Rotator Cuff

2010 Rotator Cuff Book.
indd 1
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The Ultimate Rotator Cuff

Training Guide
Proven Exercises for Injury Prevention & Rehab
2010 B F i t T r a i n i n g S y s t e m s , L LC
Brian Schiff, PT, CSCS
2010 Rotator Cuff Book.indd 1
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ii
The Ultimate Rotator Cuff Training Guide

Proven Exercises for Rehab and Injury Prevention
Copyright 2010, 2004 by Brian Schiff and B Fit Training Systems, LLC
All rights reserved. No part of this book shall be reproduced, stored in a retrieval system,
or transmitted by any means electronic, mechanical, photocopying, recording or
otherwise without written permission from the publisher. No patent liability is assumed
with respect to the use of the information contained herein. Although every precaution has
been taken in preparation of this book, the publisher and author assume no responsibility
for errors or omissions. Neither is any liability assumed for damages resulting from the
use of information contained herein.
This book is published by B Fit Training Systems, LLC, including text, graphics and
images, and is strictly intended for educational purposes. It is not intended to make any
representations or warranties about the outcome of any procedure. This electronic book is
not intended as a substitute for professional medical care. Only your doctor can diagnose
and treat a medical problem.
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About the Author
iii
Brian Schiff, PT, CSCS
graduated from The Ohio State University in 1996 with

a Bachelor of Science degree of Physical Therapy in
Allied Health Professions. Since then, he has practiced
as a licensed physical therapist specializing in sports
medicine. Through the National Strength and Conditioning
Association, Brian became a certified strength and
conditioning specialist (CSCS) in 1998. He is a founding
member of The American Association of Personal Trainers,
and recently contributed a chapter on periodization to
a fitness book entitled The Power of Champions. Schiff
also co-authored a breakthrough manual on ACL injury
prevention entitled Protecting the Athletes Knee.
Currently, he owns a private fitness studio and a

performance enhancement company specializing in sport
specific training programs for athletes of all sports and
ages. Brian is also the former strength and conditioning
coach for The Columbus Crew Major League Soccer Team.
He has presented at professional conferences and coaches
clinics on topics including training for shoulder stability,
baseball specific training, soccer specific conditioning
and sport specific training, ACL injury prevention and safe
shoulder training.
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Table of Contents
iv
Introduction...................................................................................... 1
Anatomy................................................................................................... 2
History of Rotator Cuff Disease and Pathology............................................... 4
Assessing the Shoulder............................................................................... 5
The Role of Posture..................................................................................... 8
Injury Prevention Training/Rehab................................................................. 9
Pendulum Warm-ups........................................................................ 11
Forward & Backward................................................................................. 11
Side to Side............................................................................................... 11
Clockwise & Counterclockwise..................................................................... 12

Scapular Stabilizer Exercises............................................................. 13
Standing Tubing Row.................................................................................. 13
Standing Dumbbell Row.............................................................................. 14
Serratus Anterior DB Punches....................................................................... 14
Serratus Punch Push-up Progression.............................................................. 15
Prone Lower Trap Raise............................................................................... 16
Prone Horizontal Abduction Raise................................................................ 16
Prone Extension Raise with External Rotation.................................................. 17
Shoulder Shrugs......................................................................................... 17
Straight Arm Pulls....................................................................................... 18

Rotator Cuff Exercises....................................................................... 19
Scaption................................................................................................... 19
Internal Rotation......................................................................................... 20
External Rotation (tubing)............................................................................ 20
External Rotation (dumbbell)........................................................................ 21
Horizontal External Rotation........................................................................ 22
Standing Diagonal Raise (D2 Flextion).......................................................... 22
Common Exercise Mistakes............................................................... 23
Bench Press............................................................................................... 23
Lat Pull Downs........................................................................................... 23
Military Press............................................................................................. 23
Dips/Upright Row...................................................................................... 24
Dumbbell Lateral Raise................................................................................ 24
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Table of Contents
Bonus Exercise Section...................................................................... 25

Exercise #1 Bench Press........................................................................... 25
Exercise #2 Push-Up................................................................................ 26
Exercise #3 Lat Pull Downs....................................................................... 26
Exercise #4 Upright Row.......................................................................... 27
Exercise #5 Dips..................................................................................... 28
Exercise #6 Military Press......................................................................... 29
Exercise #7 Dumbbell Lateral Raise............................................................ 30
Sample Healthy Rotator Cuff Training Program................................. 32
Injured or Inflamed Shoulder Series.................................................. 33
See Your Physician............................................................................ 39
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Introduction
TM
TRAINING SYSTEMS, LLC

