Rotator Cuff Questions

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    Rotator Cuff Questions


    Hi Everybody I have two questions. I seem to have strained my rotator cuffs, the left one more than the right and can no longer do any overhead presses. So my questions are:

    1. How often should I do direct rotator cuff rehab work? I know what kind of stretches and exercises to do, but I couldn't find any consensus on how often to do it. Some articles don't even mention it, some say every day etc.

    2. What is a good rotator cuff friendly shoulder routine I can do while healing? I can still do many non overhead press shoulder movements, lateral raises, etc but presses were kinda the cornerstone of my shoulder routine so I'm kinda a man without a country at the moment.

    The good news is I can still bench press if I dial in my techniquie, I can decline like a mother "F'er" still, and I guess I can let Incline go at the moment.

    Thanks in advance for your advice.

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    How do you know it is your rotator cuff? The rotator cuff is a collective term for a group of muscles, some of which have opposing actions so it helps to know which muscle in particular if you have someone who diagnosed you.
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    Quote Originally Posted by rambo679 View Post
    Hi Everybody I have two questions. I seem to have strained my rotator cuffs, the left one more than the right and can no longer do any overhead presses. So my questions are:

    1. How often should I do direct rotator cuff rehab work? I know what kind of stretches and exercises to do, but I couldn't find any consensus on how often to do it. Some articles don't even mention it, some say every day etc.

    2. What is a good rotator cuff friendly shoulder routine I can do while healing? I can still do many non overhead press shoulder movements, lateral raises, etc but presses were kinda the cornerstone of my shoulder routine so I'm kinda a man without a country at the moment.

    The good news is I can still bench press if I dial in my techniquie, I can decline like a mother "F'er" still, and I guess I can let Incline go at the moment.

    Thanks in advance for your advice.
    you should be doing internal/external rotation work as part of your warmup everyday. these shouldn't be strenuous, if they are, you're using too much weight. it's kind of odd that you can bench pain free but ohp's bother you. for me, it's the exact opposite.

    it's extremely important to have your form dialed in, i can't stress this enough. search the web for 'treat your own rotator cuff,' it's a pretty big pdf file and has lots of good stuff. also, go to elitefts and search there as well. i know they have some prehab routines.

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    I admit that it's self diagnosed based on the discomfort I feel when doing 90 degree external rotations with dumbells, that seems to be located right where the supraspinatus is.
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    Quote Originally Posted by rambo679
    I admit that it's self diagnosed based on the discomfort I feel when doing 90 degree external rotations with dumbells, that seems to be located right where the supraspinatus is.
    What is your ratio of pulls to presses? I recommend 2:1 pulls to presses. Also, face pulls have helped my shoulders more than any other movement.

    You should prolly give it a rest for a week or so. Then try some light ohp's and benches. When I say light I mean about 30-40% of what you normally work with. If it's still bothering you, time to get an MRI

    Good luck
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    Thanks for the advice, my Push-Pull Ratio currently is 1:1. Which I thought was good enough and gave me a sense that I was preventing injuries but clearly I need to tweak it.

    I was just starting to kick ass too on bench press so it's hard to derail that progress but I'm mature enough to realize it's neccessary. And I consider myself lucky that I can still hit legs and back in the mean time.
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    Just to clarify, pullups/pulldowns really should not be included in that since they also work the internal rotators. It really should be the ratio of internal rotation (e.g. presses, pulldowns):external rotation (e.g. rows, facepulls)
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    Quote Originally Posted by Rodja View Post
    Just to clarify, pullups/pulldowns really should not be included in that since they also work the internal rotators. It really should be the ratio of internal rotation (e.g. presses, pulldowns):external rotation (e.g. rows, facepulls)
    excellent point rodja, in addition, he shouldn't be doing any upright rows either. those things are shoulder girdle killers. i cringe when i see people doing them. i'd keep it to seated rows, bb rows - preferably pendlays, face pulls, deadlifts if he can do them pain free etc...
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    Front raises > upright rows all day

    Upright rows murder your shoulders
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    I haven't done upright rows in years, just watching them hurts my shoulders.
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    Quote Originally Posted by napalm View Post
    What is your ratio of pulls to presses? I recommend 2:1 pulls to presses. Also, face pulls have helped my shoulders more than any other movement.

