Take Care of Your Shoulders

What are the Rotator Cuff Muscles? - Brace Access

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.
Do not hang from dumbbells
Do not position noodle too high
Do not position dumbbells in arm pits
Do not breaststroke with thumbs down

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!

Author/Instructor Photo
Chris Alexander

Take It Back

Did your mother remind you to sit up straight when you were a teenager? Most of us don’t think much about our posture, but poor posture can lead to a variety of health problems.

  • Headaches. Your head weighs about 10 pounds, but every inch you tilt it forward adds10 pounds. If you tilt forward 1 inch, your head weighs 20 pounds. If you tilt forward 2 inches, your head weighs 30 pounds.
  • Rotator cuff tears. Rounding your shoulders forward pinches the tendons in your rotator cuff, which can lead to a rotator cuff tear.
  • Back pain. Slouching stresses the muscles of your back which can lead to chronic back pain.
  • Reduced lung capacity. Poor posture compresses your chest area, which means your diaphragm is not able to fully expand.
  • Increased risk of injury during exercise. Neutral spine with the core engaged is the safest position for exercising. It makes sense that working out with forward head, rounded shoulders, poor posture and an inability to fill the lungs completely with air is a recipe for injury.

For more information on problems caused by poor posture, see “What Really Happens to Your Body When You Have Poor Posture” in Live Strong.

Good posture requires core strength. Often when you hear the term core strength, you think of abdominals and crunches. But the core includes all the muscles from your shoulder girdle to your pelvic girdle, in other words, the entire trunk area. There are a variety of exercises you can do to improve core strength. These include head retractions, overhead arm raises, bridges, the Yoga tree pose and planks. There are also a variety of stretches that are helpful. These include neck stretches, chest stretches, and hip flexor stretches. For more information on these exercises see “These 12 Exercises Will Help You Reap the Health Benefits of Good Posture” from Healthline.

To improve core strength, it is also helpful to pay attention to your daily activities. Often we use our arms to support ourselves when it would be better to use our core strength instead. If you are unstable because of an illness or an injury, then you may need to use your arms. Otherwise it is better to straighten up your posture and take back your ability to move from your core. Ruth Sova did a series of 30-second videos about situations in which doing things the easy way may cause us to lose function. She entitled the series “Take It Back” and gave permission to share the videos. There are links to the videos in the titles of the six pictures above. The videos show Ruth’s sense of humor and they are delightful.

Don’t forget to also practice good posture when you exercise. See you in the pool!

Author/Instructor Photo
Chris Alexander

Exercise Motivation

Strength Training
Aerobic Exercise

I get it. It’s hard to make time for exercise. You know you should exercise. Maybe your doctor told you to exercise. But you’ve got work projects, and household responsibilities, and maybe kids with all of their activities. And then there’s social media, and Netflix, and you are so tired by the end of the day. It’s easy to postpone exercise until after you’ve made that important business presentation, or after you’ve finished your home repair project, or after your daughter’s soccer season ends.

On the other hand, no one likes to think about becoming frail as they age. According to the Clarity Final Report (2007), the things people fear the most about aging are (1) losing their independence because of poor health, poor memory or an inability to get around, (2) having to move into a nursing home, (3) losing their family and friends, and (4) having to give up driving. Exercise is the prescription for postponing most of these life-altering events indefinitely into the future. This is one reason why the American College of Sports Medicine recommends strength training 2-3 times a week and at least 150 minutes of aerobic exercise every week. Research has shown that following these guidelines is associated with lower mortality risk.

Strength Training. According to an article in the New York Times, “People Who Do Strength Training Live Longer – and Better” (August 24, 2022) people who take part in strength training sessions 1-2 times a week have a 40% lower mortality risk than those who don’t exercise at all. Muscle strength is required to get out of your chair, to open a jar of pickles, to carry your groceries into the house, to do yardwork and more. We progressively lose muscle mass as we age, but regular strength training prevents the loss of muscle mass and improves both muscular strength and endurance. Building muscle increases the amount of fat-free mass in your body and increases your resting metabolism. Stronger leg muscles protect the joints and make them more stable, which helps reduce the pain of osteoarthritis. Stronger leg muscles also reduce the risk of falls in older adults. Stronger muscles in the back and abdomen allow you to stand up straight and avoid lower back pain as you age. Strength training increases bone mineral density which lowers the risk of osteoporosis, and for those who already have low bone density it helps slow the progression of the disease. Strength training increases glucose metabolism which lowers the risk of diabetes, and for those who are already diabetic, it helps manage glucose levels. Strength training lowers the incidence of many chronic diseases, and improves psychological well-being.

