5 Reasons Direct Rotator Cuff Exercises are Necessary in a Strength Training Program
Written on February 16, 2011 at 8:36 am, by Eric Cressey
If you’ve read much of my stuff, you’ve probably come to realize that I’m quite the shoulder geek. With that title comes a lot of questions at seminars and via email, and one of the more common ones is whether I think direct rotator cuff strengthening exercises are necessary for everyone. A lot of coaches say that they aren’t essential, but I beg to differ for five reasons. Here’s why:
1. Bad Posture – Nowadays, pretty much everyone has rounded shoulders – which means that the scapulae are winged out. When a shoulder blade isn’t sitting right, the rotator cuff muscles that attach to that scapula are at a mechanical disadvantage because they are outside of their ideal length-tension relationship for creating force; it’s analogous to trying to shoot a cannon from a canoe.
Incorporating some direct rotator cuff exercises not only strengthens muscles that you know will be operating at a mechanical disadvantage, but also educates a lifter about how the scapula should be positioned for ideal shoulder function.
2. Shoulder impingement is a physiological norm. – Research from Flatow et al. demonstrated that everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has direct impingement on their rotator cuff tendons. If you know a region is going to get beaten up regardless of what you do in your life, why wouldn’t you opt to strengthen it proactively?
3. Rotator cuff tears are far more common than you think. – In consideration of the previous point, it should be no surprise that rotator cuff tears are actually far more common than one might realize – even if you look at asymptomatic subjects. Connor et al. discovered that on MRI, 40% of asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears. The general population is no different; Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60. And these studies don’t even include the ones who are actually in pain! It makes sense to strengthen these areas proactively – even if your shoulder doesn’t hurt…yet.
4. Lots of people also have labral tears. – In the past, I’ve written quite a bit about Active vs. Passive Restraints. In the shoulder, the rotator cuff would be considered an active restraint, as it’s something that can be strengthened to improve dynamic stability. The labrum, on the other hand, doesn’t get stronger with exercise; it’s a passive restraint that provides stability. So, if the labrum is torn or frayed (as it very commonly is in both lifters and overhead throwing athletes), then the active restraints – the rotator cuff tendons – need to pick up the slack.
5. The “Just do normal stuff and the rotator cuff will take care of itself” philosophy isn’t working. – That’s been tried for quite some time, and nowadays, as a society, we move like absolute crap and – as noted above – have a boatload of issues on MRI even if we’re asymptomatic. With respect to the cuff, we’ve built the deltoids up to the point that they absolutely overwhelm the rotator cuff (particularly the supraspinatus), which is trying to prevent the humeral head from migrating upward into the acromion.
My article, Clearing up the Rotator Cuff Controversy demonstrates some of our favorite rotator cuff exercises and talks about how to include them in a weekly strength training program.
For more information, check out the Optimal Shoulder Performance DVD Set.
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February 16th, 2011 at 11:27 am
As usual…great points. It amazes me that so many wait to strengthen these stabilizing muscles until they feel pain.
February 16th, 2011 at 12:24 pm
When doing direct cuff work, what type of repetition ranges are you using with your throwers (endurance ranges or hypertrophy ranges or both)? With exercises like band ER or side lying ER do you maintain constant tension on the cuff and create more of an endurance effect? Couple questions I have been pondering for a while. Thanks for the great blog.
February 17th, 2011 at 8:20 am
Great article. Maybe you could write an article on the role that the lower trapezius plays in posture and stabilizing the shoulder. The contraction of the lower traps, and de-emphasizing the elevation of the upper traps should be included in every exercise routine. I see too many athletes (and non- athletes)of all ages complain of shoulder pain, yet their exercise rountine usually involes more anterior movements than posterior movements. This imbalance is what creates the rounded shoulder and eventual shoulder challenges.
February 17th, 2011 at 8:41 am
EC, I was actually just thinking about this topic the other day. Our baseball/softball players do quite a bit more scapular stabilizing work and LYTW, but have focused less on the IR/ER with band work in the last year. We still do it, but it has much less focus than it used to. How much focus do you put on it compared to the effort in taking care of the scapular stabilizers? 50/50 or????
February 17th, 2011 at 8:50 am
Eric,
Great article. I’m just recovering from shoulder bursitis, and my orthopedist told me no more overhead lifting otherwise the bursitis could return. What are your thoughts on this?
February 17th, 2011 at 11:17 am
Do weightlifters (those who compete in the Oly lifts) do direct rotator work?
To debate point 5, the argument that a CORRECT press works the rotator cuff and everything else in the shoulder in a balanced manner is convincing to me. I recall an article by Bill Starr where he wrote that he never once saw a lifter get injured by pressing (heavy push presses and jerks, yes, but not presses) but saw lots of shoulder problems from the bench press.
I’m not saying rotations aren’t worth doing, I’m just saying that with the exception of those who already have really weak rotators, I’m not convinced rotations are necessary from a shoulder health standpoint in those who train the press seriously.
By the way, there is an old Poliquin article on T-nation where he discusses a client he had who improved his bench 30+ lbs just by bringing up his rotator strength and doing NO BENCHING the whole time. So yeah, I’ll get those rotators strong.
February 18th, 2011 at 7:43 am
I have found that focusing more on the thoracic spine rotation and extension, and shoulder blade stability and less on the RC has worked the best for me. (damaged both shoulders as a distance swimmer in high school)
My clients with old shoulder injuries (up to 20 years ago) have also done great with this concept. Correct the defects in posture and watch how much better the shoulders perform.