    You should prolly give it a rest for a week or so. Then try some light ohp's and benches. When I say light I mean about 30-40% of what you normally work with. If it's still bothering you, time to get an MRI

    Good luck
    The guidelines in this post are fairly accurate to a degree; although I don't agree that face pulls are more useful than bent over barbell rows.

    2:1 ratio of pulls to pushes is a fairly accurate suggestion. You'll also need to know how to treat a muscular imbalance in the shoulders. Your first thing to do is stop horizontal pushing, the bench press.

    The 2nd thing you need to do is stretch the overdeveloped muscles, which in this case are the internal rotators of the humerus and shoulder protractors, and stimulate the antagonists which in this case are the external rotators of the humerus and shoulder retractors.

    You can incorporate external rotation specific movements like cuban rotations and shoulder horns pre-workout.

    After you perform these specific exercises, then try stretching the internal rotators, then move on to scapula retraction focused exercises like bent over barbell rows and face pulls. You can also do things like bent over lateral raises to strengthen the posterior deltoids.

    Shoulder problems are very frequent amongst weightlifters because of so much focus on bench pressing and isolation of the chest and anterior deltoids and too little emphasis placed on the upper back and posterior shoulder muscles.
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    All good points above..the other things to consider, especially with pain during shoulder elevation which could indicate an impingement syndrome, is thoracic spine mobility (extension) and pec minor length.
    Lying on a foam roller or 2 tennis balls taped together will help with t-spine mobility
    A tight pec minor (contributing to an anterior tilted scapula) won't respond as well to stretching as it would with sustained trigger point release/self myofascial release.
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    What is a good stretch for the internal rotators?
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    I am going to be honest here and say if you have pain and rest has not helped, have it checked by a doctor. I only suggest this because today I finally had my shoulder pain issue, which I have had near a year, checked. It's not a tear or anything requiring surgery. I have an unstable shoulder and nerve impingement due to my spine being out of place a bit. I actually have lack of curve in my neck/spine. I was recommended to see a chiropractor, which I scheduled for tomorrow, and also to rehab/strengthen my subscapularis. A lot of this is bad posture mixed with over development of frontal muscles like my chest and shoulders.

    He advised to rehab it by laying on my side, bad side down, and hold a dumbbell and raise it and hold for 10 seconds. He said to do 50 of those each workout day. He said would take a year to rehab so I will take it slow and see how it feels. He also said no more bench and OHP but I can't see myself giving up lifting especially those 2 exercises. He also recommended using the cable pully machines to do workouts for the shoulder area and do internal rotation exercises. Kind of like this:

    Name:  internal-rotation.png
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    Of course I don't know where your pain is and what symptoms you are experiencing so just trying to relate and help.
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    I've only been resting and rehabing it for just over a week. It feels better after a bout of shoulder horns and cuban presses, of course this could just be mental but I'll take what I can get.
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    Quote Originally Posted by crpav View Post
    I am going to be honest here and say if you have pain and rest has not helped, have it checked by a doctor. I only suggest this because today I finally had my shoulder pain issue, which I have had near a year, checked. It's not a tear or anything requiring surgery. I have an unstable shoulder and nerve impingement due to my spine being out of place a bit. I actually have lack of curve in my neck/spine. I was recommended to see a chiropractor, which I scheduled for tomorrow, and also to rehab/strengthen my subscapularis. A lot of this is bad posture mixed with over development of frontal muscles like my chest and shoulders.

    He advised to rehab it by laying on my side, bad side down, and hold a dumbbell and raise it and hold for 10 seconds. He said to do 50 of those each workout day. He said would take a year to rehab so I will take it slow and see how it feels. He also said no more bench and OHP but I can't see myself giving up lifting especially those 2 exercises. He also recommended using the cable pully machines to do workouts for the shoulder area and do internal rotation exercises. Kind of like this:

    Name:  internal-rotation.png
Views: 2671
Size:  286.8 KB

    Of course I don't know where your pain is and what symptoms you are experiencing so just trying to relate and help.
    Exercising strengthening the internal rotators won't help his condition. Very rarely, if ever, has someone needed internal rotation work to keep up with the external rotators. The internal rotators are worked harder when driving, using a computer and during everyday tasks. The external rotators are the most neglected muscles in the shoulders. He needs external rotation focused movements and stretching of the internal rotators.

