Shoulder Care in the Javelin Throw
by Mark Fletcher, MD
As javelin throwers we are all concerned about the health of our throwing arms. Much has been said about the rotator cuff exercises. The rotator cuff, however, is only part of the story when it comes to keeping your throwing shoulder healthy. Recently, talking with health care professionals and reading research articles I have found out a great deal about the scapular stabilizers. These are the muscles that attach the shoulder blade to the posterior chest wall and, thereby, effect the function of the rotator cuff. They regulate the movement of the scapula relative to the shoulder during the large ranges of motion seen in the shoulder joint. If the scapular stabilizers aren't functioning properly it allows the scapula sag forward and causes the rotator cuff to be overworked and abused very easily as it strains with all the work being done while throwing.
The scapular stabilizers I am concerned about are: serratus anterior, trapezius (upper, middle, lower), and rhomboids (upper and lower). While I won't go in to detail about the specific motions of the scapula, I will outline a few exercises that have helped me out recently. For most of us with recurrent shoulder problems (sore cuff muscles and biceps tendonitis) the scapular stabilizers are usually weak as well and definitely contribute to our symptoms.
Serratus Anterior - Exercise is called a push up plus. You start in a push up position allow your shoulder blades to come together in the back and then push them foward as far as possible without unlocking your arms. It can be done with your feet on a bench and hands on a swiss ball for an advanced motion.
Trapezius - The upper trap is not a concern. The middle and lower trap are far weaker. Middle Trap- lying prone (face down), position your arms abducted to 90 degrees (make a T with your arms straight out). With your thumbs pointing towards the ceiling, keeping your shoulders down and relaxed (no shrugging), move your thumbs towards the ceiling..hold...and let down slowly. You should feel your shoulder blades touch and then slide laterally as you lower your hands.
Lower Trap - lying prone, position your arms at a high three quarters position ("Y" position). With your thumbs pointing at the ceiling, raise your arms...hold...and lower slowly. You should feel your shoulder blades slide down your back and then back (hard to feel, but if you do it right you will feel the burn on the bottom of your shoulder blades). Both these exercises may also be done standing (thumbs now point behind you) using a cable or stretch tubing.
Rhomboids - Prone in a T position (slightly lower T). Now the thumbs are pointing towards the floor. Use the same movement pattern as the middle trapezius exercise. Bring your hands towards the ceiling while squeezing your shoulder blades together, then slowly relax and bring your hands back to the start.
The rotator cuff exercises that are important to do are external rotation movements. Holding your elbow at your side and bent to 90 degrees. Pull a stretch tube (or pulley) across your body to full external rotation. The rotation is around your humerus (upper arm) so don't lift that elbow to complete the rotation. Can be done with dumbbells if you lie on the floor on your side, lifting the dumbbell straight off the ground. Do this exercise from your delivery position as well. Hold your elbow (bent at 90 degrees) straight out from your shoulder (90 degrees of abduction) and pull the stretch tube (attached at ankle height to something infront of you) up and back as you rotate your arm around the axis of your humerus (point your elbow at something for reference and don't let it move forward or back).
Because these are small muscles that are used all the time it is best to train them for endurance using sets of 2 for 20 reps (it can be done with more sets at lower reps: 3 x 12 or so). Concentrate on very slow eccentric movement - let the weight down very slowly - because this is the action you want to train. The posterior shoulder musculature functions to stabilize the shoulder in the joint and to decelerate the arm after the throw - these are both eccentric motions. The weight should be light enough to allow perfect form. Start with no weight and train the movements first.
These muscles are all worked together by doing exercises as bent over rows/flys, seated rows, lat pull downs/pull ups. Concentrate on the scapular stabilizers by keeping your shoulders down and relaxed and pinching your shoulder blades together before slowly letting the weight down.
Everybody has different strengths and weaknesses. Not every athlete will need to work every single little muscle separately but if you have shoulder problems you should definitely address them before you injure yourself further.