Have you ever experienced a dull ache or sharp pain in your shoulder or upper arm?
Maybe you are unable to sleep on one side because your shoulder wakes you up at
night. Perhaps you have discomfort reaching behind your back to tuck in your shirt or
grab your wallet. If so, you may be suffering from a rotator cuff injury.
Most of us will experience shoulder pain of some kind in our life. Due to the excessive
mobility in our shoulder joints, which allows for great versatility and function, we often
place excessive stress on them in our daily life. In order for you to effectively raise and
maneuver your arm, the rotator cuff must function properly.
Rotator cuff injuries, such as tendonitis, bursitis and tears, plague 20-30% of people
in our population. These injuries may be caused by natural degeneration, trauma or
overuse. It is important to understand general anatomy and how the rotator cuff functions
so that you may gain a better appreciation for injury potential, healing time frames, and
proper exercise selection.
Continued
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Anatomy
The rotator cuff consists of four small muscles, which effectively form a sleeve around the
shoulder and allow us to raise our arms overhead effectively. These muscles, consisting
of the supraspinatus, infraspinatus, teres minor and subscapularis, oppose the action of
the deltoid muscle and depress (hold down) the head of the humerus (upper arm) during
shoulder elevation to prevent impingement. This allows you to effectively raise your arm
and reach in certain ways without experiencing impingement of the soft tissue between
the top of the shoulder blade (acromion) and the head of the humerus.
For the purposes of this book, I will not discuss in detail the origins and insertions of
each particular muscle or elaborate on the nerves that innervate them. However, it is
important to understand that pain in the shoulder area can also be referred from the neck.
Therefore, one should not always assume that pain in the upper arm is due to rotator cuff
injury or tendonitis. Weakness can be seen with neck or shoulder dysfunction. In light of
this, it is always wise to consult your physician if such a problem arises.
Below, I will summarize the role of each rotator cuff muscle. One note to consider:
damage to one structure may not always lead to significant functional weakness or
limitation. These muscles work collectively and synergistically with the scapular muscles
to produce purposeful movement. As such, the body is able to compensate for power
deficiencies in many cases. These compensations may be subtle or obvious.
Supraspinatus largely responsible for initiating elevation from 0 30 degrees of
abduction (arm moving away from and parallel to the body) and assisting with elevation.
This muscle has a poor blood supply, lies beneath the acromion and is often the most
commonly affected tendon with regard to tendonitis or tears. Because of its poor blood
supply, it heals slowly and is prone to recurrent bouts of inflammation.
Infraspinatus responsible for externally rotating the arm or moving it away from the
body when the arm is at the side or when cocking to throw a baseball. This muscle also
helps decelerate the arm during follow through from an overhead motion (e.g., pitching).
Teres Minor also responsible for external rotation in the same way the infraspinatus
functions. In addition, it helps decelerate the arm during follow through from an overhead
motion (e.g., pitching).
Subscapularis responsible for internal rotation or pulling the arm in toward the body
while at the side. This muscle also assists in follow through during throwing. Because this
muscle performs the same action as that of the pectoralis major, latissimus dorsi and teres
major, it is sometimes difficult to detect weakness.
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Anatomy
Equally important to the proper function of the shoulder is a group of muscles known as
scapular stabilizers. These muscles have attachments to the scapula (shoulder blade) and
directly contribute to shoulder motion by affecting the path of movement of the shoulder
blade. You see, for every 2 degrees of shoulder abduction (arm movement away from
the body in the same plane as the body), there is 1 degree of scapular elevation. The
shoulder blade moves in addition to the arm to allow for the great freedom of movement
we enjoy. With weakness or injury, this rhythm of movement becomes altered.
Scapular stabilizer muscles include:
Serratus anterior - protracts or rounds the shoulder blade
Upper trapezius - shrugs and upwardly rotates the shoulder blade
Middle trapezius - retracts or pinches the shoulder blade inward
Lower trapezius - depresses and upwardly rotates the shoulder blade
Rhomboids - retract or pinch the shoulder blade inward
These muscles work synergistically (together) with the rotator cuff to ensure smooth
movements without shoulder impingement.
Supraspinatus
Glenoid
Head of humerus
labrum
Joint
Coracoid
process
Clavicle
Acromion
capsule
Subscapularis
Scapula
Supraspinatus
Ribs
Humerus
The infraspinatus and teres minor muscles are not pictured as they are positioned on the
back of the shoulder blade. This illustration only refers to the front of the shoulder joint.
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History of Rotator Cuff Disease and Pathology
Some people are predestined to have shoulder problems. Why? To a large degree, the
shape of the acromion (top of the shoulder blade) plays an important role in the health of
the rotator cuff tissue. There are three types of acromion: flat, hook shaped and normal.
The flat and hook versions carry a higher risk of possible injury, with the hook style
posing the greatest threat. If you have a flat or hook shaped acromion, there is less room
for the soft tissue (muscle and tendon) to glide and move during arm motion. Over time,
this naturally leads to more friction and wear and tear. This may lead to an eventual tear.
Typically, most people experience an acute onset of shoulder pain. It is often related
to vigorous repetitive activities or trauma such as lifting, painting, throwing, falling, or
jamming the shoulder. This type of pain is generally labeled tendonitis or bursitis. You
may have pain if lying on the affected side, reaching up overhead, reaching behind the
back, driving or attempting to lift with the arm out away from the body.
Tendonitis usually responds well to rest, anti-inflammatory medication, ice and rotator
cuff specific strengthening. Recovery time may range from 4 weeks to several months,
depending upon the compliance of the individual, the onset of symptoms prior to
treatment, the age of the individual, and whether or not there are any physical changes in
the tendon (structural changes including thickening or scar tissue formation are referred to
as tendonosis). X-rays are important as they will reveal any arthritic change.
Rotator cuff tears present differently. The hallmark signs of a tear are nocturnal pain,
loss of strength, and inability to raise the arm overhead. Also look for a shrug sign, in
which the person uses the upper trap to raise the arm because the rotator cuff is not able
to depress the humeral head effectively. Rotator cuff tears are most common in men age
65 and older. Tears and/or injury are typically related to degeneration, instability, bone
spurs, trauma, overuse, and diminished strength/flexibility related to the aging process.
However, youth are also at risk for injury if they are involved in repetitive overhead
sports, including swimming, volleyball, baseball, softball, tennis, gymnastics, etc.
Many people can function adequately with a torn rotator cuff provided they have a
low to moderate pain level. The primary reason for performing rotator cuff surgery is to
alleviate pain rather than to restore function. It is common for post-surgical patients to lose
some mobility/range of motion. Strength recovery is dictated by the size of tear, quality
of the torn tissue at the time of surgery, time elapsed between injury and repair, and the
surgeons ability to recreate the proper anatomical relationship.
Recovery following rotator cuff repair may take up to 18 months. However, most people
are able to return to the majority of their activities of daily living in 3-6 months. Early
mobilization, range of motion and progressive strengthening exercises in physical therapy
