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by John Izzo
Have you ever wondered what you can do to get that annoying clicking sound that comes from your shoulder to stop? Ever wonder what it is?
Yesterday, I met a 52 year old man that wanted to learn more about what I can do for him--as his trainer to reduce the incidence of the infamous creaking and clicking coming from his shoulder. He complained of an annoying shoulder clicking issue in his right arm, that he said presented no pain--just annoyance. I asked him what he did for a living and what do you know...he is a chained to his desk. Not literally. But he was a office worker spending most of his days seated in front of his computer screen. Upon an initial assessment and observation, he demonstrated the obvious signs of poor posture: protracted shoulder, upper crossed syndrome, and a posterior pelvic tilt.
Protracted shoulders are pretty evident in people that sit all day. Gravity has a tendency to usually win battles in people that are weak, sedentary, and immobile. The client usually becomes a "slave" to the seated position and soon enough loses alot of the structural integrity that enables them to be upright. Have you ever met someone that has been in their job or position for 5, 15, 20 years? They usually "look" like they have been in their job position for that period of time. Chances are with the constant pressure of gravity and the loss of core strength from the intrinsic musculature, a person’s body segments will conform to the object that is creating the opposing pressure. Let me guess, you are probably saying to yourself: "Pressure from gravity"?
Yes. The gravitational pull that exists--although we tend to forget--takes a toll on the human body over a period of time. the effect it has on the body is more evident in the elderly and people of poor stature. The pull of the earth subjects tissue, organs, and appendages to subdue to its power over a long period of time. It is most noticeable in elderly because the degeneration of the human body almost always beckons weakness--and therefore, the body segments become misaligned.
The weaker, more deconditioned, and more immobile one is they are more susceptible to the pressure exerted everyday by gravity. The stronger and more conditioned you are, the less likely your body “gives in” to the subtle stress of gravity. However, those that are chained to the seated position for years on end, become sandwiched between gravity’s subtle, yet sustaining pressure; and the reciprocal pressure of the object the body is located in between. In this case, it is the desk chair. First the non-painful click... A tear in the glenoid labrum is the most frequent cause of the clicking shoulder. Some causes of tears in the labrum are: repetitive overhead sports activities causing fatigue of the stabilizing dynamic rotator cuff muscles allowing excessive humeral head translation over the glenoid labrum; falling on an outstretched arm entrapping the superior labrum under the humeral head; and forceful eccentric contraction of the biceps during the acceleration phase of throwing in which the biceps is attempting to decelerate the rapidly extending elbow. Although rare, it is not entirely impossible for a fitness enthusiast to suffer a torn labrum. Torn labrums don’t only occur in pitchers that throw 90 mile per hour fastballs. It can be possible in the fitness setting also. All you need is a blunt and traumatic action that Take for instance, medicine ball throw-downs. You take a 10 pound medicine ball and a weakened shoulder joint on an unsuspecting exerciser, and you can have catastrophe. It is possible under the right circumstance: All humor aside, there are four factors that created the unfortunate event in the above video: Obviously, pathologies that are progressed to the point of pain should be consulted with a medical professional. By this point, radio-graphs should be required to observe for any loose bodies in the shoulder capsule or labrum. As trainers, we recognize the potential for pain causing contaminant: injury history, physical activity, exercise instruction, static posture assessment, and lifestyle—and we begin a conservative treatment by addressing instability with the scapular region. The Scap Clock Drill begins by facing an empty wall about 6-14 inches away. The distance from your feet and the wall will really depend on your upper-body strength, coordination, and pain levels. Obviously, the further you stand away from the wall, the more difficult the exercise. So I suggest you begin 6-8 inches and work your way back. Make sure the wall is smooth. Any cracks or protrusions will cause abrasions or disrupt the consistency of the movement. With palms on the smooth wall (make sure they are clean), you are going to slide your hands up and down. The further the hands travel away from the torso, you are going to lean into the wall--without touching it. Once you reach a comfortable distance, slide your palms back to the starting position. In order to really target the serratus and lower trapezius, try to keep your arms as straight as possible. A slight bend in the elbow may be allowed, but try to get in the habit of keeping them locked. In the video, I demonstrate various angles that can be used—mimicking the hands of a clock—to engage the lower traps and serratus. Practice a linear vector and once you have become coordinated and stronger, I suggest using combinations. as the title suggests, imagine the wall as a "clock face" and different points are the numbers on the clock. So you can use different angles such as: Remember, with any type of clicking that concerns you--you should consult a medical professional. It is always better to have the information based on fact, than draw up your own conclusions.
A Painful Click vs. a Non-Painful Click
If you present protracted shoulders, that means your posture assumes a "shrugging forward" look. Although, this is difficult to correct because the shoulder 'girdle' has been compromised, it is not entirely irreparable.
After a close observation and assessment, it can be found that the humeri (upper arm bone that is snug under your collar) are protracted due to the weak scapular stabilizers, particularly the serratus anterior and lower trapezius. The clicking sound you hear may be the tendon snapping over the head of the humerus -- this may due to a slight rotation of the head causing friction during certain movements. Picture this: you are riding a 12-speed bicycle and have to switch gears to accommodate for the terrain. As you switch gears on the handlebar, you hear and feel the chain and sprocket moving into place. As this occurs, there is a "rickety, rackety" clanking noise that soon ends as the chain falls into the correct shift and makes the ride smooth. Everything is normal--just a bit noisy.
Now for the painful click...
1.) Poor instruction
2.) Lack of progression
3.) Wrong technique
4.) Ego
The scapular muscles become a major focal point when addressing any type of malfunction of the shoulders. A quick and easy assessment one can perform is a simply hanging stretch that allows the user to shift the body forwards and backwards with straight arms. With the arms straight, the trainer can assess (from behind) how much movement is allowed by the scapula.
Scap Clock Drill
Remember my client from earlier? He was given an easy exercise that he could perform 3-4 times daily in his office--preferably in an empty conference room or office. Once we are able to mobilize the scapula a bit, we need to strengthen the muscles in order for them to "fire" properly when called upon.
Left hand: 12, 9, 11, 8, 7
Right hand: 12, 3, 5, 12, 5
The Scap Clock Drill can be performed with many variations. I have seen many exercisers perform it facing down (towards the floor) and using furniture gliders or socks. As with any exercise, you should really be patient, work in a pain-free zone, and remember that results come from a cumulative effort of effective program design, execution, and progression.
The shoulder is too complex of a joint to be neglected--especially if you choose to lead an active lifestyle. So I recommend performing the Scap Clock Drill, or its variations, presently in your exercise program. Focus on exercises that directly improve scapular stabilization. There are many exercises detailed in Stronger Shoulders DVD that will help improve and strengthen the shoulder joint to prevent future shoulder problems.
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Copyright . John Izzo. All rights reserved.