SHOULDER INJURIES AND HOW AN INJECTION CHANGED THE ODDS IN VEGAS - The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more! (2016)

The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more! (2016)

CHAPTER 5

SHOULDER INJURIES AND HOW AN INJECTION CHANGED THE ODDS IN VEGAS

Strikeforce Lightweight Champion Gilbert Melendez still bears the deformity of his 2012 shoulder injury. “Gilbert was in one of his final all-out practices, grappling with his teammate Jake Shields,” states his father and manager Gilbert Melendez Sr. “Jake is much bigger than my son, and they were battling on a takedown and neither man wanted to give it up. They fell to the mat and Gilbert landed hard on his shoulder and ended up separating it.” The bump from the separated acromioclavicular joint is still apparent after his injury, so much so that UFC commentator Joe Rogan commented on Gilbert’s “funky” shoulder six months later during his UFC bout against Benson Henderson.

Since it mainly depends on how you land, throws are where a lot of shoulder injuries happen. According to well-known trainer Mark DellaGrotte, “Judo throws don’t allow you to land as safely as a wrestling-style takedown. As opposed to a single- or double-leg takedown, with a judo throw you go head over heels and are often disoriented and don’t know where the mat is and can’t break your fall. This results in a lot of guys landing on their head or injuring their shoulders. I train a lot of judo black-belts and Olympians, so I have seen a lot of this firsthand.”

ANATOMY

After the knee, the shoulder is probably the most commonly injured, and discussed, joint. The shoulder provides a huge range of motion, but it does so by sacrificing some stability. In essence, the shoulder is made up of a ball-and-socket joint, similar to a large golf ball on a small tee. The ball of the shoulder is the head, or top part, of the humerus (arm bone). It sits in a shallow cup of the shoulder blade called the glenoid. The edge of the glenoid is deepened by the labrum (a ring of cartilage), which acts as a bumper and stabilizes the head in the socket. The shoulder blade also has a bony projection called the acromion that comes up and around to meet the clavicle (collar-bone). This is called the acromioclavicular (AC) joint.

The ball of the shoulder joint is held in place by ligaments, the labrum, and the pull of the rotator cuff muscles.

Front and back views of the shoulder, showing the rotator cuff, long head of the biceps, and acromioclavicular joint.

CREDIT: JOE KANASZ

In addition to the ligaments and rotator cuff, the large muscle groups around the shoulder such as the deltoid, latissimus dorsi, and trapezius help keep the shoulder in alignment and take some of the stress off of the rotator cuff and shoulder ligaments.

SHOULDER DISLOCATIONS

The most dramatic shoulder injury is a dislocation (not to be confused with an AC separation, which is discussed later). In a shoulder dislocation, the ball dislocates completely from the socket, which is what happened to MMA veteran Josh Barnett. While working for position on the ground during the beginning of the first round at Pride 28, Barnett suddenly tapped, ending the fight. “I dislocated my shoulder 30 seconds into my first fight with Mirko “Cro Cop” [Filipovic]. I had torn my labrum in training, and then during the fight, I got put into a bad position with a takedown. I couldn’t do anything about it — my shoulder was unstable. I needed surgery. I was out for eight months and my left shoulder will never have as much mobility as my right. My advice is to strengthen your shoulder and your rotator cuff muscles. If you do work the small muscles like the rotator cuff, don’t use a lot of weight. Work on stability exercises and isometric holds. Work on mobility, but not hypermobility. Whether it’s a shoulder, elbow, or knee, don’t take things to extreme mobility and don’t hammer your joints.”

The shoulder can dislocate anteriorly (forwards) or posteriorly (backwards). The vast majority of shoulder dislocations are anterior, as the arm is usually pulled away from the body driving the ball forward. As the ball moves out of the socket, it can tear a piece of the labrum or break off a piece of bone from the socket. If this happens, it can lead to chronic shoulder instability and multiple dislocations. Surgery can help prevent this by repairing the torn labrum or bone, but it is up to the fighter and his doctor as to whether they should repair it right away or wait to see if there are more dislocations. Treating a shoulder dislocation with surgery will likely prevent repeated visits to the emergency room, but it will also put the fighter on the shelf for a while as they heal.