are critical to regaining functional motion and strength.
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Assessing the Shoulder
While I do not recommend skipping the doctors office if you suffer persistent pain, there
are some quick tests you can do at home with assistance to determine if you have rotator
cuff impingement or inflammation.
Hawkins Test The examiner places the arm in a position of 90 degrees of shoulder
flexion with 90 degrees of elbow flexion and then horizontally internally rotating the
humerus while applying pressure on top of the acromion will produce pain if there is
impingement.
Neer Impingement Test With the elbow fully extended, the examiner passively
flexes the affected shoulder while applying pressure on top of the acromion. Pain is
considered a positive test for impingement.
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A-C Compression Test This test is used to rule out an AC (acromio-clavicular joint)
sprain, otherwise known as a separated shoulder or AC joint arthritis related pain. It is
possible that rotator cuff tears and pain can be related to primary AC joint issues or in
combination with them.
The examiner slowly stretches the affected arm across the body while stabilizing the
shoulder blade. Pain past midline may indicate there is an issue with the AC joint.
Apley Internal Rotation This self range of motion test often indicates rotator
cuff inflammation or impingement if there is painful, limited motion compared to the
uninvolved side.
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The Shrug Sign This self assessment involves actively raising the arm overhead.
If there is an exaggerated shrug due to excessive upper trap action and inability to lift
the arm past 90 degrees, this is a hallmark sign of a rotator cuff tear. The shrug sign
indicates the rotator cuff is not able to adequately compress the head of the humerus. The
picture below indicates a positive test.
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The Role of Posture
Did you ever wonder why you were told as a child to sit up tall? Well, it really does
make a difference. Slouching allows your shoulders to protract or round forward, and
this closes down the space that the rotator cuff occupies. Over time, this can contribute to
compressive wear and tear on the soft tissue.
Aside from trying to maintain a more erect posture, it is important to perform
strengthening exercises to reinforce posture (e.g., rows, pull downs, and reverse flies)
and routine flexibility training. Given the nature of our job place today, many people sit
for the majority of the day. They write or work on the computer much of the time. This
encourages poor posture and necessitates stretching frequently.
The primary muscle group in need of stretching is the chest. I always recommend
performing doorway stretches that include arms in a V position (sternal portion of the
pecs) and reverse T or field goal post position (clavicular portion of the pecs). You can
also perform single arm stretches with the arm slightly below shoulder height. It is best to
hold for 20-30 seconds and repeat 2-3 times. See the pictures below.
V Position
Reverse T Position
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L position w/single arm
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Injury Prevention Training / Rehab
In the following section, I will outline specific exercises that are designed to prevent and/
or rehabilitate shoulder injuries to the rotator cuff. Keep in mind that these exercises are
not meant to serve as a substitute to medical care from a physician or physical therapist
if you are currently experiencing shoulder pain. But, they provide a good blueprint for
healthy shoulder exercises and should reduce the likelihood of a future injury.
The key to avoiding rotator cuff injury is performing adequate conditioning prior to
stressing it with vigorous activities. Many weekend warriors try to pick up the softball,
baseball, football, etc. and begin throwing repetitively and forcefully without properly
warming up. In addition, they are not likely to condition before the season like
competitive athletes.
This often leads to excessive strain on the rotator cuff and swelling. The inevitable result
is soreness, especially with overhead movement or reaching behind the back. The act
of throwing is the most stressful motion on the shoulder. The rotator cuff is forced to
decelerate the humerus during follow through at speeds up to 7000 degrees/second.
Without proper strength and conditioning, the shoulder easily becomes inflamed.
Since the rotator cuff muscles are small, it is best to utilize lower resistance and higher
repetitions to sufficiently strengthen them. Gradually increasing the intensity and volume
of activity is critical to avoiding an overuse injury (particularly common among young
throwing athletes).
Remember, these are not bodybuilding type muscles. You will not use heavy loads or
expect to see great muscle hypertrophy. The payoff comes in performance and injury
prevention. Who wants to miss any playing time? The answer is obvious, but rotator cuff
pain will restrict most overhead athletes, and it often necessitates some rest in competitive
overhead athletes.
The following exercises should be performed at least 6-8 weeks prior to preseason for
overhead athletes such as swimmers, pitchers, volleyball players and quarterbacks. For
position players in baseball and softball, I generally recommend that they condition the
cuff at least 4 weeks prior to preseason drills begin. It is also important for throwing
athletes to use an interval throwing program in the preseason to condition the shoulder for
repetitive throwing at different distances and velocities.
During the in-season, each of the aforementioned athletes should perform routine
maintenance rotator cuff strengthening 1-2x/week for continued injury prevention. With
regard to the general fitness client, I recommend using rotator cuff training at least 1-2x/
week, especially if you have any pre-existing condition or history of injury. If you have
a current issue, perhaps doing these exercises three times per week with a day of rest in
between would be best.
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Injury Prevention Training & Rehab
10
Chapter 1
The exercises should not cause pain at any time. Performing them in a pain free range of
motion is an absolute must! Certainly, pain does not equal gain here. Generally, it is best
not to use loads greater than 4% of your body weight (guideline advocated by Charles
Neer, M.D.). I can not emphasize enough that these are small relatively weak muscles that
are neglected by most of you in the gym. Lighter weight and higher reps is definitely the
way to go.
Below you will find a list of appropriate scapular stabilizer and rotator cuff exercises.
These exercises are designed to improve posture, correct muscular imbalances, and
strengthen the rotator cuff. They are not intended to build lean muscle. Keeping strict form
and performing these exercises in a safe, pain free range of motion is essential.
While there is no definitive order in which to perform these exercises, I generally suggest
that you do the scapular exercises first since they are the larger muscle group.
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Pendulum Warm-ups
11
Using a light dumbbell (2-5#) you can prepare the shoulder for exercise doing pendulum
arm swings. The goal is to initiate the movement with the body and allow the arm to
follow the path of motion. This can be done forward/backward, side to side and in a
clockwise/counterclockwise direction. You may do 15-25 repetitions in each direction.
Forward & Backward
Side to Side
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Pendulum Warm-ups
(Continued)
12
Using a light dumbbell (2-5#) you can prepare the shoulder for exercise doing pendulum
arm swings. The goal is to initiate the movement with the body and allow the arm to
follow the path of motion. This can be done forward/backward, side to side and in a
clockwise/counterclockwise direction. You may do 15-25 repetitions in each direction.
Clockwise & Counterclockwise (clockwise pictured below)
Note: Remember to allow the arm to hang freely and glide in response to the movement
initiated by the body. It should feel as if it is simply dangling in the air.
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Scapular Stabilizer Exercises
13
Standing Tubing Row

