The Ultimate Rotator Cuff Training Guide

Proven Exercises for Injury Prevention

Brian schiFF, PT, cscs

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The Ultimate Rotator Cuff Training Guide

Proven Exercises for Rehab and Injury Prevention

Copyrght 2005 Ftness Edge All rghts reserved. No part of ths book shall be reproduced, stored n a retreval system, or transmtted by any means electronc, mechancal, photocopyng, recordng or otherwse wthout wrtten permsson from the publsher. No patent lablty s assumed wth respect to the use of the nformaton contaned heren. Although every precauton has been taken n preparaton of ths book, the publsher and author assume no responsblty for errors or omssons. Nether s any lablty assumed for damages resultng from the use of nformaton contaned heren. Ths book s publshed by Ftness Edge, ncludng text, graphcs and mages, and s strctly ntended for educatonal purposes. It s not ntended to make any representatons or warrantes about the outcome of any procedure. Ths electronc book s not ntended as a substtute for professonal medcal care. Only your doctor can dagnose and treat a medcal problem.

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About the Author

graduated from The Oho State Unversty n 1996 wth a Bachelor of Scence degree of Physcal Therapy n Alled Health Professons. Snce then, he has practced as a lcensed physcal therapst specalzng n sports medcne. Through the Natonal Strength and Condtonng Assocaton, Bran became a certfied strength and condtonng specalst (CSCS) n 1998. He s a foundng member of The Amercan Assocaton of Personal Traners, and recently contrbuted a chapter on perodzaton to a fitness book enttled The Power of Champions. Schff also co-authored a breakthrough manual on ACL njury preventon enttled Protecting the Athletes Knee. Currently, he owns a prvate fitness studo and a performance enhancement company specalzng n sport specfic tranng programs for athletes of all sports and ages. Bran s also the former strength and condtonng coach for The Columbus Crew Major League Soccer Team. He has presented at professonal conferences and coaches clncs on topcs ncludng tranng for shoulder stablty, baseball specfic tranng, soccer specfic condtonng and sport specfic tranng, ACL njury preventon and safe shoulder tranng.



Brian schiFF, PT, cscs

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Table of Contents
Introduction ..................................................................................... 1 Anatomy .................................................................................................. 2 Hstory of Rotator Cuff Dsease and Pathology .............................................. 4 The Role of Posture .................................................................................... 5 Common Exercse Mstakes ........................................................................ 6 Injury Preventon Tranng ........................................................................... 8 Scapular Stabilizer Exercises ............................................................ 10 Standng Tubng Row ................................................................................. 10 Serratus Anteror DB Punches ...................................................................... 11 Prone Lower Trap Rase .............................................................................. 11 Prone Horzontal Abducton Rase ............................................................... 12 Prone Extenson Rase wth External Rotaton................................................. 12 Shoulder Shrugs ........................................................................................ 13 Rotator Cuff Exercises ...................................................................... 14 Scapton .................................................................................................. 14 Internal Rotaton ........................................................................................ 15 External Rotaton (tubng) ........................................................................... 15 External Rotaton (dumbbell) ....................................................................... 16 Horzontal External Rotaton ....................................................................... 17 Standng Dagonal Rase (D2 Flexton) ......................................................... 17 Bonus Exercise Section ..................................................................... 18 Exercse #1 Bench Press .......................................................................... 18 Exercse #2 Push-Up ............................................................................... 18 Exercse #3 Lat Pull Down ........................................................................ 19 Exercse #4 Uprght Row ......................................................................... 19 Exercse #5 Dps .................................................................................... 20 Exercse #6 Mltary Press ........................................................................ 21 Exercse #7 Dumbbell Lateral Rase........................................................... 22 Sample Healthy Rotator Cuff Training Program ................................ 24
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Injured or Inflamed Shoulder Series ................................................. 25 See Your Physician ........................................................................... 31

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Introduction

Have you ever experenced a dull ache or sharp pan n your shoulder or upper arm? Maybe you are unable to sleep on one sde because your shoulder wakes you up at nght. Perhaps you have dscomfort reachng behnd your back to tuck n your shrt or grab your wallet. If so, you may be sufferng from a rotator cuff njury. Most of us wll experence shoulder pan of some knd n our lfe. Due to the excessve moblty n our shoulder jonts, whch allows for great versatlty and functon, we often place excessve stress on them n our daly lfe. In order for you to effectvely rase and maneuver your arm, the rotator cuff must functon properly. Rotator cuff njures, such as tendonts, bursts and tears, plague 20-30% of people n our populaton. These njures may be caused by natural degeneraton, trauma or overuse. It s mportant to understand general anatomy and how the rotator cuff functons so that you may gan a better apprecaton for njury potental, healng tme frames, and proper exercse selecton.