If a shoulder does become dislocated during training or a match, a fighter or his camp may try to put it back in themselves. However, this can sometimes cause further injury — including broken bones. If this happens during training and there are no doctors or certified athletic trainers around, the best thing to do is go to the emergency room. If the dislocation only happened a little while before the visit, it usually can be put back into place without difficulty. If a dislocation happens at an event, the ringside physician may elect to reduce the dislocation in the locker room or transport the fighter to the hospital for better medication. Either way, if a simple shoulder dislocation is reduced, the fighter can wear a sling for a few days for comfort, but in most cases it’s best to start a comfortable and gentle range of motion as soon as possible to prevent the shoulder from getting stiff.

View of the glenoid socket in the scapula with the biceps attaching at the top of the glenoid inside the shoulder.

CREDIT: JOE KANASZ

AC SEPARATIONS

An injury that is often confused with a shoulder dislocation is an AC sprain, also referred to as an AC separation. The AC stands for acromioclavicular, which means it is a joint formed between the acromion, which comes up and over the top of the shoulder blade, and the clavicle. When a fighter lands on their shoulder, they can cause this joint to separate, leading to an AC separation. The level of separation is graded based on how much the bones separate from each other. Lower grades are usually just sprains and can be treated with a sling until the pain gets better and the fighter gradually returns to training. The treatment of some higher grades, especially a grade III where all ligaments are torn and the clavicle is completely dislocated from the acromion, can be controversial. Some doctors will repair these with surgery, others will allow them to heal on their own. Surgery is done to prevent instability of the joint and, theoretically, to help with biomechanics. Without surgery, the joint can often heal with minimal limitations, but the fighter will have a permanent bump similar to Gilbert Melendez.

Melendez recalls how bad the injury initially looked, but also how quickly he was able to recover once the pain started to go away. “Jake went for an arm toss, and lot of times you can roll through it, but instead I resisted. I suddenly felt a lot of pain. The looks on my teammates’ faces were pretty bad at the time. But at about three weeks from my injury, I started doing some light training and hitting pads. It took about eight to 10 weeks before I could fully use my shoulder. I actually ended up separating it again, but I didn’t even notice. It looks weird, but it only minimally affects me.”

ROTATOR CUFF TEARS AND TENDONITIS

The rotator cuff, which helps hold the ball of the shoulder joint in place in its socket, is made up of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. Injuries to the rotator cuff fall on a spectrum from tendonitis (inflammation of the tendon) to partial and complete tears of one or more tendons. Usually when an athlete has a tear in the rotator cuff, it mostly involves the supraspinatus.

Partial tears of the rotator cuff present a challenge for the fighter and his doctor, as the pain from partial tears can either improve with rest and therapy or the tears may progress to full thickness, which can mean surgery and time off from fighting. Therefore, partial tears can initially be treated similarly to tendonitis with rest, anti-inflammatories, and proper therapy. UFC Welterweight Champion Pat Miletich suffered a rotator cuff injury during training. “I got thrown head first into the mat and threw my arm out and kicked my feet out to stop myself. The mat was completely covered in sweat. My arm flew behind my body and the guy let go of me right away, but I couldn’t use my arm for eight months. I used water-resistance training a lot to rebuild it. I also focused on rotator cuff raises and using my hand as a paddle under water. Once I could lift my arm up again, I would start telescoping my fist into swiss balls at different angles. I still do the exercises to maintain strength of the muscles around the joint and protect my shoulder. I also like to swim laps.”

However, if the tear is significant enough, the fighter is losing strength, and the pain is not improving, then surgery may be the solution. The surgery may be done through a small open incision or arthroscopically with the use of cameras and small instruments. In either case, the tendon is tacked back down to where it was torn off. However, if the injury is old, the muscle/tendon can become weaker, fattier, and retract so much so that the repair may not hold. That is why it is important to see a doctor for an exam and possibly an MRI as soon as you suspect a rotator cuff tear. And if you do have surgery, do not smoke cigarettes. The nicotine in the cigarettes causes the blood vessles to constrict, thereby reducing the bloodflow your tendon needs to heal.

Sean Sherk’s trainer and coach Greg Nelson recalls how an incident involving Sean’s shoulder actually affected the fight odds in Las Vegas one night before the event. “Sean had a great training camp leading up to his championship fight with Kenny Florian. We were coming up with new and creative drills to improve his guard passing and top control, while at the same time continuing to improve his lightning-fast shot. Ten days before the fight, Sean shot in for a double on one of our bigger fighters. Mistake number one was working with a bigger fighter with a great sprawl. Sean had shot in and his teammate sprawled and dropped his weight perfectly on Sean’s shoulder. In a split second, Sean went from 100% healthy to having a torn rotator cuff and a grade II AC separation. He continued to train but could not use that arm with any real strength. Considering he was fighting for the 155 pound UFC lightweight title, not fighting was not an option.