This strengthens the middle trapezius, posterior deltoid and rhomboids. Using a pole or
door, position the tubing so that the handles are even. Stand with the feet shoulder width
apart and the knees slightly bent (relaxed). Beginning with some resistance (tube is taut)
pull toward the body, squeezing the shoulder blades together and keeping the elbows
at your side. Pause for 1-2 seconds and then return to the starting position. Perform 2-3
sets of 10-15 repetitions. This can also be done with a machine. An alternate method is
keeping the elbows out with the arms abducted ~ 90 degrees. This positioning places
more emphasis on the posterior deltoid, rhomboids and middle trap, as compared to
greater assistance from the latissimus dorsi with the low row.
Low Row
1
High Row
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Standing Dumbbell Row

This can serve as an alternative exercise to the tubing rows if you do not have tubing on
hand or wish to mix it up a bit. Position the left leg forward (split stance) while holding the
dumbbell in the right hand. Keeping your back flat, lift the weight up in a rowing motion.
Pause at the top and lower back down. Repeat 10-15 times and repeat on the other side.
Perform 2-3 sets on each side.
Serratus Anterior DB Punches

This strengthens the serratus anterior, a muscle which helps to stabilize the shoulder
blade during arm elevation. Lying on the back with the knees bent and feet flat, press
the dumbbells toward the ceiling making sure to keep the elbows straight. The shoulder
blades will round forward and lift off the floor. Pause at the top of the movement, and
lower with control to the starting position. Perform 2 sets of 15 repetitions.
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15
Serratus Punch Push-up Progression

Lying face down with your body weight supported by the forearms and knees (or toes),
push the upper body up toward the ceiling (rounding the shoulder blades). Pause at the
top and then slowly return to the start position. Perform 2 sets of 15 repetitions in place of
the previous exercise.
On the knees
1
On the toes (advanced version)
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16
Prone Lower Trap Raise

This strengthens the lower trap, which is often weak and fatigues quickly. This muscle
depresses the shoulder blade and prevents impingement. Using a stability ball, raise the
arms up in a 45 degree angle as far as the shoulders allow without discomfort. Pause at
the top, and lower slowly to the starting position. This is an awkward motion, and it is
best to use a light weight and focus on controlling the motion. It is also acceptable to do
this exercise lying face down on a bench or the edge of your bed with only the affected
side. Perform 2 sets of 15 repetitions.
1
Prone Horizontal Abduction Raise

This strengthens the middle trapezius and rhomboids, which promote good posture. Using
a stability ball, raise the arms out away from the body until they are near parallel to
the floor. Keep the palms down and pinch the shoulder blades together at the top of the
motion. Lower slowly to the starting position. It is also acceptable to do this exercise lying
face down on a benchor the edge of your bed with only the affected side. Perform 2 sets
of 15 repetitions.
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17
Prone Extension Raise with External Rotation

This strengthens the posterior deltoid and latissimus dorsi, in addition to the posterior
rotator cuff muscles. Using a stability ball, raise the arms along the side of the body until
they are even with the body. It is important to keep the palms facing down during this
exercise (this position externally rotates the shoulder) as this creates greater rotator cuff
activation. It is also acceptable to do this exercise lying face down on a bench or the
edge of your bed with only the affected side. Pause at the top, and slowly lower to the
starting position. Perform 2 sets of 15 repetitions.
1
Shoulder Shrugs
This strengthens the upper trapezius. Standing with the arms resting at the side of the
body, shrug the shoulders straight up toward the ceiling. Pause at the top for 1-2 seconds.
Slowly lower the weight to the starting position. It is important not to roll the shoulders
forward or backward as this may cause grating of the scapula on the chest wall, not to
mention the upper trap muscles primary action is shoulder elevation. With this exercise,
it is okay to use loads heavier than 4% of body weight. Perform 2-3 sets of 10-15
repetitions.
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18
Straight Arm Pulls