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Anatomy
The rotator cuff conssts of four small muscles, whch effectvely form a sleeve around the shoulder and allow us to rase our arms overhead effectvely. These muscles, consstng of the supraspnatus, nfraspnatus, teres mnor and subscapulars, oppose the acton of the deltod muscle and depress (hold down) the head of the humerus (upper arm) durng shoulder elevaton to prevent mpngement. Ths allows you to effectvely rase your arm and reach n certan ways wthout experencng mpngement of the soft tssue between the top of the shoulder blade (acromon) and the head of the humerus. For the purposes of ths book, I wll not dscuss n detal the orgns and nsertons of each partcular muscle or elaborate on the nerves that nnervate them. However, t s mportant to understand that pan n the shoulder area can also be referred from the neck. Therefore, one should not always assume that pan n the upper arm s due to rotator cuff njury or tendonts. Weakness can be seen wth neck or shoulder dysfuncton. As such, t s always wse to consult your physcan f such a problem arses. Below, I wll summarze the role of each rotator cuff muscle. One note to consder: damage to one structure may not always lead to sgnficant functonal weakness or lmtaton. These muscles work collectvely and synergstcally wth the scapular muscles to produce purposeful movement. As such, the body s able to compensate for power deficences n many cases. These compensatons may be subtle or obvous. Supraspinatus largely responsble for ntatng elevaton from 0 30 degrees of abducton (arm movng away from and parallel to the body) and assstng wth elevaton. Ths muscle has a poor blood supply, les beneath the acromon and s often the most commonly affected tendon wth regard to tendonts or tears. Because of ts poor blood supply, t heals slowly and s prone to recurrent bouts of nflammaton. Infraspinatus responsble for externally rotatng the arm or movng t away from the body when the arm s at the sde or when cockng to throw a baseball. Ths muscle also helps decelerate the arm durng follow through from an overhead moton (e.g., ptchng). Teres Minor also responsble for external rotaton n the same way the nfraspnatus functons. In addton, t also helps decelerate the arm durng follow through from an overhead moton (e.g., ptchng). Subscapularis responsble for nternal rotaton or pullng the arm n toward the body whle at the sde. Ths muscle also asssts n follow through durng throwng. Because ths muscle performs the same acton as that of the pectorals major, latssmus dors and teres major, t s sometmes dfficult to detect weakness.
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Anatomy
Equally mportant to the proper functon of the shoulder s a group of muscles known as scapular stablzers. These muscles have attachments to the scapula (shoulder blade) and drectly contrbute to shoulder moton by affectng the path of movement of the shoulder blade. You see, for every 2 degrees of shoulder abducton (arm movement away from the body n the same plane as the body), there s 1 degree of scapular elevaton. The shoulder blade moves n addton to the arm to allow for the great freedom of movement we enjoy. Wth weakness or njury, ths rhythm of movement becomes altered. Scapular stablzer muscles nclude: Serratus anterior - protracts or rounds the shoulder blade Upper trapezius - shrugs and upwardly rotates the shoulder blade Middle trapezius - retracts or pnches the shoulder blade nward Lower trapezius - depresses and upwardly rotates the shoulder blade Rhomboids - retract or pnch the shoulder blade nward These muscles work synergstcally (together) wth the rotator cuff to ensure smooth movements wthout shoulder mpngement.
Supraspinatus Glenoid Head of humerus labrum Joint

Clavicle

Coracoid process

Acromion

capsule

Supraspinatus Subscapularis

Scapula

Ribs

Humerus

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The infraspinatus and teres minor muscles are not pictured as they are positioned on the back of the shoulder blade. This illustration only refers to the front of the shoulder joint.

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History of Rotator Cuff Disease and Pathology

