No Burden to Shoulder
How to prevent those all-important joints from dragging you down

By Ami Walsh

Short-Order Surgery The quick and painless solution to an all-too-common ailment I'm sure you've cooked a piece of bacon and seen it shrink," says orthopedic surgeon Gary Fanton, a physician for the U.S. Decathlon team. "That's basically collagen contracting." It is also essentially the science behind electrothermal arthroscopy, a newly available surgical procedure to mend shoulder joints stretched loose by dislocations — the shoulder's most prevalent injury for people 30 and younger. Since the FDA cleared the way for the surgery two years ago, it's mostly been professional athletes, such as San Francisco 49ers tight end Brent Jones, who stood in as guinea pigs. But with an emerging success rate of 90 percent, doctors are starting to recommend this option for others. Considering the drawbacks of the traditional alternative, electrothermal arthroscopy could be a boon for sidelined athletes. The old surgery involves cutting through the deltoid and rotator cuff muscles and nipping and tucking the baggy collagen inside the joint: The ligaments are cinched tight and stapled in place. No wonder rehabilitation requires six months to a year, with little hope of regaining your shoulder's former mobility. In contrast, shrink-wrapping, as the new approach is casually called, involves poking a spoke-size, fiberlike probe into a quarter-inch incision and snaking it through layers of muscles into the damaged joint. Precisely controlled radio waves radiate from the probe's tip, heating and shrinking the collagen fibers to snug up the ligaments. You'll be in and out in a matter of several hours, and health insurance will likely cover the $7,000 cost — half that of the old procedure. Best of all, you'll probably regain your full range of motion. Of course, Fanton can't say how long it will last. "But," he says, "we're at our two-year follow-up right now and the results appear to be as good as anything else we've been doing." — A.W.

Plan to cast flies on the Blackfoot this summer? Spike volleyballs at Huntington Beach? Portage your Mad River over land bridges in the Boundary Waters? Or even just join in the occasional softball game? Regardless of your warm-weather athletic ambitions, you'll need at least one piece of personal equipment: strong, stable shoulders. Interestingly, strong shoulders are not necessarily stable shoulders, and vice versa. So getting them in fighting shape for the season's welcome stresses requires a carefully considered plan of stretching and strengthening. It's not enough simply to bulk up. In fact, that approach may cause more harm than good.

Blame the architecture of the glenohumeral joint, the most mobile and vulnerable of them all. Here the humerus, the long bone of the upper arm, fits into a very shallow cavity on the scapula, or shoulder blade, while the four finger-size muscles that make up the rotator cuff provide tension like the lines on a tent. "If there's a weakness or tightness in one of the guy wires," says physical therapist Joe Costello, a consultant to the National Outdoor Leadership School, "then that's going to affect the integrity of the way that entire tent is pitched." Any underlying instability can lead to inflammation, limited mobility, and the buildup of scar tissue. Worse, if your rotator cuff can't keep the humeral head seated during inherently high-torque sports, you could be in line for a dislocation.

That's not to say the primary movers — the deltoid, pectoral, trapezius, and latissimus dorsi muscles — need no attention. They deserve most of the upper-body credit for actually powering our fun, so it's important that they be strong, as long as they're equally strong. A balanced weight-lifting program for the big shoulder muscles includes equal repetitions of lat pulldowns and shoulder shrugs, the military press and pull-ups, and the bench press and seated row. But in case you'd rather not repress your fresh-air urges by sticking to the gym, we've provided a host of routines you can do even as you ease into some of your favorite summer pursuits, such as swimming, kayaking, and rock climbing.

Whether you choose a weight-lifting or a sport-specific routine, it's wise to work out three times a week to prep your shoulders. Following such a program will not only develop your glamorous primary movers, but will help maintain the delicate structure that gives your shoulder so much freedom.

Swimming
The muscles you call on in the lap lane will serve you well for almost any summer activity, from maneuvering a board in the surf to shouldering a heavy pack. With every freestyle stroke, you employ the deltoids, to lift your arm out of the water, and the latissimus dorsi and pectorals, to propel your body forward. But because the rotator cuff is virtually ignored during the stroke, it can become strained while the primary movers gain power and bulk. So you might start by strengthening those vulnerable stabilizers.

