Home Baseball Content Clearing up the Rotator Cuff Controversy

Clearing up the Rotator Cuff Controversy

Written on January 31, 2010 at 7:07 am, by Eric Cressey

The college coach of one of our current pro baseball players was asking me about the rotator cuff program he’s doing with us now, and I figured I’d turn it into today’s topic.  We take a bit of a different approach with it than you’ll see with a lot of guys in the industry, and it’s basically dictated by three assertions/assumptions:

1. The true function of the rotator cuff is to stabilize the humeral head on the glenoid (shoulder socket).  While external rotation is important for deceleration of the crazy internal rotation velocity seen with throwing, it’s stabilization that we’re really after. As you can see, the humeral head is too large to allow for great surface area contact with the glenoid.

glenoid

My feeling is that the bigger muscles – particularly scapular stabilizers, the core, and the lower half – will decelerate the crazy velocities we see as long as mechanics are effective and the deceleration arc is long enough.

robertson

2. The shoulder internally rotates at over 7,000°/s during acceleration; that’s the fastest motion in all of sports.  There’s no way that the rotator cuff muscles alone with their small cross-sectional area can decelerate it.  And, to take it a step further, there isn’t much that some rubber tubing is going to do to help the cause (aside from just promoting blood flow – although I’d rather get that in a more global sense with full-body flexibility circuits, as I discussed HERE).

More important than blood flow is getting range of motion (ROM) back (particularly elbow extension and shoulder internal rotation) after a pitching outing.  In my experience, losses in ROM get guys injured faster than weakness, in my experience.  I’ve seen quite a few people come to me who have healthy shoulders, but test poorly on classic rotator cuff strength measures.  Why?  Perhaps they are very strong in their scapular stabilizers, core, and lower half and have become efficient enough to handle more of the deceleration demands in areas other than the rotator cuff.  Or, they may just be lucky; rotator cuff strength is still important!

3. We’ve mocked on the conventional bodybuilding community for training muscles and not movements: chest day, quads day – you get the picture.  Meanwhile, the baseball community is devoting five days a week to training muscles with cross-sectional areas smaller than any of these!

I’ve had multiple discussions with Mike Reinold that reaffirm this indirectly; he emphasizes that one should never train the rotator cuff to failure, as that’s not how it works in the real world.  Our job is to enhance not just its strength, but also its proprioception and rate of force development.  If we chronically abuse it with training on top of the crazy demands of throwing, we never really know how strong the rotator cuff actually is. It makes you wonder how many guys in the baseball world actually have exhausted and chronically overtrained rotator cuff muscles as opposed to weak rotator cuff muscles!

With these three assertions in mind, most of our guys in the off-season will have four days of rotator cuff work spread out over two “types” of training.  Days 1 and 3 (say, Monday and Thursday) would be more rhythmic stabilization drills similar to this (although the options are really only limited by your imagination):

The other two days are more classic rotator cuff work that prioritizes external rotation and horizontal abduction (we never do empty cans).  I do a lot of work with cables here, plus a lot in the side-lying position (EMG activity for the cuff is highest here).

We’ll also do a lot of manual resistance external rotation stuff, as it kind of “blends” conventional cuff work with rhythmic stabilizations due to the unstable load. Here’s one option:

Later in the off-season, we’ll throw in some one-arm medicine ball deceleration catches and external rotation tosses to the wall to get the thoracic spine and hips ready for the full-body demands of throwing.

Keep in mind that – as I noted – rotator cuff exercises are just one piece of the puzzle.  These are one component of a larger overall plan that addresses not only scapular stability, but also total body strength and mobility, soft tissue quality, medicine ball work, movement training, and the actual throwing program.

For more information (actually a LOT more information), check out the DVD set, Optimal Shoulder Performance: From Rehabilitation to High Performance from Mike Reinold and I.

shoulder-performance-dvdcover

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  • For the typical man in the street, what’s a good set/rep range to train rotator cuffs (eg, 2 sets of 10-12 reps twice week).

    Following injury I only really do external rotator work – is there a need for internal work to balance out? Thanks

  • Carl

    Very very intersting peice of work here. I like the last 2 videos quite a bit. Interesting. Thanks EC.

  • Outstanding work, as usual, Eric. We teach the same stuff at our facility – while band work and light DB stuff is useful to some degree, it becomes far too overprioritized while general strength training is ignored.