Some people are predestned to have shoulder problems. Why? To a large degree, the shape of the acromon (top of the shoulder blade) plays an mportant role n the health of the rotator cuff tssue. There are three types of acromon: flat, hook shaped and normal. The flat and hook versons carry a hgher rsk of possble njury, wth the hook style posng the greatest threat. If you have a flat or hook shaped acromon, there s less room for the soft tssue (muscle and tendon) to glde and move durng arm moton. Over tme, ths naturally leads to more frcton and wear and tear. Ths may lead to an eventual tear. Typcally, most people experence an acute onset of shoulder pan. It s often related to vgorous repettve actvtes or trauma such as lftng, pantng, throwng, fallng, or jammng the shoulder. Ths type of pan s generally labeled tendonts or bursts. You may have pan f lyng on the affected sde, reachng up overhead, reachng behnd the back, drvng or attemptng to lft wth the arm out away from the body. Tendonts usually responds well to rest, ant-nflammatory medcaton, ce and rotator cuff specfic strengthenng. Recovery tme may range from 4 weeks to several months, dependng upon the complance of the ndvdual, the onset of symptoms pror to treatment, the age of the ndvdual, and whether or not there are any physcal changes n the tendon (structural changes ncludng thckenng or scar tssue formaton are referred to as tendonoss). X-rays are mportant as they wll reveal any arthrtc change. Rotator cuff tears present dfferently. The hallmark sgns of a tear are nocturnal pan, loss of strength, and nablty to rase the arm overhead. Also look for a shrug sgn, n whch the person uses the upper trap to rase the arm because the rotator cuff s not able to depress the humeral head effectvely. Rotator cuff tears are most common n men age 65 and older. Tears and/or njury are typcally related to degeneraton, nstablty, bone spurs, trauma, overuse, and dmnshed strength/flexblty related to the agng process. However, youth are also at rsk for njury f they are nvolved n repettve overhead sports, ncludng swmmng, volleyball, baseball, softball, tenns, gymnastcs, etc. Many people can functon adequately wth a torn rotator cuff provded they have a low to moderate pan level. The prmary reason for performng rotator cuff surgery s to allevate pan rather than to restore functon. It s common for post-surgcal patents to lose some moblty/range of moton. Strength recovery s dctated by the sze of tear, qualty of the torn tssue at the tme of surgery, tme elapsed between njury and repar, and the surgeons ablty to recreate the proper anatomcal relatonshp. Recovery followng rotator cuff repar may take up to 18 months. However, most people are able to return to the majorty of ther actvtes of daly lvng n 3-6 months. Early moblzaton, range of moton and progressve strengthenng exercses n physcal therapy are crtcal to reganng functonal moton and strength.

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The Role of Posture

Dd you ever wonder why you were told as a chld to st up tall? Well, t really does make a dfference. Slouchng allows your shoulders to protract or round forward, and ths closes down the space that the rotator cuff occupes. Over tme, ths can contrbute to compressve wear and tear on the soft tssue. Asde from tryng to mantan a more erect posture, t s mportant to perform strengthenng exercses to renforce posture (e.g., rows, pull downs, and reverse fles) and routne flexblty tranng. Gven the nature of our job place today, many people st for the majorty of the day. They wrte or work on the computer much of the tme. Ths encourages poor posture and necesstates stretchng frequently. The prmary muscle group n need of stretchng s the chest. I always recommend performng doorway stretches that nclude arms n a V poston (sternal porton of the pecs) and reverse T or field goal post poston (clavcular porton of the pecs). You can also perform sngle arm stretches wth the arm slghtly below shoulder heght. It s best to hold for 20-30 seconds and repeat 2-3 tmes.

V Position

T Position

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Common Exercise Mistakes

All too often I see people n the gym performng exercses ncorrectly. Ths may not lead to an mmedate njury, but over tme t wll cause tendonts, pan, and lost tme from workng out. Asde from lftng mproperly, many exercse enthusasts attempt to lft too much weght. Ths combnaton s a proven recpe for njury. Below, I wll dscuss some common exercses that offer potental rsk for njury when performed mproperly. Wth a few smple modficatons, these exercses delver maxmum results wthout posng any danger to your health. Bench Press Ths s a popular exercse chosen to buld the chest, along wth the anteror deltod and trceps. Most teach takng the bar down untl t lghtly touches the chest. However, I beleve ths s unsafe because t exposes the anteror shoulder capsule to excessve load, n addton to compressng the soft tssue of the rotator cuff between the humerus and the acromon. Over tme, wth repeated bouts and heavy loads, the rotator cuff becomes nflamed. Indvduals wth any anteror shoulder laxty (looseness) or hstory of subluxaton, dslocaton or nstablty are also at ncreased rsk for rotator cuff njury or labral (shoulder cartlage) damage. Furthermore, you also have the potental to rupture the pectorals tendon (chest) wth full range pressng durng heavy loads. The safe answer s to lower the bar untl the upper arm s parallel to the floor (elbow bent to 90 degrees). Ths prevents the shoulder jont from movng nto the unsafe range. The same advce apples to push-ups and dumbbell fles. Lat Pull Downs Ths s a good exercse to strengthen the back, but when done behnd the head t can cause problems. Lke the bench press, pullng the bar down behnd the head postons the humerus n such a way that the rotator cuff can be pnched. Ths may depend on other factors, ncludng the shape of a persons acromon and degree of any present arthrts, but I stll beleve the rsk outweghs any benefit. Not to menton that keepng the bar n front of the head stll accomplshes the same movement for the target muscle, whle elmnatng the rsk of shoulder njury. Remember not to sway durng the movement, and poston the body n a slghtly reclned poston (20-30 degrees), whle pullng the bar toward the sternum. Another unrelated reason not to do behnd the neck pull downs s that t places undue stress on the cervcal spne. Military Press Ths exercse, when performed behnd the neck wth a bar, postons the shoulder n the aforementoned unfavorable poston. Done repeatedly, the rotator cuff can become nflamed. Smlar to behnd the neck pull downs, you also expose your neck to unnecessary stress. It s safer to perform the exercse n front of the head or utlze dumbbells and work n the scapular plane (a poston about 30-45 degrees forward of the plane of the body). You must watch to avod archng the low back, and t s best to use a bench wth back support to prevent ths.
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Common Exercise Mistakes

