Rotator Cuff Book (2)

8/4/2019 Rotator Cuff Book (2)

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The Ultimate Rotator Cuff

Training Guide

Brian s chiFF , PT, cscs

Proven Exercises for Injury Prevention


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The Ultimate Rotator Cu Training GuideProven Exercises or Rehab and Injury Prevention

Copyr ght 2005 F tness Edge

All r ghts reserved. No part o th s book shall be reproduced, stored n a retr evalsystem, or transm tted by any means electron c, mechan cal, photocopy ng, record ngor otherw se w thout wr tten perm ss on rom the publ sher. No patent l ab l ty assumed w th respect to the use o the n ormat on conta ned here n. Although everyprecaut on has been taken n preparat on o th s book, the publ sher and author assumeno respons b l ty or errors or om ss ons. Ne ther s any l ab l ty assumed or damresult ng rom the use o n ormat on conta ned here n.

Th s book s publ shed by F tness Edge, nclud ng text, graph cs and mages, and s ntended or educat onal purposes. It s not ntended to make any representat ons or

warrant es about the outcome o any procedure. Th s electron c book s not ntended aa subst tute or pro ess onal med cal care. Only your doctor can d agnose and treat amed cal problem.


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About the Author

Brian s chiFF , PT, cscsgraduated rom The Oh o State Un vers ty n 1996 w tha Bachelor o Sc ence degree o Phys cal Therapy nAll ed Health Pro ess ons. S nce then, he has pract cedas a l censed phys cal therap st spec al z ng n sportsmed c ne. Through the Nat onal Strength and Cond t onAssoc at on, Br an became a cert ed strength andcond t on ng spec al st (CSCS) n 1998. He s a oundmember o The Amer can Assoc at on o Personal Tra neand recently contr buted a chapter on per od zat on toa tness book ent tledThe Power o Champions.Schalso co-authored a breakthrough manual on ACL njuryprevent on ent tledProtecting the Athletes Knee.

Currently, he owns a pr vate tness stud o and aper ormance enhancement company spec al z ng n sportspec c tra n ng programs or athletes o all sports andages. Br an s also the ormer strength and cond t on ngcoach or The Columbus Crew Major League Soccer Team.He has presented at pro ess onal con erences and coachescl n cs on top cs nclud ng tra n ng or shoulder stab lbaseball spec c tra n ng, soccer spec c cond t on ngand sport spec c tra n ng, ACL njury prevent on and sashoulder tra n ng.


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Table of Contents

Introduction ..................................................................................... 1Anatomy .................................................................................................. 2H story o Rotator Cu D sease and Pathology .............................................. 4

The Role o Posture .................................................................................... 5Common Exerc se M stakes ........................................................................ 6Injury Prevent on Tra n ng ........................................................................... 8

Scapular Stabilizer Exercises ............................................................ 10Stand ng Tub ng Row ................................................................................. 10Serratus Anter or DB Punches ...................................................................... 11Prone Lower Trap Ra se .............................................................................. 11Prone Hor zontal Abduct on Ra se ............................................................... 12

Prone Extens on Ra se w th External Rotat on .................................................12Shoulder Shrugs ........................................................................................ 13

Rotator Cu Exercises ...................................................................... 14Scapt on .................................................................................................. 14Internal Rotat on ........................................................................................ 15External Rotat on (tub ng) ........................................................................... 15External Rotat on (dumbbell) ....................................................................... 16Hor zontal External Rotat on ....................................................................... 17

Stand ng D agonal Ra se (D2 Flext on) ......................................................... 17

Bonus Exercise Section ..................................................................... 18Exerc se #1 Bench Press .......................................................................... 18Exerc se #2 Push-Up ............................................................................... 18Exerc se #3 Lat Pull Down ........................................................................ 19Exerc se #4 Upr ght Row ......................................................................... 19Exerc se #5 D ps .................................................................................... 20Exerc se #6 M l tary Press ........................................................................ 21

Exerc se #7 Dumbbell Lateral Ra se ........................................................... 22

Sample Healthy Rotator Cu Training Program ................................ 24

Injured or Infamed Shoulder Series ................................................. 25

See Your Physician ........................................................................... 31


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Introduction

Have you ever exper enced a dull ache or sharp pa n n your shoulder or upper arm?Maybe you are unable to sleep on one s de because your shoulder wakes you up atn ght. Perhaps you have d scom ort reach ng beh nd your back to tuck n your sh rt ograb your wallet. I so, you may be su er ng rom a rotator cu njury.

Most o us w ll exper ence shoulder pa n o some k nd n our l e. Due to the excessmob l ty n our shoulder jo nts, wh ch allows or great versat l ty and unct on, we oplace excess ve stress on them n our da ly l e. In order or you to e ect vely ra semaneuver your arm, the rotator cu must unct on properly.

