Training Rotator Cuffs

Training
1

What is the best way for someone to bring up rotator cuff strength if they are following a 3day/week full body routine?

Day 1

Deadlift 8x3
Chinup/Dip Superset 8x3

Day 2

Inverted Row/Fist Pushup Superset 4x10
DB Row/One arm DB Bench Press Superset 5x5
Pistol Squats
Running

Day 3

Push Press 8x3
Front Squat 8x3
Pullups of various grips 3xAMRAP

I was thinking of doing 3x10 Seated External Rotations with a dumbbell after each training day.

My rotator cuff strength is about 50% of where it needs to be according to Charles Poliquin Achieving Structural Balance (8RM should be 10% of close grip bench 1RM)

Thanks!!

2

I’m really liking band dislocates right now, just shifting your hands in over the course of a set. Multiple sets of 20+ every day or so.

There’s also cuban presses (lots of external rotation) and overhead holds (isometric stability of the entire rotator cuff).

Higher-rep YTWLs are the go-to for most physiotherapists though, so consider those also.

3

Joe deFranco has a series of band pull apart exercises that are awesome.

I do the above series then finish up with a variation of the lying external rotations shown in this video. New Shoulder External Rotation / Rotator Cuff Exercise - YouTube

I had RC surgery a while back. Since then, I’ve used these two methods at the end of every gym session, and my shoulders have never felt better.

4

The link was removed, but here’s the description and video:

[quote]The variations are as follows:

10 X band pull-aparts, arms straight, hands pronated
10 X band pull-aparts, arms straight, hands supinated
10 X band pull-aparts, elbows bent at 90 degrees, hands pronated
10 X band pull-aparts, elbows bent at 90 degrees, hands supinated
10 X band pull-aparts, bent over, elbows bent at 90 degrees, hands pronated at face level
10 X band pull-aparts, bent over, elbows bent at 90 degrees, hands supinated at face level
10 X overhead band pull-aparts
I recommend starting with one set (seventy reps) a day for about a week and work up to three sets (210 reps) a day. They can be done as part of the warm up, between set work, as an accessory movement, or at the end of the workout. You can split them up or do all three sets at once. It doesn?t really matter. The only stipulation I have is don?t do all three sets prior to a heavy bench or press workout. It will fatigue your stabilizers too much. Instead, you can do one set as part of your warm up and the other two after the heavy bench session.

Usually, you?ll notice much improved strength and mobility in just a few days and significant improvement in your overall shoulder health after a few weeks.[/quote]

–

Thanks for sharing.

5

Try learning the power snatch - also incorporating overhead power holds like mentioned above. Both load the external rotators with WAY more weight than you’ll ever be able to poor man’s shoulder horn.

Here are a few gold livespills regarding the issue:
The Power Hold with cues: http://www.T-Nation.com/strength-training-topics/1734

Helpful article on getting the proper position for the power hold: http://www.T-Nation.com/strength-training-topics/1736

CT discussing internal vs external rotation: http://www.T-Nation.com/strength-training-topics/1767

Hope this helps!
Colby

6

[quote]Colbstar wrote:
Try learning the power snatch - also incorporating overhead power holds like mentioned above. Both load the external rotators with WAY more weight than you’ll ever be able to poor man’s shoulder horn.

Here are a few gold livespills regarding the issue:
The Power Hold with cues: http://www.T-Nation.com/strength-training-topics/1734

Helpful article on getting the proper position for the power hold: http://www.T-Nation.com/strength-training-topics/1736

CT discussing internal vs external rotation: http://www.T-Nation.com/strength-training-topics/1767

Hope this helps!
Colby[/quote]

That’s the thing… I don’t see how doing 10-15lbs DB shoulder external rotation can balance 200lbs+ pressing work.

That’s being said, I’d had good success with daily band work with clients with tender shoulders. But they also do the olympic lifts and some do ring work, so I doubt that the band work (or light DB work) would be enough to truly balance external shoulder rotation strength.

7

Years ago, when MM2K published Poliquin’s “Twist and Shout” article on training the ERH muscles, everyone started training them with high reps and 5 lb dumbbells (or less!). CP has recently clarified, however, that these muscles tend to be on the fast-twitch end of the spectrum, and that the high reps recommended way back in that article were only appropriate for people with ERH that were almost completely untrained – e.g., typical, average guy who does bodybuilding, not Oympic lifting, with tonnes of Bench Press and zero Cleans, Snatches, etc., and who therefore needs a few weeks of remedial work on the ERH.