    To the poster that asked what good stretches for the internal rotators are, try taking one hand and putting it behind your head holding a towel, then take the other hand behind your lower back and pulling the towel. This will help stretch out the chest muscles, which are a huge internal rotator and shoulder protractor. Doorway stretches also help significantly.
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    Quote Originally Posted by kingk0ng View Post
    Exercising strengthening the internal rotators won't help his condition. Very rarely, if ever, has someone needed internal rotation work to keep up with the external rotators. The internal rotators are worked harder when driving, using a computer and during everyday tasks. The external rotators are the most neglected muscles in the shoulders. He needs external rotation focused movements and stretching of the internal rotators.

    To the poster that asked what good stretches for the internal rotators are, try taking one hand and putting it behind your head holding a towel, then take the other hand behind your lower back and pulling the towel. This will help stretch out the chest muscles, which are a huge internal rotator and shoulder protractor. Doorway stretches also help significantly.
    This. Very, very rarely have I seen anyone need any internal rotation work since they are heavily used in presses and pulldowns/pullups.

    It sounds like the OP has some shoulder protraction issues and this is the best, yet simple, article to address this:
    http://www.mindandmuscle.net/article...-the-shoulder/
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    Thanks for the added comments and advice. I only meant my reply to relate and not to diagnose or offer advice that may not help with what issue the Op has. Sorry if I worded as such. In the end though if pain does not subside then seeing a doctor or a professional to diagnose what may be causing the problem is the best bet.

    As for the reply about not needing internal rotators was that directed toward me or toward the OP? Just asking because I believe I misspoke and I believe my doctor does want me to stretch the internal rotators over strengthening them. He instructed me to lay on my side and slightly raise the weight and hold for 10 seconds so that would be more of a stretch and not an attempt to strengthen?
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    Quote Originally Posted by crpav View Post
    I am going to be honest here and say if you have pain and rest has not helped, have it checked by a doctor. I only suggest this because today I finally had my shoulder pain issue, which I have had near a year, checked. It's not a tear or anything requiring surgery. I have an unstable shoulder and nerve impingement due to my spine being out of place a bit. I actually have lack of curve in my neck/spine. I was recommended to see a chiropractor, which I scheduled for tomorrow, and also to rehab/strengthen my subscapularis. A lot of this is bad posture mixed with over development of frontal muscles like my chest and shoulders.

    He advised to rehab it by laying on my side, bad side down, and hold a dumbbell and raise it and hold for 10 seconds. He said to do 50 of those each workout day. He said would take a year to rehab so I will take it slow and see how it feels. He also said no more bench and OHP but I can't see myself giving up lifting especially those 2 exercises. He also recommended using the cable pully machines to do workouts for the shoulder area and do internal rotation exercises. Kind of like this:

    Name:  internal-rotation.png
Views: 2671
Size:  286.8 KB

    Of course I don't know where your pain is and what symptoms you are experiencing so just trying to relate and help.
    That's a very very sad looking man lol. Lesson learned, don't f up your rotator cuffs.
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    Quote Originally Posted by crpav View Post
    Thanks for the added comments and advice. I only meant my reply to relate and not to diagnose or offer advice that may not help with what issue the Op has. Sorry if I worded as such. In the end though if pain does not subside then seeing a doctor or a professional to diagnose what may be causing the problem is the best bet.

    As for the reply about not needing internal rotators was that directed toward me or toward the OP? Just asking because I believe I misspoke and I believe my doctor does want me to stretch the internal rotators over strengthening them. He instructed me to lay on my side and slightly raise the weight and hold for 10 seconds so that would be more of a stretch and not an attempt to strengthen?
    My reply wasn't to call you out or anything, but just to help you and others with shoulder problems. The link rodja posted was spot on. If your Doctor recommended you to stretch the internal rotators, then he is exactly correct. I think you just got them confused. You strengthen the lagging muscles and stretch the overdeveloped muscles. I think he has you more along the line doing resisted static stretches from your description.
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    Quote Originally Posted by kingk0ng View Post
    My reply wasn't to call you out or anything, but just to help you and others with shoulder problems. The link rodja posted was spot on. If your Doctor recommended you to stretch the internal rotators, then he is exactly correct. I think you just got them confused. You strengthen the lagging muscles and stretch the overdeveloped muscles. I think he has you more along the line doing resisted static stretches from your description.
    Thank you. You are correct since he did not say to lift the dumbbell but rather raise it slightly and hold for a count of 10. He didn't get into specifics for what exercises to do to strengthen all the muscles involved but the link provided covers what is needed. He did say that I need to use the cable/pulley machine like exercises in the link show.