Rotator cu njur es, such as tendon t s, burs t s and tears, plague 20-30% o peoplen our populat on. These njur es may be caused by natural degenerat on, trauma oroveruse. It s mportant to understand general anatomy and how the rotator cu unctso that you may ga n a better apprec at on or njury potent al, heal ng t me rames, proper exerc se select on.

Continued


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Anatomy

The rotator cu cons sts o our small muscles, wh ch e ect vely orm a sleeve aroushoulder and allow us to ra se our arms overhead e ect vely. These muscles, cons st no the suprasp natus, n rasp natus, teres m nor and subscapular s, oppose the act on othe delto d muscle and depress (hold down) the head o the humerus (upper arm) dur ngshoulder elevat on to prevent mp ngement. Th s allows you to e ect vely ra se yourand reach n certa n ways w thout exper enc ng mp ngement o the so t t ssue betwthe top o the shoulder blade (acrom on) and the head o the humerus.

For the purposes o th s book, I w ll not d scuss n deta l the or g ns and nsert ons oeach part cular muscle or elaborate on the nerves that nnervate them. However, t s

mportant to understand that pa n n the shoulder area can also be re erred rom the neckThere ore, one should not always assume that pa n n the upper arm s due to rotator cu

njury or tendon t s. Weakness can be seen w th neck or shoulder dys unct on. As suct s always w se to consult your phys c an such a problem ar ses.

Below, I w ll summar ze the role o each rotator cu muscle. One note to cons der:damage to one structure may not always lead to s gn cant unct onal weakness orl m tat on. These muscles work collect vely and synerg st cally w th the scapular muto produce purpose ul movement. As such, the body s able to compensate or powerde c enc es n many cases. These compensat ons may be subtle or obv ous.

Supraspinatus largely respons ble or n t at ng elevat on rom 0 30 degrees oabduct on (arm mov ng away rom and parallel to the body) and ass st ng w th elevatTh s muscle has a poor blood supply, l es beneath the acrom on and s o ten the mostcommonly a ected tendon w th regard to tendon t s or tears. Because o ts poor bloo

supply, t heals slowly and s prone to recurrent bouts o nfammat on.Infraspinatus respons ble or externally rotat ng the arm or mov ng t away rom body when the arm s at the s de or when cock ng to throw a baseball. Th s muscle alsohelps decelerate the arm dur ng ollow through rom an overhead mot on (e.g., p tch ng

Teres Minor also respons ble or external rotat on n the same way the n rasp natunct ons. In add t on, t also helps decelerate the arm dur ng ollow through rom an

overhead mot on (e.g., p tch ng).

Subscapularis respons ble or nternal rotat on or pull ng the arm n toward the bowh le at the s de. Th s muscle also ass sts n ollow through dur ng throw ng. Becaumuscle per orms the same act on as that o the pectoral s major, lat ss mus dors and tmajor, t s somet mes d cult to detect weakness.


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Equally mportant to the proper unct on o the shoulder s a group o muscles known ascapular stab l zers. These muscles have attachments to the scapula (shoulder blade) andd rectly contr bute to shoulder mot on by a ect ng the path o movement o the shoulblade. You see, or every 2 degrees o shoulder abduct on (arm movement away romthe body n the same plane as the body), there s 1 degree o scapular elevat on. Theshoulder blade moves n add t on to the arm to allow or the great reedom o movemenwe enjoy. W th weakness or njury, th s rhythm o movement becomes altered.

Scapular stab l zer muscles nclude:

Serratus anterior - protracts or rounds the shoulder blade

Upper trapezius - shrugs and upwardly rotates the shoulder blade

Middle trapezius - retracts or p nches the shoulder blade nward

Lower trapezius - depresses and upwardly rotates the shoulder blade

Rhomboids - retract or p nch the shoulder blade nward

These muscles work synerg st cally (together) w th the rotator cu to ensure smoothmovements w thout shoulder mp ngement.

Anatomy

The in raspinatus and teres minor muscles are not pictured as they are positioned on the back o the shoulder blade. This illustration only re ers to the ront o the shoulder joint

Glenoid labrum

Supraspinatus

Head of humerus Joint capsule

Scapula

Clavicle Coracoid process AcromionSupraspinatus

Subscapularis

HumerusRibs


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Some people are predest ned to have shoulder problems. Why? To a large degree, theshape o the acrom on (top o the shoulder blade) plays an mportant role n the health othe rotator cu t ssue. There are three types o acrom on: fat, hook shaped and normal.The fat and hook vers ons carry a h gher r sk o poss ble njury, w th the hook stylepos ng the greatest threat. I you have a fat or hook shaped acrom on, there s less roomor the so t t ssue (muscle and tendon) to gl de and move dur ng arm mot on. Over t mth s naturally leads to more r ct on and wear and tear. Th s may lead to an eventual tea

Typ cally, most people exper ence an acute onset o shoulder pa n. It s o ten relatedto v gorous repet t ve act v t es or trauma such as l t ng, pa nt ng, throw ng, alljamm ng the shoulder. Th s type o pa n s generally labeled tendon t s or burs t s. may have pa n ly ng on the a ected s de, reach ng up overhead, reach ng beh nd back, dr v ng or attempt ng to l t w th the arm out away rom the body.