Personally, after those few weeks I still wasted years doing high rep, slow tempo external rotations with 20 lb dumbbells. I tried Plate Mates, light bands, cables – just about everything to get past that plateau, and never really improved much more. But when I did the Clean-and-Press again I actually got DOMs in my ERH muscles the first few workouts, and could actually feel those muscles for the first time ever! Shoulder troubles pretty well gone after that…

8

[quote]fama wrote:
Years ago, when MM2K published Poliquin’s “Twist and Shout” article on training the ERH muscles, everyone started training them with high reps and 5 lb dumbbells (or less!). CP has recently clarified, however, that these muscles tend to be on the fast-twitch end of the spectrum, and that the high reps recommended way back in that article were only appropriate for people with ERH that were almost completely untrained – e.g., typical, average guy who does bodybuilding, not Oympic lifting, with tonnes of Bench Press and zero Cleans, Snatches, etc., and who therefore needs a few weeks of remedial work on the ERH.

Personally, after those few weeks I still wasted years doing high rep, slow tempo external rotations with 20 lb dumbbells. I tried Plate Mates, light bands, cables – just about everything to get past that plateau, and never really improved much more. But when I did the Clean-and-Press again I actually got DOMs in my ERH muscles the first few workouts, and could actually feel those muscles for the first time ever! Shoulder troubles pretty well gone after that…[/quote]

Yep, my shoulders are always the healthiest when I work on the olympic lifts. Properly catching a clean requires an explosive external rotation, same with the snatch with the added “reactive shock absorption”.

9

[quote]Christian Thibaudeau wrote:

[quote]Colbstar wrote:
Try learning the power snatch - also incorporating overhead power holds like mentioned above. Both load the external rotators with WAY more weight than you’ll ever be able to poor man’s shoulder horn.

Here are a few gold livespills regarding the issue:
The Power Hold with cues: http://www.T-Nation.com/strength-training-topics/1734

Helpful article on getting the proper position for the power hold: http://www.T-Nation.com/strength-training-topics/1736

CT discussing internal vs external rotation: http://www.T-Nation.com/strength-training-topics/1767

Hope this helps!
Colby[/quote]

That’s the thing… I don’t see how doing 10-15lbs DB shoulder external rotation can balance 200lbs+ pressing work.

That’s being said, I’d had good success with daily band work with clients with tender shoulders. But they also do the olympic lifts and some do ring work, so I doubt that the band work (or light DB work) would be enough to truly balance external shoulder rotation strength.[/quote]

I think that a lot of the resistance is used just in stretching the opposing internal rotators though, especially if they have gotten tight over a long period of time. I went from 5 pound Cubans to 45 pound Cubans in about a month, and I am sure it was not all from getting stronger external rotators.

10

[quote]fama wrote:
Years ago, when MM2K published Poliquin’s “Twist and Shout” article on training the ERH muscles, everyone started training them with high reps and 5 lb dumbbells (or less!). CP has recently clarified, however, that these muscles tend to be on the fast-twitch end of the spectrum, and that the high reps recommended way back in that article were only appropriate for people with ERH that were almost completely untrained – e.g., typical, average guy who does bodybuilding, not Oympic lifting, with tonnes of Bench Press and zero Cleans, Snatches, etc., and who therefore needs a few weeks of remedial work on the ERH.

Personally, after those few weeks I still wasted years doing high rep, slow tempo external rotations with 20 lb dumbbells. I tried Plate Mates, light bands, cables – just about everything to get past that plateau, and never really improved much more. But when I did the Clean-and-Press again I actually got DOMs in my ERH muscles the first few workouts, and could actually feel those muscles for the first time ever! Shoulder troubles pretty well gone after that…[/quote]

except they arent on the fast twitch spectrum… … … they are mixed in most people, but of course this depends on your training as you can shift muscle fiber type per training

11

[quote]Christian Thibaudeau wrote:

[quote]Colbstar wrote:
Try learning the power snatch - also incorporating overhead power holds like mentioned above. Both load the external rotators with WAY more weight than you’ll ever be able to poor man’s shoulder horn.

Here are a few gold livespills regarding the issue:
The Power Hold with cues: http://www.T-Nation.com/strength-training-topics/1734

Helpful article on getting the proper position for the power hold: http://www.T-Nation.com/strength-training-topics/1736

CT discussing internal vs external rotation: http://www.T-Nation.com/strength-training-topics/1767

Hope this helps!
Colby[/quote]

That’s the thing… I don’t see how doing 10-15lbs DB shoulder external rotation can balance 200lbs+ pressing work.

