Shoulder Injuries – Rethinking Your Program

The shoulder is a complex area that gets injured as much as any body part in athletics. Throwing sports are not alone with shoulder problems, football presents is own set of problems as the shoulder is one of the most injured areas as well.  So with that in mind, I threw some thoughts together based on a presentation I gave two years ago on training the shoulder and back for high school coaches.  This isn’t specific to baseball by any means, in fact it’s very general and applies to all strength programs.  The general concepts should be part of properly programmed training for any athlete not specifically a throwing athlete.  Always remember, the shoulder is all about the back.

Strength coaches, football coaches, etc., we’re all guilty of loving the bench press too much. If a little is good, then more is better.  Many times, we as coaches get carried away with pressing, especially in football culture where you can argue pressing is actually a part of the sport.  The problem becomes that pressing is fine in moderation but when it’s bench press, incline press, DB bench press, pushups, military press, etc. all in an upper body day, or even within a week we may now be running our athletes into trouble.

Lifestyles today promote Upper Crossed Syndrome. Athletes are hunched over with poor posture, tight pecs, and internally rotated arms. This position alone automatically predisposes athletes to shoulder problems and not only from their sport but from training as well.  Back and scap muscles become long and weak.  Athletes become highly overactive, and tight on the front side.  If you’re program is lacking the necessary movements to try and correct this then you’re only creating more and more problems.

  1. The BACK is key

The back and more specifically the muscles attaching to the scaps are the most important area for protecting the shoulder.

If you read Scapular Instability – 68% and 100%, a previous post, you know how important the scaps are to shoulder stability.

“Scapular instability is found in as many as 68% of rotator cuff problems and 100% of shoulder instability problems. That means that two-thirds of rotator cuff problems and 100% of shoulder problems can be attributed to the scapular stabilizers.”

Focusing less on the deltoid, and more on the scapular stabilizers involved in horizontal pulling will go great lengths in keeping athletes protected.  Using a scap series even if it’s just in the warmup will add volume and activation to the back side of your athletes.  The following is our 4 Way Scap Series that we use constantly.  These can be done any number of ways, on an incline, on a stability ball, on the ground.  For those variations, go to as there are videos for all posted.

  1. Proper Programming

Maintain a ratio of at least 1:2 or better yet 1:3 for push to pull. This seems widely known but this is lacking more times than not when I help coaches with their programming.  We especially want more horizontal pulls than vertical.  A sport like football should have a minimum 1:2 ratio on push to pulls.  If you’re having lots of problems with shoulder injuries 1:3 is even better.  For throwing athletes we kick it up to a 1:3 ratio at all times. It’s not uncommon for me to see programs with 20 sets of pressing in a week vs only 5-10 sets of pulls.  If this is your program then I’m willing to bet shoulder injuries are also a part of your program.  The opposite ratio should be in place to protect your athletes.  Athletes perform on the back side, they look pretty on the front side.  Every time I write a program I have a checks and balances system to make sure I have the proper volume and ratios in place.  Whether you’re counting total volume of reps, or total sets always make sure you’re workout resembles the goal you have set forth for your program.   One of the exercises we use to bump up our volume of horizontal pulling is DB Incline Row.  This movement is a staple for us.  The lower the incline the better.

  1. The PULLUP isn’t the end all be all

More and more I talk with coaches at the high school level who often have questions on protecting the shoulder, not only baseball coaches, but football coaches as well. When their program is laid out for me I usually find out that the pullup is their only form of posterior upper work.  The pullup is awesome and great for the back.  It’s definitely a staple in most of my programs, but don’t get carried away with it thinking you’re program is equally balanced front to back if you’re only doing pullups.  The pullup isn’t your best option for protecting the shoulder.  Vertical plane movements like lat pulldowns, and pullups, all involve the lat as the prime mover, which is also an internal rotator of the shoulder just like the pecs.  So by doing more pullups we may really only be making the problem worse.  The lats do not counteract the horizontal forces from front side.  We want to offset the front side work with more of our work on the backside in the horizontal plane.  When we talk about ratio’s of 1:2 or 1:3 more back work we are talking about our horizontal pulls and scap work specifically, not vertical plane movements.  I’m not saying eliminate pullups by any means, but make sure the horizontal plane movements are the bulk of your work.

  1. Teach correct movement patterns

For horizontal pulls to benefit your athletes YOU MUST TEACH THE CORRECT MOTOR PATTERN. Teach, and coach your athletes to pull the scaps back without the shoulders rolling forward.  If your athletes look like this when doing horizontal pulls then refocus on correct technique before going forward. The following video is an old video we used to help coaches understand what their looking for in poor pulling movements.

An easy give away for bad pulls is to watch the elbow. If it’s travelling way behind the body, you’re athletes aren’t doing it right.  They are getting shoulder hyper-extension not scapular retraction, which is a bad pattern and needs correcting immediately.  Athletes actually use the stronger pecs to help the movement, which is exactly what we don’t want.  Bad pulls usually involve the head poking forward in front of the body and shoulders rounded over.  This position alone does not allow for proper action of the scaps and horizontal pull musculature.

Teach them the correct motor pattern for pulls by emphasizing squeezing their scaps back and down with their chin and head pulled back to their spine. Don’t let your athletes elevate their shoulders, or round their shoulders over forward.  We don’t want pulls with the upper trap, and or the pecs.   As the scaps retract make sure the shoulder pulls back and down.  Teach your athletes to pull with their scaps through their elbows and not with their arms. 

Notice the arm doesn’t travel way behind the torso. The shoulders actually move back behind the ear they don’t roll forward.  The scaps are creating the movement, not the arms, and/or shoulders.

Cues for Proper Pulls:
-Keep head pulled back and chin tucked
-Scaps go through full movement both in and out
-Pull with scaps not with arms. Visualize arms as the hook.
-Squeeze the scaps BACK and DOWN

Up your volume of horizontal pulls, require better technique from your athletes, and watch your number of shoulder problems decrease.

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