For those injuries that do not require medical intervention, you can attempt manage these by icing on a frequent basis and by monitoring your frequency, intensity and duration of your pain. For more information on both these topics, please refer back to our previous blog on ice and managing pain.
As with most injuries, there are exercises that we can do to help prevent these types of injuries. Obviously the best preventative technique is improving our Jiu Jitsu skills and avoiding getting caught in these positions but we all know, that does not happen all the time. So whether getting put in these positions with practicing of a technique, in live rolling or competition, properly preparing the shoulders should be an important part of your training. What does preparing the shoulders actually mean? Ensuring that your shoulders have the full range of motion needed for the sport and the shoulder strength to participate in the sport are a critical part to avoiding injury.
Total shoulder range of motion is a concept that has been described in the orthopedic literature for some time and is a common measurement taken in collegiate and professional athletes (baseball pitchers as an example). Total shoulder range of motion (TSM) is the range of motion in external rotation (ER) and internal rotation (IR) when arm is at 90 degrees of abduction. In other words, TSM = ER at 90 degrees abduction + IR at 90 degrees abduction. It is not uncommon for the right and left to have a variance in IR or ER side to side but the total shoulder range of motion should be close to equal.
The research is clear that if you have >10 degree difference in your right TSM versus your left TSM, you are 3xs more likely to suffer a labral tear, rotator cuff tear or ulnar collateral ligament tear or UCL (elbow injury) in (Shanley et al Am J Sports Med 2011) overhead sports. This makes sense if you think about it. If the range is limited and you get to the end range of motion, then other tissues then become stressed (in particular the rotator cuff, labrum and UCL). This same concept has been applied to swimmers. In these types of sports, the shoulder has to go through such a large arc of motion and if it is limited, it is much more likely to get injured. This concept of TSM can and should apply to the Jiu Jitsu athlete as well. Since our sport not only takes you into these extreme end ranges of motion, it also does this with high stress and loads applied at these end ranges, then it is imperative we make sure to include range of motion or stretches as a part of our shoulder healthy routine. Therefore the greater total shoulder range of motion, the less stress there is to the tissues.
Considering, here is a series of stretches we can do for limitations in TSM.
Sleeper Stretch - lying on your right side with your arm at 90 degrees abduction and 90 degrees horizonal adduction and palm facing down, using your left hand push your right hand to the floor until you feel a good stretch. Hold that for 30 second and repeat 4 times. Repeat on the left.
Structures stretched - posterior capsule, rotator cuff.
Kimura hamstring stretch - placing your belt around your foot, grab the end of in your hand by reaching around your back with your palm facing up. As you bend forward as far as you can so feel a stretch in your hamstring. Keeping your hand in the position, as you extend back and ease the stretch off your hamstring, you should feel a stretch in your shoulder. Hold each position for 30 seconds and repeat 4 times. Do on both right and left.
Structures stretched - anterior capsule, rotator cuff, long head of biceps
Posterior shoulder stretch - start with laying on the mat with your right arm in the position depicted below. Slowly bring your left chest toward your right elbow (effectively rolling onto your right arm) until you feel a good stretch in the posterior (back part) shoulder. Hold for 30 seconds and repeat 4 times. Repeat on the left side.
Structures stretched - posterior capsule, rotator cuff
Pec stretch - standing, place your palm on the wall with elbow straight. Slowly turn your upper body until you feel a stretch in your pec. To add some stretch to the nerves (called nerve glides) slowly rotate your head to look over your opposite shoulder. To increase further stretch, rotate your head and slowly raise palm off the wall while keep arm in contact with the wall. Hold for 30 seconds and repeat 4 times. Repeat on the left side.
Structures stretched - anterior capsule, pec majory, biceps, median nerve & C5-C7 nerve bundles.