Curvy. Round. Sexy. Don’t pretend you don’t know what I’m talking about.

That’s right. I’m talking about shoulder caps.

Nothing fills out a tank top quite like they do.

Yet, despite their silent display of how in shape you are, they can also be – quite literally – a pain to achieve. In fact, shoulder injuries are one of the more common pitfalls of weight lifting folk. While the shoulder is one of the most mobile joints in the human body, it is also one of the most unstable and prone to injury. I, unfortunately, know first hand about shoulder injuries.

My situation all began with a car accident in 1996 rendering my neck today in a very degenerative state. My neck and low back should have a natural curve like the picture on the left, but due to the degeneration, they are both straight like the picture on the right. This sets my head further forward and causes my shoulders to roll forward along with completely stressing out my neck and back muscles.

This makes it exhausting to maintain proper posture all day. I basically feel like I have to lift my chest and point my boobs to the sky all day. Not only is this a muscle stressor, but this injury causes a lot of immobility in my shoulders making me prone to impingement’s. But enough about me right now. Let’s get into the nitty gritty and take a look at  why and how we can prevent shoulder issues from happening as well as how you can maintain a pain free shoulder joint.

( You can read more about my shoulder saga in 4 Ways to Balance Your Bikini Bod and Post Show Diet Mistakes. )

Shoulder Anatomy

Shoulder anatomy is far more complex than one would expect, which is likely why it’s so easy to injure. It’s not all that different from a car: The more bells and whistles it has, the more opportunities there are for something to go wrong.

And the shoulder has lots of bells and whistles.

For example, did you know the shoulder is made up of not only the deltoid and rotator cuff, but also the latissimus, pectoralis, and rhomboid muscles? And that it has not one, but four joints?

Fun fact for dinner parties: The four joints that make up the shoulder are the sternoclavicular joint, the acromio-clavicular joint, the scapula-thoracic joint, and the glenohumeral joint (aka: the “ball and socket”). Fun words you can now use to make yourself sound smart. You’re welcome.

However, the ever-famous rotator cuff is probably the most common culprit for weight lifting injuries. Like the rest of the shoulder’s anatomy, the rotator cuff is comprised of a labyrinth of tendons and muscles known as the supraspinatus, infraspinatus, teres minor, and subscapularis.  Consider these four muscles the “Divas” of shoulder anatomy. They demand to be treated properly and when they’re not, then there’s hell to pay (which I have learned the hard way).

These Divas of the rotator cuff are responsible for keeping the “ball” of our upper arm bone stabilized within the socket (glenoid cavity) of our shoulder. When we perform a movement that causes the ball to fall out of alignment within this cavity, that’s when injuries occur. Unfortunately, it’s far too easy to do.

What’s Causing My Shoulder to Hurt?

According to the American Academy of Orthopedic Surgeons, in 2006 approximately 7.5 million people saw their doctors for shoulder pain. And the most common reason for it? “Athletic activities,” including weight lifting.

Why weight lifting? Because this sport uses ongoing repetitive movements that often require external or internal rotation of the shoulders or raising the arms above the head; motions alone that cause the ball of the shoulder to come dangerously close to breaking through the Divas’ boundaries within the socket.

What do I mean by “external” or “internal” rotation?

Do this: (illustration below) Stand with your arms stretched out on each side. Now, bend your elbows so your arms are bent at a 90 degree angle and your fingers are pointing at the sky (think of the “See? I’m unarmed Mr. Police officer!” position). Now, with your arms still in this position, take your right hand and push it down so your palm is facing the floor. This causes your shoulder to “internally” rotate. The opposite movement – taking your hand and pushing it back so the palm is facing more upwards (sort of like a wimpy throwing motion), you are now demonstrating “external” rotation.

Boy, that was hard to describe! If you are completely confused, here’s a handy illustration to make it much more clear!

Now add weight to that equation… and throw in some poor posture, previous shoulder, neck and low back injuries or degeneration causing immobility and even lack of strength in stabilizing muscles like your core.

Well that’s just asking for trouble.

Anyway, the point is, if we don’t correctly perform and control a motion while internally or externally rotating our shoulders, we are highly at risk for injury.

Why?

Because the glenohumeral joint, better known as the “ball and socket” of the shoulder, is very unstable by nature. The ball of the shoulder bone is larger than its socket, and the socket itself is quite shallow. This is what allows the shoulder to be so mobile (Yay for arm circles!), but also increases the risk that the ball can damage the tissue surrounding the socket by constantly causing friction or over-extension. Heck, the ball can pop right out of the socket all together if you aren’t careful! (Dislocation, ouch!)

However, the glenohumeral joint isn’t the only touchy area of the shoulder. There is a space between the rotator cuff and the bone at the top of the shoulder (called the acromion) where tendons of the rotator cuff are found. When we lift our arms above our heads the tendons that fall in this space can get pinched. This is known as shoulder impingement, and it can hurt like hell (this is my problem).