Aerobic Exercise. Aerobic exercise is strength training for your heart. The heart is the most important muscle in the body. It beats 24 hours a day, 7 days a week. Regular aerobic exercise increases the ability of the lungs to hold air and strengthens the heart muscle so that it pumps a greater volume of blood with each stroke. Aerobic exercise lowers the resting heart rate. The maximum amount of oxygen your heart can deliver to the working muscles declines as you age, mainly due to physical inactivity and an increase in body fat. Once it declines to a certain level, a person loses functional independence. Poor aerobic fitness is a more accurate predictor of death than risk factors such as hypertension, smoking and diabetes. Aerobic exercise retards this decline. Aerobic exercise also improves insulin sensitivity, helps prevent diabetes, can reduce coronary artery disease risk by 50%, lowers the incidence of colon cancer and breast cancer, can improve balance and prevent falls, preserves bone mineral density, can help the exerciser lose and maintain loss of body fat, lowers blood pressure (if elevated), and can improve cholesterol and triglyceride levels. Recent research suggests that aerobic exercise is also good for your gut bacteria.

The longer you go without regular exercise, the more likely you are to have dementia. You are also more likely to get diabetes, heart disease, and high blood pressure, all of which may be linked to Alzheimer’s disease. There is no time like the present to get started. You do not have to lift heavy weights. In fact more repetitions with lighter weights has been shown to be more effective with older adults. You do not have to start running marathons for your aerobic exercise. Find something you enjoy: a brisk walk in your neighborhood, ride a bicycle, play pickleball, go dancing, join a sports league, swim laps, or take a water fitness class. Check out the Plano Parks & Recreation website or the Parks & Rec website in your city for more options.

See you in the pool!

Author/Instructor Photo
Chris Alexander

Strength Training Equipment for the Pool

When people think of water fitness, they most often think of a cardio workout. While that is emphatically true, it is also possible to strength train in the pool. You don’t even need equipment. You can use the water’s resistance and the same principles for increasing intensity that you use for aerobic exercise. Once you have mastered that, adding equipment increases the resistance. Since most of the popular equipment made for use in the pool is hand-held, the targeted muscles are in the upper body:

  • Chest (Pectoralis major) – Chest fly/clap hands
  • Upper back (Trapezius) – Row
  • Side back (Latissimus dorsi) – Lat pull-down
  • Shoulders (Front and rear deltoids) – Arm swing
  • Shoulders and mid back (Rear deltoids and rhomboids) – Rear delt fly
  • Shoulders (Middle deltoids) – Arm lift to the sides
  • Rotator cuff – Shoulder medial rotation/rotator cuff sweep
  • Biceps – Arm curl
  • Triceps – Elbow extension

Increase the Range of Motion. Start by selecting your targeted muscle group, and moving your arms through their full, pain-free, range of motion. Notice how the water moves as your arms move.

Add Speed. Next increase your speed while continuing to move through your full range of motion. Your movement becomes harder. It’s easy to start slowing down, so pay attention to what you are doing.

Add Acceleration. Finally push harder against the water’s resistance. The harder you push against the water, the harder the water pushes back. You may notice that even though you are pushing harder, your movements are slowing down. When you get used to using acceleration, it is time to add equipment.