Dips/Upright Row As before, the key mstake made wth these exercses s allowng the shoulder to move beyond 90 degrees relatve to a poston parallel to the floor or perpendcular to the body. I always recommend stoppng at 90 degrees to protect the shoulder capsule and the rotator cuff. These are also not exercses I recommend to those just begnnng to work out. It s best served to ncorporate them after developng a base level of strength and masterng basc lftng movements. People wth A-C (acromo-clavcular) jont arthrts should probably avod dps, as ths jont undergoes much stress. Dumbbell Lateral Raise I beleve ths exercse s often done ncorrectly. The mstakes nclude lftng too much weght, keepng the arms straght, and rasng the arms out away from the body n the plane of the body. The force on the rotator cuff reaches 90% of your body weght when the arms are rased to 90 degrees wth the arms straght and n the plane of the body. That s a lot of force on four relatvely small rotator cuff muscles. The target muscle s the lateral deltod, but the rotator cuff s extremely actve, and t functons to allow you to rase the arm by depressng the humerus so that t passes under the acromon durng actve elevaton. When heavy loads are ntroduced n the wrong plane of moton, dsaster usually occurs. I am fanatcal about performng ths exercse correctly. The proper way to execute a lateral rase s to keep the elbows comfortably flexed (20-30 degrees) and rase the arm to no hgher than parallel to the floor. The arm should be n the scapular plane of moton (approxmately 30-45 degrees forward from the plane of the body) and the weght should be relatvely lght. Once you feel you have to shrug or use momentum to rase the weght, you need to rest or lower the weght. I feel ths s absolutely one of the worst exercses for the shoulder f done ncorrectly. In summary, I want to emphasze that good ntentons may spell bad results for the shoulder f proper form s lackng. The rotator cuff and shoulder jont s extremely vulnerable to heavy loads and repettve bouts of exercse. Gradually, t may become nflamed and hnder or lmt your workout altogether. Be sure to master form before ncreasng weght, and do not attempt to work through pan, as ths often perpetuates the problem. Remember to assess rsk and reward at all tmes, and rest assured that these modficatons wll not hnder your gans. Instead, they wll prevent mssed tme n the gym and produce happer, healther shoulders!

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injury PrevenTion Training

and

rehaB

In the followng secton, I wll outlne specfic exercses that are desgned to prevent and/ or rehabltate shoulder njures to the rotator cuff. Keep n mnd that these exercses are not meant to serve as a substtute to medcal care from a physcan or physcal therapst f you are currently experencng shoulder pan. But, they provde a good blueprnt for healthy shoulder exercses and should reduce the lkelhood of a future njury. The key to avodng rotator cuff njury s performng adequate condtonng pror to stressng t wth vgorous actvtes. Many weekend warrors try to pck up the softball, baseball, football, etc. and begn throwng repettvely and forcefully wthout properly warmng up. In addton, they are not lkely to condton before the season lke compettve athletes. Ths often leads to excessve stran on the rotator cuff and swellng. The nevtable result s soreness, especally wth overhead movement or reachng behnd the back. The act of throwng s the most stressful moton on the shoulder. The rotator cuff s forced to decelerate the humerus durng follow through at speeds up to 7000 degrees/second. Wthout proper strength and condtonng, the shoulder easly becomes nflamed. Snce the rotator cuff muscles are small, t s best to utlze lower resstance and hgher repettons to sufficently strengthen them. Gradually ncreasng the ntensty and volume of actvty s crtcal to avodng an overuse njury (partcularly common among young throwng athletes). Remember, these are not bodybuldng type muscles. You wll not use heavy loads or expect to see great muscle hypertrophy. The payoff comes n performance and njury preventon. Who wants to mss any playng tme? The answer s obvous, but rotator cuff pan wll restrct most overhead athletes, and t often necesstates some rest n compettve overhead athletes. The followng exercses should be performed at least 6-8 weeks pror to preseason for overhead athletes such as swmmers, ptchers, volleyball players and quarterbacks. For poston players n baseball and softball, I generally recommend that they condton the cuff at least 4 weeks pror to preseason drlls begn. It s also mportant for throwng athletes to use an nterval throwng program n the preseason to condton the shoulder for repettve throwng at dfferent dstances and veloctes. Durng the n-season, each of the aforementoned athletes should perform routne mantenance rotator cuff strengthenng 1-2x/week for contnued njury preventon. Wth regard to the general fitness clent, I recommend usng rotator cuff tranng at least 1-2x/ week, especally f you have any pre-exstng condton or hstory of njury. If you have a current ssue, perhaps dong these exercses three tmes per week wth a day of rest n between would be best.

