This malady can make bench presses, lateral raises, and shoulder presses next to impossible. Don't make the problem worse by ignoring it and thinking it will go away on its own.

Worse yet, some lifters think that shoulder pain is just part of training. It doesn't have to be. Whatever you do, do not ignore shoulder pain. Doing so can result in bone spurs and a torn rotator cuff. Yes, my friends, that means surgery.

Impingement syndrome is defined as a compromise of the space between the head of the humerus and the acromial arch.

In simple terms: the top of your upper arm bone is too high and close to your acromion (part of the shoulder blade (scapula) and your clavicle (collarbone). This decrease in space can come from either a structural problem (usually bone) or a functional problem (usually muscular).

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Anatomy Of The Shoulders.

Since a structural problem would likely show up as soon as someone begins lifting weights, we'll focus on functional causes of impingement, which are most likely, the culprit in the gym.

When you raise your arm, a complex chain of events takes place. A group of muscles called the scapular stabilizers (serratus, trapezius, levator scapulae, rhomboids, and teres major) function in a very precise manner to ensure that the scapula is in the right place at the right time.

At the same time, the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) finely coordinate the movement of the humerus to ensure proper alignment in relation to the scapula.

If these muscles do not coordinate this movement perfectly, the head of the humerus is likely to rise up and forward and bump into the bottom of the acromion. (To feel the top of your acromion, slide your fingers from the middle of your collarbone outward toward your deltoid. Just before getting to your deltoid you will feel the top of your acromion sticking up a bit.)

When this impingement occurs, the supraspinatus muscle and tendon, as well as the subacromial bursa, are trapped between the humerus and the acromion. When two soft structures are trapped between two bony structures, you can guess who loses. This results in swelling and tenderness of this bursa (bursitis) and the supraspinatus muscle andd tendon (tendinitis).

Working Around Shoulder Injuries

Although I don't feel that doing barbell bench presses is often the cause of shoulder impingement syndrome, it does seem to exacerbate the condition once you have it.

Therefore I would avoid BB benches if your shoulder is less than perfect. Dumbbell presses and incline presses, on the other hand, seem to be well tolerated among most everyone.

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Dumbbell Bench Press.

In addition, performing lateral raises to the point where your arm is parallel to the floor (or above) can aggravate a shoulder problem.

Try taking your laterals only up to the point where your arm is about 15-30 degrees below horizontal. Better yet, try scaption instead. Scaption is essentially where you raise the dumbbells up in a plane halfway between lateral raises and front raises.

Personally, when I'm having a shoulder flare-up, my only shoulder exercise will be scaption. It feels safe, stable, and really hits both the anterior and medial heads of the deltoid very well.

Preventing Shoulder Injuries

To avoid impingement syndrome and other shoulder maladies, there are a couple of exercises that you should avoid altogether: behind the neck pulldowns and especially behind the neck shoulder presses. Both of these exercises are favorites among many bodybuilders because of the manner in which they stimulate the working muscles.

Regardless, if they lead to injury and time away from the gym, then their benefits are more than negated by their side effects.





Click To Enlarge.

As opposed to doing pulldowns behind the neck, do them to the front. A recent EMG study shows that pulling the bar to the front actually stimulates the Latissimus Dorsi (lats) better than pulling the bar behind the neck anyway.

In addition to shoulder problems, pulling the bar behind the neck can also cause neck problems due to the amount of neck flexion that you must do to get your head out of the way of the bar.

In addition, strengthening the external rotators (infraspinatus and teres minor) and scapular retractors (rhomboids and middle traps) along with stretching the internal rotators (chest, anterior delts, and lats) will go a long way in restoring normal biomechanics to the shoulder region. In a later issue of Reform, I will cover the specifics of doing just that.

Knee Injuries

Knee problems like patellar tracking problems and patellar tendinitis seem to be the Achilles heel to women trainees much like shoulder impingement syndrome is to men.

An inherent problem lies in the fact that our hip joints are farther apart than our knee joints. In other words, our legs angle in. The angle is greater in women because they have wider hips than men, generally speaking, that is. Due to this inward angle, the patella (kneecap) has a tendency to be pulled laterally, or out to the side. This creates a problem because the patella is designed to track in a very precise groove when the knee flexes and extends.

Even the slightest lateral deviation can cause premature wear and tear on the cartilage that lies on the back of the kneecap. This is called a Patellar Tracking problem.

If left untreated, the cartilage could advance to what is known as Chondromalacia - excessive wear of the cartilage. Because a squat can subject the back of the kneecap to a force seven and a half times greater than your bodyweight, it's easy to see why even the slightest problem with the extensor mechanism can cause a lot of damage.

Pain with these injuries usually begins by hurting after an exercise session, then during the exercise session, and eventually all the time. It may even progress to the point of clicking or popping, usually as a result of cartilage damage.

People with this condition usually exhibit a positive theater sign, meaning they can't sit with their knees flexed for too long without causing some pain. More often than not, this pain is typically rather vague and described by sufferers as "inside the knee" or "behind the kneecap."

Another common chronic knee injury is Patellar Tendinitis, also called "jumper's knee." Someone who has pinpoint pain right at the base of the kneecap most likely suffers from this condition.