Buoyant Equipment. Nearly every pool facility has foam dumbbells in their equipment closet. Foam dumbbells were the first type of equipment specifically created for use in the pool. Buoyant equipment floats, therefore, the resistance comes from pushing the dumbbells down toward the pool floor. They are great for targeting the latissimus dorsi (as in the photo above) and the triceps. From a lunge position, if you lean forward 45 degrees with your spine in alignment, you can target the pectorals by pushing a chest fly toward the pool floor. Movements parallel to the floor, such as a row, an arm swing, a rear delt fly, and a rotator cuff sweep, create drag resistance, but the shoulder stabilizers must contract to hold the equipment under water. It is best to limit the number of reps for these exercises or avoid them if you cannot maintain good shoulder alignment. Movements toward the surface of the water, such as an arm lift to the sides or an arm curl, are assisted by buoyancy.

Drag Equipment. A variety of drag equipment is available. These increase the resistance of the water by increasing the surface area. Paddles have holes that allow water to flow through. Drag bells have multiple surface areas that create turbulence.

Drag equipment is not buoyant, and the resistance is in all directions – toward the pool floor, parallel to the pool floor, toward the surface of the water, and at any other angle. Drag equipment can be used to target any of the upper body muscle groups. Examples include a chest fly with paddles, a row with a kickboard, an arm swing with drag bells, a rotator cuff sweep with webbed gloves, and an arm curl with an Aqua Ohm, as in the photos above.

Rubberized Equipment. Resistance tubing and bands that are chlorine resistant have come on the market in the past several years. They work the same as rubberized equipment on land. There has to be an anchor point and the resistance is in pulling away from the anchor point. You can use a pool ladder as an anchor point, but that is impractical in a group exercise setting. The anchor point is usually one of your hands, or you can place the band behind your back, or from a seated position put it under your thighs, and then pull with both arms. Resistance tubing is too long to be able to hold a handle in each hand for most people. Try using one handle as the anchor point, then putting the other hand on the appropriate length of tubing. You can slip your wrist through the loose handle to keep it from flopping around in the water, as in the photo to the left of a rear delt fly.

Once you are comfortable with the equipment you can continue to increase the intensity by increasing the range of motion, adding speed, or adding acceleration, that is, by pushing or pulling harder. You can move up to a larger size foam dumbbell or drag bell, or a thicker resistance tube. You can hold a shorter length of rubberized equipment. You can close the holes on the paddles. You can use different pieces of equipment at different times to prevent your muscles from getting used to one type. Click on the name of each piece of equipment for a link to 10-second video of an exercise using that equipment. For strength training lesson plans both without and with equipment, see Water Fitness Progressions.

Let the pool be your all-purpose gym for both aerobic exercise and strength training. See you there!

Author/Instructor Photo
Chris Alexander

New Year’s Resolution: Exercise

According to the Statista Global Consumer Survey the Top New Year’s Resolution for 2023 is to exercise more. We all know that exercise is good for us, but we also know that New Year’s Resolutions are frequently broken. Why do people so often stop exercising? According to an article in Diabetes in Control, the reasons are (1) A perceived lack of time, (2) Exercise related injuries and (3) Exercise is not fun (which is often due to starting at an exercise intensity that is too high for their fitness level). Here are some suggestions to deal with each of these problems:

(1) A perceived lack of time. People who successfully incorporate exercise into their lives often dedicate a specific time in their schedule for working out. They plan to exercise at 9:00 AM 3 times a week, or at 6:30 PM after work on Tuesdays and Thursdays. Then they don’t schedule anything else for those times. An easy way to do this is to sign up for a class that is offered at the time that is most convenient for you. People don’t often think of water exercise as an option in January, but exercising in an indoor heated pool has its advantages over going for a jog outdoors in cold weather in the dark. According to an article in Healthy Body at Home, it takes an average of 59-66 days to create a new habit, so make an effort to stick with your class for 2 months.

(2) Exercise related injuries. The hydrostatic pressure of the water slows movement down, which greatly reduces the risk of injury during water exercise. It also reduces the risk of falling. Accidents can happen anywhere though, so make sure your pool is staffed with lifeguards.

(3) Exercise is not fun. Do you remember how much fun you had playing in the water as a child? For many people, water exercise brings back that sense of fun. At the same time you can achieve intensity levels that allow you to meet your fitness goals. That means it is possible to start at an exercise intensity that is too high for your fitness level, which can be discouraging. Instead it is a good idea to start at a moderate level (you could do this for a long time), and progress to working somewhat hard (you are starting to feel it), and then hard (making an effort to keep up), before progressing to very hard with high intensity intervals.

