So here we are in the third chapter dedicated to the pathology and the prevention of injuries in sport climbing. I have so far tried to explain the anatomical and the biomechanical pathology of the hand and the elbow joint. This time however we will address the shoulder joint.

anatomia spalla

The main feature of this articulation is of course the mobility. It represents, in fact, the area with the greatest possibility of movement in the entire body. Precisely for this peculiarity, the shoulder girdle has the need for major passive (ligaments, fibrous cartilage) and active (muscles) stabilization systems.

The shoulder girdle is formed in terms of the bones, from the shoulder blade, which creates a base of anchorage for many stabilizer muscles and for the humerus. The correct movement and expression of force is expressed thanks to good coordination and the right rhythm between the two elements mentioned above.

The muscles which play an active part in this system are divided into: the scapulothoracic (muscles coming from the torso that are attached to the scapula: trapezius, serratus, levator scapula and rhomboid). The scapulohumeral (muscles that originate from the scapula and humerus that are attached to the humerus: the rotator cuff and the teres major muscle) and the thoraco-humeral (muscles coming from the torso that are attached to the humerus: the latissimus dorsi and the pectoralis).

muscoli spalla

A correct amount of balance-length-tension-strength of these muscle groups allows for adequate movement and above all, the “economizing” of the passive structures of the joints and tendons.

From a functional point of view, the scapulothoracic muscles have the role of positioning the shoulder blade properly and therefore, offering the best articulate connection with the humeral head; the scapulohumeral muscles have the function of maintaining the fixed centre of rotation of the humeral head with respect to the shoulder blade; and finally the thoraco-humeral muscles are responsible for the large movements of the humerus.

In everyday gestures, but particularly in sports where there is a greater use of the upper limbs, the thoraco-humeral muscles are always the most trained muscles (because of their ability to express large forces of movement), to the detriment of the scapulothoracic and scapulohumeral muscles which are however always rather weak even though they are accurate. From which derives an important muscle imbalance and thus leading to postural change of the centre of rotation of the humeral head with consequent deterioration and damage to the passive (glenoid labrum and glenohumeral ligaments) and active (rotator cuff and long head of the biceps) structures.

Therefore, it is essential to insert the appropriate exercises into your training program to improve scapulothoracic and scapulohumeral muscle functionality, to restore the adequate fascial length and train agonist-antagonist muscles.

1. Strengthening exercise for the anterior serratus muscles

Starting position: On your hands and knees, with your elbows slightly bent and resting on your fists.

Execution: Push down on the fists that must remain still and push the pelvis backwards toward the heels.

15 repetitions x 3 sets.

2. Strengthening exercise for the subscapularis muscles while remaining in control of the shoulder blades

Starting position: Lying down, with the arm bent at 90 °, with the elbow slightly higher that the shoulder, supported by a pillow and the shoulder blade firmly pressed against the bed.

Execution: Internal rotation of the arm with an elastic resistance, without changing the alignment of the elbow and without the shoulder blade losing contact with the bed.

10 repetitions x 3 sets.

3. Reinforcement of the middle trapezius and rhomboid muscles.

rafforzamento muscoli

Position: Lying flat face down, with your arms slightly open at 45 °.

Execution: Tighten the shoulder blades towards the midline; remove arms from the ground by just a few centimetres, trying to keep the shoulder blades forward and without extending the lumbar column. Hold the position for 5 seconds.

10 repetitions x 3 sets.

4. Reinforcement of the external rotator muscles while remaining in control of the shoulder blades

Location: Lying flat face down with the arm bent at 90 ° and externally rotated about 90 °. Place a pillow under the shoulder so that the elbow is in line with the shoulder.

Execution: Lower the 2 kg weight and bring it back to the starting position, trying to keep the elbow aligned with the shoulder and the shoulder blade still.

10 repetitions x 3 sets.

5. Stretching the external rotator muscles and posterior capsules

Stretching

Position: On your side with your arm flexed at 90 ° and your elbow flexed at 90 °.

Execution: With the help from the other arm, internally rotate the arm towards the bed, holding the position for 15 seconds and then fluctuate.

Repeat everything 10-15 times per arm.

The proper use of the shoulder girdle during a specific gesture is the basic element for the prevention of injuries by overloading the shoulder.

• Position the shoulder blade correctly in the various stages of climbing.
• When doing lock-offs or movements, the elbow has to be positioned just before or on the vertical line of the shoulder. Moving your elbow further back than the shoulder overloads the anterior tendon-ligament structures resulting in anterior displacement of the humeral head.

posizione sbagliata

In the image: the incorrect positioning of the shoulder girdle. The elbow is slightly behind to the shoulder, the scapulothoracic muscles do not participate in the lock-off phase, resulting in anterior “movement” of the humeral head.

posizione corretta

In the image, the correct positioning of the shoulder girdle is shown. The elbow remains in front of the shoulder, the scapulothoracic muscles participate in the lock-off phase with a good positioning of the humeral head.

In the presence of pain in the shoulder it is recommended to:

– Rest.
– Do unpainful arched pendulum exercises.
– Physiotherapy.
– Painkillers (by prescription).
– Scapulothoracic and scapulohumeral exercicses, only if it does not create pain or arched if it is not painful.
– Practical bandage.

There are many pathologies that affect the shoulder and therefore it is always advised that in the presence of pain in that specific area, to refer to medical staff who are experienced in the management of such issues.

Silvio Reffo

Cover Pic: Alberto Orlandi