Don't shrug this one away

Last Updated 28 August 2015, 20:01 IST

The purpose of exercising to maintain health and fitness is lost when it becomes the cause of musculoskeletal pain and discomfort, writes Dr Harpreet Singh.

India has seen a mushrooming of gymnasiums and fitness centres in the last decade. People flock to the gym for a variety of reasons, including fitness, stress management and an overall sense of wellbeing. Many youngsters spend considerable time, money and energy in the gym to attain the stereotypical ‘perfect body shape’. And the sources of inspiration for these body building enthusiasts are the amateur trainers and the multiple posters of hunky movie stars.

In the endeavour to achieve sculpted bodies, gym aficionados get used to some kind of muscle soreness that sets in after workouts. After all, ‘no pain is no gain’. However, for many, this soreness progressively intensifies into a continuous deep nagging pain in joints that does not respond to rest and increases with each exercise session. It may be rather distressing for you to know that exercise, which has been proclaimed to benefit almost all ailments of the body and mind, if done incorrectly, can be a source of severe pain and discomfort.

Weak link

One of the most common complaints of “body builders” is pain in the shoulder joint. It usually presents whenever one reaches for the overhead shelf or the back seat of the car. Many times, people find great difficulty in getting sound sleep due to the continuous pain in their shoulder. We will briefly attempt to explain the reasons of how incorrect exercises cause shoulder pain.

The shoulder joint is enveloped by a group of muscles called the rotator cuff, which controls the movement and provides stability to the joint. One of the most common causes of shoulder pain is the compression or abrasion of the rotator cuff muscles and other soft tissue structures between bony surfaces. This is termed as shoulder impingement and is more commonly known as supraspinatus tendinitis or subacromial bursitis.

There are many reasons that predispose a person to develop shoulder impingement. The normal mechanics of the shoulder get altered by incorrect choices of exercises. These cause imbalance of strength and length of shoulder muscles leading to the development of shoulder impingement. Trainers emulate movie stars who pose with their shoulders pulled forwards in an attempt to show off the big, broad shoulders.

These muscular men also walk with their palms facing backwards. Trainers, therefore, overemphasise the strengthening of front chest muscles or pectorals. Ordinarily, a chest and shoulder workout  includes bench press, butterfly bench press, dumb-bell flys and push ups. 

The overstrengthened front muscles prevents the arm to rotate naturally as if holding the arm in a thumbs down position. Besides disrupting the balance between forward and backward rotators of arm, these exercises cause tightness in one muscle known as pectoralis minor that pulls the shoulder blade forwards into a position that further worsens shoulder impingement.

Wrong targeting
The next incorrect emphasis by trainers is often to develop a bulky, flaring neck. This is usually achieved by performing rigorous shoulder shrugs. This exercise develops only one of the parts of a back muscle called trapezius. The imbalance between different parts of trapezius disrupts the rhythm between the shoulder blade and arm movement, furthering the problem of impingement.

Exercises should be such that they maintain the normal balance of structures around the joints. If a single direction of muscles is over-strengthened for improved looks, normal joint movement is disrupted and eventually, pain is inevitable. In shoulder joints, it is pertinent to maintain the balance between the front and upper group of muscles (pectorals and upper trapezius) with the back muscles (middle/lower trapezius and serratus anterior).

The entire purpose of exercising to maintain health and fitness is lost when exercise becomes the cause of musculoskeletal pain and discomfort. This emphasises the need for proper training of trainers and coaches in gyms, regulatory bodies to check minimum standards and an increased awareness amongst the
people who enjoy body building and working out.

(The author is consultant, Shoulder Clinic, Indian Spinal Injuries Centre, New Delhi)

(Published 28 August 2015, 13:51 IST)

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