GTP TV: Ep 9 – Shoulders!

Hey. How’s it going? Welcome to Goalie Training Pro TV episode number nine! This one is all about your shoulder and it’s the last in the series of bottoms-up!


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Anyway, here we go. We’re going to talk about the shoulder. The shoulder is also know as something different in school (I’m old enough that it was still called physical education when I took it. It wasn’t kinesiology, which sounds so much cooler). But we learned that it’s actually called the glenohumeral joint. The glenoid is the socket part, and the humerus is your upper arm part, so the glenohumeral joint, that’s your shoulder. And y our shoulder is actually a really, really cool joint.

One of the things I want you to appreciate about the glenohumeral joint is, it’s a little closer to the size of a golf ball, so the glenoid fossa is fairly shallow. It’s part of what gives us so much range of motion, because it’s shallow. Our hip socket, on the other hand, is quite deep. Yeah, we can’t swing our leg, or like most of us can’t swing our leg around in circles like we can our shoulder because it’s a deep socket. Shoulder is a shallow socket, which is great, because it gives us mobility.

It’s also quite small relative to the head of the humerus. Some people describe it, it’s a little more almost like a golf ball sitting on a golf tee, so a big ball on a fairly shallow socket, so kind of picture that in your head.

So I want you to appreciate the setup of the shoulder. If you look at an image, my shoulder blade is on my back. Then there is your clavicle (or collarbone). You can also see the head of the humerus, the glenoid fossa, and your coracoid process. This is your acromion. You also have your acromion and coracoid. Those are sort of the bumps you feel in your shoulder.

What I want you to take from that is that the glenoid fossa is actually attached to my shoulder blade, so my shoulder blade sits in my back, but attached on the side is the glenoid fossa, so it’s all attached together. And your shoulder blade, your scapulas, can rotate on your ribcage.

I don’t know, I have no idea if you can see, but if someone brings their arms up to the side, the shoulder blade now has an inferior angle. The shoulder blade, as you come down, it drops back down. So as you come up, it glides up along your ribcage. As you come down, it glides back down.

Again, that’s part of what gives us a range of motion too. It’s like a dynamic shoulder girdle. It’s like imagine if your pelvis was split in two, and when you moved your legs, your pelvis could rotate with it. Then you would talk about doing the splits! Some of you are going to get ideas like, “Could I make my pelvis two parts?” No, you can’t. It doesn’t work that way.

The other thing I want you to take from this is, if we look at the anatomy, so your shoulder blade floats on your ribcage, okay, well, then what holds your arm on? Your shoulder blade isn’t attached to your ribcage. It’s not attached to what’s called your axial skeleton, your spine, or anything like that, so how do your arms just not fall off?

Well, the reason your arms don’t just fall off is because of your sternoclavicular joint. And that is right beside your clavicle or your collarbone. So your clavicle comes out, and it has a joint, and it interfaces with the scapula, so it’s a joint. It’s not like one continuous piece. And your collarbone rotates and lets you get some motion too. So the only place your arms are attached to your whole body is on this little joint, which is crazy! To me, that’s crazy! I don’t know if that’s crazy to you or not, but to me it’s crazy.

Okay. Then I want to talk about the rotator cuff, because just like with our hips. Again, try to bring up an image of it to follow along. We’re looking at the outside surface of the shoulder blade so from the back. There’s a spine that runs along the back of the scapula. You can also see the acromioclavicular joint (so the acromion and the clavicle). Then there would be the surface of the scapula that’s against the ribcage. That is the back surface.

Then look at the surface that’s against my ribcage. You can see that there’s a difference in there as well and that this should nicely show the glenoid fossa and how big that head of the humerus is.

The reason I wanted to point that out to you is so you can appreciate how the rotator cuff fits. Just like we do with our hips or some of you do with your hips, some of you are like, “I think what that Maria girl says makes sense,” and you’re starting to work more on what I call the rotator cuff of your hips, and you’ll see why in a second. A lot of you work on the big muscles that surround your shoulder, so you work on your bench muscles, or you do military press or things like that, but you don’t take the time to work on the small muscles that actually stabilize your shoulder.

I want to start by picturing the muscles that attach on the outside surface of the shoulder blade, and they’re pretty easy to learn, actually. We have that spine along the scapula, which has the supraspinatus. (Supra means “above.”) There is the infraspinatus, which is infra, inferior, below. There is the teres minor, (just to screw with phys ed students and make it hard for them to remember, I think. There’s no other reason I can think of to call it teres minor.) Then there is the undersurface of your shoulder blade. It’s called the subscapularis, which, again, makes sense, because it’s underneath the shoulder blade. So that all makes sense.