    I had my chiropractic appointment today and I go back Monday since she could not get my neck to adjust on the bad side and didn't want to force or overdo it.
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    Theres an article on T-nation i read. Its so helpful, so read it, its a must if you want to learn more.
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    Quote Originally Posted by strongman_101 View Post
    Theres an article on T-nation i read. Its so helpful, so read it, its a must if you want to learn more.
    Is it this one by any chance?
    http://www.t-nation.com/free_online_...e_finest_whine
    This is a helpful one, this article is actually the reason I didn't start this thread with the words, "my shoulder is killing me, so when can I start pressing again?"
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    Not trying to jack your thread or anything but since this seems to be going nicely I figured I'd try and get an idea of what my problem is. I injured my shoulder, assuming rotator cuff, during my shoulder workout day but I don't know what exercise it came from since I didn't feel any discomfort until that night. I can do all of my chest and back exercises perfectly fine with no pain or discomfort in my shoulder. The only time it hurts is if I try and throw something like a baseball or football or for military presses. Not really sure where to go with it right now.
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    Quote Originally Posted by broda View Post
    Not trying to jack your thread or anything but since this seems to be going nicely I figured I'd try and get an idea of what my problem is. I injured my shoulder, assuming rotator cuff, during my shoulder workout day but I don't know what exercise it came from since I didn't feel any discomfort until that night. I can do all of my chest and back exercises perfectly fine with no pain or discomfort in my shoulder. The only time it hurts is if I try and throw something like a baseball or football or for military presses. Not really sure where to go with it right now.
    This is from Joe DeFranco.

    Q: Hey Joe,
    First off. I've learned TONS of **** from your webpage and youtube videos and have applied it with great success for myself and my athletes. So thank you for being one of the FEW honest guys in the industry.

    Obviously it's no secret you train football players. My question is if you were working with a quarterback would you change anything regarding shoulder work. I understand that lower body training would likely stay the same, but I was just wondering would you still have them bench pressing with a barbell or do you think that would be too stressful on the rotator cuff and shoulder joint in general? I guess to simplify what would change on a max effort upper body day for a quarterback?

    Thanks man!

    Justin B.



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    Justin,


    I'm not one of those coaches that says, "I never let my quarterbacks perform barbell benches". I have no problem letting a quaterback barbell bench every now and then during the off-season, but it definitely shouldn't be the main focus. BTW, I don't think the barbell bench is as "bad" as most coaches think - as long as you're teaching your athletes to retract and depress their scapula, tuck their elbows, and 'push themselves through the bench' when pressing. This (proper) technique can drastically reduce the stress on the shoulder joint when barbell benching.

    The reason the barbell bench press has been labelled a "dangerous" exercise for quarterbacks is because the barbell locks you into an 'internally rotated' position (pronated grip) and your hands cannot move freely (like they can with dumbells). This "fixed", internally rotated position is associated with impingement of the rotator cuff tendons. One "remedy" for this is to have your throwing athletes press with a neutral grip barbell. In order to go from a pronated grip to a neutral grip, you must supinate your hands/forearms (which means you are externally rotating the humerus). External rotation repositions the humeral head and gives the rotator cuff tendons more "wiggle room", without impingement, as you press the bar.

    So to answer your question; if you're going to have your quarterbacks perform Max-Effort Upper Body workouts with the rest of the team, I'd suggest focussing on neutral bar pressing variations (flat, incline, floor, different grip widths, accomodating resistance, etc.) and/or dumbell press variations (5-7 rep range). Also, do not forget to incorporate push-up variations with your throwing athletes! (Although I suggust using the push-ups as more of a supplemental exercise.) Push-ups are classified as a closed-chain movement because the distal segment is fixed (hands on floor) and the proximal segment is moving (your body). Closed-chain movements will always be safer than open-chain movements. This is why push-ups are a big part of many shoulder rehabilitation programs.