That’s being said, I’d had good success with daily band work with clients with tender shoulders. But they also do the olympic lifts and some do ring work, so I doubt that the band work (or light DB work) would be enough to truly balance external shoulder rotation strength.[/quote]

because most peoples isometric ER strength measures around 20-25 lbs hence your training at 75% intensity. And mind you that the Supra, Infra, and TM are not the primary movers pressing, but primarily providing dynamic stability.

12

[quote]BHOLL wrote:
except they arent on the fast twitch spectrum… … … they are mixed in most people, but of course this depends on your training as you can shift muscle fiber type per training[/quote]

Well, I don’t know. But on CP’s old site (now the Poliquin Group), this was posted a few years ago:

"Wednesday, September 01, 2010 7:15 AM

Tip 180: The external rotators of the humerus are mainly made of fast-twitch muscles and should be trained accordingly.

Structure dictates function, and the rotator cuff muscles are about 60 percent fast-twitch muscle fibers. The external rotators are power decelerators that need to produce high forces in minimal time. Because these muscles are usually undertrained, I usually recommend higher reps and slower velocities during the initial stages of training, gradually moving towards lower reps and higher training velocities."

If the above is correct, I guess even 60% FT could still be called “mixed” since that leaves a fair amount left over for Type I and Intermediate fibers.

Also, regarding “conversion” through training, I was under the impression, (and I’m sure that I’ve read this before), that fast-twitch fibers could be made to act like slow-twitch, but not vice-versa.

Lastly, regarding your answer to CT’s comment, that light ERH exercises can’t balance hundreds of pounds of pressing and rowing, I don’t think CT meant the % of ERH maximum (75% or whatever you said). I think he meant that there is a LOT of stress tugging on the joint in one direction (e.g. 300 lb Bench Press internal rotation) and very little the other direction (e.g. 15 lb Cuban Press external rotation), so even if those tiny muscles are working near their max in the latter exercise, it won’t do a whole lot for “balancing” in the long run. But maybe CT will clarify if I’m wrong.

13

[quote]fama wrote:

[quote]BHOLL wrote:
except they arent on the fast twitch spectrum… … … they are mixed in most people, but of course this depends on your training as you can shift muscle fiber type per training[/quote]

Well, I don’t know. But on CP’s old site (now the Poliquin Group), this was posted a few years ago:

"Wednesday, September 01, 2010 7:15 AM

Tip 180: The external rotators of the humerus are mainly made of fast-twitch muscles and should be trained accordingly.

Structure dictates function, and the rotator cuff muscles are about 60 percent fast-twitch muscle fibers. The external rotators are power decelerators that need to produce high forces in minimal time. Because these muscles are usually undertrained, I usually recommend higher reps and slower velocities during the initial stages of training, gradually moving towards lower reps and higher training velocities."

If the above is correct, I guess even 60% FT could still be called “mixed” since that leaves a fair amount left over for Type I and Intermediate fibers.

Also, regarding “conversion” through training, I was under the impression, (and I’m sure that I’ve read this before), that fast-twitch fibers could be made to act like slow-twitch, but not vice-versa.

Lastly, regarding your answer to CT’s comment, that light ERH exercises can’t balance hundreds of pounds of pressing and rowing, I don’t think CT meant the % of ERH maximum (75% or whatever you said). I think he meant that there is a LOT of stress tugging on the joint in one direction (e.g. 300 lb Bench Press internal rotation) and very little the other direction (e.g. 15 lb Cuban Press external rotation), so even if those tiny muscles are working near their max in the latter exercise, it won’t do a whole lot for “balancing” in the long run. But maybe CT will clarify if I’m wrong.
[/quote]

First Part: only study looking at fiber concentration of cuff

TUDY DESIGN:
Descriptive cadaveric laboratory study.
OBJECTIVE:
To identify the fiber type composition of the rotator cuff and teres major muscles in human subjects.
BACKGROUND:
The rotator cuff is commonly injured in athletics and is a major focus of sports medicine. Although the anatomy and architecture of each muscle have been described in great detail, these muscles have never been fiber typed using immunohistochemistry or gel electrophoresis. Fiber typing is important in modeling function, exercise training, and rehabilitation.
METHODS AND MEASURES:
We harvested tissue samples for all 4 rotator cuff muscles, as well as the teres major muscle from cadavers. Tissues were frozen in liquid nitrogen and sectioned. Cryosections were labeled with commercially available antibodies against fast and slow isoforms of myosin heavy chain (MHC). We also harvested fresh (unembalmed) tissue from deceased subjects and labeled tissue sections with antibodies against fast or slow MHC and wheat germ agglutinin. Gel electrophoresis followed by silver staining was also used to identify and quantify MHC isoforms in fresh tissue samples.
RESULTS:
All of the muscles were of mixed fiber type composition. As a whole, 44% of rotator cuff fibers labeled positively for slow MHC, with slow MHC content of 54% in supraspinatus, 41% in infraspinatus, 49% in teres minor, 38% in subscapularis, and 40% in teres major. Mixed MHC isoform distribution was confirmed by SDS-PAGE, which also indicated that the IIa and IIx isoforms were roughly equally present across the muscles.
CONCLUSIONS:
Human rotator cuff muscles, at least in older subjects, have a mixed fiber type. Because we only examined older subjects, we must limit our interpretation to this population.

