Shoulder Strength Training Tips for P90x Newbies


In this podcast I respond to a listener question regarding what to do about a shoulder injury sustained whilst performing the popular home based P90x strength and conditioning program.

P90X is a 90-day program that combines a variety of exercise techniques including strength training, cardio, yoga, plyometrics, and stretching. P90X provides a fitness test to determine if the program is suitable for an individual.

The program consists of a nutrition guide, fitness plan, calendar and series of DVD videos demonstrating a variety of techniques, and moves at lower and/or higher levels of intensity.

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Read the transcript below:

Hi and welcome back to truth about shoulders. My name is Luke and I’m “The Shoulder Guy.” I’ve got a little audio insight for you into a person who contacted me from the UK. He was having trouble with his shoulder, actually halfway through a gym program. He had purchased the P90X home program. It’s a very intensive home program of strengthening, flexibility and fitness. He was pumped. He was making massive gains early on and then everything went wrong. Halfway through it he developed right shoulder and right elbow pain. The pain became so worse that he had to give the whole program away. That’s when he contacted me. He heard about, “The Shoulder Guy” and got on the email and contacted me. He wrote a very extensive list of his problems and the audio reply there I’ve given him is going to follow this.

I really hope that you can get something from it?

So, if you’re a gym guy out there, if you’re someone who is just about to partake in a weight’s training program there’s some tips in here that you’d want to understand about because it might help you to safeguard your shoulders and get shoulders for life. You want to get into a gym program, which I totally encourage you to do, but you want to do it the right way so that you get the long term benefit. You don’t start off and three months into it you’re a one-hit wonder and you’re on the injured list and you’re off and you’re on the sidelines watching everybody else do it. You’ve got to be careful with your shoulders because they tend to get lots and lots of use. I really hope that you find the following audio useful, so that it can help you in the long term with your fitness and health goals.

[01:58:00]
Mate, I understand that you’re a 32-year old male, who’d recently completed a program, a pretty intense program called the P90X. It’s a home intensive, home fitness program which involved strength conditioning, fitness and flexibility and that you’d gained a lot from that initial program, which is fantastic, mate. Unfortunately, you’ve come into, and hit a brick wall, with regards to your shoulder and elbow, looks like your right shoulder and right elbow.

Unfortunately, this isn’t uncommon and a lot of young men come to see me with these type of problems. They’re trying to get back into shape; they’re trying to get back into the gym. Halfway through their programs, it could be three or four months into it, it could be six months into it. They hit a brick wall and they’ve got to stop training like you’ve done here because of pain, because of shoulder pain and persistent pain, so much so that they’re very frustrated. They have to give up training, which is the last thing they want to do.

The things that you sort of mentioned to me is that you’re now weak. You have less flexibility in and around the shoulder. Looks like you’ve got some information which has started to help you, which is great from my report called “The Shoulder Report”. Some of the stretching that you need to start to do is a great way to gently start.

It’s important to know that tendons and muscles in and around the shoulder are sort of almost two different organs.

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Muscles are full of blood and they respond quite quickly to the loading on them and they can adapt fairly quickly. Tendons don’t. They adapt very slowly and when they come under loading that’s above their threshold for their capacity for loading, they tend to swell. We see that in and around the Achilles tendon and now we’re thinking around the shoulder that there could be a similar response. Where the tendons swells it puts pressure on this structure called the bursa which overlies numerous structures within the shoulder. The bursa’s like the oil in the engine. It keeps everything sort of lubricated and running nice and smoothly. When it gets aggravated and inflamed it becomes painful. It’s highly innovated and it can give you quite intense, sharp, grabbing shoulder pain especially when it’s pinched off.

[04:02:06]
Usually, it’s impinged or pinched against the bone that sits above it, which is called the acromion bone. That’s that sort of bone, that high bone that sits right on the top of your shoulder. Now all these structures can cause you shoulder pain and with someone who’s been involved in an intense training program, usually I see that the rotator cuff has taken a beating. The muscles can’t control the joint and the tendons become inflamed as well. There’s multi-factors, factorial problem going here. We’ll have a weak and inhibited rotator cuff. We’re potentially going to have some tendonitis within the rotator cuff tendons. Then, with associated, what they call bursitis as well. All these things are going to inhibit your ability to do bench presses, to do dips, to do above-head presses and even to put the bar behind your head to do squatting.