This strengthens the lats, posterior deltoid and middle/lower trapezius. In standing with
elbows straight (palms down) and knees slightly bent, pull the arms back toward the hips.
Pause for 1-2 seconds and return to the start position. Keep the back flat throughout.
Stand far enough back to have tension during the entire movement. This exercise can be
substituted for the pull downs referenced in the scapular stabilizer exercise section of the
program. Perform 2-3 sets of 10-15 repetitions.
Note: The scapular stabilizer exercises should generally be performed first in the
program as they are larger muscle groups, not to mention the fact they form the
foundation for normal rotator cuff function. Adjust weight as tolerated keeping in mind
that form should never be compromised, nor should you feel pain at any time as you
increase resistance.
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Rotator Cuff Exercises
19
Scaption
This strengthens the supraspinatus muscle, the most commonly affected rotator cuff muscle
and slowest to heal. Stand with the knees slightly bent (relaxed) holding the dumbbells
in such a way that your thumbs are up or on top of the dumbbells. Keep the arms
approximately 30-45 degrees forward from being perpendicular or straight out away
from the body (scapular plane) and raise the arms up to shoulder height. Pause at the top
and slowly lower to the starting position. Keep the elbows straight throughout the entire
movement. Avoid any part of the range of motion that causes pain. Perform 2 sets of 1520 repetitions.
2
Start
Mid - Position
Finish
Side View
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20
Internal Rotation
This strengthens the subscapularis muscle, as well as the chest muscles. In standing with
the knees relaxed, hold tubing and begin with the arm positioned at the side (neutral)
with light tension on the tubing. Place a small rolled towel between the upper arm and
body. Now pull the arm across the body to the stomach, while keeping the elbow at your
side. Do not allow the shoulder to rotate forward. Perform 2 sets of 15-20 repetitions.
Start
Finish
External Rotation (tubing)

This strengthens the infraspinatus and teres minor muscles. In standing with the knees
relaxed, hold tubing and begin with the arm positioned at the side (neutral) with light
tension on the tubing. Place a small rolled towel between the upper arm and body. Now,
pull the arm away from the body, while keeping the elbow close to your side. Do not
allow the shoulder to rotate backward. Perform 2 sets of 15-20 repetitions.
Start
w
Finish
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21
External Rotation (Dumbbell)

This too strengthens the infraspinatus and teres minor. I prefer this exercise over tubing
if you have an inflamed rotator cuff. The reason for this is that the dumbbell provides
consistent resistance throughout the range of motion with respect to gravity, whereas, the
resistance with tubing actually increases as the muscle becomes less able to generate
tension. Even though the tubing eliminates gravity, it still provides a force loading vs.
force generation mismatch, which tends to aggravate the rotator cuff. As such, it is
generally best to use a light dumbbell in this case.
Begin in a side lying position with the elbow at the side of the body and the arm in
neutral. Place a small rolled towel between the upper arm and body. Slowly raise the
dumbbell through a full pain free range of motion, while keeping the elbow at your side
and then slowly return to the starting position. Perform 2 sets of 15-20 repetitions.
1
Notes
You do not need to do both tubing and dumbbell external rotation. Choose one method.
However, if you are experiencing ongoing pain or inflammation, I recommend using
a dumbbell or no resistance at all in the side lying position. The key difference is that
the tubing offers increasing resistance throughout the exercise as the muscles ability to
generate force declines.
In contrast, a dumbbell offers consistent resistance throughout the exercise. With a
dumbbell, the ability to lift the weight is dependent upon raising the dumbbell up against
gravity at the beginning of the motion. This does not require added tension or effort at the
end of the movement, whereas the tubing does.
You may also choose to place a small rolled towel between the inside of the elbow and
the side of your body to emphasize keeping the elbow in and avoiding compensatory
motion from the shoulder blade.
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22
Horizontal External Rotation

This strengthens the infrapsinatus, teres minor and posterior deltoid. It also works the
shoulder in a more functional plane. Sitting on a stability ball (or bench), begin with arm
90 degrees away from the body with the palm of the hand facing the floor. Raise the
dumbbell up to 90 degrees and slowly return to the starting position. Perform 2 sets of
15-20 repetitions.
Beginning
Mid - Position
Finish
Standing Diagonal Raise (D2 Flexion)

