THE MOST EFFECTIVE TRAINING FOR SHOULDER PAIN
- Learn How to Train Through Shoulder Injuries -

Dr. Joel Seedman, PhD
This is an extended version of Dr. Seedman's training protocols as originally featured on Dr. John Rusin's website article "The 20 Most Effective Exercises to Train Around Shoulder Pain."

My approach to working with shoulder injuries is very unique in that I really don’t work around shoulder injuries.  Instead I have my athletes and clients work through the injuries by strategically incorporating standard upper body resistance movements that involve the shoulder joint (i.e. horizontal push and pull and vertical push and pull movements).  However this is done with specialized protocols.

When an athlete suffers a shoulder injury 95% of the time it’s not simply a random fluke or bad luck.  Whether it’s chronic buildup of inflammation or an acute injury, in nearly every scenario, the root cause is poor shoulder function and faulty upper body mechanics.  Even if the injury was supposedly due to impact (such as commonly witnessed in contact sports), if the muscles around the shoulder had been firing correctly and the individual had proper shoulder mechanics, the muscles around the glenohumeral joint would have been able to absorb force and protect the shoulder from various forms of trauma and strain including high impact.  It’s when the muscles are not firing properly that injury occurs around the shoulder joint regardless of how strong the individual is. 

Because the root cause is dysfunctional movement, the solution lies in restoring proper scapulohumeral rhythm and optimal glenohumeral joint mechanics.  In other words, I’ll take an athlete and have them perform variations of rows, pullups/ pulldowns, chest press, and overhead presses with lighter loads while simultaneously teaching them how to correct their body mechanics and eliminate dysfunctional positions.  This is done through a combination of eccentric isometrics, bottoms up movements, eyes closed protocols, hanging band exercises, perturbation training, offset loading, and other forms of proprioceptive training that promote optimal neuromuscular re-education. 

As a result (typically after several workouts) the athlete is able to perform any and all movements including barbell bench presses and overhead barbell presses.  In addition, not only does the re-education process allow them to thoroughly train their upper body during the time of the injury, but improving their upper body mechanics and incorporating sensory integrated movement literally acts as the most effective form of therapy and healing there is.  It’s for this reason I don’t program any soft tissue work, stretching, mobility drills, rotator cuff exercises, foam rolling, traditional therapeutic modalities, or corrective exercises but instead rely on correct exercise itself to provide the cure rather than treating the symptoms.

Having worked with quite few serious shoulder injuries the one thing I’ve consistently witnessed (regardless of the severity of the injury) is that an injured person can literally perform any and all of the same movements a healthy person can perform (this includes overhead presses). The difference is there is no room for error and the execution must be spot on. Therein lies the art of coaching.

In addition performing these movements with proper technique is actually the single most effective form of therapy for that athlete as it promotes almost immediate healing.  In essence proper movement is the most therapeutic and self-healing modality there is.  The key is re-training the person so that the movements are in fact therapeutic to their body and promote healing rather than being contra-therapeutic and destroying their body.  This is true of the shoulder joint or any other joint.

Finally it should be noted that most coaches would advise against this philosophy of using overhead presses for improving should health.  However I’ve actually seen overhead presses be one of the most critical components for improving shoulder injuries and restoring shoulder function including that in overhead throwing athletes. The key is the movement has to be performed perfectly, which often times requires proper coaching. The same is true of any other movements. 

In fact I’ve yet to see an individual that was not capable of performing an overhead press properly once they were properly coached regardless of their pre-existing shoulder injuries or anatomical limitations.  In reality it all comes down to precise execution of the movements.  So yes, faulty overhead pressing mechanics (which often times is a result of improper training and cueing from the coach) is one of the most damaging movements for the shoulder.  However, the exact opposite is true when it comes to properly executed overhead presses, as few things are more therapeutic for the shoulders.