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Sports Medicine Doctor

To hear Frank Jobe, M.D., tell it, most of us are no different from Sandy Koufax, Tommy John, Orel Hersheisher and Kevin Brown, famed Los Angeles Dodgers pitchers whose ravaged joints are among the many lobe has repaired, reconstructed and rehabbed.

"We all have a tendency to violate Wolfe's Law," says the white-haired co-director of the prestigious Kerlan-Jobe Clinic and the medical director of research at Centinela Hospital Medical Center in Los Angeles, who's served as team doctor for the Dodgers, Rams and Lakers over the past 36 years. "Wolfe's Law states that continual use builds your body, but overuse breaks it down."

Wolfe's Law once applied only to pitchers, Jobe's specialty; they tend to get injured from hurling too many 100-mph fastballs. Today, however, the biggest risk of injury is often off the field, in the typical ballclub's weight room, which, ever since muscle-bound Mark McGwire popped 70 home runs in 1998, has become more crowded than the San Diego Freeway at rush hour. And now that Barry Bonds has pushed the dinger record to 73, it's going to be SRO.

Jobe is a huge fan of resistance training, urging people to start lifting in their 20s "if they want to live to 150," the theoretical upper limit of human age. But with his warning about Wolfe's Law often falling on deaf ears ("Rookies, especially, will pump like crazy, thinking bigger is better," he says), weightlifting injuries--particularly those to the shoulder--are on the rise.

The injury-prevention plan Jobe uses to protect the shoulders of the Dodgers works just as well for his daily clientele: guys like you. And while the average gym rat doesn't have a full-time personal trainer, which lobe requires of all Dodgers to prevent overtraining, we common folk can easily implement an essential pair of his other injury-prevention tips: 1) strengthening the rotator cuff and 2) avoiding extreme ranges of motion while weightlifting.

1 Strengthen the shoulder joint by working the neglected rotator cuff muscles.

The most common injuries in sports are to the shoulder. The overhead (military) press and deep dips both put huge amounts of stress on the shoulder (see tip No. 2). So does throwing a baseball, swimming, rowing, or swinging a racquet--anything that repeatedly puts your arm over your head, or raises it out to the side or pulls it in, exerting lots of extra force on the shoulder joint.

The problem is that the shoulder isn't as strong as it looks. The humerus (upper-arm bone) has a large range of motion only because it dangles precariously off the edge of the body. The humeral head is pulled sideways against the socket of the scapula (the shoulder blade) by a series of four small upper-back muscles collectively called the rotator cuff. These muscles are the foundation, the unsung heroes, the glue that holds the shoulder joint together. When they ate weak or overpowered, the humerus gets out of line and undue stress is placed on tendons and ligaments. And you feel pain.

It's easy to strengthen the rotator cuff muscles--if you can remember to work them, that is. Since these so-called "precision" muscles (which precisely center the humeral head) are invisible from the outside, they're easy to overlook. Big mistake.

We love to build up the glamorous "outside" muscles, the triceps, biceps, delts, lats. "Ironically," says Jobe, "the stronger these get relative to the rotator cuff, the more at risk you are of pulling the humerus out of its tenuous socket, injuring the AC joint (the juncture of the clavicle and the acromion, the front of the shoulder blade) and even tearing some tendons." The latter is the dreaded "torn" rotator cuff. Bottom line: Ignore the rotator cuff at your own peril.

The three following exercises will hit the four RC muscles. Start with two- or three-pound weights in each hand and work up. Do three sets of 10 to 15 reps twice a week. Routines should run 20 minutes max.

1. SUPRASPINATUS, the muscle that helps the deltoid raise the arm to the side and aids outward arm rotation.

Exercise: Hold dumbbells by your sides in a sitting position (1a), then raise both your hands straight out to the sides (1b). Lower slowly.

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2. INFRASPINATUS/TERES MINOR, two muscles that help pull the arms downward (as in a pull-up).

Exercise: Lie on your side on a bench with weight in hand, your elbow touching your hip and your arm bent at a right angle (2a). Rotate your arm upward, pivoting your elbow as you lift the weight away from the bench (2b). Slowly lower.

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3. SUBSCAPULARIS, a muscle on the front of the shoulder blade that assists with inward rotation of the arm.

Exercise: With your elbow at your side and your forearm at a 90-degree angle, turn sideways (3a). Push/pull elastic bands in a parallel arc across your body (3b). Turn and repeat on the opposite side.

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2 Avoid the extreme ranges in certain at-risk weightlifting exercises.

"Extreme ranges of motion can overstress any joint," warns Jobe. That's especially true for the shoulder, which bears the brunt of upper-body weightlifting stress. "Reaching your arms too far backward on, say, a pectoral contraction is risky, for an obvious reason: At the farthest point, the shoulder joint is not supported by muscles anymore--only tendons and ligaments. With the pressure of heavy weights, you risk rotator cuff injuries."

Therefore, the key to weight-room safety is not necessarily avoiding certain exercises altogether, but avoiding going too far.

Marilyn Pink, Ph.D., P.T., a key member of lobe's Centinela Medical Center team, implores weightlifters to follow one general rule: Keep the elbows and the press/pull bars in front of your body on all exercises. "Any time you put your body below or in front of your elbows--an unnatural position--you're asking for trouble," she says. This creates excessive leverage on the head of the humerus bone, stretching the connective tissue around the shoulder joint.

Given those parameters, the list of at-risk exercises is long. It starts with weight-room enemy No. 1, the military press, and even includes a few old favorites that may seem perfectly safe, like dips and push-ups.

1. MILITARY PRESS

* Targets: Shoulder, upper back, triceps

* Avoiding injury: Use lighter weight and higher reps (heavier weight can cause you to compromise form and creates shearing forces at the shoulder joint), and try to keep the upward thrust slightly forward. Don't let your elbows go behind your body. Better yet, advises Pink, use a bench with a slight incline, which will help keep the bar in front of you at all times. (Also, keep your lower back flat on the bench rather than arching it. This will help prevent a back injury.)

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2. BENCH PRESS

* Targets: Chest, shoulders, triceps

* Avoiding injury: To ensure that your body remains in front of your arms, lower the bar to the point where your elbows are level to, not lower than, the horizontal plane of your body. (By keeping your elbows out away from your body, you'll be able to bring the bar down closer to your chest for a greater range of motion.) Placing your knees up and your feet flat on the bench helps to protect your lower back, which again can be vulnerable if you compromise form.

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3. PUSH-UP

* Targets: Chest, shoulders, triceps

* Avoiding injury: "Risky when you lower your chest all the way to the ground, below the elbow," Pink says, because this position again puts your upper arm behind your body. Also, the Jobe team recommends a "push-up plus." From a moderate depth, push yourself up, maintaining a straight body line. Then spread your shoulder blades apart and try to create a little hump between them. This strengthens the scapular muscles of the shoulder blades, which support the humerus joint.

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4. DIP

* Targets: Chest, shoulders, triceps

* Avoiding injury: "This one is suspect to begin with because your arms start in an unnatural position--behind you," says Pink. "Dips can put shearing force on the shoulder joint, and can eventually damage the rotator cuff if you dip too low and are weak and heavy." Machine dips are safer because your arms are positioned in front of your body.

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5. MACHINE FLYE

* Targets: Chest, shoulders

* Avoiding injury: Risky in extreme hands-back position (again putting too much leverage on the head of the humerus). Start the exercise with the pads even with your chest.

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