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