Shoulder Instability Or Dislocations

shoulder instability anatomy

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Shoulder is the most mobile joint of the body. This allows you to lift your arm, rotate your arm and lift your arm over your head. It’s possible to have a greater range of motion with less stability.

How

Shoulder instability

This happens when the humerus head (the upper arm bone) is forced out of the shoulder’s cavity. Usually this happens as a result of a sudden traumatic injury.

Once the shoulder is dislocated, the shoulder is vulnerable to repeat. When the shoulder is loose and slips several times, it’s called a chronic shoulder instability.

The shoulder is made of 3 bones : humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).

Dislocation shoulder

shoulder dislocation anatomy

This may be partial, which means that the arm’s ball partially comes out from the cavity. This is called a subluxation. This can be complete which means that the arm’s ball comes out completely from the cavity.

Symptoms

Symptoms of chronic shoulder instability are :

  • Pain caused by the shoulder injury

  • Repeated shoulder’s dislocation

  • Repeated instance of the shoulder giving out

  • A persistent sensation of the shoulder that is loose, slipping out of the joint or hanging.

Diagnosis

Specific tests help assess shoulder instability (including general relaxation of ligaments). A doctor may prescribe imaging tests such as X-rays, CT Scan or MRI to confirm the diagnosis and identify other problems.

Treatment

First, chronic shoulder instability treated with nonsurgical options. If these options don’t relieve pain and instability, surgery may be needed.

Nonsurgical treatment

shoulder dislocation treatment non surgical

Generally, it often takes several months of nonsurgical treatment before success can be assessed. Nonsurgical treatments includes :

  • Activity modification

  • Non-steroidal anti-inflammatory medication

  • Physical therapy

Surgical treatment

shoulder dislocation treatment surgery bankart repair

Often, surgery is often required to repair torn or stretched ligaments so that they can maintain the shoulder joint in place.

Bankart lesions (tearing of the front labrum from the cavity) can be repaired surgically using suture anchors to reattach the ligaments to the bone.

Arthroscopy => Soft tissues of the shoulder can be repaired using tiny instruments and small incisions. It’s a procedure that is done the same day or outpatient. Arthroscopy is a minimally invasive surgery. The surgeon examines the inside of the shoulder with a small camera and performs the operation with special instruments.

Open surgery => These are patients who require open surgical intervention. This involves making a wider incision on the shoulder and performing the repair under direct visualization.

Rehabilitation

After surgery, the shoulder can be temporarily immobilized with a sling. When the sling is removed, it’s essential to do ligament rehabilitation exercises. These exercises improve the range of motion of the shoulder and avoid scarring during ligament healing. Thereafter, exercises for strengthening the shoulder will be added in the rehabilitation program.

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-Steph

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Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph

The Reasons For An Asymmetric Body (Part 1)

asymmetircal body

I watched a Jamcore DZ’s video  and I learned good stuff.

When I look in the mirror, I see that my right biceps is bigger than my left biceps. And I also see that my left calf is bigger than my right calf. I think you too, you have weak points and an asymmetrical body like me.

I tried several technique to clear the weak point of my left biceps by doing more reps or lifting heavier with my left arm. But it didn’t work as I thought and I realized that there were even more factors that caused my asymmetrical body.

You have to know that there are real weak points and false weak points. And yes, there are 2 type of weak points.

Past sports

sports

These are the sports that you have done regularly before you train seriously at the gym. For exemple, I played soccer for 2-3 years so I developed a lot of my legs and calves. I have been doing karate, kung-fu and taekwondo for years (I have more than 15 years of martial art) so I developed a lot my back, my arms, chest and my abs. My past sports allows me to develop all these muscles (calves, legs, back, arms, chest and abs) even more easily.

Now I’m going to tell you about the difference between a real weak points and a false weak points. In my case, I have nice abs, nice, chest. My arms are correct (I have one arm bigger that the other) and my legs are correct (I have one leg bigger than the other).

For example, a soccer player or a cyclist will use his/her legs and calves more often. A boxer will use his/her arms, back and abs more often. This shows that the past sports is important in muscle development because people developed more rapidly the upper body’s muscles rather the lower body muscles or the reverse.

So don’t worry because absolutely everyone has an asymmetric body (if you know a person who has a 100 % symmetrical body, attention, it’s a robot).

Genetic

genetic

It’s the moment to go to the higher level. Now, you understood that there are people who can easily develop the upper body’s muscles rather that the lower body’s muscles or the reverse. In both case, there is the same problem : an asymmetry.

