stability

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

Don't Neglect the Neck

Neck position is highly undervalued in the lifting community.

I’ll give you a little secret: your neck position determines the position of everything else in your body. If you want to build strength, you better consider the position of your neck.

An extended neck position relies more on joints and ligaments for stabilization instead of muscles.

An extended neck means excess compression on the back half of the spine.

An extended neck means an extended back.

An extended neck means shut off abdominals (and we want those on, remember?).

An extended neck is good for testing strength, not building it.

An extended neck is bad for longevity.

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If you’ve had back pain in the past, please, for the love of the universe, stop looking at the sun when you lift. This position makes you stronger when you do it, but you use your spine to stabilize heavy weight instead of your muscles.

This is a fallback stabilization pattern for when you’re testing strength, like in a competition. This is not a long-term solution for building length over the next few decades.

I’ve seen so many athletes who are broken down because they stabilize hard with their backs. They don’t know how to shut them off. They don’t know how to use their abs. They don’t even know how to tuck their chin.

I personally know an athlete who told me his professional career would have been over three years ago if he hadn’t come to work with us. That is amazing. #startedfromextensionnowwehere

I work with the people who wore down faster than their body could repair. The athletes who broke before their playing career was over. The athletes who never built a foundation.

P.S.  I’m currently working on a FREE product that'll teach you how to build the movement foundation of all movement foundations.  If you're interested in getting the goods, which you should be, then drop your email below and I'll send it to you once its ready:

about the author

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Lance Goyke, CSCS, is a Nerd Extraordinaire and secret admirer of lesbians everywhere whose expertise focuses on the human body. His clientele ranges from other trainers to kids to house moms to fighters to baseballers to anyone who needs to be taught how to exercise. Go invade his home base at www.LanceGoyke.com.

Understanding and Controlling Injury: The Law of Repetitive Motion

Photo Credit:  Ben Solomon/The New York Times/Redux/REA

Unfortunately, injury is a part of life and a part of sports.  If you play long enough and push hard enough (which you’ll have to if you want to be good) you’re bound to run into little tweaks and pulls every now and then.

The key is to minimize there frequency, ensure quick recovery, and avoid the big guns like your ACL.

Step numero uno in avoiding injury is to understand it.

Why does it happen?  What factors make me more likely to become injured?  And stuff like that.

Unfortunately, most people don’t have the slightest understanding of injury and shrug it off as an unfortunate circumstance.

Don’t be one of those people.

With the right approach you can both understand and prevent it (well…prevent may not be the best word, but you’ll be better at limiting it than your peers).

THE LAW OF REPETITIVE MOTION

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Let me introduce you to the law of repetitive motion–aka the most user friendly injury equation of all time.

As you can see, 4 variables dictate your likelihood of getting injured:

I (injury)

Don’t feel like this one needs explanation.

N (number of repetitions)

The obvious explanation is the number of reps you perform of a particular exercise.  For example, doing 5 reps of the back squat versus doing 72.  Here are a few other items it applies to as well:

Steps taken throughout the day

Bending over to pick something up

Reaching up to grab something out of the cupboards

Throwing a baseball

Sitting (yes…that’s right…sitting counts as one gigantic rep)

Does this mean the answer is to try and keep N as low as possible?  No because you also have to consider form.  An individual who moves well and has good form can afford a higher N than an individual who moves poorly.

F (force)

This is kinda confusing, but it’s the force of every repetition as a function of maximal muscular strength.  Thus, if you increase your maximal muscular strength F will decrease because your body is better able to handle the external load.  Here’s a really simple example (I understand that this is way oversimplified, but it’s just to help you see the point):

Maximal muscular strength subject a:  100 newtons

Maximal muscular strength subject b:  75 newtons

Force form external load:  60 newtons

Which subject is better prepared to handle the load?  Or which subject will the load have a greater impact on?  It’s subject b because he or she is weaker.  At the end of the day, being strong reduces the amount of force placed on the body.

A (amplitude)

Amplitude, in its simplest since, is range of motion.  The tighter you are the more prone you are to injury (sort of).  On the other end of the spectrum, you can be too loose.  As I mentioned before in Why You Should Squat and Deadlift Heavy, you have to think of range of motion on a continuum.  At one end of the spectrum is the bodybuilder who has a fair amount of stability but horrendous mobility, and on the other end is the yoga queen who has way too much mobility and zero stability.

