Fixing the Flaws: Weak Rotator Cuff / Scapular Stabilizers

Written on May 7, 2007 at 12:41 pm, by Eric Cressey

I group these two together simply because they are intimately related in terms of shoulder health and performance.

Although each of the four muscles of the rotator cuff contributes to humeral motion, their primary function is stabilization of the humeral head in the glenoid fossa of the scapula during this humeral motion. Ligaments provide the static restraints to excessive movement, while the rotator cuff provides the dynamic restraint. It’s important to note, however, that even if your rotator cuff is completely healthy and functioning optimally, you may experience scapular dyskinesis, shoulder, upper back, and neck problems because of inadequate strength and poor tonus of the muscles that stabilize the scapula. After all, how can the rotator cuff be effective at stabilizing the humeral head when its foundation (the scapula) isn’t stable itself? Therefore, if you’re looking to eliminate weak links at the shoulder girdle, your best bet is to perform both rotator cuff and scapular stabilizer specific work.

In my experience, the ideal means of ensuring long-term rotator cuff health is to incorporate two external rotation movements per week to strengthen the infraspinatus and teres minor (and the posterior deltoid, another external rotator that isn’t a part of the rotator cuff). On one movement, the humerus should be abducted (e.g. elbow supported DB external rotations, Cuban presses) and on the other, the humerus should be adducted (e.g. low pulley external rotations, side-lying external rotations). Granted, these movements are quite basic, but they’ll do the job if injury prevention is all you seek. Then again, I like to integrate the movements into more complex schemes (some of which are based on PNF patterns) to keep things interesting and get a little more sport-specific by involving more of the kinetic chain (i.e. leg, hip, and trunk movement).

On this front, reverse cable crossovers (single-arm, usually) and dumbbell swings are good choices. Lastly, for some individuals, direct internal rotation training for the subscapularis is warranted, as it’s a commonly injured muscle in bench press fanatics. Over time, the subscapularis will often become dormant – and therefore less effective as a stabilizer of the humeral head – due to all the abuse it takes.

For the scapular stabilizers, most individuals fall into the classic anteriorly tilted, winged scapulae posture (hunchback); this is commonly seen with the rounded shoulders that result from having tight internal rotators and weak external rotators. To correct the hunchback look, you need to do extra work for the scapular retractors and depressors; good choices include horizontal pulling variations (especially seated rows) and prone middle and lower trap raises. The serratus anterior is also a very important muscle in facilitating scapular posterior tilt, a must for healthy overhead humeral activity. Supine and standing single-arm dumbbell protractions are good bets for dynamically training this small yet important muscle; scap pushups, scap dips, and scap pullups in which the athlete is instructed to keep the scapulae tight to the rib cage are effective isometric challenges to the serratus anterior.

Concurrently, athletes with the classic postural problems should focus on loosening up the levator scapulae, upper traps, pecs, lats, and anterior delts. One must also consider if these postural distortions are compensatory for kinetic chain dysfunction at the lumbar spine, pelvis, or lower extremities. My colleague Mike Robertson and I have written extensively on this topic. Keep in mind that all of this advice won’t make a bit of difference if you have terrible posture throughout the day, so pay as much attention to what you do outside the weight room as you do to what goes on inside it.

Eric Cressey
www.BuildingtheEfficientAthlete.com

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4 Responses to “Fixing the Flaws: Weak Rotator Cuff / Scapular Stabilizers”

1. Roland Fisher Says:
   May 7th, 2007 at 11:32 pm

   Thanks Eric, it is not too often we find this caliber of post in a blog.

2. M Murthy Says:
   July 22nd, 2012 at 11:48 pm

   First of all, brilliant post. But I find it really baffling and annoying that NOBODY talks about the scapula when a person suffers from Rotator Cuff related tendonitis. Every post, blog, youtube excercise etc. focuses ONLY on the shoulder/ rotator cuff and NOT on the scapula….why is that? Even two physiotherapists that I have been to for rotator cuff impingement in the past, did not even mention the phrase “scapula strengthening” to me. It is only my recent physio who says that she will ignore the rotator cuff until my scapula is strong enough to provide the stabilizing effect to the cuff. Hence my pet peeve….it is ignorance, or is the physiology so complex that none of the so-called professionals knows about it??!!

   Anyway, thanks again for such a high-calibre post. I know its an old post, but never too late to appreciate something.

   Cheers

3. Eric Cressey Says:
   July 23rd, 2012 at 6:18 am

   You hit the nail on the head, Mayur. This blog post might interest you, too:

   http://ecressey.wpengine.com/training-the-rotator-cuff-and-scapular-stabilizers-simultaneously

4. Sean Murray Says:
   November 18th, 2013 at 6:00 pm

   Great read Eric! I’ve had issues with my overhead position all through my CrossFit experience. Particularly my left shoulder that limits handstand press ups and barbell pressing. I’ve had Impingement issues in the anterior. My left shoulder is dropped ( think from bags over shoulder all through youth) Tight in the left pec area and i just feel very weak and unstable on the left side. Wasn’t until about 2 years ago that a winged scapula was referred to and that my left scap was missing movement and locked down in anterior tilt.
   I do notice it feels sticky during protraction in scap push ups and can now feel that lack of motion as i go overhead. Given some food for thought!