“Sean met with a doctor and told him he wanted to fight, so what could he do to decrease the pain and give him a better range of motion? The doctor gave him a cortisone injection to relieve the inflammation, giving him increased range of motion and decreased pain.” [Doctor’s note: While cortisone injections can reduce inflammation acutely, repeated injections are controversial due to the risk of complications, including nerve damage, joint infections, cartilage damage, and tendon weakness.]

Nelson continues, “Later, the doctor at the UFC event asked Sean, in front of Kenny, which shoulder he got an injection in. Sean immediately said, ‘It was my knee.’ The doctor, looking at his papers said, “No, this said you had a cortisone injection in your shoulder.” Up until that point we had kept the shoulder injury away from everyone. Prior to the doctor saying that in front of Kenny, and who knows who else heard, Sean was a 3 to 1 favorite to win. Within an hour after the pre-fight medical exam, the odds in Las Vegas went to even. Regardless, Sean ran through Kenny’s guard and dominated the fight, beating Kenny Florian by unanimous decision to win the UFC lightweight title belt.”

Winning the belt, however, is not the end of Sean’s story on rotator cuff injuries. “When I tore my rotator cuff 10 days before fighting for the UFC championship, it was hard to make a decision whether or not to fight. I couldn’t sleep or train, but I still made it to the fight and won the championship. I then had the surgery one week after the fight, but quickly tore it again. A big issue was that I just didn’t take enough time to properly rehab. I trained too hard too soon.” With surgery, the end of the story does not occur when you wake up in the recovery room after an operation. It continues long after with proper rehab and physical therapy. Even with partial, non-operative tears, rehab is important, and understanding the anatomy of the shoulder is the first step in setting up a proper recovery program.

Like partial and full tears, rotator cuff tendonitis is also very painful, especially with overhead activities. The first treatment for tendonitis is to take anti-inflammatories and rest from activities that aggravate the shoulder. Once the pain subsides, the fighter should focus on proper biomechanics to make sure the shoulder is moving smoothly, as well as to strengthen the large muscle groups around the shoulder to take some of the stress off the rotator cuff.

BICEPS TENDONITIS

The biceps has two heads. One tendon is attached to the coracoid, a bone below the clavicle. The other tendon actually goes across the top of the shoulder joint and attaches to the top of the socket. The part of the biceps that runs inside the shoulder joint can become inflamed and irritated, leading to biceps tendonitis, which feels like pain in the front of the shoulder. Pain in this location can greatly hinder a fighter’s training. This is exactly what happened to MMA legend Bas Rutten.

The former UFC Heavyweight Champion and three-time King of Pancrase World Champion had multiple bouts of biceps tendonitis throughout his career. “I would say my knees and tendonitis that I have in both arms are my biggest injuries. When I hit a bag too hard, or I have to use a lot of power to defend an arm submission, then there was always the chance the tendonitis would start, and when it did, training would be a nightmare every day — very painful.”

For Bas, rest was the best treatment for his biceps tendonitis, but as a professional athlete he couldn’t stop training, so he would work around the injury. “The doctor would say, ‘No training,’ but of course that wasn’t a possibility. I would train around the arm — sometimes arms — and just kick and do sprinting drills. I tried ultrasound, laser, anything they had out there. Rest would be the best. That’s my line to my students.”

BICEPS RUPTURES FROM THE SHOULDER

The long head of the biceps inside the shoulder can actually rupture or be purposefully cut and reattached by a surgeon to relieve shoulder pain. While training for an upcoming fight, UFC Welterweight Champion Carlos Newton felt an odd sensation in his shoulder. “I was sparring inside the cage. I had a move I often did when someone went for a double-leg takedown; I would do a high crotch counter, pick him up with one arm, and flip him on his back. One day, my partner shot in, I did a side step, countered, and lifted with one arm, and he went straight up in the air like I was going to throw him out of the cage. At that moment, I felt something snap softly in my shoulder. Everyone looked at me, and there was a little divot at the top of my shoulder by the biceps. I sat out a few minutes, and then returned to training for a little bit, but something felt wrong. So I called it a day and went to see my doctor. It looked to him like a partially torn biceps. I had an MRI, and the next day he said it was a partial tear, which they normally don’t do anything for. I suggested getting the opinion of a surgeon. I wanted to keep training and wanted to make sure I didn’t put my biceps at risk for further injury. After examining me and my MRI, the surgeon suggested going in and looking with a shoulder arthroscopy in three weeks’ time.