Tendon t s usually responds well to rest, ant - nfammatory med cat on, ce and rotatorcu spec c strengthen ng. Recovery t me may range rom 4 weeks to several monthsdepend ng upon the compl ance o the nd v dual, the onset o symptoms pr or totreatment, the age o the nd v dual, and whether or not there are any phys cal changes the tendon (structural changes nclud ng th cken ng or scar t ssue ormat on are re erras tendonos s). X-rays are mportant as they w ll reveal any arthr t c change.

Rotator cu tears present d erently. The hallmark s gns o a tear are nocturnal pa nloss o strength, and nab l ty to ra se the arm overhead. Also look or a shrug s gn,wh ch the person uses the upper trap to ra se the arm because the rotator cu s not ableto depress the humeral head e ect vely. Rotator cu tears are most common n men ag

65 and older. Tears and/or njury are typ cally related to degenerat on, nstab l ty, bonspurs, trauma, overuse, and d m n shed strength/fex b l ty related to the ag ng processHowever, youth are also at r sk or njury they are nvolved n repet t ve overheadsports, nclud ng sw mm ng, volleyball, baseball, so tball, tenn s, gymnast cs, etc.

Many people can unct on adequately w th a torn rotator cu prov ded they have a lowto moderate pa n level. The pr mary reason or per orm ng rotator cu surgery s toallev ate pa n rather than to restore unct on. It s common or post-surg cal pat ents lose some mob l ty/range o mot on. Strength recovery s d ctated by the s ze o tearqual ty o the torn t ssue at the t me o surgery, t me elapsed between njury and repaand the surgeons ab l ty to recreate the proper anatom cal relat onsh p.

Recovery ollow ng rotator cu repa r may take up to 18 months. However, most peopare able to return to the major ty o the r act v t es o da ly l v ng n 3-6 months. Emob l zat on, range o mot on and progress ve strengthen ng exerc ses n phys cal tare cr t cal to rega n ng unct onal mot on and strength.

History of Rotator Cuff Disease and Pathol ogy


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Common Exercise Mistakes

All too o ten I see people n the gym per orm ng exerc ses ncorrectly. Th s may not to an mmed ate njury, but over t me t w ll cause tendon t s, pa n, and lost t me rwork ng out. As de rom l t ng mproperly, many exerc se enthus asts attempt to lmuch we ght. Th s comb nat on s a proven rec pe or njury. Below, I w ll d scusscommon exerc ses that o er potent al r sk or njury when per ormed mproperly. Wa ew s mple mod cat ons, these exerc ses del ver max mum results w thout pos ngdanger to your health.

Bench Press Th s s a popular exerc se chosen to bu ld the chest, along w th theanter or delto d and tr ceps. Most teach tak ng the bar down unt l t l ghtly touches thchest. However, I bel eve th s s unsa e because t exposes the anter or shoulder capsuto excess ve load, n add t on to compress ng the so t t ssue o the rotator cu betwethe humerus and the acrom on. Over t me, w th repeated bouts and heavy loads, therotator cu becomes nfamed. Ind v duals w th any anter or shoulder lax ty (looseneh story o subluxat on, d slocat on or nstab l ty are also at ncreased r sk or rotato

njury or labral (shoulder cart lage) damage. Furthermore, you also have the potent al torupture the pectoral s tendon (chest) w th ull range press ng dur ng heavy loads. The sanswer s to lower the bar unt l the upper arm s parallel to the foor (elbow bent to 90degrees). Th s prevents the shoulder jo nt rom mov ng nto the unsa e range. The samadv ce appl es to push-ups and dumbbell f es.

Lat Pull Downs Th s s a good exerc se to strengthen the back, but when donebeh nd the head t can cause problems. L ke the bench press, pull ng the bar downbeh nd the head pos t ons the humerus n such a way that the rotator cu can be p nchTh s may depend on other actors, nclud ng the shape o a persons acrom on and

degree o any present arthr t s, but I st ll bel eve the r sk outwe ghs any bene t. Not tment on that keep ng the bar n ront o the head st ll accompl shes the same movemeor the target muscle, wh le el m nat ng the r sk o shoulder njury. Remember not to

sway dur ng the movement, and pos t on the body n a sl ghtly recl ned pos t on (20-degrees), wh le pull ng the bar toward the sternum. Another unrelated reason not to dobeh nd the neck pull downs s that t places undue stress on the cerv cal sp ne.