Now, the shoulder pain will inhibit your shoulder muscles, so you’re instantly feel weaker. With continued loading and overuse the muscles and soft tissues at the back half of the shoulder become less flexible. You’ll notice that, as you have too, mate, that you’ll find it difficult to internally rotate or put your hand behind your back or take your hand across the opposite shoulder too.

When the shoulder joint becomes less flexible, the forces that go through the joint increase and what we know now is potentially the bore starts to move up and forward within the socket. It doesn’t stay centered as it needs to be to get your muscles to work more effectively. You start to lose stability within the shoulder joint and potentially you’re now going to impinge the soft tissues up against the acromion bone underneath and the CA ligament at the front there too. All of these things sort of tend to then promote each other and you end up with a dysfunctional shoulder. That when you continue to load it, it doesn’t perform well.

[06:00:00]
You tend to continue to aggravate the already inflamed tendons and bursa. Then you end up pretty much as you have. You’ve got to give away the training program, which is unfortunate. Now, the best way out of it is…the tips that I’ve got ready for you, is ultimately you want to get a good diagnosis from a physical therapist at home. The differential diagnosis that I would say would be either it’s going to be an AC joint problem. So if you can use your index finger and point directly to the top part of the shoulder and say, “Yep, that’s my pain right there on the top of my shoulder.” Then it’s likely to be an AC joint problem.

I’ve seen a few in weightlifters and those guys that go out there that load their shoulders very heavily. They can get some resorption of the AC joint, which means that the end of the clavicle bone or the collarbone starts to… the bone starts be taken back up by the body. That’s called osteolysis and people that continue to do heavy benching can sometimes get AC joint problems and AC joint pain, which will stop them pressing.

The other problem, which you potentially could have, is obviously tendonitis, tendionopathy, which is probably the more correct term. As things go on, then the bursa, the associated bursitis and then impingement too. For want of a better term, it’s probably a bursitis and impingement problem that we see which is very common in the shoulder. The rotator cuff itself has started to fail; it can’t continue to handle what you’re trying to throw at it. What you need to do is to take relative rest. Not completely rest. Y you don’t want to totally put the arm in a sling and not use it. You want to take relative rest from aggravating activities. Ideally, you want to take some anti-inflammatory medication if you’ve got onto the problem very quickly. Ibuprofen is the way to go.

[08:00:00]
We know that Ibuprofen has a good effect on reducing the swelling within the tendon tissue and helps to reduce the swelling within the rotator cuff tendons, to minimize bursitis and those type of things too. Ibuprofen can work. You want to check whether you can take that effectively by double-checking with your doctor. If things persist and you can’t get your pain under control, which is ideally the first thing we need to do. You want to get it down to a two out of a ten level or below with Ibuprofen, with relative rest, with minimizing the load that you’re lifting and aggravating activities that upset your arm. If that sort of fails, then you might need some more help by injecting the shoulder with a hydrocortisone local anesthetic into the subacromial bursa. That’s something we use commonly here is Australia. It can work really effectively to get on top of your pain and then enable you to get into the gentle stretching program and the gentle loading program once more.

Now, the two stretches we have for the shoulder, which I would encourage you to start to do two to three time a day very gently, is the across-body stretch and the sleeper stretch. Those two will help to gently keep your soft tissues compliant, both the musculotendinous part of your rotator cuff and also what they call the posterior capsule. Now, you don’t want to overstretch the front half of your shoulder, which a lot of people tend to do, big chest stretches and pec minor stretches. It doesn’t make since to be doing that. It’ll stretch out the front half of the attachment of your rotator cuff and continue to cause you pain. Effectively, that’s what you’re doing when you’re in a deep bench press position, which you want to avoid.

The next thing you need to do is stay out of those positions, especially when you start to go back to train. You need to stay out of those deep positions. You need to keep your elbows in front of your body when you’re bench pressing and the same thing when you’re pressing above your head. If you start to bring your elbow behind your body, then you’re going to put a lot of pressure on the front half of your shoulder and cause your rotator cuff to start to work in an overloaded sort of way.

[10:00:00]
Now, the next thing after you gently stretch, we’ve got to then get back and gently start to activate the rotator cuff again. Pain inhibits muscle and it will inhibit your ability to feel when you’re actually using your arm properly. Bigger muscles will want to take over. Your pecs and your lats will want to take over and try to control the arm. You’ll want to splint the arm to your side or splint the arm in some way, so that you can get some power through it.