Obviously older population (who tend to lose FT) but gives a general sense of the cuff being mixed orientation

Part 2: Dr. Jacob Wilson wrote a review publish in NSCA a little while back on this topic. NO you can orient fiber type in either direction

I’m not sure what your meaning is for the last part. I was simply saying most people’s maximal isometric strength (which is greater than conc/ecc) is usually between 20-30 pounds into external rotation, therefore, training with 10-20 loads can induce a training effect.

However if your training simply to lift loads overhead then specificity of training the cuff overhead is important. I however do not see this “as a cure for shoulder pain, and something that will reduce many or most people’s shoulder problems.” For me I choose not to perform overhead lifts and I don’t like training the cuff at end range flexion/scaption where it is actively insufficient.

14

I’ll be honest… I only care about rotator cuff training in order to reduce my impingement, and the associated inflammation. Some things I’ve done have made it better, some things have made it worse.

Since this thread started, I started going that band pullapart series (so, 4 or 5 days now?) and that has also been working well for me. The combination of that and the band dislocates seem to be changing my posture ever so slightly. Normal everyday activities don’t seem to hurt quite as much (using the washer and dryer is the most notable “painful” activity.) And then the anti-inflammatories + overall rest has been helping with the inflammation (duh).

I don’t actually see a good need to train the rotator cuff directly, except in a rehab type of scenario like I’m dealing with.

For whatever reason though, a few of these exercises have seemed to be enough to open up the subacromial space so that I’m not constantly re-inflaming the tendons in my day-to-day life. SGHP, rows, facepulls, overhead work just wasn’t enough – for me.

15

[quote]BHOLL wrote:
Obviously older population (who tend to lose FT) but gives a general sense of the cuff being mixed orientation
…
Part 2: Dr. Jacob Wilson wrote a review publish in NSCA a little while back on this topic. NO you can orient fiber type in either direction

I’m not sure what your meaning is for the last part. I was simply saying most people’s maximal isometric strength (which is greater than conc/ecc) is usually between 20-30 pounds into external rotation, therefore, training with 10-20 loads can induce a training effect.[/quote]

Yes, I did read that abstract - actually just a few minutes after my previous post. I don’t think anyone ever claimed or believed the ERH were 100% FT fibers. But that study, while limited to an older population, actually corroborates the point I was making before: almost all of the muscles they studied were found to be more FT than ST (though admittedly not by a wide margin). The exception is the subscap, but even in that case it was “only” 54% ST… and as you noted, an older population *could skew the findings a bit, so MAYBE younger people would have even more FT in their ERH.

The point is, these findings are hardly an argument for training these muscles forever with endurance protocols and baby weights, or training them the way one trains a slow muscle like the soleus.

16

[quote]LoRez wrote:
I’ll be honest… I only care about rotator cuff training in order to reduce my impingement, and the associated inflammation. Some things I’ve done have made it better, some things have made it worse.

Since this thread started, I started going that band pullapart series (so, 4 or 5 days now?) and that has also been working well for me. The combination of that and the band dislocates seem to be changing my posture ever so slightly. Normal everyday activities don’t seem to hurt quite as much (using the washer and dryer is the most notable “painful” activity.) And then the anti-inflammatories + overall rest has been helping with the inflammation (duh).

I don’t actually see a good need to train the rotator cuff directly, except in a rehab type of scenario like I’m dealing with.