Military Press Th s exerc se, when per ormed beh nd the neck w th a bar, pos tthe shoulder n the a orement oned un avorable pos t on. Done repeatedly, the rotatorcu can become nfamed. S m lar to beh nd the neck pull downs, you also expose youneck to unnecessary stress. It s sa er to per orm the exerc se n ront o the head or udumbbells and work n the scapular plane (a pos t on about 30-45 degrees orward othe plane o the body). You must watch to avo d arch ng the low back, and t s best touse a bench w th back support to prevent th s.


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Dips/Upright Row As be ore, the key m stake made w th these exerc ses sallow ng the shoulder to move beyond 90 degrees relat ve to a pos t on parallel tothe foor or perpend cular to the body. I always recommend stopp ng at 90 degreesto protect the shoulder capsule and the rotator cu . These are also not exerc ses Irecommend to those just beg nn ng to work out. It s best served to ncorporate them adevelop ng a base level o strength and master ng bas c l t ng movements. People wA-C (acrom o-clav cular) jo nt arthr t s should probably avo d d ps, as th s jo nt undmuch stress.

Dumbbell Lateral Raise I bel eve th s exerc se s o ten done ncorrectly. Them stakes nclude l t ng too much we ght, keep ng the arms stra ght, and ra s ng theout away rom the body n the plane o the body. The orce on the rotator cu reaches90% o your body we ght when the arms are ra sed to 90 degrees w th the arms stra ghtand n the plane o the body. That s a lot o orce on our relat vely small rotator cumuscles. The target muscle s the lateral delto d, but the rotator cu s extremely act vand t unct ons to allow you to ra se the arm by depress ng the humerus so that t passunder the acrom on dur ng act ve elevat on. When heavy loads are ntroduced n thewrong plane o mot on, d saster usually occurs. I am anat cal about per orm ng th sexerc se correctly. The proper way to execute a lateral ra se s to keep the elbowscom ortably fexed (20-30 degrees) and ra se the arm to no h gher than parallel to thefoor. The arm should be n the scapular plane o mot on (approx mately 30-45 degrees

orward rom the plane o the body) and the we ght should be relat vely l ght. Once yoeel you have to shrug or use momentum to ra se the we ght, you need to rest or lower

the we ght. I eel th s s absolutely one o the worst exerc ses or the shoulder donncorrectly.

In summary, I want to emphas ze that good ntent ons may spell bad results or theshoulder proper orm s lack ng. The rotator cu and shoulder jo nt s extremelyvulnerable to heavy loads and repet t ve bouts o exerc se. Gradually, t may become

nfamed and h nder or l m t your workout altogether. Be sure to master orm be orencreas ng we ght, and do not attempt to work through pa n, as th s o ten perpetuates th

problem. Remember to assess r sk and reward at all t mes, and rest assured that thesemod cat ons w ll not h nder your ga ns. Instead, they w ll prevent m ssed t me n tand produce happ er, health er shoulders!

Common Exercise Mistakes


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injury P revenTion Training and r ehaB

In the ollow ng sect on, I w ll outl ne spec c exerc ses that are des gned to prevent or rehab l tate shoulder njur es to the rotator cu . Keep n m nd that these exerc senot meant to serve as a subst tute to med cal care rom a phys c an or phys cal therap

you are currently exper enc ng shoulder pa n. But, they prov de a good bluepr nt healthy shoulder exerc ses and should reduce the l kel hood o a uture njury.

The key to avo d ng rotator cu njury s per orm ng adequate cond t on ng pr or stress ng t w th v gorous act v t es. Many weekend warr ors try to p ck up the so tbaseball, ootball, etc. and beg n throw ng repet t vely and orce ully w thout properlwarm ng up. In add t on, they are not l kely to cond t on be ore the season l kecompet t ve athletes.

Th s o ten leads to excess ve stra n on the rotator cu and swell ng. The nev table s soreness, espec ally w th overhead movement or reach ng beh nd the back. The act

o throw ng s the most stress ul mot on on the shoulder. The rotator cu s orced todecelerate the humerus dur ng ollow through at speeds up to 7000 degrees/second.

W thout proper strength and cond t on ng, the shoulder eas ly becomes nfamed.S nce the rotator cu muscles are small, t s best to ut l ze lower res stance and h ghrepet t ons to su c ently strengthen them. Gradually ncreas ng the ntens ty and voo act v ty s cr t cal to avo d ng an overuse njury (part cularly common among yothrow ng athletes).

Remember, these are not bodybu ld ng type muscles. You w ll not use heavy loads orexpect to see great muscle hypertrophy. The payo comes n per ormance and njury

prevent on. Who wants to m ss any play ng t me? The answer s obv ous, but rotator pa n w ll restr ct most overhead athletes, and t o ten necess tates some rest n competoverhead athletes.

