Injuries to the rotator cuff have risen significantly over the past few decades. Nowadays it seems that everyone who’s trained seriously for more than half a dozen years suffers from some degree of rotator cuff problems or has pain in the shoulder itself. The severity ranges from nagging aches during the night to sharp pains that prevent you from doing any physical activity that involves your arm.
Rotator cuff problems are a rather recent occurrence in strength training and bodybuilding. They’ve come about for several reasons: doing far too much upper-body work without corresponding effort for the upper back, overworking the bench press, using sloppy form on the bench press and performing behind-the-neck exercises.
The single biggest culprit is the bench press, or, rather, the overemphasis of it and the use of poor benching technique. I’ve come to that conclusion because trainees who don’t include flat-bench presses in their routines don’t have rotator cuff problems; for example, Olympic weightlifters and trainees who prefer the incline over the flat-bench press. Until the early 1970s, when the bench replaced overhead, or military, presses as the primary upper-body exercise, rotator cuff problems were unheard of. Back then, if trainees used the bench press, they regarded it as an auxiliary exercise, while they did overhead presses at nearly every workout. That made the muscles of the rotator cuff stronger, since overhead pressing works them directly. Once the trend shifted to flat-bench presses, rotator cuff injuries started cropping up’some small, some major.
I should mention that the bench press is not the villain per se. When you use proper technique and don’t overwork it but, rather, do it in a sensible manner in your weekly routine, it’s a very beneficial exercise in bodybuilding and strength training. In most cases the problem is caused by sloppy form: Since many trainees believe that this is the only lift that matters, anything goes. That means rebounding the bar forcefully off your chest, bridging, twisting, squirming and many other maneuvers that resemble gymnastic feats.
Another major cause of rotator cuff damage is behind-the-neck exercises. That’s especially true for younger trainees and those who haven’t yet established a solid strength foundation. The shoulder girdle simply isn’t designed to move in that direction, and when you add resistance, the situation becomes more risky. Behind-the-neck presses, chins and pulldowns all place your rotator cuffs in jeopardy. I’ve been harping on that fact for years, but the message hasn’t gotten across to many. All of those exercises are just as productive when performed to the front and not at all risky, so why tempt the gods? It’s a gamble you’re not going to win.
One of the problems with behind-the-neck exercises is that when you do feel the pain in your rotator cuff, it’s too late. Now, if you combine sloppy form on the bench with one or more behind-the-neck movements, you’re heading down the unhappy road to a rotator cuff injury’where recovery is not always swift and you could require surgery.
If you look through an anatomy book, chances are you won’t find a section on the rotator cuff. What exactly is it, and where is it located? That’s useful information, since many people who tell me that they think they have rotator problems really don’t. Their injuries are higher up, in the shoulder joint itself. In most cases the exercises I recommend also help with shoulder problems, unless they’re severe. Then it’s time to seek medical help.
The bones of the shoulder are involved in the rotator cuff. There’s the shoulder blade (scapula), the collarbone (sternum) and the upper-arm bone (humerus). The meeting of those bones forms four joints, although only two are considered part of the rotator cuff, the acromio-clavicular, or A/C, joint and the gleno-humeral, or G/H, joint. The A/C joint is formed at the meeting of the shoulder blade and collarbone. It gets its name from the acromion, which is the portion of the shoulder blade that’s involved with the collarbone. The gleno-humeral joint is formed where the humerus meets the part of the shoulder blade known as the glenoid fossa. The head of the humerus sits in a ball-and-socket capsule that’s loose enough to allow the head of the arm bone to be drawn out of the socket about an inch. The adjoining muscles, tendons and ligaments are responsible for keeping the bone in place and resisting the tendency of the arm to pull out too far.
There are lots of muscles involved in the rotator cuff. Both heads of the biceps are actively involved, but only the long head of the triceps acts on the shoulder. The three deltoid heads are obviously involved, and while the pecs are not, they most certainly are related to the shoulder joint. The traps play a major role, yet I’ve never seen them mentioned in any article about the rotator cuff. The lats are part of the puzzle too, although the real core of the cuff is a group of small, extremely powerful muscles that run from the top of the shoulder down into the back: the supraspinatus, infraspinatus, teres minor, teres major and subscapularis. The teres major isn’t as important to the rotator cuff as the teres minor, as its action is more closely related to the lats. In fact, the teres major has been called the ‘lats’ little helper.’ It does, however, play a small role.
If you have access to an anatomy book or a wall chart of the muscular system, find these small groups, and note where they all join together. That’s the rotator cuff. Naturally, if you seek medical help, you’ll find out for certain if you do have a rotator cuff injury. If the pain is in the shoulder joint itself, you may have an inflammation of the soft bursa sac that cushions the humerus inside the socket of the G/H joint. It could also be tendinitis, a calcium deposit or fibrosis, which refers to scar tissue built up over the years.
This article is aimed at lifters who’ve just started experiencing rotator cuff pain. If you’ve had the problem for a long time or it’s severe, however, go to a medical doctor. Then you can use the information here to help strengthen it.
Most athletes know about the series of movements that physical therapists and athletic trainers give to people who have rotator cuff problems. They’re excellent for warming up the muscles and for rehab, but on their own they do very little to help improve strength. At some point you need to include some direct weight work so those small groups get stronger.
This process requires some experimenting, since no two injuries are exactly alike. At this stage you must be able to differentiate between a sharp, stabbing pain, which tells you that you’re aggravating the injury, and a dull ache that subsides during the exercise. For example, when you try doing front raises, the first seven reps hurt, and then on the eighth rep the pain goes away. When that happens, you’re on the right track.