Patellar tendinitis is frequently a result of tight quadriceps, in addition to overuse. When the quads are chronically tight, they will pull excessively on the quadriceps tendon. Over time, this extra stress on the tendon will cause it to get inflamed.

As you may know, an inflamed tendon is called tendinitis, and, as I mentioned before, it will usually rear its ugly head just below the patella. Hence the name patellar tendinitis.

Click To Enlarge.

AVOID: Behind the neck pulldowns and shoulder presses.

Working Around Knee Injuries

A good rule to follow is, "if it hurts, don't do it." I don't want to be one of the doctors who always says, "Oh, just stay off it for a few weeks and take these anti-inflammatories." I am very pro-exercise.

However, if an exercise really causes your knee to hurt, it's probably doing more damage to an already injured knee. (Same goes for your shoulder, too.)

Hack squats, lunges, and full range-of-motion leg extensions tend to exacerbate these conditions. Although not an exercise per se, going down stairs tends to be painful as well. Leg presses with your feet fairly high on the platform and partial leg extensions like described before, tend to be tolerated well by most people. Preventing Knee Injuries As with most overuse injuries, pain from patellar tracking problems and patellar tendinitis are also a result of either a sudden increase or change in activity.

Therefore, you want to make sure to adhere to the GPO principal. GPO stands for Gradual Progressive Overload. The key word being Gradual. If you've been doing three sets of leg extensions and three sets of squats once per week for quads, then suddenly doing five sets of each twice per week, you're asking for knee pain.

Likewise, if you've been squatting 225lbs for ten reps, your next goal should be 230 or 235lbs for ten reps. Don't suddenly jump up to 275lbs. Make use of those little 2.5 pound doughnuts in your gym. They're not there for wimps, they're there for intelligent people who know how to apply GPO. Besides progressing gradually, there is another important rule to follow when trying to prevent knee injuries. Avoid letting your knee go past your toes when doing exercises like squats and lunges.

Doing so will put a lot more stress on your knee than if you keep your knee behind your toes in the bottom position of these exercises. I must admit though, that the quads sure get a great stretch and subsequent stimulation when the knee exceeds the toe line. You may know some people who train by exceeding the knee/toe line on a regular basis and they never have knee problems. Likewise, some people can smoke two packs of cigarettes a day for 50 years and never get lung cancer.

	How To Reduce Stubborn Knee Injuries In All Sports! Check out these five home-based exercises that are shown to make your knees stronger and get you off the injured reserve list in a hurry! [ Click here to learn more. ]

Regardless, both increase your risk for complications. Ensuring adequate strength of the vastus medialis (teardrop of the quads) is essential in preventing and treating patellar tracking problems. If the vastus medialis is weak, it allows the patellar to drift laterally, as is already its tendency given the fact that our legs angle inward, and, as I said, especially in women.

As for prevention and treatment of patellar tendinitis, begin by stretching the quadriceps. This will help to provide a long-term solution. In addition, you should consider having some soft-tissue work like Active or MyoFascial Release done on your quadriceps to help loosen them up and keep them loose. Although not nearly as effective, regular deep tissue massage will also help a bit.

Cryotherapy
Good For All Your Inflammatory Ailments.

Although cryotherapy sounds like some sort of futuristic medical treatment in which your body is frozen and preserved until a cure is found for your ailment, it simply refers to the use of ice to treat inflammation. Both the shoulder and knee injuries mentioned above will respond well to this simple procedure you can do at home. You can also use cryotherapy on elbow tendinitis and just about any sprain/strain that you may incur.

To properly use cryotherapy, begin by placing a thin, wet rag on the affected area. Then place the ice pack (a bag of crushed ice or even frozen vegetables will suffice) on top of the rag. Allow the ice pack to sit on the area for up to twenty minutes or until the area goes numb, whichever comes first. Leaving it on longer than that can cause the body to actually bring more blood and inflammation to the already inflamed area. Of course it can cause frostbite as well, neither of which are good. Although most people would prefer to put heat on most injuries, ice is usually your best choice.

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AVOID: Letting Your Knee Go Past Your Toes.

I will agree that heat temporarily feels better, but in the long run it will simply cause more inflammation than what already exists. That's the exact opposite of what you want. Avoid the instant gratification and go with ice on any injury that involves (or may involve) inflammation.

Nutritionally Speaking

Don't forget the role that nutrition plays in healing any inflammatory ailment. First of all, make sure to consume plenty of the Omega 3 fatty acids (aka linolenic acid). Omega 3's have been shown to ultimately have an anti-inflammatory effect within the body.

Fish oil and flax oil are two of the most concentrated sources of this coveted essential fatty acid. Likewise, try to avoid excessive saturated fats which can actually have a pro-inflammatory effect. Lastly, try a joint support product that contains the clinically proven 1,500 mg of Glucosamine along with 1,200 mg of Chondroitin. Stick with a reputable brand.

To close, don't do any exercise that hurts. If you continue to add insult to injury, your pain will never go away.

For those of you who do not have any knee or shoulder pain, training intelligently will help you to remain pain free. As the saying goes, "an ounce of prevention is worth a pound of cure."

	What Do Other People On The Forum Think? Discuss your problems with chondromalacia and how it had affected you. Find out what others have done to deal with it and prevent it from happening in the future! [ Learn More ]

Dr. Clay Hyght

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