For whatever reason though, a few of these exercises have seemed to be enough to open up the subacromial space so that I’m not constantly re-inflaming the tendons in my day-to-day life. SGHP, rows, facepulls, overhead work just wasn’t enough – for me.[/quote]

I don’t actually see a good need to train the rotator cuff directly, except in a rehab type of scenario like I’m dealing with.

maybe thats why your hurt…

17

[quote]fama wrote:

[quote]BHOLL wrote:
Obviously older population (who tend to lose FT) but gives a general sense of the cuff being mixed orientation
…
Part 2: Dr. Jacob Wilson wrote a review publish in NSCA a little while back on this topic. NO you can orient fiber type in either direction

I’m not sure what your meaning is for the last part. I was simply saying most people’s maximal isometric strength (which is greater than conc/ecc) is usually between 20-30 pounds into external rotation, therefore, training with 10-20 loads can induce a training effect.[/quote]

Yes, I did read that abstract - actually just a few minutes after my previous post. I don’t think anyone ever claimed or believed the ERH were 100% FT fibers. But that study, while limited to an older population, actually corroborates the point I was making before: almost all of the muscles they studied were found to be more FT than ST (though admittedly not by a wide margin). The exception is the subscap, but even in that case it was “only” 54% ST… and as you noted, an older population *could skew the findings a bit, so MAYBE younger people would have even more FT in their ERH.

The point is, these findings are hardly an argument for training these muscles forever with endurance protocols and baby weights, or training them the way one trains a slow muscle like the soleus.
[/quote]

your not making much sense, firstly the subscapularis has the highest percentage of fast twitch fibers which is in accordance with why pitchers can throw a baseball hard. The supraspinatus has the highest percentage of slow twitch fibers and is the muscle heavily involved in stabilization while overhead pressing.

Furthermore, you are correct, the elderly age does make a difference, BUT this only further suggests that these numbers favor fast twitch %'s as a decrease in activity actually increases the % of fast twitch fibers. hence the older population in this study most likely skewed the numbers in favor of FT fibers. The more training your perform the more % type 1 and type IIa are biased. Hence why bodybuilders are heavily type 1/type IIa.

Lastly, baby weights at 10-15# are well within most people’s training zone of 70-80% as I previously stated. Nevertheless the RTC is responsible for stabilization and does not play an enormous role in force production, except for IR. In regards to the baby weights, do you think holding a bar over your head is much more challenging then 8-10 reps of a reasonable weight? Plus it is an isometric exercise which translates poorly to other exercises and only to that specific ROM +/- 15 degrees. In conclusion I am not making a case against overhead Iso’s but merely a case for why sidelying ER with dumbbells in the scapular plane is a worthwhile exercise.

18

[quote]BHOLL wrote:

[quote]LoRez wrote:
I don’t actually see a good need to train the rotator cuff directly, except in a rehab type of scenario like I’m dealing with.[/quote]

maybe thats why your hurt…
[/quote]

No, I’m hurt because I did some maximal explosive behind-the-neck pressing, and lowered the bar to my traps, while not having adequate T-spine mobility.

19

[quote]LoRez wrote:

[quote]BHOLL wrote:

[quote]LoRez wrote:
I don’t actually see a good need to train the rotator cuff directly, except in a rehab type of scenario like I’m dealing with.[/quote]

maybe thats why your hurt…
[/quote]

No, I’m hurt because I did some maximal explosive behind-the-neck pressing, and lowered the bar to my traps, while not having adequate T-spine mobility.[/quote]

behind the neck maximal presses??? the 80s called and what that exercise back brothaaaa

20

[quote]BHOLL wrote:
your not making much sense, firstly the subscapularis has the highest percentage of fast twitch fibers which is in accordance with why pitchers can throw a baseball hard. The supraspinatus has the highest percentage of slow twitch fibers and is the muscle heavily involved in stabilization while overhead pressing.[/quote]

You’re correct - I meant to say supraspinatus (not subscap), as the supraspinatus is the one (the only one) that’s more than 1/2 ST, at the specified 54%.

[quote]BHOLL wrote:
Furthermore, you are correct, the elderly age does make a difference, BUT this only further suggests that these numbers favor fast twitch %'s as a decrease in activity actually increases the % of fast twitch fibers. hence the older population in this study most likely skewed the numbers in favor of FT fibers. The more training your perform the more % type 1 and type IIa are biased. Hence why bodybuilders are heavily type 1/type IIa.[/quote]

Let me see if I have this right: you’re saying that FT fibers – the stronger, larger fibers – actually increase as one ages, or as one becomes more “detrained” ???

Uhh…sorry, I just don’t believe that at all. And I believe that if bodybuilders have more Type I and IIa fibers than, say, powerlifters have of Type IIb, it’s because of the METHODS bodybuilders use: traditionally with longer TUT, often with slower lifting tempos, etc.

[quote]BHOLL wrote:
do you think holding a bar over your head is much more challenging then 8-10 reps of a reasonable weight?[/quote]

Yes.

Sure, I don’t think anyone really disputes that - it’s just that (as CT himself has said in the Livespills quoted above) the usefulness of such exercises is limited, and it’s not the only way these muscle should trained.