Research on injuries in specific sports indicates that shoulders equate for around 60% of all CrossFit injuries and in overhead sports, on average 1 in 3 athletes will incur a shoulder injury during a given season. In contact sport, we know up to 55% of rugby players are competing with some kind of shoulder issue. A significant proportion of these will be associated with what we term ‘rotator cuff related shoulder pain’.
We still see such high incidences of shoulder rotator cuff injuries despite the best efforts of current rehabilitation, functional fitness and strength and conditioning programmes.
So we either accept the research and say ‘well that’s the way it is’, or we decide to be proactive and improve the performance of our shoulders by better preparing for the demands we wish to place upon them.
Final point before we get into the detail. Don’t toss this off as ‘just more of the same old rotator cuff chat’.
I see a lot of painful shoulders. As part of our personal coaching programmes, we accurately test strength in those shoulders and in the vast majority of cases there is a weakness in the rotator cuff of the injured shoulders. So we train that rotator cuff and then test it again. What we see is that pain goes down when strength goes up.
It’s not rocket science, you just need to get onboard with the fact that rotator cuff exercises work. And because we specialise in getting our clients the outcomes they want, we’re really big on doing the things that work.
3 WAYS TO A STRONGER ROTATOR CUFF
Before we get started, it’s worth explaining that the rotator cuff plays a pivotal role in centring the humeral head on the socket of the scapula. The balance of the anterior cuff (subscapularis - internal rotation) and the posterior cuff (teres minor, infraspinatus and supraspinatus - external rotation) significantly influences shoulder movement quality. If you’re an anatomy geek, look at the image below which shows how the rotator cuff muscles work to hold the humeral head in position. The subscapularis is shown in blue.
ONE – HOW STRONG IS YOUR ROTATOR CUFF
To give you some insight on what you need to do to get stronger, it’s worth testing your internal and external rotator cuff strength. Our Shoulder Test includes a couple of ‘field tests’ specifically for your rotator cuff that you can do yourself and will give you a good starting point and some useful information. You can sign up to our full Shoulder Test here.
ISOMETRIC EXTERNAL ROTATION HOLD
Start conservatively and build to a weight you can hold for 10 seconds. The Benchmark target is 10% bodyweight for 10 seconds; however, you do not need to hit that today.
ISOMETRIC INTERNAL ROTATION HOLD
Start conservatively and build to a weight you can hold for 10 seconds. The Benchmark target is 15% bodyweight for 10 seconds; however, you do not need to hit that today.
WHAT DOES IT MEAN?
Does it matter if you have one shoulder that is weaker than the other or external rotation is very different to internal? In most cases, a shoulder that functions well in athletic tasks is one which has appropriate levels of strength and balance.
As a rough baseline we would like to see less than 10% asymmetry from left to right. Research would also indicate that external rotation should be around 80% of internal rotation, however this is not hard and fast as we need to think about activity specific demands.
What we often see in these tests is the shoulder someone has problems with, also often tests weaker or doesn't feel as good in one of these isometric holds.
That gives us an indicator that some strength work into either internal or external rotation would be beneficial for your shoulders.
TWO – BUILD ROTATOR CUFF STRENGTH
The internal and external rotation lock and loads are great priming exercises for the rotator cuff to get the shoulder feeling ready to move.
THREE – CONNECT THE CHAIN
For a shoulder to function well, it needs a strong connection to a stable pelvis.
THE SHOULDER COMPLEX WORKS AS AN INTEGRAL AND SEQUENTIAL PART OF THE WHOLE MUSCULOSKELETAL SYSTEM AND DOES NOT FUNCTION IN ISOLATION.
Up to 80% of forces in athletic tasks are generated from the lower body and core. If there are links in the chain that are sub-optimal, such as the inability to create enough stability to deliver higher power output, you'll either see a drop in performance or other links in the chain will have to work harder to pick up the slack.
So we can’t just think about isolated strength in the rotator cuff. That strength needs to be connected with the rest of the body and therefore we need to think about shoulder performance in more global movement patterns.
Here are a couple of exercises that focus on kinetic chain integration with the shoulder. Check out our YOUTUBE channel for more videos.
CRABWALK
The crab walk is one of our ground-based movement patterns which is particularly going to focus on extension of the shoulder helping with shoulder mobility and integrating it in with the mid-section.
SPLIT SQUAT WITH OVERHEAD PRESS
Often times we need to think about improving the connection between the shoulder and the pelvis, particularly if we we've got some tightness around the hips that's causing restrictions in our overhead range of motion. This is a great exercise to cue us back into some good positions.
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