Written on August 25, 2009 at 4:35 pm, by Eric Cressey
A Quick Tip for Sparing the Shoulders
One thing we all know is that when returning someone from a shoulder problem, it’s generally assumed that starting in an adducted position – meaning that the arms are at the side – is preferred over a more abducted position (where the arms are elevated) for external rotation variations. The more adducted position minimizes the amount of impingement on the rotator cuff while still allowing us to challenge the posterior rotator cuff.
As such, the side-lying external rotation is a great exercise for folks to use when trying to strengthen the rotator cuff without exacerbating their shoulder pain. In fact, this exercise has actually shown the best EMG activity of the infraspinatus and teres minor of any exercise tested.
The head is always supported, and we generally start those entry-level folks with a towel or pad between the elbow and the side to prop the arm to about 30 degrees of abduction, which is actually less stressful on the shoulder than having the arm completely up against the side.
In addition to performing this exercise with a dumbbell or plate, you can use manual resistance to accommodate the strength curve, overload the eccentric component, and add a greater element of dynamic stabilization.
Obviously, though, we can’t always just train people in the more adducted position; the rotator cuff also has to function as a dynamic stabilizer as we get more abducted – and eventually, overhead. So, it’s valuable to start doing some external rotation variations at 90 degrees of abduction. And, this is where this week’s tip comes in.
Traditionally, folks will go directly to the frontal plane to position the humerus, and the rotation will occur in the sagittal plane. I actually prefer to begin folks in the scapular plane when starting them in the more abducted position. In the first video below, you’ll see that the reps are done in the frontal plane. In the second video, though, I reposition my body to so that the humerus is actually about 30 degrees forward of the frontal plane – which is the scapular plane.
The scapular plane is much less stressful on the shoulder, and it is a great “middle-of-the-road” between the adducted and traditional abducted external rotation variations you’ll see. For more information on the scapular plane, I’d highly recommend this article by Dr. Warren Hammer.
Of course, all of this is a very “rotator-cuff-centric” mindset, and there are loads of other factors you need to consider when dealing with shoulder issues. I discussed them in more detail in this previous newsletter.