“I had the go ahead to train in the meantime, so I kept training and had a great three weeks of training right up until the day of surgery. The surgeon went in and saw that the biceps was completely torn off the insertion into the shoulder. It had been completely torn but never slid down, so it looked only like a partial tear on the MRI. Since it was completely torn, he reinserted it into my arm bone through a small hole. I was back to training in about six weeks with no loss of motion, strength, or discomfort.” What Carlos describes is called a biceps tenodesis — reattaching the biceps into the arm bone. Some athletes have had the long head of the biceps tear in the shoulder and actually felt pain relief from the tear, and they continued to play without any issues. John Elway actually won two Super Bowls without ever having surgery after his biceps ruptured from its attachment in the shoulder of his throwing arm.

BICEPS RUPTURES AT THE ELBOW

As mentioned, the muscle of the biceps starts at the shoulder and ends by inserting at the elbow. It is at this insertion where athletes can also rupture their biceps. Contrary to popular belief, the biceps is not the main flexor of the elbow — that’s the brachialis muscle. Matt Serra tore his biceps, and both he and his trainer, Ray Longo, feel it commonly occurs when guys are dehydrated, tight, and tired. Matt remembers, “I was training for UFC 36 against Kelly Dullanty. I wasn’t used to cutting weight the right way and I was dehydrated. I was sparring and I got lit up by a Golden Glover. During the sparring session, I tore my biceps. I did lose some strength, but I managed to win the fight with my legs by triangle choke.”

Ray Longo adds, “I saw Matt throw an overhead punch, and right away, I could see it rolled up into his shoulder. We had a decision to make. Do you fight? Do you have surgery? He wanted to avoid surgery and fight. He had a deformity but only lost a little strength. He had 10 fights since the injury. He has a deformity, but he has done well. Back then, we fought with injuries, but now the stakes are a little higher and the careers can be more lucrative. My job as a coach is safety first and getting a guy to the fight as healthy as possible.

“If you hurt your arm or your shoulder, you have to keep moving. Don’t just give up and sit on the couch. Talk your doctor and see what you can do. We can work around it. I had a kickboxer who had the same injury and had it surgically repaired and did well. The biggest risk, to me, is dehydration. As they get close to the fight, the fighters are dehydrated and tired. When you are training, you need to stay hydrated and get lots of sleep. As a coach, you need stay on top of the athletes to stay hydrated and rest up so their body has a chance to recover and heal.”

LABRAL TEARS/SLAP LESIONS

The labrum is the rim of cartilage that runs around the shoulder socket to help deepen it and provide additional stability. If a shoulder dislocates, the labrum can be torn, causing the ball to continue to dislocate. If the labrum tears at the top, it may be referred to as a SLAP lesion, which stands for superior (up top) labrum, torn anterior to posterior (from front to back). This particular injury may occur when the arm is severely rotated backwards or jarred directly upwards.

Where the SLAP lesions occur on the labrum is also where the biceps attaches inside the shoulder joint. The treatment for a SLAP tear depends on a fighter’s symptoms. He or she may be able to rest it and train without pain afterwards. However, if surgery is needed, the torn labrum and biceps can be tacked back down to the shoulder socket. Sometimes the biceps tendon needs to be cut and reattached farther down the arm. The recovery may take several months and the results of SLAP repairs are not as promising in people over the age of 40. The best way to diagnose this injury is by a physical examination and MRI.

Before UFC 172, Brazilian Glover Teixeira was in a 20-fight win streak over seven years. At the same time, UFC Light Heavyweight Champion Jon Jones was on a streak of his own, 10 wins including six successful title defenses. Glover was known for his heart and his fortitude, but many fighters have never been the same after facing the champion, and Glover was added to that list. American Top Team coach Ricardo Liborio recalls when Glover injured his labrum. “John Hackleman and I were in Glover’s corner. In the first round, Jones applied a standing arm-bar and shoulder crank. When Glover came back between rounds, his shoulder was huge and swollen, twice as big as the other one. He didn’t complain, but just asked for some ice. So, we put one bag of ice on his neck and another on his shoulder. He fought the rest of the match, ultimately losing to Jon Jones via unanimous decision. An MRI later revealed he had torn his labrum, but fortunately was able to avoid surgery.”