This is a more advanced exercise that strengthens the entire rotator cuff. It also maximally
stresses the cuff as it places it in an overhead position. Begin in standing with relaxed
knees and with the palm against the opposite thigh. Slowly raise the dumbbell up and
overhead. As the arm elevates, you will allow the forearm to rotate out and the thumb to
move from a downward to an upward position (hitchhiking position). Lower slowly to the
starting position. Perform 2 sets of 15-20 repetitions.
Beginning
Mid - Position
w
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Finish
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Common Exercise Mistakes
23
All too often I see people in the gym performing exercises incorrectly. This may not lead
to an immediate injury, but over time it will cause tendonitis, pain, and lost time from
working out. Aside from lifting improperly, many exercise enthusiasts attempt to lift too
much weight. This combination is a proven recipe for injury. Below, I will discuss some
common exercises that offer potential risk for injury when performed improperly. With
a few simple modifications, these exercises deliver maximum results without posing any
danger to your health.
Bench Press This is a popular exercise chosen to build the chest, along with the
anterior deltoid and triceps. Most teach taking the bar down until it lightly touches the
chest. However, I believe this is unsafe because it exposes the anterior shoulder capsule
to excessive load, in addition to compressing the soft tissue of the rotator cuff between the
humerus and the acromion. Over time, with repeated bouts and heavy loads, the rotator
cuff becomes inflamed. Individuals with any anterior shoulder laxity (looseness) or history
of subluxation, dislocation or instability are also at increased risk for rotator cuff injury or
labral (shoulder cartilage) damage. Furthermore, you also have the potential to rupture
the pectoralis tendon (chest) with full range pressing during heavy loads. The safe answer
is to lower the bar until the upper arm is parallel to the floor (elbow bent to 90 degrees).
This prevents the shoulder joint from moving into the unsafe range. The same advice
applies to push-ups and dumbbell flies.
Lat Pull Downs This is a good exercise to strengthen the back, but when done
behind the head it can cause problems. Like the bench press, pulling the bar down
behind the head positions the humerus in such a way that the rotator cuff can be pinched.
This may depend on other factors, including the shape of a persons acromion and
degree of any present arthritis, but I still believe the risk outweighs any benefit. Not to
mention that keeping the bar in front of the head still accomplishes the same movement
for the target muscle, while eliminating the risk of shoulder injury. Remember not to
sway during the movement, and position the body in a slightly reclined position (20-30
degrees), while pulling the bar toward the sternum. Another unrelated reason not to do
behind the neck pull downs is that it places undue stress on the cervical spine.
Military Press This exercise, when performed behind the neck with a bar, positions
the shoulder in the aforementioned unfavorable position. Done repeatedly, the rotator
cuff can become inflamed. Similar to behind the neck pull downs, you also expose your
neck to unnecessary stress. It is safer to perform the exercise in front of the head or utilize
dumbbells and work in the scapular plane (a position about 30-45 degrees forward of
the plane of the body). You must watch to avoid arching the low back, and it is best to
use a bench with back support to prevent this.
. B
4/19/10 11:35 AM
Common Exercise Mistakes
24
Dips/Upright Row As before, the key mistake made with these exercises is
allowing the shoulder to move beyond 90 degrees relative to a position parallel to the
floor or perpendicular to the body. I always recommend stopping at 90 degrees to protect
the shoulder capsule and the rotator cuff. These are also not exercises I recommend to
those just beginning to work out. It is best served to incorporate them after developing a
base level of strength and mastering basic lifting movements. People with A-C (acromioclavicular) joint arthritis should probably avoid dips, as this joint undergoes much stress.
Dumbbell Lateral Raise I believe this exercise is often done incorrectly. The
mistakes include lifting too much weight, keeping the arms straight, and raising the arms
out away from the body in the plane of the body. The force on the rotator cuff reaches
90% of your body weight when the arms are raised to 90 degrees with the arms straight
and in the plane of the body. That is a lot of force on four relatively small rotator cuff
muscles. The target muscle is the lateral deltoid, but the rotator cuff is extremely active,
and it functions to allow you to raise the arm by depressing the humerus so that it
passes under the acromion during active elevation. When heavy loads are introduced
in the wrong plane of motion, disaster usually occurs. I am fanatical about performing
this exercise correctly. The proper way to execute a lateral raise is to keep the elbows
comfortably flexed (20-30 degrees) and raise the arm to no higher than parallel to the
floor. The arm should be in the scapular plane of motion (approximately 30-45 degrees
forward from the plane of the body) and the weight should be relatively light. Once you
feel you have to shrug or use momentum to raise the weight, you need to rest or lower
the weight. I feel this is absolutely one of the worst exercises for the shoulder if done
incorrectly.
In summary, I want to emphasize that good intentions may spell bad results for the
shoulder if proper form is lacking. The rotator cuff and shoulder joint is extremely
vulnerable to heavy loads and repetitive bouts of exercise. Gradually, it may become
inflamed and hinder or limit your workout altogether. Be sure to master form before
increasing weight, and do not attempt to work through pain, as this often perpetuates the
problem. Remember to assess risk and reward at all times, and rest assured that these
modifications will not hinder your gains. Instead, they will prevent missed time in the gym
and produce happier, healthier shoulders!
. B
4/19/10 11:35 AM
Bonus Exercise Section
25
In this section, I will outline some additional shoulder/upper body exercises that are
often done incorrectly in the gym. When these particular exercises are done with poor
form and excessive loads, the results can be disastrous. Even with lighter loads, over time
repetitive lifting with faulty alignment will lead to overuse injuries and probably tendonitis.
Exercise # 1 Bench Press

With my background in physical therapy, and having experienced severe rotator cuff
tendonitis firsthand, I can tell you how harmful this exercise truly is when done improperly.
So, what is improper form? I always recommend limiting the range of motion on descent
to the point where the upper arm is parallel to the floor. Lowering past this plane places
excessive stress on the front of the shoulder joint.
With heavy loads or repetitive loading, you expose the ligaments, cartilage and rotator
cuff to wear and tear. Additionally, you may even be at risk for rupturing the pectoralis
(chest) muscle. While some purists in the strength and conditioning field will argue that
limiting motion affects strength gains, I would argue that the risk of injury outweighs any
benefit gained from the additional range of motion. Not to mention the fact that I have
not lost strength on the bench after performing this modified version for over 10 years.
. B
4/19/10 11:35 AM
26
Exercise # 2 Push-up
This is a great upper body strengthening exercise. However, much like the bench press,
moving beyond 90 degrees with the shoulders on the descent places undue stress on the
shoulders. For this reason, it is not advisable to lower beyond this point.
1
Exercise # 3 Lat Pull Downs

This exercise is designed to strengthen the back, specifically the latissimus dorsi. In the
past, many have done this exercise behind the head. In addition to placing unnecessary
stress on the neck, this positioning puts added stress on the shoulders. Pulling the bar
behind the head forces the humerus into the top of the shoulder blade and can compress
the rotator cuff. In light of this, I suggest pulling the bar to the sternum. Recline the body
approximately 20-30 degrees and lower the bar in front of the head, squeezing the
shoulder blades down and together.
. B
4/19/10 11:35 AM
27
Exercise # 4 Upright Row
This exercise is a popular method of strengthening the shoulders and adding muscle mass
to the lateral deltoids and upper traps. It may be done with dumbbells, tubing or with a
cable attachment. The key to avoiding damage with this exercise is to stop the movement
once the arms reach 90 degrees, or are parallel to the ground. Going above this position
will lead to impingement of the rotator cuff. Remember to lead with the elbows and allow
the hands to follow in a natural path of motion.
. B
4/19/10 11:35 AM
28
Exercise # 5 Dips
Dips are difficult for people to do and place a lot of stress on the shoulder complex. In
addition to placing high demands on the shoulder joint and rotator cuff itself, the clavicle
and acromio-clavicular joint is also exposed to significant loads during this exercise. Dips
are designed to strengthen the upper body, more specifically the chest, shoulders, and
triceps. This exercise is similar to the upright row with regard to shoulder positioning.
Whether using a dip apparatus, assisted dip machine or flat bench, it is important not
to lower the body past a point where the upper arms are parallel to the floor. I do not
recommend this activity (even when done properly) for people with current rotator cuff
injuries, A-C joint arthritis, shoulder instability, or those with partial/complete rotator cuff
tears or prior surgery to repair a tear.
As a general rule, I use this exercise infrequently for clientele over the age of 40 as it
tends to add repetitive stress to the AC joint and may lead to overuse injuries.
. B
4/19/10 11:35 AM
29
Exercise # 6 Military Press