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injury PrevenTion Training & rehaB

The exercses should not cause pan at any tme. Performng them n a pan free range of moton s an absolute must! Certanly, pan does not equal gan here. Generally, t s best not to use loads greater than 4% of your body weght (gudelne advocated by Charles Neer, M.D.). I can not emphasze enough that these are small relatvely weak muscles that are neglected by most of you n the gym. Lghter loads and hgher reps s defintely the way to go. Below you wll find a lst of approprate scapular stablzer and rotator cuff exercses. These exercses are desgned to mprove posture, correct muscular mbalances, and strengthen the rotator cuff. They are not ntended to buld lean muscle. Keepng strct form and performng these exercses n a safe, pan free range of moton s essental. Whle there s no defintve order n whch to perform these exercses, I generally suggest that you do the scapular exercses first snce they are the larger muscle group.

Chapter 1

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scaPular sTaBilizer exercises

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Standing Tubing Row

Ths strengthens the mddle trapezus, posteror deltod and rhombods. Usng a pole or door, poston the tubng so that the handles are even. Stand wth the feet shoulder wdth apart and the knees slghtly bent (relaxed). Begnnng wth some resstance (tube s taut) pull toward the body, squeezng the shoulder blades together and keepng the elbows at your sde. Pause for 1-2 seconds and then return to the startng poston. Perform 2-3 sets of 10-15 repettons. Ths can also be done wth a machne. An alternate method s keepng the elbows out wth the arms abducted ~ 90 degrees. Ths postonng places more emphass on the posteror deltod, rhombods and mddle trap, as compared to greater assstance from the latssmus dors wth the low row.

Low Row
1 2

High Row
1 2

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scaPular sTaBilizer exercises

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Serratus Anterior DB Punches

Ths strengthens the serratus anteror, a muscle whch helps to stablze the shoulder blade durng arm elevaton. Layng on the back wth the knees bent and feet flat, press the dumbbells toward the celng makng sure to keep the elbows straght. The shoulder blades wll round forward and lft off the floor. Pause at the top of the movement, and lower wth control to the startng poston. Perform 2 sets of 15 repettons.

Prone Lower Trap Raise

Ths strengthens the lower trap, whch s often weak and fatgues quckly. Ths muscle depresses the shoulder blade and prevents mpngement. Usng a stablty ball, rase the arms up n a 45 degree angle as far as the shoulders allow wthout dscomfort. Pause at the top, and lower slowly to the startng poston. Ths s an awkward moton, and t s best to use a lght weght and focus on controllng the moton. It s also acceptable to do ths exercse lyng face down on a bench. Perform 2 sets of 15 repettons.

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scaPular sTaBilizer exercises

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Prone Horizontal Abduction Raise

Ths strengthens the mddle trapezus and rhombods, whch promote good posture. Usng a stablty ball, rase the arms out away from the body untl they are near parallel to the floor. Keep the palms down and pnch the shoulder blades together at the top of the moton. Lower slowly to the startng poston. It s also acceptable to do ths exercse lyng face down on a bench. Perform 2 sets of 15 repettons.

Prone Extension Raise with External Rotation

Ths strengthens the posteror deltod and latssmus dors, n addton to the posteror rotator cuff muscles. Usng a stablty ball, rase the arms along the sde of the body untl they are even wth the body. It s mportant to keep the palms facng down durng ths exercse (ths poston externally rotates the shoulder) as ths creates greater rotator cuff actvaton. Pause at the top, and slowly lower to the startng poston. Perform 2 sets of 15 repettons.

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scaPular sTaBilizer exercises

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Shoulder Shrugs
Ths strengthens the upper trapezus. Standng wth the arms restng at the sde of the body, shrug the shoulders straght up toward the celng. Pause at the top for 1-2 seconds. Slowly lower the weght to the startng poston. It s mportant not to roll the shoulders forward or backward as ths may cause gratng of the scapula on the chest wall, not to menton the upper trap muscles prmary acton s shoulder elevaton. Wth ths exercse, t s okay to use loads heaver than 4% of body weght. Perform 2-3 sets of 10-15 repettons. 1 2

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roTaTor cuFF exercises

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Scaption
Ths strengthens the supraspnatus muscle, the most commonly affected rotator cuff muscle and slowest to heal. Stand wth the knees slghtly bent (relaxed) holdng the dumbbells n such a way that your thumbs are up or on top of the dumbbells. Keep the arms approxmately 30-45 degrees forward from beng perpendcular or straght out away from the body (scapular plane) and rase the arms up to shoulder heght. Pause at the top and slowly lower to the startng poston. Keep the elbows straght throughout the entre movement. Avod any part of the range of moton that causes pan. Perform 2 sets of 1520 repettons. 1 2

Side View

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roTaTor cuFF exercises

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Internal Rotation
Ths strengthens the subscapulars muscle, as well as the chest muscles. In standng wth the knees relaxed, hold tubng and begn wth the arm postoned at the sde (neutral) wth lght tenson on the tubng. Now pull the arm across the body to the stomach, whle keepng the elbow at your sde. Do not allow the shoulder to rotate forward. Perform 2 sets of 15-20 repettons.