    According to DeFranco, athletes involving throwing like quarterbacks and pitchers should try to perform bench presses with their hands parallel (facing each other) due to the humerus being in such an internally rotated position during a flat bench press with a barbell.
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    I do all of my DB chest presses with a slightly neutral grip to keep my elbows tucked and take stress off of my shoulders.
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    Speaking of Joe Defranco, I've been doing 100 band pullaparts a day for shoulder health on his recommendation.
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    Quote Originally Posted by kingk0ng View Post
    This is from Joe DeFranco.
    Yeah, I only ever do DB bench presses because barbell presses always seemed to bug my shoulders. My shoulders have never been too great so I'd always warm up my rotator cuff beforehand. Never had any problems until my last shoulder workout where I think I may have hyperextended something in my shoulder when hitting my rear delts/upper back. I'm going to be taking a high dose of fish oils starting tomorrow to see if inflammation has anything to do with it.
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    Quote Originally Posted by broda View Post
    Yeah, I only ever do DB bench presses because barbell presses always seemed to bug my shoulders. My shoulders have never been too great so I'd always warm up my rotator cuff beforehand. Never had any problems until my last shoulder workout where I think I may have hyperextended something in my shoulder when hitting my rear delts/upper back. I'm going to be taking a high dose of fish oils starting tomorrow to see if inflammation has anything to do with it.
    99% of the time, it's bc people do not know how to bench properly and have an imbalance in internal:external rotators.
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    Quote Originally Posted by Rodja View Post
    99% of the time, it's bc people do not know how to bench properly and have an imbalance in internal:external rotators.
    I know how to bench properly since watching Dave Tate's videos a couple years back. My shoulders pop/feel uncomfortable even when I do side or front arm raises. It's nothing to do with BB benching itself. My shoulders are just pretty meh in general.
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    Quote Originally Posted by broda View Post
    I know how to bench properly since watching Dave Tate's videos a couple years back. My shoulders pop/feel uncomfortable even when I do side or front arm raises. It's nothing to do with BB benching itself. My shoulders are just pretty meh in general.
    That's the aforementioned imbalance in the internal:external rotators.
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    Alright, thanks! I'll start doing rotator exercises starting tomorrow along with high doses of Omega 3's and see if that helps out my shoulder. I'll let you guys know how it goes.


    Quote Originally Posted by Rodja View Post
    This. Very, very rarely have I seen anyone need any internal rotation work since they are heavily used in presses and pulldowns/pullups.

    It sounds like the OP has some shoulder protraction issues and this is the best, yet simple, article to address this:
    http://www.mindandmuscle.net/article...-the-shoulder/
    I passed this so at least I know that that isn't the problem for me.
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    Quote Originally Posted by Rodja View Post
    99% of the time, it's bc people do not know how to bench properly and have an imbalance in internal:external rotators.
    You are exactly right. 99% of the people with shoulder problems are those with imbalance in their internal and external rotators.
    Former Marine, UT-BSN, NSCA-CPT, NASM-CPT, CSCS
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    2 week injury update -
    It's been 2 weeks with no benchpress and no military press, I do rehab work at every workout, I stretch my external rotators every day, and I do 100 band pull aparts every day.

    My shoulder feels fine during everyday activity and barely bothered me when I moved this weekend except when it was put in a really akward position. I tested it today at the gym and I could military press 30 lb dumbells with 0 pain, when I moved up to 40 I felt a dull ache in my left shoulder similar to how it felt for the first few weeks I ignored it and worked through it.

    I can close grip benchpress, do push ups, and 1 armed pushups with no pain at all. I tried a few reps with 135 on bench and felt little to no pain as well. I also am taking no anti-inflammitories to mask the pain(save the "natural" kind in cissus and Animal Flex).
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    Start stretching your pecs alot more!!! Especially your pec minors!!! Thats step 1.
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    I actually have been incorporating Pec minor and major stretches in my daily routine.
    I still can't touch my toes though as an aside.
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    Yea flexibility is def a must man. Doing hard stretching after your workout especially. Try doing facepulls, overhead shrugs, and levator scapulae shrugs for high reps (15-20). Do them every other day to every 2 days. In between those do your regular lat movements. Like chins, lat pull downs, cable lat pushdowns. (All Unilateral). And Keep up with the stretches. Im on the same journey as you with my shoulder. Mine is way better now. I feel my seratus anteriors working a lot more since im stretching the pecs more.
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    Oh use 3-4 sets
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    And rotator cuff stretches after your bench/chest days as well
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