This is by far one of the most popular and effective means to build shapely shoulders.
For the same reasons explained earlier with the lat pull downs, I again recommend not
performing shoulder presses behind the head. Additionally, it is important not to lower the
bar or dumbbells below the point where the upper arms are parallel to the floor (shoulder
height) to avoid compressive forces on the cuff. I also suggest keeping the arms in the
scapular plane throughout the movement (30-45 degrees forward of the plane of the body).
Lastly, keep your back pressed firmly against the bench during the exercise. If the back
begins to arch, this typically means the weight is too heavy or you are becoming fatigued.
This exercise should not be done if you are experiencing pain with overhead motion.
Start - Front
. B
Finish - Side
4/19/10 11:35 AM
30
Exercise # 7 Dumbbell Lateral Raise

Perhaps, this is one of the most common shoulder exercises I see routinely done
incorrectly. It is a great way to strengthen the lateral deltoid, but when done with
improper technique, it often leads to rotator cuff tendonitis.
The most common mistake I see is performing this activity with the arms completely
straight and moving them out directly away from the side. Keeping the arms straight
provides a long lever and places a high amount of torque on the joint and rotator cuff.
With this alignment, you also encourage shoulder impingement. It is essential to keep the
shoulders in the scapular plane throughout.
The second major mistake is using too much weight. Heavier loads require using
momentum and other larger muscles to accomplish the lift (such as the low back and
hip extensors). Men are generally the biggest offenders on this point. Remember, the
movement should be slow, and you should be able to pause momentarily at the top of the
lift.
Next, I often witness people raising their arms above shoulder height. Although the cuff
functions most from 70 120 degrees of elevation, I have found that raising the arm
above 90 degrees encourages impingement in a loaded shoulder and often aggravates
a persons symptoms. Sometimes, it is necessary to limit the range of motion further based
on pain. This is okay. As a matter of fact, you should only perform the exercise with a
weight and range of motion that does not increase pain.
. B
4/19/10 11:35 AM
31
Exercise # 7 Dumbbell Lateral Raise (continued)

The final error is related to set-up position. Many simply stand erect with their feet too
close together during this exercise. A better method is to stand with the feet shoulder
width apart and the knees slightly bent. This will prevent cheating by using momentum
and engage the core muscles throughout the exercise. It is important to maintain a flat
back or the natural curve of your spine in this athletic position.
This exercise is similar to scaption, but places a greater load on the lateral deltoid due
to the different hand position (palm down). If you are unable to do lateral raises without
pain, scaption will also activate the lateral deltoid and serve as a good precursor to
returning to lateral raises.
I generally recommend avoiding lateral raises with bands or tubing as the load
continually increases, while the muscles ability to generate force decreases. With
repetition, this approach to training leads to a sore shoulder. Performing this exercise on
a cable also provides a significant challenge in terms of controlling the movement and
should only be done occasionally with lighter weight and perfect form.
1
Start
Finish
Side View Finish

w
. B
4/19/10 11:35 AM
Sample Healthy Rotator Cuff Training Program
32
Healthy Shoulder Series (2x/week)
Day #1
Scapular Stabilizer Muscles
Dumbbell or Tubing Rows (p. 14) 3 sets of 10-15 reps
Lat Pull Downs (or Straight Arm Pulls) (p. 26) 3 sets of 10-15 reps
Serratus Dumbbell Punches (p. 14) 2 sets of 15 reps
Dumbbell Shoulder Shrugs (p. 17) 2-3 sets of 10-15 reps
Rotator Cuff Muscles

Scaption (p. 19) 2 sets of 15-20 reps
Seated Dumbbell Horizontal External Rotation (p. 22) 2 sets of 15-20 reps
Internal Rotation w/Tubing (p. 20) 2 sets of 15-20 reps
Day #2
Prone Lower Trap Dumbbell Raise (p. 16) 2 sets of 15 reps
Prone Horizontal Abduction Raise (p. 16) 2 sets of 15 reps
Prone Extension Raise w/External Rotation (p. 17) 2 sets of 15 reps

External Rotation w/Arm at Side (tubing or dumbbell) (p. 20-21) 2 sets of 15-20 reps
Standing Diagonal Dumbbell Raise (p. 22) 2 sets of 15-20 reps
. B
4/19/10 11:35 AM
Injured
or Inflamed
Shoulder Series
33
6 Week Program (3x/week)
Training Notes
During this program, it is generally best to avoid overhead lifting. Once most of the pain or
discomfort resolves, you can gradually resume overhead training.
At the completion of the initial 4 weeks, you should notice improved strength, more range of
motion and less discomfort with shoulder movements and function. Throughout this time, none
of the exercises should cause any discomfort or pain. If you can not perform an exercise
without pain, it is best to limit the range of motion or discontinue it altogether.
If you are making progress with the exercises, then you can progress to the final phase of
this 6 week program. In the final phase, more emphasis is placed on transitioning back
to overhead positions and functional movements. Less emphasis is placed on shrugs and
serratus punches, as sufficient stabilization strength should have been attained in the initial
month of training. Again, it is critical to make sure the exercise is completely pain free!
. B
4/19/10 11:35 AM
Injured
or Inflamed
Shoulder Series
34
Day #1 (Week 1 & 2)