Here are some guidelines to help you work through these progressions. In shallow water the base moves are walk, jog, kick, rocking horse, cross-country ski, and jumping jacks. Walking is good for warming up and cooling down. Jog, kick, rocking horse, cross-country ski, and jumping jacks all have multiple variations. (1) Jog. You can jog with the feet hip distance apart or wide. You can cross the midline in front with an inner thigh lift or cross the midline in back with hopscotch. You can lift the knees in front or the heels in back. (2) Kick. You can kick forward, kick across the midline, kick side to side, or kick backward. (3) Rocking horse. Rocking horse can be done front to back or side to side. (4) Cross-country ski, jumping jacks and all the base moves can be varied by using different arm movements or different foot positions. While performing these moves, your heart rate and breathing rate should increase noticeably. Your muscles will feel like they are working, but you could maintain this level for a while before having to stop. You may compare this to a brisk walk.

Increase the Range of Motion. When working at a moderate pace becomes easier, it’s time to go to the next stage. Large moves take more effort than smaller moves. Increasing the range of motion increases the intensity to somewhat hard. Get the knees high in your jog and pump the arms in big movements. Start your inner thigh lift with the feet wide apart and lift the inner thigh high. Start your hopscotch with the feet wide too. Kick higher – front, side or back. Lift your knees high in front and your heels high in back with your rocking horse. Perform cross-country ski with your full range of motion. Take your feet as wide as possible in your jumping jacks and cross the legs in the center. Focus on achieving your full, pain-free range of motion. At this level your heart rate, breathing pattern and muscles are telling you that you are working hard. You have to breathe through your mouth since nose breathing is not enough to give you the oxygen you need. You are past the point of feeling like you could do the exercise all day.

Add Speed. When increasing the range of motion becomes more comfortable, it’s time to add speed. Faster moves increase the intensity level to hard. The tendency, however, is to decrease the range of motion as speed is increased. You work much harder if you maintain the same full range of motion while speeding up. Pay attention to what you are doing to avoid slowing down. Your heart is pounding, you are breathing hard and you would rather breathe than talk. You can only say 2-3 words before you have to take a breath. This intensity is not comfortable and cannot be maintained for a long time.

Add Acceleration. Once your body gets used to working hard, it’s time to push it up to very hard by adding acceleration to your moves. There are two ways to add acceleration. (1) Accelerate off the pool floor, or jump. Take your jog to a leap and your wide jog to a frog jump. Perform your inner thigh lift and hopscotch with a rebound. Rebound with your kicks as well. Jump and tuck your feet under you with cross-country ski. With jumping jacks, jump and touch your heels together before landing with your feet wide apart. (2) Accelerate against the water’s resistance, or add more force to the move. Take your jog to a steep climb by stretching out your arms and pressing alternate hands down while at the same time lifting the knees high and then pressing the heels down toward the pool floor, as if climbing a steep mountain with trekking poles. Lift your inner thigh with power as you press the opposite hand down forcefully toward the thigh. Perform a high kick powering the leg on the downward phase or power both upward and downward. Kick side to side with arms and legs opposite, adding power to the move. Instead of rebounding as you kick side to side, you can stay grounded, and you might be surprised at how hard it is. Karate front kicks and side kicks also involve using force against the water. Kicks backward, cross-country ski and jumping jacks can all be performed with power. Try the cross-country ski low in the water so that more of your body must push against the water’s resistance. Be mindful about what you are doing because the harder you push against the water, the harder the water pushes back. Forget talking at this level. You may be able to belt out one word at a time, but you don’t want to because breathing is your goal. Your muscles are screaming for oxygen and therefore your breathing pattern and heart rate is rapid. This intensity level is reserved for shorter intervals, and you are so glad that there is a limit.

This description of aquatic exercise intensity levels comes from the Aquatic Fitness Professional Manual. Lesson plans that demonstrate how to progress through these intensity levels can be found in Water Fitness Progressions. Good luck with your New Year’s Resolution to exercise more. See you in the pool!

Author/Instructor Photo
Chris Alexander