We don’t usually think about our shoulders, but we use them all the time to do things like lifting a bag of groceries, opening the car door, wiping the kitchen counter, picking up a child, lifting a drink, combing our hair, reaching behind our back to thread a belt through the loops and more. Two major bones of the shoulder are the humerus or arm bone, and the scapula or shoulder blade. The four muscles of the rotator cuff stabilize the shoulder joint or keep it in its proper position. Muscles in our chest and back and the deltoids on top of the shoulder are responsible for moving our arms in all the multiple directions they are capable of. Our shoulders are complex and amazing!
Rotator cuff injuries are common and increase with age. Fifty percent of adults over 60 have rotator cuff tears. Thirty-four percent of adults who have rotator cuff tears have no symptoms. For more information about the causes and treatment of a rotator cuff tear, see this article from the Mayo Clinic. It is a good idea to take care of your shoulders by keeping your muscles strong before an injury occurs. The water is an excellent place to do this because buoyancy decreases joint compression and allows better muscle function and relaxation. When the shoulders are submerged, circulation increases which assists in removing toxins and bringing in nutrients. Start by relaxing the shoulders. When your shoulder blades are flat, the rotator cuff is in good alignment. With your arms by your sides, turning the palms forward helps to bring the shoulders in good alignment. Some shoulder exercises to try in the water are:
- Lat pull-down. Hold resistance tubing overhead and pull the ends down to the sides.
- Jumping jacks with the thumbs up.
- Breaststroke with the thumbs up
- Rear delt fly. Pull the ends of resistance tubing apart at shoulder level.
- Shoulder extension. Bring the arms in front of the body at the surface of the water and press down. You can add resistance with drag equipment, such as paddles. Or hold resistance tubing at the surface of the water with one hand and pull the opposite end down with the other arm.
- Cross-country ski with the palms facing forward.
- Rotator cuff sweep. Bring your elbows down near, but not glued to, your waist. Sweep your hands out to the side and back to center. Or keep your hands out to the sides and walk backwards.
- PNF. (1) Bring one fist to the opposite shoulder then sweep it diagonally out to the side near the hip with the palm facing back. (2) Bring one fist to the opposite hip then sweep it diagonally up to the side with the palm up, as if pulling a sword out of its scabbard and brandishing it.
- Figure eights to the sides, to the front, or one arm at a time.
In addition to strengthening the shoulder, there are some cautions to help you avoid an injury. Look at the drawing of the shoulder bones. The head of the humerus is like a golf ball sitting on a tee (the glenoid cavity). This allows the shoulders to be extremely mobile, but they are not designed for weight bearing. Therefore, do not hang on walls, because then you are using your shoulders to support your weight. The photos demonstrate some other things NOT to do. You want to avoid impinging the shoulder, which means pinching the tendons of the rotator cuff. Impingement occurs when you hang from foam dumbbells with the arms extended to the sides and when you are suspended from foam dumbbells in a reclining position. Using a noodle around the torso can also cause impingement if it is too high. Position it mid-torso, just below the shoulder blades. Do not hang from foam dumbbells under the armpits as it damages the nerves in the armpit. Always wear a deep-water belt when using foam dumbbells in deep water. Keep your feet on the pool floor when using foam dumbbells in shallow water. Keep your shoulders relaxed while working with foam dumbbells. Impingement occurs when using the equipment with shoulders shrugged. If you have difficulty holding the dumbbells under water without shrugging the shoulders, use a smaller set of dumbbells, or switch to webbed gloves. Another instance of impingement occurs when the arms are extended to the sides with the shoulder internally rotated, that is with the thumbs down. That is why the breaststroke is done with the thumbs up. Yes, swimmers do the breaststroke with the thumbs down, but they are in a horizontal position, not in the vertical position of exercisers in a water fitness class. Be careful about bringing your arms too far back when doing a breaststroke. This exposes the head of the humerus, risking an injury. Keep your hands within your peripheral vision, unless you are doing a slow stretch.
Overhead reaches are functional, but do not sustain them for too long. The shoulder muscles fatigue quickly, so take a break after a few repetitions, or alternate arms. Do not bring the arms in and out of the water. As the arms break the surface, the resistance is suddenly gone, and the movement becomes ballistic. When you hold your arms out to the sides, do not continuously maintain a position between 80 and 120 degrees, because that can cause bursitis. It is better to have the arms at a 70 degree angle. Fast arm circles overload the small shoulder muscles. Slow the arm circles down. When holding a noodle in the hands for upper body work, it is best to have the hands shoulder distance apart. If the hands are too narrow, the shoulders are rounded. If the hands are too far apart, the shoulder blades are no longer neutral. Triceps dips with the noodle behind the back are also hard on the shoulders, and there are many triceps exercises that are more effective.
Take care of your shoulders so you can continue to lift those grocery bags, open the car door, wipe the kitchen counter, pick up a child, lift your drink, brush your hair, and reach behind your back to thread your belt through the loops without pain.
Ruth Sova, MS – Shoulders Mini Session 9-8-22
Pauline Ivens, MS & Catherine Holder, PT Do No Harm 2011
See you in the pool!