We’re human beings, we are not perfect and that is normal. Professional bodybuilders also have an asymmetric body like you. It’s for everyone like that. When we look at the mirror, we have a more developed part than the other.

Here are the causes.

Bone

bone

Because of your bones, there is one side of you body that can lift easily heavier weights that the other. So the side muscles that can lift easily heavier develop faster.

A) clavicle length

We all have a longer clavicle than the other. Take you time, check the length of your clavicles, you will be surprised. When the clavicle is longer, this affects the leverage when you lift weights. This means that it boost your strength and your muscular growth.

But, there is a solution to avoid that there is a big difference between the 2 sides. It’s learning to isolate and feel your muscle. I use a technique called « magic touch ». Before doing a set, I touch with my fingers the muscle that I have to work. This allows me to be focus and stay focus on muscle sensations. This is to create the connection between my brain and my muscle.

This is why it’s important to take light weights to learn how to perform a movement to learn the muscles sensations. For example, bench press. There are people who use too much shoulders when the arms are straight. Bench press is an exercice to work mainly chest and not shoulders. So pay attention to your muscles sensation when you to an exercise and adjust.

B) Short and long muscles

This is really a genetic case. There are people with short muscles or long muscle. Take as an example a short biceps and a long biceps.

A short biceps responds slowly to training because the muscles is less close to insertion with the joint.

A long biceps respond quickly to the training because the muscle is closer to insertion with the joint.

As you can see, there are some similarities with the clavicle’s length. When the muscle is long, it’s easier to develop the muscle.

This is something you can’t change and doing an operation to lengthen your muscle is useless. It’s your genetics that decides whether your muscles are short or long.

dorian yates

Wait, it’s not over yet, there’s still plenty of other things in the genetics that influence muscle development. In your training, you can use several techniques to stimulate your muscle fibers like « High Intensity Training » . Dorian Yates (6x Mr. Olympia), used this technique during his career as a professional bodybuilder. This technique stimulates muscle fibers even more that hypertrophy .

There is also nerve genetics. It’s the ability to isolate and feel the muscle you’re working on. It’s an ability that improves only with experience and time.

Here is the end of the Part 1. The Part 2 comes soon.

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-Steph

How To Do Trap Bar Shrugs

trap bar shrugs

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Standing with your legs slightly apart. You’re in front of the trap bar on the floor or on a support :

  • Take the trap bar, paying attention to centering your grip (attention : with heavy weight, a poorly adjusted grip will rock the bar backwards or forwards).

  • You have your head straight or a little bent forwards and your abs squeezed. Do shoulder shrugs.

This exercise works the upper trapezius which is inserted on the clavicle, the acromion and the scapular spine and which goes up to the superior nuchal line the the skull.

The rhomboid major / minor muscles and levator scapulae muscle work a little bit.

The trap bar created to work trapezius by lifting heavy weights without rubbing against the thighs like dumbbells or barbell.

la barbell.

Note

People with long clavicles will always have more difficulty doing shoulder shrugs than people with short clavicles.

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-Steph

Squat Correctly (Part 2)

sqaut

I read a Nerd Fitness article  and I learned good stuff.

Click here to read the Part 1 

Barbell Squat

I know 3 types of squat and this is the best known : the high bar back (also named « Olympic Squat » or « Oly Squat »), the low bar back squat and the front squat. Maybe there are others but I’ll talk about the best known.

The difference is how you place the barbell.

Depending on how you place the barbell on your body, this will modify the squat’s mechanism and geometry. Which means that you will use your muscles slightly differently depending on how you place the barbell.

  • The Low Bar Back is a posterior chain dominant squat

    posterior chain muscle

  • The High Bar Back and Front Squat are a quad dominant squat.

Here a diagram form the book « Starting Strength » to better visualize the barbell’s placement.

diagram barbell placement squat strating strenght

Don’t worry, these 3 squat’s type work the same basic muscles. As you know each exercise has its variants. Now, you know the 3 variants of squat.

Go, find in your gym a squat rack,  a power cage or a squat stand  and place the barbell at the height of your clavicle. If you can’t do this and the height is too low or too high, choose the too low. I have never seen anyone lift on toe and with heavyweight, the accident is guaranteed.

power rack squat rack squat stands

As you read in my articles « Know how much weight to lift (Part 1 et Part 2) » [url link], it’s important to do a warm up with the barbell without weight. I don’t want to know how much you want to lift, do some sets with the barbell without weight to prepare your muscles and joints.

Low bar back squat

It’s the most popular squat’s type for beginners, general lifters and powerlifters. It’s also the squat’s type taught in the book « Starting Strength », one of the best book for beginners.