Since you can take elastic bands anywhere, the following rotator cuff exercise is one you can do either before a pool workout or on its own. Stand with one end of a band under your right foot and grasp the other end with your right hand, palm facing out. Raise your arm straight in front of you, with your thumb pointing down, to shoulder height. Do ten repetitions; then switch sides and repeat. This is also a nice warm-up for further shoulder work, such as sculling. You'll need a pool for this one. Hop in the deep end and make figure-eights with your hands to stay afloat. Five minutes of this provides a well-rounded rotator-cuff workout.

Next, outfit yourself with hand paddles to strengthen the delts, lats, and pecs. Just be careful that the paddles' surface area isn't much bigger than your own hand, advises Gerry Rodrigues, coach of UCLA's masters swim team, lest you invite too much resistance. Use the paddles right after your regular warm-up, for the middle third of your workout, and then swim the rest of your laps without them.

Swimming drills, of course, benefit your shoulders only if you've already mastered the mechanics. Rodrigues offers two tips to properly focus your freestyle effort: Don't let your hands cross the centerline of your chest, and swivel your hips on each stroke — it'll lighten the load on your shoulders.

Kayaking
For any sport in which the field of play is above your head, such as volleyball, climbing, and paddling, you need strength in the muscles associated with the scapula. While kayaking helps to develop the trapezius and rhomboids, which glide your scapula across the back of your ribs with each stroke, swift currents can strain the shoulder and easily cause dislocations. "When people's rotator-cuff muscles get fatigued," says osteopath Dave Jenkinson, the U.S. Canoe and Kayak Team's doctor, "the shoulder can flip a little and — boom! — you've got a problem."

One of the best exercises to prevent injury and promote power in the scapula muscles is the Jobe's push-up, a modification on the classic. Do a normal push-up — hands shoulder-width apart, body plank-straight — but round out your back and shoulders as much as possible at the top of the push. Hold it for ten seconds. Three sets of ten make a good stand-alone exercise or warm-up. To stretch the same area, hold a towel in your right hand, toss the other end over your right shoulder, and reach behind with your left hand to grab the loose end. Gently pull the towel up an inch or two — enough so you feel the stretch but not so much that it hurts. Hold this position for 30 seconds; then slowly pull the towel down, stretching the muscles in the opposite direction. Do this three times; then switch sides and repeat.

If you plan to use your river time as a workout, Jenkinson recommends first warming up on the water for ten minutes. In a swift current, spin your boat around and navigate upstream, which will get the blood flowing through all the shoulder muscles. On quiet water, you might face downstream and paddle backward. One last note: Jenkinson stresses that good form is critical. "You should never have your top hand behind your head," he says. "That's the classic position to dislocate your shoulder."

Climbing
"Think back to our ancestors," says NOLS's Costello, theorizing on the awe-inspiring mobility of the human shoulder. "They were doing all kinds of contorted motions, swinging in trees and climbing." Alas, we've since devised more civilized ways of getting around, which is why rock climbing ranks as one of our most anatomically challenging activities, requiring shoulders both powerful enough to defy gravity and flexible enough to defy injury.

But a little rotator-cuff exercise — such as the external and internal rotation — goes a long way to encourage the humeral head to stay put. Hold a light dumbbell in each hand (in the field you can substitute a can of beans or small rock). Keeping your upper arms pinned to your sides and your elbows bent at 90 degrees, rotate each arm slowly outward, then inward. Do 12 repetitions. To stretch the shoulder's large muscles, Costello recommends extending your arms straight out and reaching forward as far as you can, letting your upper back round slightly. Then reverse the motion, keeping your arms out but squeezing your shoulder blades together. Repeat the reach six times.

On the rock, start out gradually to prevent shoulder strain. Alison Osius, three-time national sport-climbing champion, warms up on what for her are easy routes, climbing a 5.10, say, on a top rope before leading a 5.13 pitch. "You have to make an effort to find them," she says of her warm-up climbs. "But if there are only two easy routes, I'll do each one two or three times." If you can't find a suitable route, simply start with 15 minutes of bouldering, clambering back and forth, looking for big holds that accommodate relatively undemanding lateral moves to warm up your shoulders without unduly stressing them. Such a show of respect, however modest, will ensure that you pursue all your summer activities not only with more power, but with less risk. "The thing about shoulder injuries," muses paddler Jenkinson, "is it's a hell of a lot easier to prevent them than it is to rehab them."

Ami Walsh is an avid swimmer and fledgling climber who lives near Ann Arbor, Michigan.

Illustration by Gordon Studer