Home Baseball Content Baseball Strength and Conditioning Programs: How Much Rotator Cuff Work is Too Much? – Part 1

Baseball Strength and Conditioning Programs: How Much Rotator Cuff Work is Too Much? – Part 1

Written on January 9, 2012 at 8:15 am, by Eric Cressey

In a recent presentation in front of a bunch of baseball coaches, I made the following statement – and it turned a lot of heads:

I think most people overtrain the rotator cuff nowadays, and they do so with the wrong exercises, anyway.

To illustrate my point, I’m going to ask a question:

Q: What is the most common complication you see in guys as they rehabilitate following a Tommy John Surgery?

A: Shoulder problems – generally right around the time they get up to 120 feet.

Huh?  Shoulder pain is a post-operative complication of an elbow surgery?  What gives?

First, I should make a very obvious point: many of these guys deal with shoulder stiffness as they get back to throwing simply because they’ve been shut down for months.  That I completely expect – but remember that it’s stiffness, and not pain.  They always throw their way out of it.

The more pressing issue is what is taking place in their rehabilitation – and more specifically, what’s taking place with the synergy between their rehabilitation and throwing program. Let me explain.

Rehabilitation following a UCL reconstruction is extensive.  While different physical therapists certainly have different approaches, it will always be incredibly heavy on rotator cuff strength and timing, as well as adequate function of the scapular stabilizers.  Guys always make huge strides on this front during rehab, but why do so many have shoulder pain when they get further out with their long tossing?  The answer is very simple:

Most people don’t appreciate that throwing a baseball IS rotator cuff training.

Your cuff is working tremendously hard to center the humeral head in the glenoid fossa.  It controls excessive external rotation and anterior instability during lay-back.

It’s fighting against distraction forces at ball release.

And, it’s controlling internal rotation and horizontal adduction during follow-through.

Simultaneously, the scapular stabilizers are working incredibly hard to appropriately position and stabilize the scapula on the rib cage in various positions so that it can provide an ideal anchor point for those rotator cuff muscles to do their job.

A post-op Tommy John thrower – and really every player going through a throwing program – has all the same demands on his arm (even if he isn’t on the mound, where stress is highest).  And, as I wrote previously in a blog about why pitchers shouldn’t throw year-round, every pitcher is always throwing with some degree of muscle damage at all times during the season (or a throwing program).

Keeping this in mind, think about the traditional Tommy John rehabilitation approach.  It is intensive work for the cuff and scapular stabilizers three times a week with the physical therapists – plus many of the same exercises in a home program for off-days.  They’re already training these areas almost every day – and then they add in 3-6 throwing sessions a week.  Wouldn’t you almost expect shoulder problems?  They are overusing it to the max!  This is a conversation I recently had with physical therapist Eric Schoenberg, and he made another great point:

Most guys – especially at higher levels – don’t have rotator cuff strength issues; they have rotator cuff timing issues.

In throwing – the single-fastest motion in all of sports – you’re better off having a cuff that fires at the right time than a cuff that fires strong, but late.  Very few rotator cuff exercise programs for healthy pitchers take that into account; rather, it’s left to those doing rehabilitation.  Likewise, most of the programs I see altogether ignore scapular stability and leave out other ways to train the cuff that are far more functional than just using bands.

Now, apply this example back to the everyday management of pitchers during the season. Pitchers are throwing much more aggressively: game appearances, bullpens, and long toss.  They need to do some rotator cuff work, but it certainly doesn’t need to be every day like so many people think.

I’ll cover how much and what kind in Part 2.  In the meantime, if you’d like to learn more about the evaluation and management of pitchers, check out Optimal Shoulder Performance.

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  • While I don’t train baseball players (actually I did train one once) I can comment on how important this is to note for the everyday person. Walk into any gym and you’ll see people doing external rotation with a towel in their armpit on the cable machine probably prescribed by a professional.

    Since attending a workshop put you by you I’ve learnt to evaluate internal and external rotation and have found the problem is almost never strength in the cuff. It’s stability and firing patterns.

    Again getting away from baseball players but stability work and scapular control does wonders for healing damaged rotator cuffs (if that was even the problem in the first place). Too often the rotators are mis-diagnosed as the problem as well — but that’s another conversation all together.

    Bear walks and overhead carries work great when inflammation has gone down.

  • Good post Eric. One thing about sports and human performance is that it’s easy to fall into the “see spot run” mentality.

    When you see someone do something, you immediately start to do it. And as a whole, us Americans are obsessed with strength so we always try to load up exercises maximally.

    So if most shoulder issues are caused by overuse and misfiring as a result of too much cuff work, we’re shooting ourselves in the foot. Much to think about.

  • Jon May

    Wait a second the shoulder and elbow are related? Good points, especially with the timing nugget. Next thing your going to tell us the hips and lower extremity should be involved in shoulder programs! Keep up the great work.

  • Great article Eric. I think you wanted to type in controlling internal rotation and horizontal adduction during follow through.
    Anyway, we get it. I’m a huge fan of using multiple disciplines with my scapular stabilization exercises and integrated functional patterns. Bodyweight and light dumbbells for prone exercises, and a variety of tools when integrating the hips including trx system, cable unit, kettle bells, moderate load dumbbells, tubing, and body blade.

    Look forward to part 2.

  • gregory

    My recent MRI revealed full tear at supraspinatus
    and humeral head. Will continuing to play and
    throw with this diagnosis cause further damage?

  • Gregory,

    Impossible to say, as MRIs can be very deceiving and must be considered in light of your symptoms, strength levels, mobility levels, etc. However, in my experience, you aren’t getting far with a full supraspinatus tear.

  • jeff

    Gregory,
    It is not in your best interest to throw with a full supraspinatus tear. Eric is dead-on that MRIs can be deceiving. But not for a diagnosis of a full tear. Pretty hard for the MD to miss that one. MRIs can be deceiving with partial tears but rarely does an MRI produce a false positive of a full tear.

  • Bob Hbuer

    Unrelated issue
    Are you a proponent for landmine presses for overhead athletes (baseball primarily)

  • Hey Eric

    A quick question- what are some of the exercises that you are referring to as the wrong exercises?

  • Bob,

    Yes, we use them quite frequently.

  • You often refer to throwing a baseball as the fastest single motion in all of sports. I would love to know some of the others, especially hitting a volleyball as that is my niche. Is there a study you could point me too? Thanks a ton for all your shoulder knowledge!!

  • Curtis,

    I don’t have any studies on hand, but I’m sure that if you check out pubmed.com, you’ll be able to find quite a few.


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