UFC Heavyweight Champion Cain Velasquez has actually suffered two torn labrums, one in each arm. His head coach at AKA, Javier Mendez, recalls the injuries: “Cain suffered labral tears in 2010 and 2013. The first one, in 2010, was against Brock Lesnar, and the other was in 2013 in his third fight against Junior dos Santos. Both needed surgery. When the JDS fight was over, Cain basically told me, ‘I think I hurt my shoulder again.’ After he cooled down, he was still hurting, so we went to get an MRI. There was a slight tear and he tried to rehab it for a few weeks but ended up needing surgery.”

The first-ever UFC Flyweight Champion Demetrious Johnson also tore his labrum and required surgery. He remembers, “It hurt even brushing my teeth. I had arthroscopic debridement and PRP [platelet-rich plasma] injections. I rehabbed for six weeks, working on range of motion and flexibility. I did some reverse grip pull-ups. Swimming is also good. To prevent it [from happening] again, I keep my deltoid, latissimus, and pectoral muscles strong. I also stay away from heavier guys during training.”

As with any injury, rehab time is vital, and Javier Mendez makes sure all his fighters get the proper clearance before they can return to the Octagon: “We follow the doctors’ and therapists’ advice exactly as they tell us. As a head coach and trainer, I have to enforce this. Sometimes, with a guy who really wants to get back too soon, the only thing I can do is lock them out of the gym. I know how fighters are and I want to hear it directly from the doctor. Even with Cain. I trust Cain, but when he said the doctor cleared him for light striking, I contacted the doctor directly to get clearance.”

GOING SLOW WITH SHOULDER REHAB

Frank Shamrock describes his encounter with a SLAP tear, “I had a SLAP tear in my right shoulder from throwing a punch. I was training with a boxer using 16 oz gloves, got him in a corner, and tried to punch him in the head, missed him, and felt the pain immediately. I fought two weeks later in the K-1 World Grand Prix against Elvis Sinosic and won by split decision. Later, I had arthroscopic surgery to fix it. After I recovered, I felt better and could achieve a full range of motion.”

Frank then goes on to explain his rehabilitation program for this injury, “For shoulder therapy, using the shaking bow was useful. It made a huge difference for me. Also, walking forward or back with the swiss ball under me and using the swiss ball to ‘write’ letters with my hand. I also focused on stretching and relaxing the muscles of my upper body. I noticed I often tensed up too much when I threw a punch, and that may have contributed to why I tore it.

“Shoulder injury prevention is all about keeping loose and flexible. You need to keep them strong with a structured regimen. All of my workouts begin with assessing flexibility and then warming up. I end all of my workouts with a review to see what feels tight and focus on achieving a good relaxation and range of motion. Using my arms in water helped keep my shoulder and arms strong and flexible. I would just get in the water and move them.”

It takes an extensive amount of time and effort to recover from a shoulder injury, which is why it’s one of the most feared injuries in MMA. Since the pain will force you to take time off from moving the shoulder, it’s likely that atrophy of the arm muscles will occur. This means taking the time to rehab is necessary to keep your strength and range of motion. As Cesar Gracie warns, “Shoulder injuries affect everything. Your arm, your chest, your back all hurt. With a shoulder injury, you are limited in MMA fighting.” MMA champion and elite grappler Dean Lister has also had experiences with shoulder injuries, rehab, and prevention. He understands the importance of seeing qualified doctors to evaluate these joints before it’s too late, and he agrees that shoulders tend to take a long time to heal. “Shoulder injuries are extremely complex. Many athletes such as myself have torn both shoulders badly. This is why some fighters cannot perform simple daily activities. I know some fighters that still fight but cannot lift up their own children. The shoulders are a complicated area — so pay a lot of attention to them. There are several rotator cuff warm-ups you can employ for training that will help with your athletic future. If you do have a serious shoulder injury that does require surgery, stick with your rehab in a steady manner. It can be frustrating, but in my experience shoulders tend to heal slower than other injuries, so don’t jeopardize your recovery by going too fast too soon.”

