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.
Don’t know how you did it, but as I read this article I was taking a break from looking for references re: why most scapular kinematic studies are done in the scapular plane. nice…
would just like to say all the articles i read from you are interesting and informative and make me feel like i,m learning more and more and as a newly qualified pt thats just what i need. ps wish i could come and work at your place even if it was just for a couple of weeks as i,m sure i would learn so much. thanks keith
August 25th, 2009 at 5:06 pm
Don’t know how you did it, but as I read this article I was taking a break from looking for references re: why most scapular kinematic studies are done in the scapular plane. nice…
thanks
August 25th, 2009 at 6:03 pm
Thanks Eric. Great material. I always wondered why the towel between elbow and body when doing the rotation exercises. Now I know.
U rock!
Steve
August 25th, 2009 at 6:40 pm
Nice Eric. Pertubations on a band while the arm is externally rotated in scapture is a great activation movement too.
August 25th, 2009 at 10:10 pm
Great article Eric, i actually have gone to Dr Hammer in the past for Graston technique on my shoulder and he really knows his stuff
August 26th, 2009 at 8:59 am
would just like to say all the articles i read from you are interesting and informative and make me feel like i,m learning more and more and as a newly qualified pt thats just what i need. ps wish i could come and work at your place even if it was just for a couple of weeks as i,m sure i would learn so much. thanks keith
August 26th, 2009 at 4:28 pm
eric, good as always.
Go Buckeyes!
August 26th, 2009 at 10:37 pm
Eric,
Great article.
Did my masters on rotator cuff exercises. So much more to talk about.
Rick Kaselj
http://www.ExercisesForInjuries.com
.
August 27th, 2009 at 7:58 am
The cable external rotation in the scapular plane work so well for my shoulder. Thank you.