rehab

Training the Rotator Cuff: Assessing and Programming for Optimal Shoulder Performance

Whether you’re an aspiring collegiate baseball player trying to improve throwing velocity, or a weekend warrior trying move serious weights, it’s important to understand how to keep your shoulders healthy to truly maximize the benefits of an aggressive strength training program. As a coach thats worked with hundreds of baseball athletes, I'm often asked how to incorporate certain exercises to have strong and healthy shoulders. Given the unique velocity and range of motion demands of the baseball players that I work with, I've learned some important lessons on how to keep shoulders both moving and functioning properly.

So...here we go.

The Cuff

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The rotator cuff is made up of 4 muscles (supraspinatus, infraspinatus, teres minor, subscapularis), and its main role is to keep the humeral head centered in the glenoid.

While that may sound simple in theory, it's really a complicated process because it's analogous to keeping a golf ball centered on a golf tee. To make things even more difficult, let’s imagine that golf tee is moving:  as you raise your arm overhead to throw a ball or to press a dumbbell or barbell, the position of the scapula will change, so we hope the rotator cuff is able to provide enough dynamic control to prevent contact with the acromion, thus avoiding impingement.

When I first assess clients as they come in, I usually see three main limitations at the shoulder:

1.  Faulty position of the scapula relative to the ribcage

2.  Poor rotator cuff strength

3.  Poor motor control of the shoulder

It’s important to understand the cycle of injury, and how each of these limitations impacts that cycle.  Here's a great graphic illustrating just that.  In particular, this graphic does an outstanding job depicting how a lack of strength (functional instability) can lead to earlier onset of fatigue, poor motor control, and mechanical instability (laxity/pathology).  Aka things we don't want.

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Here's another fun fact to consider before we move on:  cumulative fatigue increases sympathetic tone as a stress response, thus creating sub optimal joint positioning (cue mind blowing).

All in all, what we're talking about is balancing position, strength, fatigue and motor control.

It's All About Position

When looking to enhance shoulder health, it all starts with making sure you have ideal joint positioning. If the muscles can’t generate good leverage and moving segments don’t articulate well with stationary segments, a joint isn’t going be able to move freely or produce/withstand maximal forces.

A very basic example of that can be seen via a length-tension and force-length relationship.  While these graphs are getting after the same thing, I've given you both to help you better understand what's happening:

As the above graphs illustrate, there's an optimal resting muscle length that allows for just the right amount of overlap between myofibrils for force production.  Once you get outside that range, the muscle will not function as optimally (this is what happens when position is out of whack).

Most ardent clients will come in looking something like this:

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They are very Lat dominant, bilaterally extended through their rib cage, with anteriorly tipped scapulae. On the table, they will likely present with bilaterally limited shoulder IR and bilaterally limited shoulder flexion.

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Before we try and do any sort of mobility work, or address rotator cuff strengthening, we need to re-establish a more neutral resting position for the shoulder and optimal starting position for the muscles to do their jobs! I like to start with an All Fours Belly Lift Drill.

All we are looking for here is a good bilateral reach through the floor, creating an activation of both Serratus Anterior (protraction), and creating some desperately needed thoracic flexion. The key once in this positon, is to deeply inhale, getting air into your upper back, then forcefully exhaling and drawing your ribs down. This is repeated for 5 breaths.

Creating Strength

When it comes to strengthening the rotator cuff I usually implement drills focusing on shoulder abduction, or external rotation. These are two motions that will typically fail upon muscle testing. Since the posterior cuff is heavily relied upon to decelerate the arm at the tail end of the throwing motion, I focus specifically on developing the strength of these muscles with our baseball players.

External rotation drills at 90 degrees are usually best, and I will use a variety of dumbbells, manual resistance, or cable resistance.

I look for good ball in socket rotation, and for the client to feel activation in the posterior shoulder, not in the front.

Another drill I started to implement a lot within the last year or so is the Chain Full Can.

I like that this drill utilizes variable resistance from the chains, creating a gradual increase in resistance as the athlete flexes their shoulder in the scapular plane. Also, to be honest, it makes a fairly boring drill typically used with small pink or purple dumbbells into something a little bit more legit.  This matters when you're working with a bunch of baseball players who are secretly enormous meatheads on the inside.

