The stabilizers of the shoulder are the mid-level executives of the strength training world. With reasonable oversight and training they do their job well, but they are utterly hopeless when the boss (the larger shoulder structures and ultimately, you) does something stupid that renders their efforts useless or, at the very least, diminished. Just as with the mid-level executives in the corporate world, when the boss wants someone to demean for failure, the shoulder stabilizers bear an inordinately large share of the blame. It is common to see an athlete assuming every single issue with the shoulders stems from the much-discussed but little-understood rotator cuff, or some specific muscular imbalance which must be corrected painstakingly with some ghetto-ized version of a physical therapy modality they saw on YouTube. This is even more prevalent in the well-educated, who often overthink any ache or pain they experience and skip the simple interventions to go right to band distracted PNF with pressure-augmented reflex modulation, or some such tool that sounds equally fancy but likely isn't warranted.
In this post, I want to discuss simple interventions for misbehaving shoulders. If you are spending 30 minutes on rehab work and special warm-ups you are either too hurt to train or, more likely, you are just using the splatter approach - throwing everything you can think of at it in hopes something will work. But it need not be that complicated and with a little attention to detail you can prevent issues while fixing the ones you have.
The first thing we need to get out of the way here is proper mechanics while lifting. If your form is atrocious you don't need rehab. You need to learn how to move. This must be the first step when dealing with shoulder problems: ensure you are moving correctly, with proper posture. Fixing your bullshit form will fix 90% (just a guesstimate to represent how staggering the number is) of the problems you face with the shoulder.
Secondly, once proficiency is established, consideration needs to be made for muscular balance. All of your time spent pressing with no pulling will inevitably lead you to pain and problems. This again is not a rehab issue. You simply need to train correctly. Of the minority of issues not related to mechanics during movement, the majority are due to simple imbalances. Complicated variations of movements and dedicated rehab work is a waste of time here. Fix your structure by allocating training efforts.
If neither of these is the issue, you are one out of a hundred, or maybe less.Once we have extablished a true stabilizing issue in the shoulder girdle we need to set out to find what the problem is. And here it gets tricky. Most likely, you cannot do this on your own, even if you are trained to do so. You need an outside view from a qualified diagnostician. The 18 year old PT at the gym is not one of these, and neither is the guy who slings test in the locker room or that really hot Zumba instructor. Seek out a physiologist or coach who specializes in rehab, an athletic trainer, a sports medicine physician, or a manual therapist of some sort (NMT, DPT, DC, ART). Once the problem is identified a specific rehabilitative approach will be recommended to address the specific issues you have.
Many athletes of a more advanced sort, who have their training nailed down and their movements perfected, are looking for a basic set of movements to do as an adjunct to ensure weakness or movement restriction does not develop in the stabilizers. These include the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor) as well as other muscles acting on the shoulder girdle, depending on the movement in question. This article, while being a little on the academic side and thus boring as hell, provides a good synopsis of the basic movements we use to affect stability in the absence of special situations. These should be done when instability has been noted and the issue is not being solved by regular training, but may not be appropriate if you are injured.
http://www.pitt.edu/~neurolab/publications/1992-1996/BorsaPA_1994_JSportRehab_Functional%20assessment%20and%20rehabilitation%20of%20shoulder%20proprioception%20for%20glenohumeral%20instability.pdf
It's worth noting though, that in most cases, going as far as all that is simply time taken away from more important aspects of training. The following is the basic preventive toolbox I use to manage and prevent shoulder issues. It addresses joint position and mechanics, imbalances, and stability deficits while taking literally minutes.
1. Muscle Snatches: These force stabilization of the shoulder girdle in myriad ways, in both dynamic and static positions; recruit the rotators, traps, and thoracic muscles involved in shoulder mechanics; and force activation of high threshold motor units that are often missed in traditional rehab movements.
2. Face pulls. Superior to pull-aparts in my opinion, face pulls involve horizontal abduction of the shoulder, depression and rotation of the scapula, and external rotation of the humerus. EMG data even indicates it is a sufficient stimulus to cause a training effect in the medial deltoid.
3. Pushups: These can be added as a warm-up drill or used as a stand-alone. The light load allows focus on shoulder position and mechanics and testing multiple positions can help identify issues. This link includes some more detail and offers examples of modifications. http://articles.elitefts.com/training-articles/what-you-don%E2%80%99t-know-about-the-push-up/
That's it. I use these drills regularly, sometimes as a separate session and sometimes added into existing programming, as a basic way to ensure proper function, stability, and mechanics. If you are looking for a preventive strategy, this is simple and quick, and if you are looking to start rehabbing, this will allow you to make some corrections to the issues on your own. As always, evaluate the need, match the training stress to the need, and modify as needed based on result. Don't over-complicate, don't over-work, and don't look so intently at the details you forget the big picture. With proper training, you will not need real rehab in your training. Now that you aren't wasting time with a bunch of irrelevant corrective work picked arbitrarily, you have more time to put weight over head, so do it.
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