Then just appreciate how it all attaches to the head of the humerus. There are the tendons where the muscle attaches. See how they really can control the head of the humerus and the rotation of your arm and stabilize that. Those are the muscles of the rotator cuff.

I guess too we can talk about how your shoulder has a labrum just like your hip. It’s really important in the shoulder, because it gives a little more depth to the joint so that it gets it a little bit more stability.

The biggest thing in terms of keeping a healthy shoulder, maximizing the performance of your shoulder… actually let me say this first.

It’s important for you guys, and I don’t know that you appreciate it, because if you don’t have full degrees of freedom of your shoulder or a good range of motion, if you have the kind of posture where you round your shoulders forward … First of all, get in your ready position, which brings you forward a little bit anyway. Then round your shoulders forward, and then try to position like a glove saver or a little reach. It’s hard to do, so then what do you have to do? You have to turn your body to get your arm where it needs to be, which is going to put you out of position.

Not to mention you’re holding your joint in an end range, it’s going to actually add a little bit more fatigue. That’s an important key that you should appreciate. Plus, it’s going to reduce the risk of injury!

The key point in this, or the key thing is really, scapular control, so controlling, using those muscles to control your shoulder blade so that your rotator cuff muscles and your big powerful muscles are in a position to do their job. And that’s something that we lose sight of all the time.

When I worked at the Fowler Kennedy Sport Medicine Clinic in the physio department helping to rehab athletes, pretty much every athlete who came in with a shoulder injury, the very first thing we started with was scapular stabilization. Probably 70% of them, that was all they needed, they got better, and we never saw them again.

So what is scapular stabilization? It’s so silly, but it has a lot to do with posture. When your parents tell you like, “Sit up tall,” or … It really is, it is that important, I hate to tell you. But when you get your posture, don’t just extend and kind of stick out your chest.

Think of, first thing, imagine you’re getting pulled, like a string coming out the top of your head that’s pulling you longer. (You all just sat up taller. I know you did.) So that’s one part of it. The other thing we get is a rounded shoulder posture, because we sit. We sit in school. We kind of hang out there. We sit at home, and some of you even carry that onto the ice, which is a really bad habit.

Thomas Myers said something like, “Habit becomes posture. Posture becomes structure.” He means that we just have a habit of going like slouching sometimes, like we’re not always like that, but we have a little habit of slouching. Well, then that habit becomes posture, and then that becomes sort of our go-to, and we’re always like that, and then that becomes structure.

A lot of us, it’s not even just, “Oh, we’ll just pull your shoulders back,” because we’re so tight and short there that we really can’t, so when we try to do it and we want to get the feeling, we end up extending our back, because then it feels like we’re there, which isn’t the way to go.

The number one thing we start on is just a scapular retraction, and it looks like nothing. So picture the interior angles of my shoulder blades, and all I’m going to do is just squeeze them together a little bit for 5 to 10 seconds and then slowly relax. You can see from the front when I do it, it just looks like I’m pushing my shoulders back a little bit, and then I slowly relax.

When I’m coaching and teaching people to do it, if I see their elbows go back behind them, right away that’s a red flag that they’re not doing it properly, or again, if their back extends, they’re not doing it properly. There shouldn’t be any change in my posture that way, so that is the basic plank of scapular stabilization.

Again, it seems so, “Oh, I know, but give me the good exercises, the advanced exercises.” That’s the number one thing that you need to do, so just start there. Trust me. You need that good foundation.

Okay, we’re going to talk about injuries now. We’re going to talk about the difference between dislocations, subluxations, and separations. (This is kind of a little pet peeve of mine when people get it mixed up, but they just don’t know, so I know you’re not doing it on purpose to make me mad.)

A separated shoulder is a clavicle, so either at the AC joint or the SC joint, that joint has got compressed and you’ve basically sprained those joints (much like you would sprain an ankle.) Often it happens when you get squished, so you see it more in skaters when they get squished into the boards and kind of “accordioned” like that, but it could happen to you too if somebody falls on you, something like that. Really uncomfortable. Not much you can do for it.

There’s a grade one which is basically just like, “Oh, I just tweaked my ankle,” except in your shoulder. Grade two is like, yeah, you’ve torn some of the fibers, and those are ligaments, they connect bone to bone. You’ve torn some of those fibers, and it might even be a little bit bump, like bumped up a bit. A grade three is like, no, you’ve complete, you’ve really blown that thing out. I think sometimes they do have to do surgery for those ones, or sometimes people just go around with the funny bump on their shoulder. So that’s a separation. It’s a thing of, it’s a clavicle, shoulder girdle kind of thing.