Low Row (or Dumbbell Rows) (p. 13) 2-3 sets of 10-15 reps

External Rotation (Dumbbell) (p. 21) - 2 sets of 15-20 reps
Day #2 (Week 1 & 2)


Day #3 (Week 1 & 2)

High Row (or Dumbbell Row) (p. 13-14) 3 sets of 10-15 reps

. B
4/19/10 11:35 AM
Injured
or Inflamed
Shoulder Series
35
Day #1 (Week 3 & 4)

Serratus Push-ups (p. 15) 2 sets of 15 reps
Prone Horizontal Abduction Raise (p. 16) 2 sets of 10-15 reps

Day #2 (Week 3 & 4)

High Row (or Dumbbell Rows) (p. 13-14) 3 sets of 10-15 reps
Serratus Push-ups (p. 15) 2 sets of 15 reps

. B
4/19/10 11:35 AM
Injured
or Inflamed
Shoulder Series
36
Day #3 (Week 3 & 4)

Serratus Pushups (p. 15) 2 sets of 15 reps

. B
4/19/10 11:35 AM
Injured
or Inflamed
Shoulder Series
37
Day #1 (Week 5 & 6)


Day #2 (Week 5 & 6)

High Row (or Dumbbell Rows) (p. 13-14) 2-3 sets of 10-15 reps

. B
4/19/10 11:35 AM
Injured
or Inflamed
Shoulder Series
38
Day #3 (Week 5 & 6)


. B
4/19/10 11:35 AM
See Your Physician
39
The previous exercise program is not intended to replace professional medical care by
a physician or physical therapist. It is simply designed to strengthen the rotator cuff and
scapular stabilizer muscles, correct muscular imbalances and improve shoulder function. If
you suffer from chronic shoulder pain, experience an acute onset of significant shoulder pain,
or notice gross weakness and limitation with activities of daily living, it is recommended that
you see your physician for a complete evaluation.
After completing the six week program, you may not be pain free. In this case, I generally
recommend continuing with week 5 and 6 exercises for several more weeks until your
symptoms resolve. Chronic pain often takes longer to respond to treatment. If you do not
experience improvement with the program, it is recommended that you seek professional
medical evaluation and treatment.
With that said, I hope the information in this book will enable you to train more safely and
efficiently in the future. At the very least, the techniques described here will allow you to
avoid many common exercise pitfalls that lead to compressive wear and tear on the rotator
cuff itself. While it is not absolutely necessary to perform rotator cuff strengthening on a
weekly basis, I highly recommend incorporating the training modifications as outlined earlier
with respect to the bonus exercises. In addition, keep in mind the importance of posture,
flexibility and rotator cuff strengthening in relation to proper shoulder function.
For more information regarding my training or consulting services you can e-mail me at
info@brianschiff.com and www.brianschiff.com.
. B
4/19/10 11:35 AM
4/19/10 11:35 AM

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2010 Rotator Cuff Book.

The Ultimate Rotator Cuff

Brian Schiff, PT, CSCS

2010 Rotator Cuff Book.indd 1

The Ultimate Rotator Cuff Training Guide

2010 Rotator Cuff Book.indd 2

About the Author

Brian Schiff, PT, CSCS

graduated from The Ohio State University in 1996 with

Currently, he owns a private fitness studio and a

2010 Rotator Cuff Book.indd 3

2010 Rotator Cuff Book.indd 4

Bonus Exercise Section...................................................................... 25

See Your Physician............................................................................ 39

2010 Rotator Cuff Book.indd 5

TRAINING SYSTEMS, LLC

2010 Rotator Cuff Book.indd 1

2010 Rotator Cuff Book.indd 2

2010 Rotator Cuff Book.indd 3

History of Rotator Cuff Disease and Pathology

2010 Rotator Cuff Book.indd 4

Assessing the Shoulder

2010 Rotator Cuff Book.indd 5

Assessing the Shoulder

2010 Rotator Cuff Book.indd 6

Assessing the Shoulder

2010 Rotator Cuff Book.indd 7

The Role of Posture

2010 Rotator Cuff Book.indd 8

L position w/single arm

Injury Prevention Training / Rehab

2010 Rotator Cuff Book.indd 9

Injury Prevention Training & Rehab

2010 Rotator Cuff Book.indd 10

Forward & Backward

2010 Rotator Cuff Book.indd 11

Clockwise & Counterclockwise (clockwise pictured below)

2010 Rotator Cuff Book.indd 12

Scapular Stabilizer Exercises

Standing Tubing Row

2010 Rotator Cuff Book.indd 13

Scapular Stabilizer Exercises

Standing Dumbbell Row

Serratus Anterior DB Punches

2010 Rotator Cuff Book.indd 14

Scapular Stabilizer Exercises

Serratus Punch Push-up Progression

On the toes (advanced version)

2010 Rotator Cuff Book.indd 15

Scapular Stabilizer Exercises

Prone Lower Trap Raise

Prone Horizontal Abduction Raise

2010 Rotator Cuff Book.indd 16

Scapular Stabilizer Exercises

Prone Extension Raise with External Rotation

2010 Rotator Cuff Book.indd 17

Scapular Stabilizer Exercises

Straight Arm Pulls

2010 Rotator Cuff Book.indd 18

Rotator Cuff Exercises

2010 Rotator Cuff Book.indd 19

Rotator Cuff Exercises

External Rotation (tubing)

2010 Rotator Cuff Book.indd 20