External Rotation (tubing)

Ths strengthens the nfraspnatus and teres mnor muscles. In standng wth the knees relaxed, hold tubng and begn wth the arm postoned at the sde (neutral) wth lght tenson on the tubng. Now, pull the arm away from the body, whle keepng the elbow close to your sde. Do not allow the shoulder to rotate backward. Perform 2 sets of 1520 repettons.

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roTaTor cuFF exercises

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External Rotation (Dumbbell)

Ths too strengthens the nfraspnatus and teres mnor. Begn n a sde lyng poston wth the elbow at the sde of the body and the arm n neutral. Slowly rase the dumbbell through a full pan free range of moton, whle keepng the elbow at your sde and then slowly return to the startng poston. Perform 2 sets of 15-20 repettons. It s generally best to use a lght dumbbell.

Notes
You do not need to do both tubng and dumbbell external rotaton. Choose one method. However, f you are experencng ongong pan or nflammaton, I recommend usng a dumbbell or no resstance at all n the sde lyng poston. The key dfference s that the tubng offers ncreasng resstance throughout the exercse as the muscles ablty to generate force declnes. In contrast, a dumbbell offers consstent resstance throughout the exercse. Wth a dumbbell, the ablty to lft the weght s dependent upon rasng the dumbbell up aganst gravty at the begnnng of the moton. Ths does not requre added tenson or effort at the end of the movement, whereas the tubng does.
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You may also choose to place a small rolled towel between the nsde of the elbow and the sde of your body to emphasze keepng the elbow n and avodng compensatory moton from the shoulder blade.
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roTaTor cuFF exercises

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Horizontal External Rotation

Ths strengthens the nfrapsnatus, teres mnor and posteror deltod. It also works the shoulder n a more functonal plane. Sttng on a stablty ball (or bench), begn wth arm 90 degrees away from the body wth the palm of the hand facng the floor. Rase the dumbbell up to 90 degrees and slowly return to the startng poston. Perform 2 sets of 15-20 repettons.

Standing Diagonal Raise (D2 Flexion)

Ths s a more advanced exercse that strengthens the entre rotator cuff. It also maxmally stresses the cuff as t places t n an overhead poston. Begn n standng wth relaxed knees and wth the palm aganst the opposte thgh. Slowly rase the dumbbell up and overhead. As the arm elevates, you wll allow the forearm to rotate out and the thumb to move from a downward to an upward poston (htchhkng poston). Lower slowly to the startng poston. Perform 2 sets of 15-20 repettons.

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Exercise # 1 Bench Press

Wth my background n physcal therapy, and havng experenced severe rotator cuff tendonts firsthand, I can tell you how harmful ths exercse truly s when done mproperly. So, what s mproper form? I always recommend lmtng the range of moton on descent to the pont where the upper arm s parallel to the floor. Lowerng past ths plane places excessve stress on the front of the shoulder jont. Wth heavy loads or repettve loadng, you expose the lgaments, cartlage and rotator cuff to wear and tear. Addtonally, you may even be at rsk for rupturng the pectorals (chest) muscle. Whle some pursts n the strength and condtonng field wll argue that lmtng moton affects strength gans, I would argue that the rsk of njury outweghs any benefit ganed from the addtonal range of moton. Not to menton the fact that I have not lost strength on the bench after performng ths modfied verson for over 10 years.

Exercise # 2 Push-up
Ths s a great upper body strengthenng exercse. However, much lke the bench press, movng beyond 90 degrees wth the shoulders on the descent places undue stress on the shoulders. For ths reason, t s not advsable to lower beyond ths pont. 1 2

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Exercise # 3 Lat Pull Downs

Ths exercse s desgned to strengthen the back, specfically the latssmus dors. In the past, many have done ths exercse behnd the head. In addton to placng unnecessary stress on the neck, ths postonng puts added stress on the shoulders. Pullng the bar behnd the head forces the humerus nto the top of the shoulder blade and can compress the rotator cuff. In lght of ths, I suggest pullng the bar to the sternum. Reclne the body approxmately 20-30 degrees and lower the bar n front of the head, squeezng the shoulder blades down and together. 1 2

Exercise # 4 Upright Row

Ths exercse s a popular method of strengthenng the shoulders and addng muscle mass to the lateral deltods and upper traps. It may be done wth dumbbells, tubng or wth a cable attachment. The key to avodng damage wth ths exercse s to stop the movement once the arms reach 90 degrees, or are parallel to the ground. Gong above ths poston wll lead to mpngement of the rotator cuff. Remember to lead wth the elbows and allow the hands to follow n a natural path of moton.