If there’s one activity that’s responsible for stressing that glenohumeral joint or rotator cuff tendon, it’s strength training.

High Risk Exercises for Shoulder Injury

Because shoulder exercises require motion of the, well, shoulder, by nature everything that you do to develop those shoulder caps puts you at risk. However, there are some exercises that have a higher potential for injury than others. Here are a few that you should try to avoid:

Barbell overhead press (military press) behind the neck. As I mentioned, lifting weight over our heads runs the risk of pinching those rotator cuff tendons, but lowering it behind our head is a recipe for disaster. This position forces our shoulders to externally rotate to the point that we can over-extend or unnaturally stretch the tendons and muscles of the rotator cuff. Not to mention the need to bend the head forward to accommodate the lowering bar, adding risk to the neck and back as well. Plus it just looks and feels awkward. Don’t do it.

Lat pull downs behind the head. You’re right, this isn’t an exercise for delts, but it still causes external rotation of the shoulders while forcing the head forward. If you don’t remember why you shouldn’t do this, read the paragraph above. Maybe again after that just to be sure you got it this time.

Upright rows with the elbows coming above shoulder height during the lift. The important part of this message is “elbows coming above shoulder height during lift.” When you do this, you run the risk of pinching those rotator cuff tendons between your shoulder bones. I don’t know about you, but pinching a tendon between bones just sounds awful. That’s because it is. So don’t do it.

Lateral raise with elbows coming above shoulder height during the raise portion of the exercise. There seems to be a pattern here. Shoulder impingement risk. Again, don’t do it.

What Shoulder Exercises to Do:

With the exception of behind-the-neck exercises, nearly all shoulder exercises can be performed or modified to lessen or avoid injury. Here are some tips on what you can do to build those sexy shoulder caps safely:

Always use good form. While we know that lifting heavy is what initiates muscle growth, it also makes performing a shoulder exercise correctly extremely difficult. Yes, lift as heavy as you can, but only enough that your arms aren’t wobbling to and fro, as this can cause painful external or internal rotation of the shoulders. This is especially crucial while performing overhead exercises. Concentrate on keeping the movement controlled. If you’re unable to do so, use less weight. Yes, you want to look like a bad ass, but it’s not very bad-assy when you’re stuck in bed after shoulder surgery.

Use higher reps/lower weight. If you’re like me, you may already have shoulder pain. In this case, “powering through it” is only going to make things worse. Instead, drop the amount of weight you are using and opt for higher reps instead. While heavy weight initiates hypertrophy, fatiguing the muscle can still create that definition you’re dreaming of. Of course, if lighter weights continue to cause pain, please see your doctor. Powering through it is only going to make things worse. Yes, I know I already said that. But it was worth saying again.

Modify exercises that have greater potential for injury. While lateral raises and upright rows are shoulder exercises in the “don’t do” list, you can modify them to lessen the risk of injury. In both cases you do not want to lift the weight any higher than shoulder height. For example, in an upright row, concentrate on keeping those elbows no higher than shoulders. You don’t need to bring the bar all the way up to your chin to hit those delts. You can also take a wider hold on the bar as opposed to the traditional narrow hold on the bar. For lateral raises: lift the weight no higher than shoulder height. It’s just as effective and causes much less stress on the shoulder.

Make sure you do equal amounts of “pull” exercises as you do “push.” Some people (men especially) focus a great deal on building “big pecks” (“Dude, how much can you bench?”), but don’t give as much attention to their back development. As I mentioned earlier, the shoulder muscles are directly related with the latissimus and rhomboid muscles in the back. Having equally strong muscles in the front and back of your body helps keep motions of the shoulder proportionately stabilized. When I went through physical therapy for a shoulder impingement a few years ago, a big part of my program was strengthening my lower traps with resistance bands.

Warm up the shoulder before your workout by performing exercises specifically for the rotator cuff muscles. Despite being last on the list, this is probably the most important suggestion I can make. It’s never good to pick up a weight before warming up the muscle group being used. Your rotator cuff muscles, while small, are no exception. Keeping those rotator cuffs mobile and strong helps keep stability in check, reducing your chances for injury. Not sure of the best way to warm up the rotator cuff? No problem, here’s a video demonstrating some techniques you can incorporate easy at home or in the gym.

My shoulder already hurts, what do I do?

Because the shoulders are so delicate, chances are good that many of you are already experiencing shoulder pain. If this is the case, the best thing you can do is rest the area. This means, don’t do any exercises that stress the shoulder for a week or two. However, if this does not alleviate the issue, I highly recommend you see a doctor as you may have to take more active measures to repair the problem. Unfortunately, while shoulders are quick to injure, they are not quick to heal. Physical therapy may be needed or, if you’ve been powering through it for weeks, months, or years, surgery may be the only sure-thing for a full recovery.