Much of recovering from an injury is understanding your body and focusing on other ways to improve. It’s hard for a fighter to stop training completely, so being smart about what parts of your body you exercise can allow you to recover from an injury, while continuing to train. To Gilbert Melendez, “Recovering or working around an injury is mental. When I hurt my shoulder, I had to say to myself, I can use my legs and run. I can use my other hand. There are so many aspects to MMA that can keep you busy. I started experimenting with light resistance therapy bands and focus on my body awareness. Strong body awareness comes with slow movements and stretching.”

KEEPING YOUR SHOULDER STRONG

The shoulder is a naturally unstable joint. The ball just barely fits into the cup. In order to keep it healthy, it’s important to keep the large muscle groups around the shoulder strong to assist the rotator cuff in centering the humeral head on the glenoid.

Famed UFC coach Mike Winkeljohn, who helped shape UFC champion Jon Jones, Rashad Evans, and other famed fighters, notes the importance of stretching. “I think one of the most important parts of training is the warm-up. I think strikers don’t stretch enough, especially their upper body. They also need to balance their upper-body training. Many of them do too many pushing exercises and not enough pulling exercises.”

Many fighters are familiar with the military press and other exercises that work the large muscle groups of the shoulder region, but exercises for shoulder injury prevention need to focus on not only these big muscle groups, but also the smaller muscles, such as the rotator cuff. MMA veteran Renzo Gracie learned the value of resistance bands early on in his career and this lesson has stuck with him throughout the years. “At one point, I injured my shoulder. I couldn’t raise my arm. When I went to raise my arm, it would lock. To rehab, I started using light weight and resistance bands, starting very slowly. I focused on stretching and motion and increasing blood flow to promote healing. I believe it’s very important for fighters to use the resistance bands for their shoulders. It’s just as important as the warm-up and cool-down. They are fabulous. Every day in the gym, the first thing I would do is warm up my shoulders, even before a treadmill run. My advice is to make it part of your regular routine and warm-up.”

UFC Hall of Famer Mark Coleman echoes these sentiments, but reminds fighters that they have to actually put in the time. “Make sure to warm up your rotator cuff before training. There are great exercises out there, but you have to make sure you put in the time to warm up or to rehab.” Cesar Gracie agrees that therapy bands are a great exercise. “You need to warm up to prevent shoulder injuries. When you are going live, you need a sweat going. I know it’s hard. These guys get in the gym and want to go right away. But you need to take the 20-30 minutes to get warm. Therapy bands are good, but unfortunately most people don’t use them unless they have been injured.”

UFC interim champion Carlos Condit follows a similar program for rotator cuff and shoulder warm-up. “We do rotator cuff work, lying on a bench with light dumbbells, rotating the arm with the elbows bent at 90 degrees. I also lift my arms in a ‘Y’ or ‘W’ using heavy bands, sitting with my back flush against the wall. I do my rotator cuff warm-up before almost every workout, especially on strength and conditions days.”

SHOULDER INJURY PREVENTION EXERCISES

It is important to emphasize both balanced strength and range of motion of the shoulders.

To work on range of motion, you can grab a broomstick or bar behind your back and move it out to either side.

You can also raise the bar from in front over your head.

Simple movements help warm up and maintain range of motion. Resistance bands are a great way to warm up and strengthen your rotator cuff before a workout. Internal and external rotation at the side and up in the air work the different muscles of the rotator cuff.

You can also use light weights while lying on your side, but be careful not to use too much weight so you isolate the rotator cuff in a safe manner.

Lateral dumbbell raises

and squeezing your shoulder blades together helps coordinate the shoulder blade and the rest of your shoulder. This coordination helps reduce cuff and ligament injury.

Many athletes develop tightness in the shoulders, especially in the back. Simple cross-body stretching

or the “sleeper” stretch can prevent you from developing too much tightness. Working the large muscles groups around the shoulder can help prevent the smaller muscle groups and ligaments from becoming stressed.

After a proper warm-up, start working in the larger muscle groups. The chest press is a good exercise for the pectoralis muscles.

You can also alternate arms on the incline press for a varied workout which emphasizes neuro-muscular control.

Reverse curls or “skull-crushers” work the triceps,

upright rows work the trapezius muscles,

as do shoulder shrugs.

Seated rows help work the lattisimus dorsi muscles.