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Exercise # 5 Dips
Dps are dfficult for people to do and place a lot of stress on the shoulder complex. In addton to placng hgh demands on the shoulder jont and rotator cuff tself, the clavcle and acromo-clavcular jont s also exposed to sgnficant loads durng ths exercse. Dps are desgned to strengthen the upper body, more specfically the chest, shoulders, and trceps. Ths exercse s smlar to the uprght row wth regard to shoulder postonng. Whether usng a dp apparatus, asssted dp machne or flat bench, t s mportant not to lower the body past a pont where the upper arms are parallel to the floor. I do not recommend ths actvty (even when done properly) for people wth current rotator cuff njures, A-C jont arthrts, shoulder nstablty, or those wth partal/complete rotator cuff tears or pror surgery to repar a tear. 1 2

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Exercise # 6 Military Press

Ths s by far one of the most popular and effectve means to buld shapely shoulders. For the same reasons explaned earler wth the lat pull downs, I agan recommend not performng shoulder presses behnd the head. Addtonally, t s mportant not to lower the bar or dumbbells below the pont where the upper arms are parallel to the floor (shoulder heght) to avod compressve forces on the cuff. I also suggest keepng the arms n the scapular plane throughout the movement (30-45 degrees forward of the plane of the body). Lastly, keep your back pressed firmly aganst the bench durng the exercse. If the back begns to arch, ths typcally means the weght s too heavy or you are becomng fatgued. Ths exercse should not be done f you are experencng pan wth overhead moton. 1 1

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Exercise # 7 Dumbbell Lateral Raise

Perhaps, ths s one of the most common shoulder exercses I see routnely done ncorrectly. It s a great way to strengthen the lateral deltod, but when done wth mproper technque, t often leads to rotator cuff tendonts. The most common mstake I see s performng ths actvty wth the arms completely straght and movng them out drectly away from the sde. Keepng the arms straght provdes a long lever and places a hgh amount of torque on the jont and rotator cuff. Wth ths algnment, you also encourage shoulder mpngement. It s essental to keep the shoulders n the scapular plane throughout. The second major mstake s usng too much weght. Heaver loads requre usng momentum and other larger muscles to accomplsh the lft (such as the low back and hp extensors). Men are generally the bggest offenders on ths pont. Remember, the movement should be slow, and you should be able to pause momentarly at the top of the lft. Next, I often wtness people rasng ther arms above shoulder heght. Although the cuff functons most from 70 120 degrees of elevaton, I have found that rasng the arm above 90 degrees encourages mpngement n a loaded shoulder and often aggravates a persons symptoms. Sometmes, t s necessary to lmt the range of moton further based on pan. Ths s okay. As a matter of fact, you should only perform the exercse wth a weght and range of moton that does not ncrease pan.

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Exercise # 7 Dumbbell Lateral Raise (continued)

The final error s related to set-up poston. Many smply stand erect wth ther feet too close together durng ths exercse. A better method s to stand wth the feet shoulder wdth apart and the knees slghtly bent. Ths wll prevent cheatng by usng momentum and engage the core muscles throughout the exercse. It s mportant to mantan a flat back or the natural curve of your spne n ths athletc poston. Ths exercse s smlar to scapton, but places a greater load on the lateral deltod due to the dfferent hand poston (palm down). If you are unable to do lateral rases wthout pan, scapton wll also actvate the lateral deltod and serve as a good precursor to returnng to lateral rases. I generally recommend avodng lateral rases wth bands or tubng as the load contnually ncreases, whle the muscles ablty to generate force decreases. Wth repetton, ths approach to tranng leads to a sore shoulder. Performng ths exercse on a cable also provdes a sgnficant challenge n terms of controllng the movement and should only be done occasonally wth lghter weght and perfect form.

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samPle healThy roTaTor cuFF Training Program

Healthy Shoulder Series (2x/week)

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Day #1 Scapular Stabilizer Muscles

Rows 3 sets of 10-15 reps Lat Pull Downs 3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps Seated Dumbbell Horzontal External Rotaton 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

Day #2 Scapular Stabilizer Muscles

Prone Lower Trap Dumbbell Rase 2 sets of 15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps External Rotaton w/Arm at Sde (tubng or dumbbell) 2 sets of 15-20 reps Standng Dagonal Dumbbell Rase 2 sets of 15-20 reps

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injured

or inFlamed

shoulder series

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6 Week Program (3x/week)

Training Notes
Durng ths program, t s generally best to avod overhead lftng. Once most of the pan or dscomfort resolves, you can gradually resume overhead tranng. At the completon of the ntal 4 weeks, you should notce mproved strength, more range of moton and less dscomfort wth shoulder movements and functon. Throughout ths tme, none of the exercses should cause any dscomfort or pan. If you can not perform an exercse wthout pan, t s best to lmt the range of moton or dscontnue t altogether. If you are makng progress wth the exercses, then you can progress to the final phase of ths 6 week program. In the final phase, more emphass s placed on transtonng back to overhead postons and functonal movements. Less emphass s placed on shrugs and serratus punches, as sufficent stablzaton strength should have been attaned n the ntal month of tranng. Agan, t s crtcal to make sure the exercse s completely pan free!

