THE IMPORTANCE OF ROTATOR CUFF EXERCISES
Rotator cuff exercises for the shoulder is an exciting topic. We can all agree on the importance of strengthening the rotator cuff muscles (which are the supraspinatus, infraspinatus, teres minor, and the subscapularis – an easy acronym is that they spell SITS.) However, the method by which people choose to strengthen them, or should I say the theory can vary quite a bit. From the use of TheraBand’s with isolated based movement exercises to functional patterns involving the whole body and muscular system.
Some shouting others are wrong, and others are swearing their way is the best. Is it possible everyone is correct? I think we are often (with many things in life) doing our best, just having the wrong conversation. I will go over the two different theories mentioned above and give my thoughts with some tips to optimize both options, leaving you the reader with a clear understanding of the pros and cons of both. In my Shoulder & Rotator Cuff Mobility and Rehabilitation Program, I focus on both and explain the importance of each. Teaching natural movement of the body is crucial, but as I explain throughout the blog – the athlete or client must be ready for that stage.
ISOLATED MUSCLE BASED THEORY
This is the idea that we should be using things like TheraBand (or other elastic bands) for rotator cuff exercises like external rotation/internal rotation and light weights for exercises like the “Empty Can” (see a video below for the Empty Can exercise from my Shoulder & Rotator Cuff Program)
PROS & TIPS:
If we are suffering from shoulder pain these rotator cuff exercises will help. In the video below you will notice that I focus on both the external rotation below 90 degrees and also “above” 90 degrees (above is actually at 90 degrees.) One HUGE tip here is to focus on both the exercises and learn which one the culprit is of your pain. People that are struggling with overhead movements such as throwing sports athletes or moms and dads with daily activities could struggle more with the version at 90 degrees. Tennis players having pain with a forehand or backhand might notice the other exercise being harder.
These exercises are also a fantastic approach to teaching new movement. From kids to adults we see more and more problems that come from the inability to activate specific muscles or muscle groups. Our nervous system is intelligent and sometimes wants to take shortcuts – such as using the larger muscle groups and forgetting about the smaller ones (i.e., the rotator cuff.) This leads to a weakness in the stability of the shoulder and increases the “extra” movement of your humerus (arm bone) in the fossa (shoulder joint.) Now imagine raising your arm over your head and think about the injury we all know as “impingement syndrome.” If the arm bone moves too much in the joint, then you can imagine this “pinching” motion taking place.
You can make the same argument with the empty can exercise. This focuses on a muscle called the supraspinatus (See pic of the supraspinatus below.) You can see how this could be easily pinched with an over the head arm movement if there is too much translation (the fancy word for movement) in the shoulder joint.
So, all in all, I am a fan of exercises that isolate muscles. However, THEY MUST BE IMPLEMENTED CORRECTLY. I will explain further below.
More and more research is coming out suggesting that the best rotator cuff exercises are ones that focus on movements our nervous system and muscular system understand. If you have watched the Empty Can video, you will notice it is not a regular movement pattern our shoulder would go through (similar to a leg extension machine & a box step up. One is a natural movement, and the other is entirely human-made.) I will go into greater detail when I discuss the next option for rotator cuff exercises, but it is essential to understand that this theory does not make these exercises pointless. Implementing these exercises to teach the activation of the shoulder blades, different rotator cuff muscles, or to increase the warm-up for an athlete is ok and a good idea. I also like using them to teach younger athletes discipline.
It becomes a responsibility they must remember along with showing them the importance of their body. In “physioland” we have two essential types of rehab exercises – open chain and closed chain. Open chain rotator cuff exercises (like the TheraBand rotator cuff exercises) are the more basic movements and essential for beginners (or directly after injury) while closed-chain rotator cuff exercises (like the handstand) are the more advanced version and for the later stages of rehab. Closed chain exercises focus more on getting the athlete or individual back to functional patterns and advancing their movement and strength to prevent further injury. We often still use open chain exercises when the athlete or individual is entirely in the closed chain stages. So why not do the same here?
FUNCTIONAL MOVEMENT BASED EXERCISES:
These are exercises such as Bear Crawls, Inch Worms, Crab Walks, and Handstands that focus on whole body movement with the idea that this will activate and train the nervous system to fire all stability muscles (not just the rotator cuff) when needed.
PROS AND TIPS:
First, I will come clean and admit that this is my belief and favorite way of training the athlete or client. However, the individual must be ready for this stage, if they are not, other injuries/aches and pains will occur. A perfect example is a handstand. In the video below I talk about the importance of this exercise & emphasize the importance of the wrist position. When this is done incorrectly or implemented too soon in someone’s rehab protocol – it is not uncommon to see the increase of wrist pain or even worse wrist injury.
I subscribe to the idea that our body is the smartest piece of machinery out there. So teaching it movements like the handstand, it will learn when to fire the smaller muscles. Our nervous system will understand it needs the deltoids, butt, and chest to create the power necessary to hold and maintain this position. The nervous system will also understand that without the activation of ALL OF THE STABILIZING MUSCLES, not just the rotator cuff – this exercise is not possible.
The functional movement based exercises are not only an excellent option for a variety of external rotation exercises but also to help locate all the weak stabilizers throughout the body. An added benefit on top is that not only are they becoming stronger, but the nervous system is now laying down new myelin-based pathways (which are crucial for learning) and memorizing the sequence of firing/muscle activation needed to make you a better and more efficient human. From winning the last point in Wimbledon to picking up your child, you will do this better and more efficient because of these new neural pathways.
Simple, they are more complexed movements and this means the individual needs a certain movement efficiency or a scaled version that fits his or her skill/strength level AND EVEN MORE IMPORTANT they must stay focused the entire time because the technique is essential. That should not scare anyone away, but it should remind the adults to focus on their movement and technique and the coaches to remind the kids or athletes the importance of the same.
Both theories are correct in their way, we need to understand when the implementation of one is better than the other. We also need to understand it is ok to use a mixture of both, and the percentage of each depends on our athlete/client or goal. If you want to use a TheraBand/isolated movement-based program, that is fine. Try to make it as functional as possible (how I added the below 90 and above 90 degrees together in one set of the rotator cuff exercises.) If you are focused on the functional movement based exercises, remember that technique is crucial, and it is ok to still use the “open-chain” exercises in between. Please check out my Shoulder & Rotator Cuff Rehabilitation & Mobility Program if you are suffering from shoulder pain or a rotator cuff injury