Get a grip…

You can get a lot of information from a handshake. A good, firm, vigorous handshake often tells me the individual is strong, healthy, interested and enthusiastic. However, a weak, limp, flaccid handshake often tells me the individual is cautious, timid, weak, lethargic or disinterested. And the over-the-top bone crusher handshake usually tells me the individual is trying to assert their dominance or trying to compensate for something else that is lacking.

The handshake has been around for as long as humans have evolved to walk upright and freed their front limbs from locomotion. The handshake is primarily used as a greeting in many cultures across the globe, with variations in how, where, and why it is done. For example in many tribal communities offering to shake hands with a stranger shows that you are not carrying a weapon and so are not a threat. In Asia handshakes are not often done, rather the bow is preferred, and in the Middle East you never offer your left hand to shake as it’s a great insult, and a woman’s hand is never to be touched unless it is offered by her.
The handshake has also evolved some rather bizarre rituals that can signify membership to a secret club or organisation, and in sports, they are often used to celebrate achievements with intricate and synchronised, fist bumps, hand slaps, and arm movements that boggle the mind.

Check it!

Now I always shake my patients hands when I greet them but I also like to check many of my patients grip strength. Checking grip strength has been found to be a quick, simple and reliable test for risk assessment for various other health issues such as cardiovascular disease and other causes of mortality (ref). But the main reason I check grip strength is that I know it is closely associated with shoulder strength, and I deal with shoulders a lot (ref).
The shoulder is a slave to the hand. The sole purpose of the shoulder is to place the hand where we need it. The shoulder moves the hand to feed us, clean us, defend us, or just to reach for the tv remote control to change the channel.
The hand and the shoulder are also closely associated when either is injured, for example, weakness of the Rotator Cuff has been found in those with hand injuries who have had no shoulder injury or problems in the past (ref).
We also know that gripping produces an increase in muscle activity in the shoulder without the shoulder even to have to move (ref and ref). Even just thinking about gripping and moving the hand has been shown to have a positive effect on muscle function and strength. This fascinating study here demonstrates that even when the hand and wrist are completely immobilised just performing mental imagery exercises of wrist and hand exercises significantly prevents muscle atrophy. The power of the mind and its effects on the body are just amazing.

Train it!

Therefore if a weak grip means a weak shoulder, then I think grip strength training is something to consider with all shoulder rehab. Grip strengthening is something I use often in my rehab with painful shoulders. First it can be used very simply just by repeatedly squeezing the hand when the arm and shoulder is static. I find simple hand squeezing and tensing is good for those really weak and really painful shoulders that can’t or don’t want to move much due to too much pain or fear.
Simply resting the arm in a comfortable position and squeezing the grip purposefully for a few minutes can work wonders on pain inhibition. Why and how this works I’m not sure, maybe its due to the analgesic effects of isometric contractions or some other non-specific factor, but for most patients with high pain and high fear levels simple purposeful gripping can be a really useful first strategy to start decreasing pain, fear and threat.
Purposeful grip strengthening can also help supplement rehab exercises for those patients with not so high pain or fear levels. I use strong hand squeezing cue often helps those with those painful arcs on elevation from subacromial issues. Simply getting patients to squeeze their hand as they move through their painful arc can quickly and effectively reduce it. Again how and why this works is unclear, it could be from the increased activity of the cuff better controlling humeral head movement, it could be from increased cuff muscle activity which then affects the scapulo-thoracic muscles and movements, or it could be from other non-specific factors such as refocusing attention to another area away from the shoulder, who knows, who cares!

Using a purposeful strong grip is something that has and still is often used by strength and conditioning coaches to help improve performance and training. It is a well established and well-known technique to instruct a lifter to squeeze or crush the bar during heavy lifts. This not only helps to hold the heavyweights but can also help with control during the movement. Many lifters, myself included, will say that when squeezing the bar or handle hard an unstable heavy weight feels less unstable.
I often talk about grip and its role on my courses sometimes using my best Arnie Schwartzeneggar impression telling physios to get their patients to “grip it and rip it”. If you want to hear more about my courses and Arnie impressions please find details here.
So ‘getting a grip’ can be a simple yet effective strategy for helping painful and weak shoulders on a number of levels. So when you next do some shoulder rehab don’t only focus on the shoulder, or the cuff, or the scapula, instead look above and below the shoulder. And a good place to start for many is to get them to “grip it and rip it baby”.
As always thanks for reading
Adam