Part 4: The Climber’s Shoulder
Welcome back climbers! In the last blog post of this 4-part series, we will examine a common shoulder injury: the rotator cuff tear. Rotator cuff injuries can affect either the muscle belly or the tendon of the rotator cuff. As a quick review from a previous post, tendons attach muscle to bone and can stretch while functioning as a “spring,” storing energy to increase the power of our muscles. They also have a poor blood supply, so they don’t heal as quickly when injured. Muscle fibers, on the other hand, receive a plentiful supply of blood, which gives them a quick ability to heal when injured.
Let’s take a look at the anatomy of the shoulder. The shoulder complex is a complicated joint that includes three bones: the humerus (upper arm), the clavicle (collarbone), and the scapula (shoulder blade). The rotator cuff is made up of four muscles whose attachments begin and end on these bones: the infraspinatus, the supraspinatus, the teres minor, and the subscapularis. In rotator cuff injuries, the supraspinatus muscle or tendon is affected most commonly. The most important thing to know about the shoulder joint is that about 2/3 of its’ motion comes from the movement of the glenohumeral joint (the ball and socket,) while the other 1/3 comes from the movement of the scapula itself. When your scapula is moving poorly, you can end up pinching the supraspinatus between the humerus and the acromion of the scapula when you bring your arm overhead, which is a common cause of rotator cuff injuries. This also happens to be the position your arm is in about 90% of the time you are climbing!
Injury Prevention
Rotator cuff injuries can be caused by a wide variety of factors, but we can decrease the risk in climbing activities by improving the coordination of scapular movement during shoulder motion. When we bring our arms overhead, the scapula should upwardly rotate without elevating, which will open up the space between your scapula and humerus and decrease the risk of pinching the supraspinatus. Thankfully there is an easy visual cue you can use to monitor if this is happening. When you raise your arm, your shoulder should not lift up towards your ear. If you see your shoulder is elevating, focus on pulling it down while lifting your arm. Once you get the hang of this in the air, start trying to keep your shoulders depressed while hanging on the wall as illustrated in the photos below. Keeping your shoulder blades active this way, instead of letting them hang loose near your ears, is the most important thing you can do to decrease your risk of injuring your rotator cuff.
Here are a few other exercises you can use to help strengthen the muscles involved if you find it difficult to maintain this position on the wall:
Prone I’s:
While lying on your stomach have your arms directly overhead. Lift your arms up away from the ground by moving the scapulas ONLY. If will feel like you are squeezing your shoulder blades together and pushing them towards your feet.
Prone Y’s:
While lying on your stomach have your arms at a 45-degree angle so they are making a Y shape with your body. Lift your arms up away from the ground by moving the scapulas ONLY. It will feel like you are squeezing the top of your shoulder blades together.
Here is a link to a video of these exercises: https://www.youtube.com/watch?v=pJbh46wX1Xw&ab_channel=GregLouie
I hope that the exercises presented in this 4-post series will help you prevent some of the more common injuries that climbers sustain. If you do get injured or are feeling pain when climbing, I encourage you to schedule an appointment with an MTI physical therapist. They will provide you with a full assessment and create a customized rehabilitation plan including hands-on manual therapy and specifically dosed exercise just for you so you can get back to climbing, pain-free!