The ollow ng exerc ses should be per ormed at least 6-8 weeks pr or to preseason oroverhead athletes such as sw mmers, p tchers, volleyball players and quarterbacks. Forpos t on players n baseball and so tball, I generally recommend that they cond t on thecu at least 4 weeks pr or to preseason dr lls beg n. It s also mportant or throw ngathletes to use an nterval throw ng program n the preseason to cond t on the shoulder repet t ve throw ng at d erent d stances and veloc t es.

Dur ng the n-season, each o the a orement oned athletes should per orm rout nema ntenance rotator cu strengthen ng 1-2x/week or cont nued njury prevent on. Wregard to the general tness cl ent, I recommend us ng rotator cu tra n ng at least 1-2week, espec ally you have any pre-ex st ng cond t on or h story o njury. I youa current ssue, perhaps do ng these exerc ses three t mes per week w th a day o rest between would be best.


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injury P revenTion Training & r ehaB

The exerc ses should not cause pa n at any t me. Per orm ng them n a pa n ree rangmot on s an absolute must! Certa nly, pa n does not equal ga n here. Generally, t snot to use loads greater than 4% o your body we ght (gu del ne advocated by CharlesNeer, M.D.). I can not emphas ze enough that these are small relat vely weak musclesthat are neglected by most o you n the gym. L ghter loads and h gher reps s de n tethe way to go.

Below you w ll nd a l st o appropr ate scapular stab l zer and rotator cu exerc seThese exerc ses are des gned to mprove posture, correct muscular mbalances, andstrengthen the rotator cu . They are not ntended to bu ld lean muscle. Keep ng str ctand per orm ng these exerc ses n a sa e, pa n ree range o mot on s essent al.

Wh le there s no de n t ve order n wh ch to per orm these exerc ses, I generally sugthat you do the scapular exerc ses rst s nce they are the larger muscle group.


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Standing Tubing Row

s caPular s TaBilizer e xercises

Th s strengthens the m ddle trapez us, poster or delto d and rhombo ds. Us ng a pole door, pos t on the tub ng so that the handles are even. Stand w th the eet shoulder w dapart and the knees sl ghtly bent (relaxed). Beg nn ng w th some res stance (tube s tapull toward the body, squeez ng the shoulder blades together and keep ng the elbowsat your s de. Pause or 1-2 seconds and then return to the start ng pos t on. Per orm 2sets o 10-15 repet t ons. Th s can also be done w th a mach ne. An alternate method

s keep ng the elbows out w th the arms abducted ~ 90 degrees. Th s pos t on ng placmore emphas s on the poster or delto d, rhombo ds and m ddle trap, as compared togreater ass stance rom the lat ss mus dors w th the low row.

Low Row

High Row1 2


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Serratus Anterior DB Punches


Th s strengthens the serratus anter or, a muscle wh ch helps to stab l ze the shoulderblade dur ng arm elevat on. Lay ng on the back w th the knees bent and eet fat, pressthe dumbbells toward the ce l ng mak ng sure to keep the elbows stra ght. The shoulderblades w ll round orward and l t o the foor. Pause at the top o the movement, andlower w th control to the start ng pos t on. Per orm 2 sets o 15 repet t ons.

Prone Lower Trap RaiseTh s strengthens the lower trap, wh ch s o ten weak and at gues qu ckly. Th s muscdepresses the shoulder blade and prevents mp ngement. Us ng a stab l ty ball, ra se tharms up n a 45 degree angle as ar as the shoulders allow w thout d scom ort. Pause atthe top, and lower slowly to the start ng pos t on. Th s s an awkward mot on, and t best to use a l ght we ght and ocus on controll ng the mot on. It s also acceptable to th s exerc se ly ng ace down on a bench. Per orm 2 sets o 15 repet t ons.

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Prone Horizontal Abduction RaiseTh s strengthens the m ddle trapez us and rhombo ds, wh ch promote good posture.Us ng a stab l ty ball, ra se the arms out away rom the body unt l they are near paralleto the foor. Keep the palms down and p nch the shoulder blades together at the top othe mot on. Lower slowly to the start ng pos t on. It s also acceptable to do th s exerly ng ace down on a bench. Per orm 2 sets o 15 repet t ons.

Prone Extension Raise with External RotationTh s strengthens the poster or delto d and lat ss mus dors , n add t on to the posterrotator cu muscles. Us ng a stab l ty ball, ra se the arms along the s de o the body they are even w th the body. It s mportant to keep the palms ac ng down dur ng thexerc se (th s pos t on externally rotates the shoulder) as th s creates greater rotator cuact vat on. Pause at the top, and slowly lower to the start ng pos t on. Per orm 2 sets 15 repet t ons.

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Shoulder ShrugsTh s strengthens the upper trapez us. Stand ng w th the arms rest ng at the s de othe body, shrug the shoulders stra ght up toward the ce l ng. Pause at the top or 1-2seconds. Slowly lower the we ght to the start ng pos t on. It s mportant not to roll thshoulders orward or backward as th s may cause grat ng o the scapula on the chestwall, not to ment on the upper trap muscles pr mary act on s shoulder elevat on. W thth s exerc se, t s okay to use loads heav er than 4% o body we ght. Per orm 2-3 se10-15 repet t ons.