One of the best exercises for the rotator cuff is long pulls on the lat machine from the low position, a.k.a. seated cable rows. Use a V-bar attachment, keep your torso perfectly erect throughout the exercise, and don’t cheat at all. In the beginning keep the weights light and concentrate on making the movement smooth. At the finish of the pull, as you bring the V-bar into your chest, pull your elbows past your body and squeeze your shoulder blades together. Keep the reps high, 15s or 20s, for three or four sets. When you know you’re getting stronger, drop the reps and make it a strength movement. A rowing machine is also beneficial for rehabbing and strengthening the rotator cuff.
Any type of overhead lift, such as military presses, push presses and jerks, is most useful, since the act of holding a weight overhead hits the rotator cuff group directly. Start with pressing and use dumbbells, not the bar. Dumbbells force the shoulders to work a bit harder, and they also allow you to hold them without placing the injured area in a hurtful position. Do standing or seated presses, three sets of 15 or 20. As your strength improves, lower the reps, add some sets and move on to the bar.
Dumbbell lateral and front raises are helpful. Experiment with a variety of hand positions to find the one that doesn’t bother you’at least not as much. Try palms down, palms up and in between, with your thumbs up. If it hurts to do lateral raises, go more to the front. Do both front and lateral raises, either at the same session or on alternate days, three sets of 20 on each. I’ve discovered that most people who have some sort of shoulder or rotator cuff problem can find some angle on the incline bench that doesn’t bother them. Again, I recommend dumbbells in the beginning, since you can find a way to hold them that doesn’t irritate the injured area. Start with four sets of 15 or 20, and gradually lower the reps and increase the poundages until you can work with a bar.
Dips are absolutely one of the best shoulder and arm exercises of all. If you’re able to do them, add them to your program. You’ve probably noticed that I haven’t mentioned flat-bench presses. I’m not anti-benching, but if you’re having rotator cuff problems, you should drop them and substitute inclines or overhead presses. I realize that many trainees feel lost without flat benches, and in those cases I suggest relegating the exercise to an auxiliary role, using dumbbells and staying with fairly high reps, 20s. In the event that the dumbbells also hurt, eliminate the bench and put all your effort into inclines, overhead presses or dips.
Quite often people with rotator cuff injuries can do only one exercise for the shoulder girdle: dips, inclines or presses. One is better than none, so if that’s your situation, make that your primary exercise until the injury heals.
The traps are most critical in supporting the shoulder girdle, and since they lap over the rotator cuff area, they’re important to those groups as well. Eventually, you’ll want to do heavy shrugs in the power rack, although that might not be possible right away. If that’s the case, use dumbbells and do the shrugs while sitting on a bench with your feet up on the bench. John Grimek showed me that trick, and it really does help to isolate the traps. Stay with 20s for three or four sets, and steadily work the weight upward until you can do power shrugs.
High pulls, done with a close or wide grip, are most beneficial for building upper-back strength. One reason I like high pulls is that they hit the rear deltoids dynamically, and the rear delts are hard to strengthen. You may have to wait until your injured area gets stronger before you do them, but add them as soon as possible. The stronger you make your traps, the better.
When you don’t have powerful traps, you put too much stress on the smaller supraspinatus, which runs along the top of the shoulder blade. Strong traps act like suspensions on cantilevered bridges. Any exercise that works the traps involves the teres minor and infraspinatus as well.
Bent-over rows are also great for mending and strengthening the rotator cuff and certain types of shoulder problems. Use dumbbells, one hand at a time, for three or four sets of 20. Those hit the rotator cuff group and the rear deltoid straight on. Not long ago a friend said he was having chronic pain in his shoulders after every workout and that it often continued into the night. I knew he kept some weights and dumbbells in his garage and told him to start doing one set of 50 reps of bent-over rows with a light dumbbell at the end of every session and to do a couple of sets at home on nontraining days. A week later he checked in, happy as a lark. No more pain. He does the bent-over rows six days a week now.
I should mention that one of the primary reasons that many trainees experience rotator cuff or rear-delt pain even when they use perfect form on the flat bench is simply disproportionate strength. Many who train only do heavy exercises for the front part of the upper body. The back, particularly the upper back, is neglected, and if they do any work for their traps or middle back, it’s of the weenie nature’light weights, with moderate-to-high reps to keep from breaking a sweat. So while the front portions of their shoulders get extremely strong, the rear portions lag way behind. Eventually, those relatively weaker muscles cannot handle the stress placed on them and start to complain.
The problem is easily corrected. Start doing some heavy back work, especially for those groups in the upper back: high pulls, heavy shrugs, long pulls with lots of weight and bent-over rows. If the problem has not escalated too far, you can remedy it in a short time. Of course, you need to start out using sensible poundages, but your goal should be to end up shrugging in the mid-to-high 500s, high pulling in the mid-300s and handling 300-plus on the bent-over row. When you reach those high standards, your back muscles will be plenty strong, and as an added bonus, the new back strength will also enhance your pressing power.
Wide-grip high pulls are great for developing strong lats. Wide-grip chins and lat pulldowns are also useful. Bent-over rows involve the lats as well. The lats get plenty of work, especially if you’re doing heavy high pulls and shrugs, so you don’t have to do anything specific for them. Most trainees give their triceps enough strength work; however, when I’m trying to improve a weak or damaged rotator cuff, I add straight-arm pullovers because they’re the very best for hitting the long head of the triceps.
Keep in mind that the shoulder joints and rotator cuffs are more fragile than you might imagine. Include plenty of specific exercises in your program to keep them healthy and strong.
Editor’s note: Bill Starr was a strength and conditioning coach at Johns Hopkins University from 1989 to 2000. He’s the author of The Strongest Shall Survive and Defying Gravity. IM
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