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injured

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shoulder series

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6 Week Program (3x/week)

Day #1 (Week 1 & 2) Scapular Stabilizer Muscles

Low Row 2-3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps External Rotaton (Dumbbell) - 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

Day #2 (Week 1 & 2) Scapular Stabilizer Muscles

Lat Pull Downs 3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps External Rotaton (Dumbbell) - 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

Day #3 (Week 1 & 2) Scapular Stabilizer Muscles Rotator Cuff Muscles

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Hgh Row 3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps

Scapton 2 sets of 15-20 reps External Rotaton (Dumbbell) - 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

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shoulder series

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6 Week Program (3x/week)

Day #1 (Week 3 & 4) Scapular Stabilizer Muscles

Low Row 2-3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps External Rotaton (Dumbbell) - 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

Day #2 (Week 3 & 4) Scapular Stabilizer Muscles

Lat Pull Downs 3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps Seated Dumbbell Horzontal External Rotaton 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

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injured

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6 Week Program (3x/week)

Day #3 (Week 3 & 4) Scapular Stabilizer Muscles

Lat Pull Downs 3 sets of 10-15 reps Serratus Dumbbell Punches 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps External Rotaton (Dumbbell) - 2 sets of 15-20 reps Seated Dumbbell Horzontal External Rotaton 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps

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injured

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6 Week Program (3x/week)

Day #1 (Week 5 & 6) Scapular Stabilizer Muscles

Low Row 2-3 sets of 10-15 reps Prone Lower Trap Dumbbell Rase 2 sets of 15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps External Rotaton (Dumbbell) - 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps Seated Dumbbell Horzontal External Rotaton 2 sets of 15-20 reps

Day #2 (Week 5 & 6) Scapular Stabilizer Muscles

Hgh Row 2-3 sets of 10-15 reps Prone Lower Trap Dumbbell Rase 2 sets of 15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps Serratus Dumbbell Punches 2 sets of 15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps Standng Dagonal Dumbbell Rase 2 sets of 15-20 reps

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injured

or inFlamed

shoulder series

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6 Week Program (3x/week)

Day #3 (Week 5 & 6) Scapular Stabilizer Muscles

Lat Pull Downs 3 sets of 10-15 reps Prone Lower Trap Dumbbell Rase 2 sets of 15 reps Prone Horzontal Abducton Rase 2 sets of 15 reps Prone Extenson Rase w/External Rotaton 2 sets of 15 reps Dumbbell Shoulder Shrugs 2-3 sets of 10-15 reps

Rotator Cuff Muscles

Scapton 2 sets of 15-20 reps Seated Dumbbell Horzontal External Rotaton 2 sets of 15-20 reps Internal Rotaton w/Tubng 2 sets of 15-20 reps Standng Dagonal Dumbbell Rase 2 sets of 15-20 reps

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see your Physician

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The prevous exercse program s not ntended to replace professonal medcal care by a physcan or physcal therapst. It s smply desgned to strengthen the rotator cuff and scapular stablzer muscles, correct muscular mbalances and mprove shoulder functon. If you suffer from chronc shoulder pan, experence an acute onset of sgnficant shoulder pan, or notce gross weakness and lmtaton wth actvtes of daly lvng, t s recommended that you see your physcan for a complete evaluaton. After completng the sx week program, you may not be pan free. In ths case, I generally recommend contnung wth week 5 and 6 exercses for several more weeks untl your symptoms resolve. Chronc pan often takes longer to respond to treatment. If you do not experence mprovement wth the program, t s recommended that you seek professonal medcal evaluaton and treatment. Wth that sad, I hope the nformaton n ths book wll enable you to tran more safely and efficently n the future. At the very least, the technques descrbed here wll allow you to avod many common exercse ptfalls that lead to compressve wear and tear on the rotator cuff tself. Whle t s not absolutely necessary to perform rotator cuff strengthenng on a weekly bass, I hghly recommend ncorporatng the tranng modficatons as outlned earler wth respect to the bonus exercses. In addton, keep n mnd the mportance of posture, flexblty and rotator cuff strengthenng n relaton to proper shoulder functon. For more information regarding my training or consulting services you can e-mail me at bschiff@thefitnessedge.cc or visit www.thefitnessedge.cc.

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