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r oTaTor c uFF e xercises

ScaptionTh s strengthens the suprasp natus muscle, the most commonly a ected rotator cu muand slowest to heal. Stand w th the knees sl ghtly bent (relaxed) hold ng the dumbbells

n such a way that your thumbs are up or on top o the dumbbells. Keep the armsapprox mately 30-45 degrees orward rom be ng perpend cular or stra ght out awayrom the body (scapular plane) and ra se the arms up to shoulder he ght. Pause at the top

and slowly lower to the start ng pos t on. Keep the elbows stra ght throughout the ent rmovement. Avo d any part o the range o mot on that causes pa n. Per orm 2 sets o20 repet t ons.

Side View


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External Rotation (tubing)Th s strengthens the n rasp natus and teres m nor muscles. In stand ng w th the kneerelaxed, hold tub ng and beg n w th the arm pos t oned at the s de (neutral) w th l ghttens on on the tub ng. Now, pull the arm away rom the body, wh le keep ng the elbowclose to your s de. Do not allow the shoulder to rotate backward. Per orm 2 sets o 15-20 repet t ons.

Internal RotationTh s strengthens the subscapular s muscle, as well as the chest muscles. In stand ng w tthe knees relaxed, hold tub ng and beg n w th the arm pos t oned at the s de (neutral)w th l ght tens on on the tub ng. Now pull the arm across the body to the stomach, whkeep ng the elbow at your s de. Do not allow the shoulder to rotate orward. Per orm 2sets o 15-20 repet t ons.

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External Rotation (Dumbbell)Th s too strengthens the n rasp natus and teres m nor. Beg n n a s de ly ng pos t othe elbow at the s de o the body and the arm n neutral. Slowly ra se the dumbbellthrough a ull pa n ree range o mot on, wh le keep ng the elbow at your s de and theslowly return to the start ng pos t on. Per orm 2 sets o 15-20 repet t ons. It s generabest to use a l ght dumbbell.

NotesYou do not need to do both tub ng and dumbbell external rotat on. Choose one method.However, you are exper enc ng ongo ng pa n or nfammat on, I recommend us nga dumbbell or no res stance at all n the s de ly ng pos t on. The key d erence s ththe tub ng o ers ncreas ng res stance throughout the exerc se as the muscles ab l tygenerate orce decl nes.

In contrast, a dumbbell o ers cons stent res stance throughout the exerc se. W th adumbbell, the ab l ty to l t the we ght s dependent upon ra s ng the dumbbell up agagrav ty at the beg nn ng o the mot on. Th s does not requ re added tens on or e orthe end o the movement, whereas the tub ng does.

You may also choose to place a small rolled towel between the ns de o the elbow andthe s de o your body to emphas ze keep ng the elbow n and avo d ng compensatorymot on rom the shoulder blade.

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Horizontal External RotationTh s strengthens the n raps natus, teres m nor and poster or delto d. It also works theshoulder n a more unct onal plane. S tt ng on a stab l ty ball (or bench), beg n w th90 degrees away rom the body w th the palm o the hand ac ng the foor. Ra se thedumbbell up to 90 degrees and slowly return to the start ng pos t on. Per orm 2 sets o15-20 repet t ons.

Standing Diagonal Raise (D2 Flexion)Th s s a more advanced exerc se that strengthens the ent re rotator cu . It also max mstresses the cu as t places t n an overhead pos t on. Beg n n stand ng w th relaknees and w th the palm aga nst the oppos te th gh. Slowly ra se the dumbbell up andoverhead. As the arm elevates, you w ll allow the orearm to rotate out and the thumb tomove rom a downward to an upward pos t on (h tchh k ng pos t on). Lower slowly start ng pos t on. Per orm 2 sets o 15-20 repet t ons.

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Bonus e xercise s ecTion

Exercise # 3 Lat Pull DownsTh s exerc se s des gned to strengthen the back, spec cally the lat ss mus dors . In past, many have done th s exerc se beh nd the head. In add t on to plac ng unnecessarstress on the neck, th s pos t on ng puts added stress on the shoulders. Pull ng the barbeh nd the head orces the humerus nto the top o the shoulder blade and can compressthe rotator cu . In l ght o th s, I suggest pull ng the bar to the sternum. Recl ne the bapprox mately 20-30 degrees and lower the bar n ront o the head, squeez ng theshoulder blades down and together.

Exercise # 4 Upright RowTh s exerc se s a popular method o strengthen ng the shoulders and add ng muscle mato the lateral delto ds and upper traps. It may be done w th dumbbells, tub ng or w th acable attachment. The key to avo d ng damage w th th s exerc se s to stop the movemonce the arms reach 90 degrees, or are parallel to the ground. Go ng above th spos t on w ll lead to mp ngement o the rotator cu . Remember to lead w th the elband allow the hands to ollow n a natural path o mot on.