At the initial portion of this movement, if someone has weakness in their rotator cuff they may either crank back into lumbar extension or shrug to compensate their way to the top portion of the lift.  Since most of the links are resting on the floor at the beginning of this movement, the load is less, so the athlete is less apt to compensate to flex their shoulder.   At the top portion of the lift, all of the links are off of the ground and the load is highest where the rotator cuff needs to be strengthened most.

Using chains for this drill also increases grip demands, which causes reflexive rotator cuff activation. And finally, chains are unstable, since they’re suspended in the air, creating the need for added contribution from the rotator cuff to stabilize the shoulder in the glenoid as it goes through a full range of motion.

Control and Timing

The next step is to integrate motor control and rotator cuff timing to ensure proper dynamic stability of the shoulder. Rhythmic Stabilizations are my go to drills to these qualities in varying positions of instability. These drills force you to react to external resistance to stabilize whatever joint is being acted upon, enhancing proprioceptive control and timing of the rotator cuff and the muscles that act upon the scapulae.

These are great drills to train rotator cuff control/timing in various positions without excessively loading up the shoulder. I actually conducted my Master’s Thesis on the implementation of Rhythmic Stabilization drills and their effect on throwing performance. I found that players who presented with a greater degree of laxity benefitted more in terms of throwing performance—measured in velocity. Clients that may present with higher degrees of laxity lack the ability to stabilize their joints through muscle stiffness. Therefore, these drills can be really beneficial in addressing this deficit in motor control.

Where to Go

The big question now is where does all of this fit together into a program? I find that you can split up your rotator cuff strength and motor control work into separate days. For instance, any rhythmic stabilization drills would pair nicely with a primary lower body lift since it's low load and can be done as active rest. I usually program for 3-4 sets of 5-10 seconds depending on number of positions and overall difficulty.

When incorporating direct rotator cuff work, I will put these exercises at the end of an upper body training session to mitigate overall effects of fatigue. I will usually program 2-3 sets of 8-12 reps on a given training day. Try adding these in to your overall training routine and let me know what you think.

Closing Thoughts

It’s important to understand that building rotator cuff strength and control is a sequential process. At each phase of a training program, the exercises must coordinate with training goals. All in all, the key is finding out what you need as an individual and then attacking the weakest link. If you are generally lax, stretching may be the worst thing you can do! However, if you're toned up and positioned horribly, training for stability might come secondary to repositioning and improving range of motion.

I know that was a lot of technical information, so if you feel like you're head is spinning in three different directions don't hesitate to drop me a line below in the comment section.

about the author

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Sam Sturgis

Sam holds a Bachelor’s Degree in Athletic Training from Quinnipiac University (2010) and Master’s Degree in Strength and Conditioning from Springfield College (2012).  A skilled Strength Coach and Athletic Trainer at Pure Performance Training in Needham, MA, Sam works primarily with baseball athletes and clients rehabilitating from injury.  Sam has developed a successful off-season baseball Strength & Conditioning program for youth athletes in the greater Boston area. Sam also serves as the Athletic Trainer for the New England Ruffnecks baseball program.

To contact Sam, he can be reached at ssturgisppt@gmail.com

Programming Around An Injury: 5 Things You Have to Know

In all long term pursuits there are obstacles that define you. The path to success isn’t exactly linear. In the realm of iron, often times these obstacles are pain or injury related. And believe it or not…working through pain and/or injury usually isn’t your best option.

Way too often I see people loose their hard earned gains over an injury, and it’s sickening.

It’s important to understand that there are certain phases of an injury where it may not be in your best interest to train around it, however, there are certainly instances where an athlete can continue to make strategic progress toward their goal while rehabilitating an injury.

In essence, an injury doesn’t mean it’s time to stop training, it just means you have to be very smart in the way you approach training.

When it comes to making a full recovery, step one is to not let the injury define you:

You can still be a good deadlifter even if your lower back isn't allowing you to pull.

That national title can still be in your hands even with a tender ankle.

Ultimately, assuming an athlete isn't completely restricted by their injury, you can still implement certain modalities that'll get a training effect and boost performance.

Look at the Adaptations at Jeopardy

Cardiac output, blood pressure, and aerobic enzymes can drop in as little as a week, meaning aerobic adaptations quickly deplete. However, this can be combated with three lower intensity or two higher intensity aerobic sessions a week.

Anaerobic adaptations, on the other hand, tend to stick around a little longer and can be maintained with one to two moderate to vigorous training sessions per week. That means missing one or two heavy sessions a month won't kill your strength.