A dislocation is the ball and socket, and a dislocation is “BOOM”. It is out. And unless you just always, always dislocate, it’s going to have to be put back in by somebody, and that’s uncomfortable. Now, here’s the thing that happens with those that sometimes we forget about. When there’s tension there, there’s the head of the humerus is being held in the socket, so when there’s enough force to grind that thing out and then grind it back in, you get two things. You’ll often tear the labrum, where it goes out and comes back in, so you’ll make sort of a groove that’s called a Bankart lesion. Sometimes it will take a little piece of bone with it. That’s called a bony Bankart.

But you’ll also get a defect on the backside of the humeral head where again, and I’m talking about an anterior dislocation, so on the posterior side of the humeral head you’ll get a little groove where it’s gone in and come out again. That’s called a Hill-Sachs lesion. Sometimes that tear, the labrum is a problem, and it needs to be repaired. Sometimes it’s not a problem per se, although now we have a nice little pathway for that thing to come out again, so it’s made the joint less stable, which, again, is a problem.

A subluxation is just like it doesn’t come right out, it just kind of shifts in there and give you the heebie-jeebies. It’ll be really sore, or it can be really sore, and still take time to rehab and things like that, but it’s not a full boom boom dislocation. Usually if it’s just like, “I think my shoulder popped out,” but it’s not like, “Oh, my shoulder is out,” kind of like … You know if your shoulder’s out.

So it’s not like what you see … You guys probably don’t even know Lethal Weapon, but like in Lethal Weapon, Mel Gibson gets out of the thing, and he just goes and smashes his shoulder on the thing to put it back. That’s not how it works, and even then it’s like, “Okay, you need to go to the emergency room. Now get an X-ray. Make sure it wasn’t a bony Bankart and that there isn’t a bone fragment stuck in there now that has to be removed.”

Okay, so those are the biggies, and in goaltenders, dislocations often happen. You’re like reaching out to cover a puck and somebody falls on you. That’s a common mechanism for that.

Impingement. If you can sort of see from a picture how, there is the acromion and the clavicle, and then here’s the supraspinatus coming in, and it goes under them almost like a little tunnel. Even if you can see the hook of the coracoid process. When I move my shoulder all those things could get pinched. Those tendons could get pinched under these little hooks and bridges that they pass through.

The shoulder is amazing because we get so much range, but it also means there’s so much stuff packed into a really tight area, so things can get pinched, and that’s what an impingement is. You can impinge the long head of your biceps, and usually it does, it really feels like a pinch, like that’s sore. Again, the number one thing we do is, well, squeeze your shoulder blades back and work on that posture because too, if I’m here I’m going to, it’s way easier for me to pinch.

Don’t do this if you have a sore shoulder or get a sore shoulder, but for the rest of us, if we kind of get crappy posture, not like crazy, but if we just let our shoulders roll forward and then we try to make a circle with our arm, it kind of gets flat. That’s fine, but if I just get in my good posture, do you see how it just goes so smoothly?

If we have a little bit of crappy posture, and then we’re doing stuff or even lifting weights and we’re kind of grinding on that, getting things pinched, grinding on them, it’s going to eventually irritate it enough that your shoulder says, “No way. Forget it. Stop.” You can get an impingement. You get tendinosis. Again, the first thing we do is like, do this with your shoulder blades. Learn how to stabilize your scapula.

Rotator cuff tear, usually you do something and you feel like, “Oh.” Sometimes you’ll be like, “Oh, no, I think it’s okay,” but then you’ll go to reach for something in the upper cupboard and be like, “Oh, that hurts,” or putting on your jacket. You’ll be like, “It’s fine, but just doing this thing hurts.”

That’s a rotator cuff tear. Again, depends on the degree. Any injuries like that, just go see a really good sport physiotherapist, have them assess it so that you know what your plan of attack is. We talked about a torn labrum, and usually that is associated with a dislocation or an instability in the shoulder.

Coming back, the key to controlling it is scapular, like posture, scapular positioning.

Then getting a nice, stable rotator cuff. Again, it’s like some of the hip exercises we do. The idea isn’t to do as much weight as you can. The idea is to give those muscles some stamina to get them doing what they’re supposed to do, so not letting other bigger muscles take over and do their job. It’s not to sort of, “I can do 75-pound external rotations.” That’s going to be counterproductive to you.

So I’m just going to tie a Thera-Band band loosely around a pole. People, they’ll say, “Oh, do you have like yellow Thera-Band?” “No, no. I use the black.” That is too heavy. These muscles, if we use a heavy weight, we can do it, but other muscles are going to be helping out, and then we’re not really getting the benefit we want.