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Exercise # 5 DipsD ps are d cult or people to do and place a lot o stress on the shoulder complex. Inadd t on to plac ng h gh demands on the shoulder jo nt and rotator cu tsel , the claand acrom o-clav cular jo nt s also exposed to s gn cant loads dur ng th s exerc seare des gned to strengthen the upper body, more spec cally the chest, shoulders, andtr ceps. Th s exerc se s s m lar to the upr ght row w th regard to shoulder pos t on

Whether us ng a d p apparatus, ass sted d p mach ne or fat bench, t s mportant notto lower the body past a po nt where the upper arms are parallel to the foor. I do notrecommend th s act v ty (even when done properly) or people w th current rotator cu

njur es, A-C jo nt arthr t s, shoulder nstab l ty, or those w th part al/complete rotattears or pr or surgery to repa r a tear.


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Exercise # 6 Military PressTh s s by ar one o the most popular and e ect ve means to bu ld shapely shoulders.For the same reasons expla ned earl er w th the lat pull downs, I aga n recommend notper orm ng shoulder presses beh nd the head. Add t onally, t s mportant not to lowerbar or dumbbells below the po nt where the upper arms are parallel to the foor (shoulderhe ght) to avo d compress ve orces on the cu . I also suggest keep ng the arms n thescapular plane throughout the movement (30-45 degrees orward o the plane o the body).Lastly, keep your back pressed rmly aga nst the bench dur ng the exerc se. I the backbeg ns to arch, th s typ cally means the we ght s too heavy or you are becom ng at guTh s exerc se should not be done you are exper enc ng pa n w th overhead mot on.

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Perhaps, th s s one o the most common shoulder exerc ses I see rout nely donencorrectly. It s a great way to strengthen the lateral delto d, but when done w thmproper techn que, t o ten leads to rotator cu tendon t s.

The most common m stake I see s per orm ng th s act v ty w th the arms completelystra ght and mov ng them out d rectly away rom the s de. Keep ng the arms stra ghtprov des a long lever and places a h gh amount o torque on the jo nt and rotator cu .W th th s al gnment, you also encourage shoulder mp ngement. It s essent al to keepshoulders n the scapular plane throughout.

The second major m stake s us ng too much we ght. Heav er loads requ re us ngmomentum and other larger muscles to accompl sh the l t (such as the low back andh p extensors). Men are generally the b ggest o enders on th s po nt. Remember, themovement should be slow, and you should be able to pause momentar ly at the top o thel t.

Next, I o ten w tness people ra s ng the r arms above shoulder he ght. Although the cuunct ons most rom 70 120 degrees o elevat on, I have ound that ra s ng the arm

above 90 degrees encourages mp ngement n a loaded shoulder and o ten aggravates apersons symptoms. Somet mes, t s necessary to l m t the range o mot on urther bon pa n. Th s s okay. As a matter o act, you should only per orm the exerc se w thwe ght and range o mot on that does not ncrease pa n.


Exercise # 7 Dumbbell Lateral Raise


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Exercise # 7 Dumbbell Lateral Raise (continued)

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The nal error s related to set-up pos t on. Many s mply stand erect w th the r eet tclose together dur ng th s exerc se. A better method s to stand w th the eet shoulderw dth apart and the knees sl ghtly bent. Th s w ll prevent cheat ng by us ng momentuand engage the core muscles throughout the exerc se. It s mportant to ma nta n a fatback or the natural curve o your sp ne n th s athlet c pos t on.

Th s exerc se s s m lar to scapt on, but places a greater load on the lateral delto d duto the d erent hand pos t on (palm down). I you are unable to do lateral ra ses w tpa n, scapt on w ll also act vate the lateral delto d and serve as a good precursor toreturn ng to lateral ra ses.

I generally recommend avo d ng lateral ra ses w th bands or tub ng as the loadcont nually ncreases, wh le the muscles ab l ty to generate orce decreases. W threpet t on, th s approach to tra n ng leads to a sore shoulder. Per orm ng th s exerca cable also prov des a s gn cant challenge n terms o controll ng the movement andshould only be done occas onally w th l ghter we ght and per ect orm.

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s amPle h ealThy r oTaTor c uFF Training P rogramHealthy Shoulder Series (2x/week)

Scapular Stabilizer MusclesRows 3 sets o 10-15 repsLat Pull Downs 3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsSeated Dumbbell Hor zontal External Rotat on 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 reps

Day #1

Scapular Stabilizer MusclesProne Lower Trap Dumbbell Ra se 2 sets o 15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsExternal Rotat on w/Arm at S de (tub ng or dumbbell) 2 sets o 15-20 repsStand ng D agonal Dumbbell Ra se 2 sets o 15-20 reps

Day #2


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injured or inFlamed s houlder s eries 6 Week Program (3x/week)

Dur ng th s program, t s generally best to avo d overhead l t ng. Once most o thed scom ort resolves, you can gradually resume overhead tra n ng.