  • Mark Young

    You cleared up my rotator cuff problems that I had for 20 years before I began reading your articles. As far as I am concerned, you have solved my problem shoulders with Neanderthal No More. Since then, I have referred friends of mine who were bench pressers, shot putters, and various other strengh atheletes, to your work; and without exception, they were rehabilitated. They were shocked, as I was, that their problems stemmed from imbalances in their rotator cuff muscles, and not from age, or wear and tear created by training. I knew instantly why you said, “Don’t tell me about your shoulder problems” on Face Book. You had solved them years ago.

  • I was wondering if you incorporate these types of exercises earlier in the training session or throughout as fillers?

  • Patrick Quinn

    I had been looking for an article regarding the frequency of rotator cuff training and this is exactly what I was looking for.

    How do you feel about the “shoulder horn?” I’ve been using one at my gym and I was wondering if you use it, like it and/or hate it.

    By the way, I loved Maximum Strength and still follow a similar template. I know you mentioned a while back that you were considering a sequel. Is that still in the works?

  • RT

    Great info. Will the DVD have sample progressions?

  • Marcus Holliday

    Eric, Good info and good links to your other posts about conditioning for pitchers. Question…while most folks in the performance world and in athletic training (I am an ATC) understand and accept the concepts related to some of the detrimental effects of distance running/training, why are people still unwilling to change their routines? What I mean is if the minor/major league folks are still having pitchers run poles, etc… along with other more ‘traditional’ pitcher-training techniques why should we expect the college coaches with whom we work to ever honestly change their workout and practice routines. I work with coaches who understand what I’m trying to explain to them about minimizing the endurance work, while maximizing the sprint and agility work, but they can’t seem to be convinced enough to change the way they’re coaching simply because they think they’re pitchers ‘need to have their legs under them’ to throw 5+ innings.

    All the Best!

  • Jeremy Hartman

    Marcus,
    The easiest way I put it to my coaches it to take a look at long distance runners and their injury rates compared to other general sports. Long distance runners are not muscular, regularly injured, not very ‘movement’ athletic, ect…
    Next I said look at short distance/sprinters: very athletic, very strong, agile, ect…
    I then asked which type of program would better work for our athletes.
    I also explained this to my kids as well and it was like a light bulb went off as most of kids will run long distances on their own because in their mind, that is the way to get in shape.
    Hope this helps!

  • eugene sedita

    Me again, No, not really, 7,000 degrees/sec. ? Yoiks. Fer real?

  • Great Stuff EC

  • Johnny

    Hi Eric, I really like what you about training movements not muscles. But How can you adapt or train those movements in the non athletic population who have very limited range of motion?
    Should they still train those movements and train their mobility until they can successfully move like they should? Or should they work on individual muscles, which will make them more stiff.

  • Eldridge

    Hi Eric found the article interesting specially the last two throwing the medicinal ball exercises the other exercises are pretty normal Good work Eric.

  • Hollister

    Nice stuff Eric!
    Question: Where can a guy get the training balls shown in deceleration training videos? I’ve searched for them before, but didn’t really find the same comparison in how the ball adapts to the desired training movements such as the ones shown in your one-arm medicine ball deceleration catches and external rotation tosses… Thanks much.

  • Pat McGill

    Hi Eric,

    Wondering what your opinion is on SICK scapular syndrome is? this is a common injury to baseball pitchers, what do you think the best rehab is?

    thanks,
    Pat

  • Pat,

    It’s an extremely common finding…just about 100% of shoulder issues. It’s important to realize that overhead throwing athletes will never be symmetrical; you’re just managing their asymmetry within certain limits. Rehab is different for everyone, but for most, it comes down to improving function of lower traps and serratus anterior while improving t-spine mobility and cuff strength.

  • Mick

    Eric I always enjoy your articals. What is your thoughts on using Olympic rings for recruiting shoulder stablisers.

  • Thanks for this, Eric. I’m fully in agreement on two of your points in particular. First, not using the fully extended arm (empty can) for strength training. The torque loading is just too great and when do we use this in real life?

    Second, not training the cuff to failure. The cuff is just part of a whole panoply of control and there is too much emphasis in the industry for isolated regimes, in my view.

    Thanks once again.
    Andrew

  • Justin Leno

    Dear Eric,

    Great Piece!

    You also mentioned in an earlier article that on should not train their rotator cuff to failure. In that case what sets/reps would u recommend for RCs? Would the guideline of hitting 25-50 reps to failure hold for RCs?

    Thanks
    Justin


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