So you want to work on your external rotation. Stand the band in the opposite hand of the side it’s tied to. And we just start at neutral, so just keeping my elbow tucked in to the side and pulling out and away from my body. So it’s a small range of motion. That’s all I get, and it’s okay. It doesn’t make me a better person if I can get that much further. It’s cool.

And I put my opposite hand on my shoulder, so I feel that I’m just rotating that humerus. I’m not using my scapula to help.

Then we would go internal rotation. So we switch the to hand that’s on the side where the band is tied. And we usually go knuckles to belly button, because that’s sort of the line of pull on the muscle fibers. I start with my knuckles on my belly button, and I come out, and I come in. This is hard, because I really want my elbow to stay put. It’s just a nice rotation.

So that’s internal and external rotation. Those are a couple really basic ones.

We also use a lot of, I love this one, it’s just a W. So we untie the band and hold it in either hand. And I start with my palms up and my elbows at my side, and then I pull apart and I make kind of a W with my arms, as I pull apart and then I come back down.

I tell the troops you’re going to, like you’re carrying a tray of drinks, and then you’re making a W without extending your back, so that’s what you’ll want to do. Again, not forcing it to try to get an extra centimeter of range.

Those are the ones we start with, and then we progress to other exercises.

Then what we work on too is like when we’re doing arm exercises or a landmine press or something, is making sure we’re keeping a nice, stable shoulder blade as we do that. We’ll use a press for an example. We’re not starting it by elevating (or tensing) our shoulder. That’s a real common pattern is to elevate your shoulders and use your upper traps for everything. We want to sort of get those shoulders down a little bit, down slightly and back to get a good position.

Like if you row, I can row pretty heavy without my upper traps going on. There’s no reason when you pull you have to elevate your shoulder, but it’s a really common compensation pattern that we spend a lot of time trying to break that habit.

Then keep in mind that you need to balance your pushes with your pulls. People do a lot more pushing exercises, because you can see those muscles in the mirror. People want to have a bigger, more developed chest so that they look good, which is great, but we forget to do pulling exercises.

Also people who just work out with body weight, it’s actually pretty hard unless you have a chin-up or can do chin-ups to balance it out. At home tons of people, they’re like, “I started doing push-ups, and I’m just, try to do 100 push-ups a day.” Well, that’s a lot, and there’s no pulling going on to balance it, so you’re making those muscles stronger and stronger and stronger, and working them here more and more and more, so it’s a problem.

You need to balance out. If I’m doing a pushing exercise, I’m going to need to do a pulling exercise, and they need to be balanced, or even a little bit extra in terms of getting this retraction, because so many of you are really prone to a bad kind of a posture.

I’ll give you one more little goalie one that we do. Again, start with the other stuff. You have to have good stabilization first, but we’ll do it with very, very light weights. Even just two-and-a-half-pound plates. Don’t even do, “Oh, I could do that with, I did that with 15s,” because, again, you’re going to be pulling in big muscles that we’re not trying to work.

I just call it goalie figure eights, but just to build a little stamina in the shoulder. If we start with our arms out and we make a small figure eight with our arms. I’m trying to go fairly quick, but again, keep my shoulders down so I shouldn’t be using everything to make it work, and then we’ll come out to the side and do the same kind of thing.

Then (this is a progression) we might get a little more into like our glove position. This gives a bit of external rotation, so now we’re getting a bit of those external rotators of the rotator cuff, and then go figure eight in that pattern. That’s just nice to build a little bit of stamina in the shoulders, because I don’t know, probably lots of you don’t notice it, but if the play’s in my end a lot, and I’m really trying to think about my glove position and keeping my glove where I want it, my shoulder actually gets tired. If we’re just doing passing before we play and working on our passing, my shoulder gets exhausted just trying to pass, so that’s something that we use to get a little bit stronger.

That’s it! That’s what you need to know about your shoulder. There’s a million other things you can know about the shoulder, it’s a fascinating invention, but if we’re on a need-to-know basis, that’s what you need to know.

Thanks for joining me on Goalie Training Pro TV, episode nine. I’ll be back next week with episode 10. I don’t know what I’m going to talk about yet, so if you have a suggestion, leave it in the comment box so I can do that for you next week, because I’m open to ideas. We’ve covered head to toe the body. These are all posted over on YouTube. My channel is GoalieTrainingProTV, in case you missed when we talked about the ankle, the knee, the hip, the back, your melon. We pretty much covered it all.

See you guys next time! Cheers.