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Like the bell curve above illustrates, the best place to be is somewhere in the middle.  You want a good balance between mobility and stability.

R (relaxation)

I can’t stress the importance of quality relaxation enough.

Being able to unwind and hit the chill button has a large impact on your bodies ability to recover.  Unfortunately, relaxation doesn’t carry much weight today.  People are constantly jacked up on caffeine running from their apartment to work, from work to the gym, from the gym back to work, from work to home to do more work etc. etc.

This type of lifestyle tends to jack up your sympathetic nervous system (the one controlling your fight or flight response), and keeps it turned on all the time.

That’s not supposed to happen.

From a biological standpoint, the sympathetic nervous system is supposed to be turned on rarely (key the name fight or flight).   It’s supposed to be what kicks in when you’re foraging in the woods for some berries, and a giant black bear pops up trying to eat your face.

I know the deadline your stressing about, or the traffic you hit in the morning doesn’t seem as bad as the bear, but your body doesn’t know that.  It’s not going to differentiate between the two.  It views stress as stress.

Anywho, the ability to flip the switch and get back into the parasympathetic nervous system is vital to your overall health, and it’s something I recommend you practice.

KEY TAKEAWAYS

With all of that mind, here are some key takeaways to help you limit injury:

Keep N small by not staying in one posture for extended periods of time (sitting at work), or repeating the same thing over and over again (cough cough people who have their kids pitch year round for multiple travel teams)

Keep F low by getting strong

For A, if you’re hypermobile spend time stabilizing your joints.  Stretching for you will only create greater instability.  If you’re really tight and missing range, then you need to figure out why.  Is it an alignment issue?  Is it a capsular issue?  Is it bony restrictions?  Is the muscle short?  Is the muscle stiff?  Is it protective tension?  These are all things that need to be answered before coming up with a game plan.  Either way, you need to get your functional range back.

Keep R high by taking a chill pill.  But seriously, here are a few ways to attack R.  First,  be sure to foam roll because it helps improve muscle tone.  Second, do some focused breathing drills (crocodile breathing is a good example).  Third, find a release that helps you relax.  For me, it’s reading fiction.  I do it every night before bed.  For you it may be having a glass of wine.  I don’t know.  Just find something.

Are You Lax?

So a few weeks back I had a girl (who will remain anonymous) come to me complaining of feeling chronically “tight.” She said for the past few weeks she’d been stretching like crazy and no matter what she did she couldn’t get rid of the “tight” feeling in her hips.  Not only that, she was complaining of anterior hip pain after a long day of walking.

A few questions later I found out she had been a dancer for a large portion of her life, and had a pretty good idea of where I wanted to go next (I honestly can’t even comprehend all the things I’d tear in the process of getting into this position).

Seeing as I was at home just relaxing with my roomies (aka not a good place to perform a thorough assessment) I went with a quick and easy test of general laxity:  the Beighton hypermobility test.

Laxity, for those of you who aren’t familiar, is basically how much “give” your ligaments have.  Some people have naturally stiff joints, while others have naturally loose joints.

Here’s a quick video of the test, and I’ll explain what it means below:

As you can see, the test consists of 5 quick assessments, and here are some rough guidelines for what would be considered a “positive” test for laxity:

1. Elbow hyperextension > 10° (left and right sides) 2. Knee hyperextension > 10° (left and right sides) 3. Flex the thumb to contact with the forearm (left and right sides) 4. Extend the pinky to >90° angle with the rest of the hand (left and right sides) 5. Place both palms flat on the floor without flexing the knees

Needless to say, she passed with flying colors and is someone I’d definitely categorize as being lax.

As I mentioned above, laxity refers to how much give your ligaments have.  So you’d like to think someone who’s really lax would feel loosey goosey all the time, but that’s just not the case.  Many times, people who have a lot of laxity (like this girl did) will complain of feeling tight all the time.  This, however, is not true muscular shortness or stiffness, but rather, the body laying down trigger points in an attempt to provide stability to an unstable joint.

For this reason, stretching is often contraindicated for people who are really lax because they’re causing more harm than good.  They’re merely stretching into greater instability and pissing their body off in the process (aka what she was doing)

A better strategy for these individuals is to focus on generating stability and stabilization from the right places, and that could mean doing things like squatting, deadlifting, pressing and rowing.  It all depends on the person and what they need.

If you have any questions, be sure to post them below and I’ll help you out.