by Mitch Hauschildt, MA, ATC, CSCS
I perform a lot of shoulder rehab with athletes and patients on a regular basis. This ranges from fairly major cases such as post operative labral repairs, rotator cuff repairs and thoracic outlet syndrome to biceps tendinitis and shoulder impingement. All of these conditions come with their own set of challenges, restrictions and obstacles for helping patients get past their pain and injury and back to doing the things they love.
The one thing that they all have in common is that the solution to fixing the issue is to find their dysfunction, wherever it may be, and fix it. That may be a mobility restriction, motor control problem, poor proprioceptive feedback, a strength deficit or a host of other issues. And, when I say find the dysfunction and fix it, I am referring to anywhere in the body. The concept of regional interdependence tell us that every part of the body is connected and as one part moves, the rest of the body will react. I feel confident when I say that he shoulder is the most complex joint in the body, thus fixing it requires a complex strategy due to everything that is involved.
One thing that I was taught early on in my educational process is to strengthen the rotator cuff as a fundamental and foundational exercise that is imperative to rehabilitating a shoulder injury. This includes internal rotation and external rotation exercises, as well as isolated supraspinatus strengthening such as the empty can movement.
As most young professionals, I sheepwalked through the therapy process with my patients and followed suit. I performed rotator cuff strengthening standing with bands, lying down with weight, seated with manual resistance, lying prone on their stomach and so on. If it involved the rotator cuff, I was all for it. Over time, I began to read and learn from some of the best movement specialists in the country and they started to plant some seeds in my mind that maybe strengthening the rotator cuff isn’t the best way to rehab my patients.
After a lot of thinking and wrestling with the topic, I just couldn’t justify isolated cuff strengthening anymore, so I stopped doing it. It just didn’t make sense and the reason is honestly really simple:
The rotator cuff is a stabilizer, not a prime mover
I will never argue the importance of the rotator cuff. It is extremely important for creating stability in the shoulder and holding the head of the humerus against the glenoid. If it isn’t working properly or is torn, the humeral head will get sloppy and impinge on something in the shoulder, creating pain and further issues.
The issue isn’t whether or not it is important. The issue is training it to function the way it is intended to function. Every muscle can create motion to a certain degree because they will shorten (that’s all muscles really do), moving their origin and insertion closer together. But, just because it can create movement doesn’t mean it’s designed to or should. This is the case with the rotator cuff.
The job of the rotator cuff in the shoulder is to turn on and off at the right time, in the right sequence and with the right rhythm in order to balance all of the other forces placed upon the shoulder and ultimately maintain joint centration. Is is intended to stabilize.
Since it is a stabilizer, it doesn’t make sense to train it as a prime mover
I prefer to allow the larger muscles such as the pecs, deltoid and lats to create movement. They are much larger, more powerful and better positioned to create motion than the rotator cuff is. Train those muscles to create movement. Train the rotator cuff to stabilize.
How do we do we train the cuff to stabilize?
The easiest place to start is with grip training. There is a direct neurological connection between the cuff and grip strength. It is your body’s natural protective mechanism for the shoulder. It is your brain’s way of limiting your ability to pick up something that is heavier than your shoulder can handle.
Improving grip strength and the ability to pack your shoulder is a great place to start improving motor control. After that, progress to consciously loading the body and reseting timing with deadlifts (starting the movement by packing, gripping and then lifting) and TRX rows and so on.
I do want to be clear in that I don’t think that rotator cuff strengthening is dangerous and if you do it that you are necessarily wrong. I just think that it is a waste of time because at the end of the day, it doesn’t appropriately prepare the body to move the way it actually moves. I would rather spend my time working on things that actually improve function and that is why I don’t strengthen the rotator cuff anymore.
Thanks Mitch,
I will use this with a client who is having troubles with rotating her shoulder.
I’ve found in my practice over the last few years I tend to work the rotator cuff less, and focus on the pecs, lats, and deltoid more when it comes to shoulder pain. Working backwards usually helps the client ease into the pain that can come with TrP work. Plus, it saves my thumbs.
Appreciate this post. Will try it out.
Would you advise more isometric rotator cuff exercises in multiple positions as well as the gripping exercises you have advocated?
I think that isometrics might work. Honestly, I don’t hate RC exercises because they aren’t dangerous and are simple to teach. But, I also think that my time can be spent better elsewhere. But, if you want to use some variations, including isometrics, I think it is fine.