Once you have adjusted the barbell’s height, be in front of the barbell. Take a step to be under the barbell and grab it with your hands. For this squat’s type, you’ll use a thumbless grip so that your wrists aligned with your forearms.

Usually the grip’s width is near of the shoulders to create a meaty shelf to place the barbell on the muscles in our upper back (deltoid posterior). If you aren’t comfortable, you can have a wider grip. And with time, when you have more flexibility, you can have a grip near of your shoulders.

Here is the difference between a « wrapped grip » (left) and « thumbless grip » (right) : 

barbell wrapped grip thumbless grip

Once the barbell is on your back, stand up, contract your core (squeeze butt and abs) and step back. Normally, if you followed instructions well, you can only step backward. If you can take a step forward, you’re in the wrong direction.

This squat’s type is a posterior chain dominant squat and you’ll be able to lift heavier that the 2 others squat’s type.

High bar back squat

For this type of squat, you’ll start the same way but you’ll put your thumble around the barbell. This isn’t a thumbless grip.

The grip’s width is near of the shoulders to create a meaty shelf to place the barbell on the muscles in our upper back (deltoid posterior) like for the low bar back squat.

If you lack of flexibility to have a narrow grip, you can place the barbell 5cm (2inches) higher on your trapezius instead on your posterior deltoid. Which means that the barbell is placed almost on your shoulders.

Look the difference between a high bar back squat (left) and a low bar back squat (right) :

high bar back squat low bar back squat

Attention : the barbell placed almost on your shoulders and not on your spine. If you feel the barbell touching your spine, it’s too high and this can cause serious damage.

Place the barbell on your back and take a step back. Stabilize and tighten your core and squat down.

To do this squat version well, you need to keep your torso more upright. If you had difficulties to keep your torso upright with the bodyweight squat, it will be a little be more difficult here.

You can try, there is no problem but lift lightweight until you do it well to correct yourself. It would be a pity if your torso collapses and the barbell rolls on your neck (avoid this pain, really).

Front squat

For this squat’s type, you need to place the barbell in front of your shoulders. This squat’s type is quad dominant so you have to be able to keep your torso even higher than the high bar back squat.

Instead of stepping under the barbell, you place the barbell in font of you on your shoulder. To grip the barbell, it’s a little bit more complicated because you need to have mobility and flexibility in your wrists.

Front squat is done with a full grip around the barbell like the other 2 squat types but most people let the barbell roll on their fingertips (a three finger grip is enough). If you like’re me, you don’t manage to have 3 finders around the barbell, there are 2 variants :

Keep your hands to hold the barbell (if not the 3 fingertips is enough) and keep your shoulders high so that your upper arms are parallel to the floor. And squat down.

It’s important that you keep your shoulder as high as possible during the front squat. When you’re gonna squat down, you’re gonna feel the weight on your arms and it will probably correct your position, drop the weight otherwise you will hurt yourself.

What squat do ?

This is an excellent question. You’ll meet 2 clans that clash in the gyms : high bar back squat VS low bar back squat. Both clans have good arguments but that doesn’t help you make a choice.

The truth, test the 3 types and look with which you feel most comfortable, which you have the best technique and with which you can squat down the lowest (your hips joints lower than your knees). Once you have well studied and tested the 3 types of squat, you’ll find your type of squat.

Share this article if you think it can help someone you know. Thank you.

-Steph

Lateral Raise

lateral raise

I read a Frederic Delavier’s book « Strength Training Anatomy » and there is good stuff.

Standing with your legs slightly apart. Your back straight, your arms along your body with a dumbbell in each hand :

  • Raise your arms to the horizontal with your elbows slightly flexed

  • Back to the start position

This exercice works deltoids, mainly middle portion.

The middle portion composed of several bundles which have the shape of a feather converging on the humerus and having the function of maintaining relatively heavy weights and of moving the arm accurately in all directions. It’s smart to vary the start of the movement (hands behind butt, hands on sides or hands in front), which makes it possible to word well all middle portion’s bundles.

According to the different morphologies (long/short clavicle, acromions more or less covering, humerus insertion of the deltoid more or less low), it’s necessary to seek the optimal working angle to his/her morphology.

Lateral raise works also the supra-spinous, non visible muscle that lies deep in the spra-spinous fossa of the scapula (shoulder blade) and is attached to the major tubercle of the humerus.

We can raise arms over the horizon and work upper part of the trapezius.

This exercice is done with relatively light weight and set of 10-25 reps. Vary working angles with short rest times. Work unitl it burn to have better results. To have more intensitiy, it’s possible between each rep to keep arms horizontally a few seconds.

-Steph

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