Building Mass Despite Shoulder Injury

Question:

My client is looking to build strength and mass for the up coming rugby season. There are a few problems, though. He is only 17 years old, and he has had shoulder problems in the past. From what he tells me, his shoulder subluxates with certain movements while being loaded. I asked him to see his physician to make recommendations regarding his shoulder, but I've received conflicting information about strength training at his age. I don't see a problem with it, especially since he has been weight training for a few years already. He plays at prop, meaning he has a large amount of muscle mass already. I can't find any information regarding strength training at his age. Could you please give me some advice? Thank you very much.

Answer:

From a maturation standpoint, the majority of 17 year old athletes are developmentally capable of coping with moderately aggressive strength training, if appropriately designed and administered. I think you should probably be more concerned with his training history and shoulder issue than his age.

If you analyze the loading this athlete undergoes playing rugby, you will see that he has to regularly receive and produce substantial multidirectional forces that are many times multiples of his and/or his opponents and teammates body weight. Contrary to the beliefs of many medical professionals, simply moving this loading into the controlled environment of the weight room has never been scientifically (or practically) proven to be dangerous.

Moreover, at this age, this athlete is going need to start strength training, if for no other reason than for injury prevention. It is very possible that the shoulder subluxation may have been avoided or lessened in severity if this athlete would have been doing APPROPRIATE strength training.

With younger athletes, you will want to focus from the core out. Inherent spinal support and control is paramount and is fundamental to ensuring proper lifting mechanics, safety and joint health. Avoid training on machines that provide support and control for the athlete. Rather, let the athlete’s demonstration of support, control and technique under a load (not simply the fact that he completed the prescribed number of reps) be the indicator that he is prepared to increase in intensity and exercise complexity.

As you would do with a client of any age, I would collect as much information about his history as you can, starting with the shoulder.

• Can the athlete recall a specific incidence that caused the initial problem (i.e., falling, excessive humeral transition while locked in during a scrum, etc)?
• In what joint position did the injury occur/reoccur (this might tell you where within the shoulder damage has occurred)?
• Where does he feel pain?
• Is there a point during a range of motion where this athlete feels apprehension or a feeling of impending subluxation?

If you suspect any sort of labrum, capsule, tendon, ligament damage, I would refer him to a specialist if he has not already been. He may need some surgical intervention.

I would also take a look at his training history. Many young athletes regularly participate in very poorly constructed workouts that tend to be anteriorly dominant and void of appropriate coaching. This type of program can predispose and cause many types of shoulder issues.

You could almost equate the humeral head to a slightly shrunken billiard ball sitting in a spoon (the glenoid fossa). Unlike the hip, there is very little support from the bony structures of the joint, therefore leaving the responsibility up to the soft tissues. Since the non-contractile tissues (capsule, ligaments) can become lax when excessively lengthened during repeated subluxations, they tend to do very little for maintaining the humeral head in its central location within the glenoid fossa. This places even more responsibility on the muscles that innervate the joint. If these muscles are imbalanced in opposition (i.e., front to back, side to side, inside to outside such as deltoid strength to rotator cuff strength), you will develop a propensity for excessive humeral translation.

You should also examine the motion of the scapula. Since the scapula is a floating structure and it houses the fossa for the humeral bone, any dysfunction in the movement of the scapula directly affects the stability, strength and alignment of the shoulder. Since it tends to be typical of most youth strength training programs to neglect the upper back muscles (and the serrates) you may find them to be weak and lengthened and the anterior muscles to be over activated and short.

Issues affecting the balance of the shoulder muscles (strength and length tension relationships) should be addressed first and foremost. You can then progress into more neuromuscularly challenging activities. Regardless of what you do, be sure to look at the shoulder from a kinetic chain perspective and remember that many muscles away from the shoulder dramatically impact it.