My perspective is different since the training focus is on improving mobility more than anything else.
February 18th, 2011 at 12:39 pm
Eric,
What type of exercises can I have one of my high school athletes do pre-op for a labral tear?
Thank you,
Jeremy
February 19th, 2011 at 5:20 pm
Hi Eric,
I agree on this 100%, i have come across so many clients that have range of movement issues with their shoulders and the rotator cuff is one of the most common areas that people dismiss and won\’t do anything about until it\’s too late. Good post, let\’s hope more people do the things they need (and not just the things they want!).
February 20th, 2011 at 7:12 pm
Hi Eric. What do you think about kettlebells for shoulder stability? I mean things like turkish getups, side presses and windmills? With these exercises you are required to hold the weight overhead/infront of you whilst moving your body. Turkish getups are used in shoulder rehab. I believe these exercises teach you to actively keep your humerus in its socket.
February 21st, 2011 at 5:07 am
Some great points here, i’ve been slacking slightly on my own rotator cuff training lately, I’m gonna do it more from now on 🙂
February 21st, 2011 at 11:23 am
Eric,
Very lucid post. Hopefully, the “fitness” world will listen & cut down on impingement promoting deltoid dominant routines. We would all like to see a greater emphasis on a solid stability foundation.
Thanks,
Craig
February 21st, 2011 at 6:39 pm
I think that there is definitely a place for these drills, but I’m not convinced that they alone will get the job done for the Average Joe. Used in conjunction with traditional external rotations and rhythmic stabilization drills, though, I think they have a lot of value.
February 21st, 2011 at 6:41 pm
Jeremy,
Depends on the type and extent of the labral tear. I’d probably start with closed chain rhythmic stabilization drills and external rotation drills with the arm abducted 30 degrees. Examples:
February 21st, 2011 at 6:42 pm
Both very important as well. I’ll be covering this in a future blog post, Keith. I’m convinced that there are three different gross stabilization strategies across the population.
February 21st, 2011 at 6:43 pm
Ben,
I’ll be devoting a full blog post to this. Suffice it to say that natural selection is a big player in this. How many O-lifters do you think there are that simply didn’t make it that far because a) their shoulders gave out or b) their posture was so crappy that they quit because they weren’t any good?
February 21st, 2011 at 6:43 pm
I’d stay away from overhead pressing for an extended period of time, and if you decide to re-integrate it, do so gradually with DB pressing in the scapular plane.
February 21st, 2011 at 6:44 pm
I’d say 2:1 scapular stability to RTC in terms of total sets and reps.
February 21st, 2011 at 6:45 pm
Mike – already did an entire series! Check out “Correcting Bad Posture” Parts 1-5.
February 21st, 2011 at 6:45 pm
We’ll work everywhere from 5-12 reps. Constant tension would be ideal, although we never train the cuff to failure.
March 8th, 2011 at 6:18 pm
Hi,
I remember a post by Charles Poliquin way back, about an individual should be able to externally rotate 20% of what they can bench in order to be at a reduced risk for shoulder injury, specifically injury from weight lifting. Seems like alot for the rotator cuff, especially if someone can bench over 300lbs.
January 1st, 2012 at 6:00 pm
Eric,
When I first read the title of this post, I thought, “No way, Cressey’s going to throw it out there that rotator cuff exercises aren’t necessary”. Should’ve known better. I see so many youth in the gym just hammering at their chest with the bench press that it also lends itself to the rounded shoulders while putting little priority on the antagonists. So there’s also that “ideal” that being strong on the bench will separate you in some ways from others.
Conor
January 2nd, 2012 at 2:57 pm
Please make sure your pal Joe meglio sees this so he understands why Physical Therapists do these foo foo exercises.
June 30th, 2013 at 7:12 am
Eric,
Totally understand the importance of dispersing the decelerating forces throughout the trunk/core and lower body for throwing athletes.
But for swinging athletes (eg. Volleyball players or even swimmers) who are overhead athletes in an open chain system how does that affect the distribution of forces or training factors?
June 30th, 2013 at 10:46 am
Eric,
In a past post, I think in your Baseball blog, you stated, I think, that for overhand athletes; i.e., pitchers and the like, that the act of throwing as much as they do gives the RTC plenty of exercise and as a result, these athletes don’t need a significant amount of extra RTC strengthening. I think I have this right.
That being the case, how does this current post fit in with that previous RTC discussion. Should they be considered separate and the overhand athlete being considered a special case for RTC training?
June 30th, 2013 at 4:07 pm
Eric another great article.interesting about the cuff and labrum can help me with my CES,
Thanks,Mayo
June 30th, 2013 at 4:52 pm
Eric, Thank you for these articles!
My Dr said I have hurt my tendon and to avoid any shoulder movement for 12 weeks but is unsure if this would be temporary or permanent. What should I do to recover and prevent further injury?
June 30th, 2013 at 4:52 pm
Jim,
You definitely misunderstood me. Throwers definitely still need cuff work – and certainly more than the general population would. My point was that you may have to cut back on the volume you do during the in-season period because throwing is so stressful.
June 30th, 2013 at 4:54 pm
Elliott,
Very simply, they need to be that much better in their scapular stabilizers and cuff. They are in a slightly better position because the arm speed isn’t quite as high and they aren’t throwing off a mound, but that’s not to say they can get lazy on any arm care work, especially when you realize they’ve got a higher incidence of congenital laxity.