At the complet on o the n t al 4 weeks, you should not ce mproved strength, more rao mot on and less d scom ort w th shoulder movements and unct on. Throughout thnone o the exerc ses should cause any d scom ort or pa n. I you can not per orm anexerc se w thout pa n, t s best to l m t the range o mot on or d scont nue t altog

I you are mak ng progress w th the exerc ses, then you can progress to the nal phase oth s 6 week program. In the nal phase, more emphas s s placed on trans t on ng backto overhead pos t ons and unct onal movements. Less emphas s s placed on shrugs anserratus punches, as su c ent stab l zat on strength should have been atta ned n the month o tra n ng. Aga n, t s cr t cal to make sure the exerc se s completely pa n

Training Notes


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Scapular Stabilizer MusclesLow Row 2-3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsExternal Rotat on (Dumbbell) - 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 reps

Day #1 (Week 1 & 2)

Scapular Stabilizer MusclesLat Pull Downs 3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 reps


Day #2 (Week 1 & 2)

Scapular Stabilizer MusclesH gh Row 3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 reps


Day #3 (Week 1 & 2)


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Scapular Stabilizer MusclesLow Row 2-3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 reps


Day #1 (Week 3 & 4)

Scapular Stabilizer MusclesLat Pull Downs 3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsSeated Dumbbell Hor zontal External Rotat on 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 reps

Day #2 (Week 3 & 4)


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Scapular Stabilizer MusclesLat Pull Downs 3 sets o 10-15 repsSerratus Dumbbell Punches 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsExternal Rotat on (Dumbbell) - 2 sets o 15-20 repsSeated Dumbbell Hor zontal External Rotat on 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 reps

Day #3 (Week 3 & 4)


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Scapular Stabilizer MusclesLow Row 2-3 sets o 10-15 repsProne Lower Trap Dumbbell Ra se 2 sets o 15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsExternal Rotat on (Dumbbell) - 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 repsSeated Dumbbell Hor zontal External Rotat on 2 sets o 15-20 reps

Day #1 (Week 5 & 6)

Scapular Stabilizer MusclesH gh Row 2-3 sets o 10-15 repsProne Lower Trap Dumbbell Ra se 2 sets o 15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 repsSerratus Dumbbell Punches 2 sets o 15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 repsStand ng D agonal Dumbbell Ra se 2 sets o 15-20 reps

Day #2 (Week 5 & 6)


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Scapular Stabilizer MusclesLat Pull Downs 3 sets o 10-15 repsProne Lower Trap Dumbbell Ra se 2 sets o 15 repsProne Hor zontal Abduct on Ra se 2 sets o 15 repsProne Extens on Ra se w/External Rotat on 2 sets o 15 repsDumbbell Shoulder Shrugs 2-3 sets o 10-15 reps

Rotator Cuff MusclesScapt on 2 sets o 15-20 repsSeated Dumbbell Hor zontal External Rotat on 2 sets o 15-20 repsInternal Rotat on w/Tub ng 2 sets o 15-20 repsStand ng D agonal Dumbbell Ra se 2 sets o 15-20 reps

Day #3 (Week 5 & 6)


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s ee y our P hysician

The prev ous exerc se program s not ntended to replace pro ess onal med cal care bya phys c an or phys cal therap st. It s s mply des gned to strengthen the rotator cuscapular stab l zer muscles, correct muscular mbalances and mprove shoulder unct o

you su er rom chron c shoulder pa n, exper ence an acute onset o s gn cant shoulor not ce gross weakness and l m tat on w th act v t es o da ly l v ng, t s recom you see your phys c an or a complete evaluat on.

A ter complet ng the s x week program, you may not be pa n ree. In th s case, I generrecommend cont nu ng w th week 5 and 6 exerc ses or several more weeks unt l yoursymptoms resolve. Chron c pa n o ten takes longer to respond to treatment. I you do noexper ence mprovement w th the program, t s recommended that you seek pro ess omed cal evaluat on and treatment.

W th that sa d, I hope the n ormat on n th s book w ll enable you to tra n more sae c ently n the uture. At the very least, the techn ques descr bed here w ll allow yoavo d many common exerc se p t alls that lead to compress ve wear and tear on the rotacu tsel . Wh le t s not absolutely necessary to per orm rotator cu strengthen nweekly bas s, I h ghly recommend ncorporat ng the tra n ng mod cat ons as outl nw th respect to the bonus exerc ses. In add t on, keep n m nd the mportance o postfex b l ty and rotator cu strengthen ng n relat on to proper shoulder unct on.

For more in ormation regarding my training or consulting services you can e-mail me at bschi @theftnessedge.cc or visit www.theftnessedge.cc.


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