Everybody is familiar with this expression. But if you suffer discomfort during a shoulder workout, it could spell trouble. What starts as a twinge can soon get worse, yet many gymgoers ignore it until the pain becomes intolerable.
It’s a familiar tale. Shoulder injuries are among the most common in the gym and often require lengthy rehabilitation or surgery. Well-intentioned but harmful advice often makes matters worse.
The bottom line is that the shoulder is a complex joint. It’s worth taking time to learn the basics and following the steps necessary to prevent your gains from being compromised by injury.
The shoulder is the most flexible joint in the body, but the flip side is, it’s also one of the less stable.
I say “joint,” but it is not actually a single joint. It is the articulation between the head of the humerus bone on the upper arm and the glenoid fossa socket on the shoulder. It’s often likened to a golf ball resting on a rather large tee. The joint is designed for maximum mobility to allow a broad spectrum of upper-body movement, but this inherent instability is at the root of many problems.
The rotator cuff is crucial because it stabilizes the shoulder. Most shoulder injuries affect the rotator cuff, and the purpose of most rehab work is to strengthen it.
The rotator cuff consists of four muscles that can be remembered by the acronym SITS: supraspinatus, infra-spinatus, teres minor, and subscapularis. These muscles originate from different parts of the scapula (shoulder blade) and insert into the humeral head, converging together into a tendinous “cuff ” around the joint.
Problems usually occur when tight internal shoulder rotators pull the humeral head forward and inward. If the external shoulder rotators are weak, they are unable to counteract this force, and this leads to pain in the rotator cuff.
Although the pain is felt in the shoulder, the root of the problem is usually more widespread. The chest, back, and biceps muscles all traverse the shoulders, so every upper-body workout activates the rotator cuff to some extent. Unfortunately, many of the exercises we do for these body parts cause internal shoulder rotation. There is a mismatch between the internal and external shoulder rotators. Guys who hammer their pecs and lats are potentially storing up problems by overtraining their internal rotators and neglecting their external rotators.
1. Studies testing the rotator cuff strength of patients with shoulder impingement syndrome consistently show muscular imbalances between external rotator and internal rotator muscles of the injured shoulder.
2. Significant decreases in electrical activity in the supraspinatus and infra- spinatus rotator cuff muscles were found in subjects with shoulder impingement syndrome compared with uninjured subjects.
3. A number of studies have measured the strength ratio of the external rotators and internal rotators in healthy uninjured subjects. They report that one should be at least 60 to 70% as strong as the corre- sponding muscle group. So if your inter- nal rotators can lift a weight of 10 pounds, your external rotators should be able to pull a weight of between 6.5 and 7.5 pounds to prevent muscular imbalances.
Golden Rules
1. Do not ignore shoulder pain. Training through it will lead to more serious injury, which will require longer and more invasive treatment. If you experience pain, incorporate rest and a modification period into your program to keep the muscles from grating and teach them how to be exercised safely.
2. Be wary of exercises that require excessive internal rotation of the shoulder, such as front raises, lateral raises with thumbs down, and upright rows. These moves put the supraspinatus muscle in a potentially compromised position.
3. Strengthen your middle and lower trapezius and rhomboids to increase shoulder blade stability. Try reverse flyes with straight elbows to hit the middle traps.
4. Keep external rotators strong and internal rotator muscles flexible to avoid a poor internal/external strength ratio, which results in the humeral head pulling forward. Regular stretching after workouts helps.
If you search for rotator cuff exercises on the Internet, a plethora of generic moves appears. The exer- cises here don’t cover everything, but they are the most effective moves for guys looking to improve their range of motion and the strength of their rotator cuff and scapula.
The rotator cuff is composed of a similar number of slow- and fast- twitch muscle fibers, so your aim should be to increase muscular endurance, and you should vary the tempo. Resist the urge to go heavy: This program is about preventing injury rather than hypertrophy, so it’s a short-term measure that will allow you to gain without pain afterward.
Incorporate the following exercises into your routine for four weeks. They will greatly increase your chances of avoiding injury and allow you to blast your delts safely in the months to follow.
In Weeks 1 and 2, do 3 x 30 reps and adopt a slow tempo of 3 seconds up, 3 seconds hold, 3 seconds down.
In Weeks 3 and 4, do 4 x 20 reps, adopting a fast tempo of 1 second up, 0 second hold, and 2 seconds down.
1. Reverse Pallof Press
OBJECTIVE: To isolate activation of the rotator cuff muscles and avoid unwanted contractions of the deltoids. START: Hold a cable pulley or resistance band by your chest and stand with your right shoulder pointing toward the machine. You should be able to feel tension on the cable. MOVEMENT: Keeping your shoulders and hips square, press the cable straight out in front of your body, resisting the tendency to rotate toward the machine. The left shoulder should work to stop internal rotation through the movement. Hold, then slowly return your hands to your chest.
2. Step-Away Isometric Cuff
OBJECTIVE: To help the infraspinatus and the teres minor muscles contract in isolation of the deltoids, which is a key component of shoulder stability. START: Holding a cable pulley or resistance band, stand with your arm by the side of your body and your elbow at 90 degrees. MOVEMENT: Keep the arm in the starting position and lunge sideways. Focus on preventing the arm from rotating inward.
3. Plank With Ventral External Rotation
OBJECTIVE: A strong core is a key component of good shoulder function, so simultaneously performing a plank with a rotator cuff exercise is doubly beneficial. START: Adopt a plank position with a resistance band looped around your wrists. MOVEMENT: Keep your head neutral and back flat and move alternative forearms outward a couple of inches out to the side.
4. Landmine Press
OBJECTIVE: To strengthen the rotator cuff. It provides a better angle for shoulder pressing than overhead presses due to the neutral grip. START: Adopting a shoulder-width stance, pick up an anchored bar in one hand. MOVEMENT: Extend the elbow, pushing the weight up, then fully extend the hips and knees to produce maximal force.
5. Overhead Windmill
OBJECTIVE: To stabilize the scapula by making the body work around the stable arm and shoulder rather than the shoulder moving on the stable body (as in traditional shoulder presses). This works the shoulder in a different way by challenging the rotator cuff to constantly activate and stabilize. START: Press a kettlebell directly upward and maintain an extended arm throughout the exercise. MOVEMENT: With your legs at a suitable distance apart to allow both hip and shoulder flexibility, turn out- ward the foot on the opposite side to the extended arm and reach down and touch your toes. Keep your legs straight (but not necessarily locked) and your chest out.
6. Bosu Pushup
OBJECTIVE: This staple exercise of shoulder rehabilitation programs improves control of the scapula. START: Begin in an elevated pushup position on the backside of a Bosu. Brace your core and remain contracted throughout the movement. MOVEMENT: Lower your body until your chest nearly touches the surface. Pause, then push up. Once your arms are fully extended, continue pressing and drive your shoulder blades toward the ceiling. Return to the starting position.
Graham Burne has bachelor of science degrees in physiotherapy and sports science. He is a clinical specialist and physiotherapist working in the U.K.’s National Health Service, private practice, and elite sport. He is the clinical director of wholelifephysio.com. For more information, visit kxlife.co.uk.
