket joint.  Compared to the hip where the majority of the socket is bony, the shoulder socket or rotator cuff is primarily composed of soft tissue-muscles, tendons and ligaments.  It is at this level where most shoulder injuries occur.  There are four small muscles which form the rotator cuff.  The Infraspinatus muscle lies along the mid-portion of your shoulder blade or scapula and then attaches to your Humerus bone.  Its function is to externally rotate your humerus and upper arm and does 60% of this work when it contracts.  The Supraspinatus muscle lies along the top of the scapula bone and also attaches to the head of the humerus.  Its primary function is to assist in elevating the humerus such as reaching your arm out in front of you.  The Teres Minor muscle lies along the inferior border of the scapula and is also responsible for anterior stability of the humerus in the socket and assists with external rotation of the arm.  Finally the Subscapularis muscle, it lies on the front side of the scapula bone closest to the chest wall.  It has a primary function of internally rotating and stabilizing the arm.  As a group these muscles make up the rotator cuff and provide stability to the rounded head of the humerus effectively keeping the "ball" in the socket.
Rotator cuff pain is most commonly caused by two scenarios.  The rotator cuff can be torn with injury to one or more muscles it is composed of.  This usually occurs when you suffer some trauma such as falling on an outstretched arm.  Age and general wear of the shoulder joint increase the risk of rotator cuff tear over the years.  Rotator cuff pain can also occur secondary to repeated stresses such as raking or shoveling which inflame the supporting tendons.  Often times therapy, shoulder injections and sometimes even surgery are required to improve or resolve these symptoms.

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There are ways to isolate the rotator cuff muscles which in turn can reduce your risk of rotator cuff irritation.  The key to isolating out the muscles of the rotator cuff is to do exercises with your elbow tucked in next to your body.  The first group of exercises is best thought of as the cashier exercises. Think of swinging your hand and wrist across your body with your arm bent to 90 degrees at the elbow much like a cashier scanning the items at the grocery store.  Start with your hand directly in front of your abdomen and now draw your hand outward away from your body being certain to keep your elbow next to your body.  Now across to your abdomen.  These exercises are best done with slight resistance something like a large rubber band or with 2-3 pounds of weight being pulled from the side.

For the second set of exercises begin in the same position except this time draw your arm forward so that your elbow comes 8-10 inches in front of your body and then relax and push your elbow backwards behind your body roughly the same distance.  This time you are pulling backward and pushing forward.  The focus is still to keep your elbow in tight and not raise out to the side.  The best image for this exercise is that of distance runner who runs with his arms up tight to his body swinging them gently.  Again mild to moderate resistance is the key.
As far as frequency and duration of these exercises, it is best to perform them at least 3 times per week for 10 to 15 minutes daily.  Spend 3 to 4 minutes on each exercise doing them gradually.  Just this small activity a few times per week is enough to strengthen and protect your rotator cuff muscles, and will better prepare you for your fall activities--raking, shoveling or whatever they may be.
Timothy J. DeVries  PA-C


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