Ultimate power really comes from a nice, active rotator cuff. We’re not really focusing on strengthening at this stage at all. We just want to see if we can get your rotator cuff muscles moving. The best way to do that in this way is to gently start to look at gently activating the muscles potentially through an isometric internal or external rotation and then moving onto an external rotation focus. We really got to get the back half of your shoulder nice and strong and that’s through external rotation.

The best two exercises really probably are looking either at a theraband external rotation with the arm by the side, gently by the side, not squeezed into the side or a sideline external rotation. Now, both of those with a very light load, a half kilo or a yellow theraband with the lightest one that you might have there in the UK and very gentle loading. You’ve really got to concentrate on your overall shoulder position. Usually, the shoulder blade is pulled forward and down. You actually want it to be back and up. A lot of personal trainers, especially here in Australia, will advocate a back and down position.

I totally think that’s completely wrong.

Your shoulder blades need to be actually pulled back and up. So we open up the chest. We tilt the shoulder blades slightly up and back and it puts the rotator cuff muscles into a better position to enable them to work. If you’re really focused anteriorly, which means at the front, and most gym programs are, you’ll have the tendency to pull your chest and shoulders forward and down. You’ve really got to avoid that. If you continue to do that you’re probably going to continue to get shoulder pain too. That’s something to work on as well, mate.

[12:00:00]
Now, taking protein, it’s fantastic. Usually, when you first start a program, anyone who’s first starting the first couple of monthsare really related to what they call an increase in neural drive. There’s no real hypertrophy of muscle going on. Taking protein within the first couple of months is probably a waste of time. As you then move into the muscular phase of where muscle is actually changing and we’re developing more muscle and hypertrophy of muscle, then probably protein makes more sense at that stage.

Now, you’ve just got to watch with other exercises too, mate. When you’re doing behind-the-head squats, so you’ve got the bar behind your head, you’ve just got to watch that your shoulders will actually be in a stretched position there. We know that tendons that are inflamed don’t like to be put on stretch; any tendon really doesn’t want to be put on stretch. They’re not that compliant, so you’ve got to be careful of what other exercises you choose.

The questions really that you’ve posted here to me, what the hell is the problem? Well, I think potentially it’s going to be either going to be bursitis with impingement or secondarily it could be an AC joint problem. The best way to fix it quickly is to understand what’s going on first, to take relative rest, to minimize loading, to don’t put your arm into positions where you’re going to aggravate or overstretch the tendons. Be careful of what the exercises are that you choose to go back and do, initially. You’ve got to gently stretch out the back part of your shoulder.

Most importantly, you’ve got to get your rotator cuff active again and that needs to be active on a nice properly positioned shoulder blade. It can’t be down and forward and pulled forward by your bigger muscles. It’s got to be kept back and up and nice and level with the opposite side too. The best way to gently activate your rotator cuff, ideally, is through and external rotation program using very, very light load and looking at gently making a change over three to four months. If you go too hard and too fast with loading up the tendons once more, you’re going to suffer. You’re going to keep this problem going. You’ve got to almost trick the tendons into believing that nothing else has changed. In fact, you’ve actually increased the loading that you’re doing. You’ve got to be very careful about how you progress your loading. At the end of day, then you want to then put the rotator cuff back in with the rest of your body and making sure that you’ve got a good strong lower half, a good core strength and then a nice strong shoulder.

[13:58:05]
You need to probably train a little bit more differently. You need to then minimize overall range of motion, I believe, to make sure you’re training the right muscles and not putting undue stress onto your shoulder when you go back and train. You want to gradually, slowly but surely build up because you’re wanting to do this for the long term, ultimately. It’s no use having a fast blast for three months and getting massive over three or four months and then falling in a heap and not being able to train for six months. It doesn’t really make sense to me.

Wayne, if you don’t mind, it’d be great to put this on the “Truth about Shoulders” podcast so that others can hopefully benefit from the information I’ve mentioned to you today. I’m sure there’s plenty of other men and women out there that are struggling with shoulder pain in relation to weights programs and gym training. Thank you very much for sending those questions through to me and giving me the opportunity to answer them for you. Hopefully, they’re of benefit to you and the wider population as well. Mate, thank you very much and I look forward to talking to you again soon if you’ve got any further questions. Bye for now.

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Leave a Juicy Comment Below:

  • Great thing to have some training tips.

    • Luke Van Every

      Thanks, there’s plenty more on the website and plenty more to come.

      All the best,
      Luke