Home Blog 3 Things Everyone Should Know About the Shoulder

3 Things Everyone Should Know About the Shoulder

Written on April 6, 2010 at 5:47 am, by Eric Cressey

A while back, I sent off an email to my good friend Alwyn Cosgrove about our Optimal Shoulder Performance DVD set, and he asked me what I thought were the three most important things that folks – from fitness professionals to regular ol’ weekend warriors – ought to know with respect to the shoulder.  Here were the first concepts that came to mind:

1. You should NEVER be intimidated when you hear/see the words “rotator cuff tear” or “labral tear.”

Why?  Because if you are training clients, you are absolutely, positively already training people who have these issues but are 100% asymptomatic.  Some interesting research:

Miniaci et al. (2003) found that 79% of professional baseball pitchers – the people who put the most stress on their shoulders on the planet – actually had “abnormal labrum” features.  They concluded that “magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of ‘nonclinical’ findings.”

Meanwhile, rotator cuff tears often go completely unnoticed. Sher et al. (1995) took MRIs on the shoulders of 96 asymptomatic subjects, and found cuff tears in 34% of cases, and 54% of those older than 60.  Meanwhile, another Miniaci study (1995) found ZERO completely normal rotator cuffs in those under the age of 50 out of a sample size of 30 shoulders.


What’s my point?  Both the people who are in pain AND those who have absolutely no pain can have disastrous looking shoulder MRIs.  So, in many cases, it is something other than just the structural deficit that causes certain people to experience pain.  To me, that difference is how they move.

A torn labrum may become symptomatic in a thrower with poor shoulder internal rotation.  Or, a partial thickness cuff tear my reach the pain threshold in a lifter who doesn’t have adequate scapular stability.

In short, a MRI report doesn’t tell you everything there is to know about a shoulder – and you need to assume that a lot of your clients are already jacked up.

2. When assessing a shoulder, everything starts with total motion. In healthy shoulders, total motion – which comes from adding internal rotation and external rotation – should be the same on the right and left side.  This “arc” may occur in a different place on each shoulder, but as long as it’s symmetrical from side-to-side, you’re off to a good start – and that’s when you work further down the chain to see what’s going on with scapula stability, thoracic spine mobility, etc.


3. 100% of all shoulder problems involve scapular dysfunction. The interaction of the glenoid fossa of the scapula (socket) and humeral head (ball) is what allows the glenohumeral joint (shoulder) to do what it needs to do.  However, most individuals have some form of shortness (e.g., pec minor, levator scapulae) or weakness (e.g., serratus anterior, lower trapezius) of muscles working on the scapula.  These inefficiencies alter glenohumeral alignment and increases stress on the rotator cuff, biceps tendon, labrum, and glenohumeral ligaments.  Identifying and addressing scapular issues is a key step in preventing shoulder pain.

For more information, check out the Optimal Shoulder Performance DVD set.

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10 Responses to “3 Things Everyone Should Know About the Shoulder”

  1. Jason Hodges Says:

    I remember in the early days of MRI, it’s utility in the knee was clearly obvious. However, a lot of orthopods were more skeptical about shoulder MR because it showed a lot of abnormality in asymptomatic patients and also missed pathology because of technical limitations during the early days of MRI. It just goes to prove the old adage of “treat the patient, not the xray/MRI”

    Jason Hodges MD (radiologist)

  2. Jeff Cubos Says:

    Wrote a review on Predictive Factors for Management of RC Tears on ResearchReviewService.com

    Here’s a summary http://www.jeffcubos.com/2010/03/25/rotator-cuff-tears-predictive-factors-for-management/

    Eric, if you or anyone else wants my full review, just send me an email:



  3. Jim Hart Says:

    I appreciate this great information. As a trainner dealing with a baby boomer population I come across numerous issues involving shoulder pain, limited range of motion and minor aches and pains due to age and general wear and tear. Eric’s information is always the latest, cutting edge, useful and applicable to a wide range of client needs. Should be a part of every trainers reference library. ( if you are a good trainer!)

  4. charles Lamana Says:

    Personally for me, I always had shoulder issues, ever 2 or so months I would end up not being able to get my arm over head. Then I discovered through Eric, Mike Boyle, et al just how important scapular stability is in performing pushing movements, added more pulling movement, foam rollin, scapular push-ups, thoracic stretching, and what I think for me is essential face pulls. Now when I lift while there maybe be some soreness afterward there is no pain while lifting, and with follow-up of the above, I am now enjoying good shoulder complex health.

  5. Rick Kaselj Says:



    Great post.

    I am a big fan of the shoulder.

    Totally agree with you about looking at the scapula.

    Rick Kaselj


  6. Dorothy Corbett Says:

    I can sympathise with anyone injuring their shoulder as I did that years ago slipping on a polished floor The whole bone came out just like a dogs bone Torture treatment went on for months and to this day cannot raise my right arm over my head even with physio
    Sincerely Dorothy dorro17

  7. Warren Jones Says:

    I’m seventy-three. In my life, I have had chronic (all day, every day) shoulder pains on three occasions, once for two years, and twice for a year each time. I never asked a doctor about them, and I never did anything about them, but they eventually went away by themselves. This is the story of my life. I’ve had pain severe enough to make me tear-up, but it, too eventually went away by itself without treatment. Some day, unreported and untreated pain will be the death of me. I might add that what I’ve read elsewhere corresponds with what you’ve said, so I bought a little booklet on preventing and treating Rotator Cuff Tear. I sometimes neglect to do my stretching exercises, but the goal is stretching exercises four days a week. I’ve misplaced the booklet, but I am doing five different thirty-second stretches for each shoulder, and I’ll be doing seven different exercises as soon as I remember the missing two or find the booklet. Oh, I might say that my self-diagnosis as respects my previous shoulder pains is that they were caused by bursitis. One last point: I am now being careful about by shoulders because I lift weights and I don’t spare myself. If ever I tear my rotator cuffs, it will be because of my weightlifting activities.Thanks for remembering me. I think I’ll bookmark this.

  8. Rees Says:

    Hail to #3!!!

  9. Tim Peirce Says:

    I used to think I had a “bum shoulder” because my mom had “bum shoulders” and I dislocated mine pretty badly early in my lifting career.

    Fortunately my motto of “do what you can and not what you can’t” kept me pushing myself and learning and growing. “Can’t” for me means impossible as dictated by reality.

    Without a doubt it’s been paying attention to my “scapula dysfunction” that has made my “bum shoulder” issue non-existent.

  10. Steve Says:

    Question – I’m 48 yr old suffering from adhesive capsulitis. MRI showed no RC tear and labrum is healthy. Limited mobility in raising arm and external rotation as well as internal. Started after surgery to remove spur in elbow and repair tendon. Made worst after broken arm just above the wrist. Any suggestions on physical therapy? Doing the usual PT (arm bike, pulley, foam rolling, tennis or lacrosse ball massage) with my ortho and physical therapist. Trying cortisone injection this week. If that doesn’t help going with artho capsule release.

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