Troubleshooting November 2013

on Friday, 01 November 2013.

I feel like something is wrong in both shoulders when I train a number of exercises for delts. It feels somewhat injurious although not bad enough that warrants me visiting a Doctor. I just sometimes have to change the angles that I am working, or sometimes I feel I have the strength to increase my weights, but I don't because I feel if I do it will cause something more serious in my shoulder area. I suspect rotator cuff issues. Any advice?

To manage shoulder pain effectively it is essential to understand the concept of impingement and in particular the relationship between impingements and instability. Most shoulder pathology relates to these two factors in some way.

To understand the concept of impingement, it is necessary to understand the functional anatomy of the rotator cuff tendons and their relationship to the structure both above and below them. Impingement occurs when the space below the acromion, the coracoacromial arch and the AC joint above and the glenohumeral joint below is functionally narrowed. This impingement causes mechanical irritation of the rotator cuff tendons resulting in haemorrhage and swelling.

Impingement can occur from:
Encroachment from above
Swelling of the rotator cuff tendons
Excessive swelling of the humeral head.

The external rotator of the shoulder includes two small muscles called the infraspirnatus and the teres minor. These are much weaker than the internal rotators, which include the pecs and the lats. To distinguish between external and internal rotation of the shoulder, imagine you are standing and shaking hands with someone with your right hand. While in that position, if you move your right hand, you're externally rotating your shoulder.

The problems with shoulders are that some people, over the short and medium term, may not appear to suffer harm, it is only in the long term. Exercises that are notorious for causing shoulder harm include the behind the neck press, upright row, lateral pull-down to the back of the neck and almost any kind of fly movement. Some of these movements will almost certainly harm the rotator cuff muscles also.

Shoulder damage is also caused by potentially sound exercises which are ruined by poor technique. These include the wide grip bench press and overhead press, wide-grip dip or any press that uses an excessive range of motion, including the dumbbell bench press, and the lateral pull-down to the front with a very wide grip.

Excessive training volume and/or frequency can lead to injured shoulders very easily. Any shoulder, chest or back exercise heavily works your shoulders. Even on an abbreviated program – where, for example you train each exercises once a week but while training three times a week all together- you are likely to be overtraining your shoulders. So be careful how you structure your shoulder workout, rigorously analyse your program and see if you can see signs that you may be overtraining or harming your shoulders. Also perhaps get a very experienced coach/trainer to review your form to ensure you are correctly executing your choices of exercises.

What are your thoughts on the leg press as an exercise and is it an alternative for the squat in your opinion?
If I had to choose one exercise over the other it would always be the squat, but individual circumstances are unique, that may require a different prescription. The leg press is a major multi-joint exercises in its own right regardless of whether you squat or not. If for some reason a trainee needs a break from squatting it is an excellent alternative. For trainee's that have poor leverages for the barbell squat that make the squat only a marginally productive if not dangerous movement again it is an excellent alternative. The group of trainees I am eluding too would include really tall trainees and those of more average height but with proportionally long limbs and a short torso. They are most likely to be well-suited to the deadlift, thus making the deadlift/leg press a well-suited match up. The leg press is also a respectable option when the squat can no longer be performed due to lower-back or knee limitations.

Some gym goers are quite disdainful of the leg press, and suggest that those who don't squat are somehow copping out. For those that cannot squat and leg press with equal safety, then the leg press is an excellent exercise to have regularly in your program.
The biggest advantage that I can see with the leg press over the squat is that it is far less technically challenging. Because of this it is easier to work yourself maximally and safely in the leg press as opposed to the squat. You can maintain correct form while leg pressing to failure than it is squatting with a barbell across your back to failure.

By taking the lower back out of the exercise, assuming that you use great form, the leg press enables you to work your thighs and glutes to the limit without having your lower back utilised except as a stabiliser. This is great for trainees who have lower backs that fail before their legs do when squatting. With some machines, because of the control over pressing depth and foot placement, knee stresses can be lessened substantially in the leg press relative to the squat, thus enabling trainees with knee limitations to get heavy work for their thighs and glutes.

So for me, I think the leg press isn't a cop out from squats and that it is a brilliant exercise in its own right to pack on quad muscle. Not only that, but it may help increase your potential in the squat and deadlift because of its assistance value for those two great movements. However assuming all things are equal and that you can perform both exercises safely and with good form the squat is the superior exercise.