While this is outside the scope of this article, it's also important to understand the relationship between anaerobic and aerobic adaptations.  They are very much intertwined and play important roles in the functioning of each other.  To learn more about this, I'd recommend checking out our energy systems webinar by clicking here.

Classify

The next step is to objectively classify the functional capabilities surrounding the injury:

“How much pain free volume can you handle?

What are the restrictions in range of motion?

Are there external limitations (splint, casts, harness etc)?

Does the site of pain exhibit impaired recovery?”

Taking a deeper look at the adaptations at jeopardy, and classifying the scope of the problem are both absolutely critical to the success of your program.

Aerobic Strength Training

Aerobic strength training protocols are very effective and very underutilized training methods, especially in strength sports.  Aerobic adaptations are incredibly important for strength athletes for a multitude of reasons, but here are a few to get your head spinning

1.  Decrease in resting heart rate helps balance the autonomic nervous system via increased vagal tone

2.  Increases in stroke volume have a direct effect on the creation of pressure throughout the organism, and both of these (#1 and #2), in turn, increase cardiac output

3.  Increases in resting calcium levels and enzymes lead to much more powerful contractions

4.  VEGF (vascular endothelial growth factor, which leads to growth hormone further down the cascade) increases in response to metabolic waste built up during training, and has a profound effect on recovery over time.

Some of my favorite protocols include: Charlie Francis style tempos paired bodyweight exercises, low impact unilateral plyometrics, and volume unilateral resistance training (rear foot elevated, half kneeling press, get-ups, etc).

Unilateral Work

Another very important tool to utilize is unilateral work, especially in those with one limb out of commission. The myth of ignoring it due to the creation of muscle imbalances isn't true. Motor program adaptations, especially if there's a lack of sensory-motor feedback to one limb, are spread to both arms.

Meaning if you have a broken ankle, doing unilateral plyometrics on the non injured ankle will benefit the injured side. This is essential in rehabilitating and maintaining adaptations on the affected side.

Some Samples

To help visualize what a program would look like I have attached two very different programs for two very different athletes with very different situations.

The first is Nick. He is amongst the most elite amateur strongmen in the nation, and has a fractured ring finger and torn ligament on his right side.  He has severe swelling in the finger, along with some daily pain and goes to physical therapy twice a week. Currently, he cannot grasp much in his right hand or overly extend his wrist, and he trains three days a week. His longterm goal is to get his Light Weight Pro Card in strongman, however, his current goal is to maintain his strength while improving movement quality and work capacity until the finger is completely healed. Due to this being his long term goal, most of his volume and time are spent in his movement prep. His resistance training, on the other hand, leans more toward aerobic strength to assist with recovery and to avoid over fatiguing his nervous system due to his limited move pool.

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The next athlete’s program I will share with you is Summer--a high level strongman athlete herself.  She's been dealing with chronic and debilitating foot pain in her right foot due to an ineffective surgery several years ago.  Thus, she cannot perform much running or load the foot frequently, and struggles with dorsiflexion.  To make matters even more complicated, she's currently in a boot trying to resolve the issue.

With all of that in mind, here are Summer's primary goals right now:  increase upper body muscle mass and strength.  In order to help facilitate that goal, her movement prep and resistance training are geared toward upper body volume.  Also, seeing as her injury may be longer in its healing process, she will go through multiple blocks with a similar template.

Here's a sample day of her training  (If you're interested in hearing more about Summer’s story, click here).

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Perhaps the most important part of programming for an injured athlete, besides keeping them as healthy as possible, is to keep their levels of motivation high.  Work hard to narrow their focus, and find things they can still work on despite their limitations.  For example, this could be an ideal time to set short term goals that aren’t always a priority, such as improving body composition or focusing on movement quality.

Lastly, be sure to take into consideration the impact a limited movement pool will have on programming volumes and intensity.  You cannot vary their routines to the extent you do a healthy athletes, so be sure to monitor volume and intensity very closely to avoid overtraining.

Hope you enjoyed the article, and post any questions or comments you have below.

about the author

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Andrew Triana “The Leucine Frog” is a promising young coach who has an intense passion for his clients success and writing. It is evident in his work that he is relentless in his pursuit of excellence. At 20 years old Andrew has produced National champions, World champions, Pro strongmen, and has helped many others reach their goals.  Follow him on Twitter (@AndrewTriana) and Instagram (@andtriana).