Rotator Cuff Questions

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  1. 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.


  2. 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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  3. 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.

    <----5 shoulder surgeries...

  4. 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.

  5. 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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  6. 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.

  7. 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)
    M.Ed. Ex Phys


  8. 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...

  9. Front raises > upright rows all day

    Upright rows murder your shoulders

  10. I haven't done upright rows in years, just watching them hurts my shoulders.

  11. 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.
    Former Marine, UT-BSN, NSCA-CPT, NASM-CPT, CSCS

  12. 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.

  13. What is a good stretch for the internal rotators?

  14. 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: 7213
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.

  15. 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.

  16. 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: 7213
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.
    Former Marine, UT-BSN, NSCA-CPT, NASM-CPT, CSCS

  17. 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/
    M.Ed. Ex Phys


  18. 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?

  19. 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: 7213
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.

  20. 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.
    Former Marine, UT-BSN, NSCA-CPT, NASM-CPT, CSCS

  21. 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.

  22. Theres an article on T-nation i read. Its so helpful, so read it, its a must if you want to learn more.

  23. 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?"

  24. 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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