Grip Strength: Why It Matters For Your Shoulder The shoulder is a complex joint that involves many different structures and motions. It is the connection between the upper limb and torso and is highly involved in many sports/activities. This also means that it is an area that is often injured within athletic populations, including those participating in regular resistance training. It has been estimated that up to 36% of resistance training related injuries involve the shoulder complex (1). These injuries have a broad range with regards to the specific structures being affected, the type of injury, and the specific mechanisms causing the injury. These cannot only impact your performance in activities/gym, but also in your daily life.   So why does grip strength matter?  Grip strength has been shown to correlate with overall function of the shoulder. A study by Antony et al found an increase in shoulder muscle activity (increased shoulder stabilizer activation, decreased activation of compensatory muscles – anterior/middle deltoid) occurred when the amount of force used to grip increased (2). This basically means that if you squeeze your hand harder, there will be increased muscle activity in muscles that help stabilize the shoulder. Another study by Horsley et al, looked at the connection between grip strength and rotator cuff strength in healthy individuals. They found there was increased strength the rotator cuff in individuals that had higher grip strength (3). Try this!   Place your right arm at your side and your left hand on your right shoulder. You can hold onto an object, or just make a fist with your right hand.  Start to squeeze the right hand, slowly ramping up the strength till a max contraction.  You will notice that as you start to increase the strength of the contraction, the muscle activation starts to increase in the shoulder (you should feel the muscles in the arm/shoulder fire).  There have been several proposed reasons for this relationship. One involves the concept of irradiation, which entails the transmission of neural impulses from a contracting muscle to the surrounding muscles. This will not only increase the activation of the surrounding muscles, but also increase their strength output (if they are involved in the action). Another theory is that the tension/forces are transmitted via myofascial/myotendinous expansions running up the arm, providing a network for this transmission (4).   What makes up grip strength?  Most people believe that overall grip strength is purely produced by the flexors of the forearm (muscles responsible for closing the hand). But it is actually also involves the extensors of the wrist/hand (muscles that open the hand). These will act as an opposing force to the flexors to help create functional stability of the joint (4). How can this help me? Try incorporating exercises that involve the use of grip strength (carry variations, Kettle Bell “bottoms-up” presses, 1-arm hangs, etc.) into your routine. It can be beneficial to not only build muscle, but also increase grip strength.   Suitcase Carry Kettle Bell "Bottoms Up" Press Grip strength alone is not the cure for all shoulder injuries! There are many different factors to consider for each individual case and injury; this is just a small piece of a much bigger puzzle. This post is meant to shed light on an often overlooked area when it comes to shoulder health and function. If you are experiencing any shoulder pain or would like to work on preventing future shoulder issues, feel free to contact me and we can go over some options for you.    Written by Dr. Jon Perry Chiropractor 1. Kolber, M. J., Beekhuizen, K. S., Cheng, M. S. S., & Hellman, M. A. (2010). Shoulder injuries attributed to resistance training: a brief review. The Journal of Strength & Conditioning Research, 24(6), 1696-1704. 2. Antony, N. T., & Keir, P. J. (2010). Effects of posture, movement and hand load on shoulder muscle activity. Journal of Electromyography and Kinesiology, 20(2), 191-198. 3. Horsley, I., Herrington, L., Hoyle, R., Prescott, E., & Bellamy, N. (2016). Do changes in hand grip strength correlate with shoulder rotator cuff function?. Shoulder & elbow, 8(2), 124-129. 4. Robb, A., Weinberg, B. Athletic Movement Assessment Manual (Taken June 24-25, 2017).

Anyone who has ever ran, cycled, walked great distances or been generally physically active has probably experienced the notorious “tight” and painful IT band. Foam rollers (otherwise known as the modern day torture device) have become mainstream in treating these “tight” IT band issues. You likely own one, have used one or have seen those wonderful pieces of foam lying around your gym.

Don't get me wrong, I am a huge advocate for foam rollers. I use one semi-regularly and recommend their use to my clients all the time. They often produce quick (however painful) relief from whatever lower body issue being faced. However, there is a time and a place for their use and it is important to recognize when your foam roller is just not doing the trick.

Quick anatomy lesson. Despite common belief, the Iliotibial Band (ITB) is not a muscle and is therefore not under our active control. Rather, it is a passive piece of connective tissue that runs from the side of the hip bone (the ilium {ili-}) to the top/outside portion of the shin bone (tibia {-tibial}). The ITB merges into two key muscles at the hip, the gluteus maximus and tensor fascia latae (TFL). Activation of these muscles puts the ITB under tension to allow for specific hip movements and stabilization of the outside of the knee.

The ITB can in fact be “tight” in some individuals. Limited hip mobility and lack of flexibility throughout the connective tissue of the entire body are usually contributing factors to this “tension”. In these individuals, foam rolling can be VERY effective (and also usually VERY painful).

However, you can still get pain in your outer thigh, hip and knee and not have a “tight” ITB. Rather, your pain can be due to the ITB being overworked and broken down as a result of specific weaknesses at the hip. A small amount of foam rolling can still give some relief, but it is not an adequate long term solution in this case.

Ever seen someone who has “knocked knees”? Some individuals are born this way, meaning their joints and bones are structured naturally in this position. However, the majority of individuals I see with ITB issues are not in fact born this way. Rather, they have developed weaknesses over time that has caused their knee(s) to fall in towards their midline while standing, walking, cycling, running, jumping etc.

 

(Supermodel Karolina Kurkova with “knocked knees”)

The gluteus medius and maximus are two very important muscles in the outer hip that work to prevent the “collapse” of your knee(s). Both are often underdeveloped and under utilized in individuals with ITB and outer hip/knee issues. Stand on one leg and perform a mini squat. Does your knee fall in as you squat? Or does it stay straight over your second toe? If it falls in, or feels unsteady, your gluteus medius (and maybe maximus) are likely to blame. These two muscles work together to keep your pelvis level and your leg straight and steady beneath you.

So how to fix this? You need to first learn how to isolate and recruit these muscles in a non-functional (or non weight-bearing) way. Clamshells and glute bridges are likely familiar exercises and a great way to start depending on your degree of weakness (see below). However, it is important that you then progress into “functional exercises”. You must learn how to activate your glutes in weight-bearing positions with focus on controlling your knee during different movement patterns. If you can't activate your glutes to prevent your knee from falling in during a small one legged squat, you definitely won't be using these muscles while walking, running, cycling, jumping or doing your activity of choice.

 

If you're interested in where you may fall on the spectrum of “weak glutes” and/or have a nagging hip, knee or ITB issue, I would be happy to fully assess you and tailor a program that is specific to your needs.

Feel free to e-mail me at lauren@catalyst-health.ca if you have any physio related questions. I am always happy to discuss any issues or concerns you may have. 

Lauren Sutherland

Registered Physiotherapist

Registered Strength & Conditioning Specialist

Catalyst Health