Strengthening Your Rotator Cuff Muscles

Strengthening the rotator cuff muscles is integral to keeping your shoulder joint strong and injury free. For a detailed description of what causes shoulder impingement, please visit my blog post on that topic here.

The rotator cuff consists of four small muscles. The supraspinatus is the topmost muscle. It lays across the top of the scapula (shoulder blade). The muscles (laying posteriorly – the closest to the skin) are the teres minor and the infraspinatus. The muscle under the scapula (laying anteriorly) is the subscapularis.

The supraspinatus, along with the deltoid, abducts (lifts up from the side) the arm. The teres minor and infraspinatus externally rotates the arm. The subscapularis internally rotates the arm.

The rotator cuff muscle that gets most injured is the supraspinatus. The muscle I strained was my left supraspinatus.

rounded shoulders = winged scapula

Our rounded shoulders are the main reason we injure our rotator cuff muscles. Most of us have desk jobs in which we sit in a rounded forward posture. This posture causes tight and shortened pectorals (chest) muscles and lengthened upper back muscles. When muscles stay in an abnormally lengthened position, they become inactivated and weak, often leading to an injury when worked. Also, when the muscles around our scapula (the rotator cuff muscles) do not hold our scapula hugging close to our back, this causes them to wing out, which puts stress on the entire scapulothoracic joint, as well as the shoulder joint (glenohumeral joint), which also can lead to an injury.

Retract and depress = winging disappears

So to combat this default posture the exercise I suggest is to retract and depress your shoulders, also called “packing your shoulders”. To do this contract your muscles in your upper back to bring your shoulder blades together towards your spine. Along with that movement press your shoulders down. This will slide your shoulder blades down your back. Hold this position for 10 seconds and repeat. I recommend doing this exercise 3 times, holding 10 seconds each. Work up to holding for longer time frames and repeating this sequence often during the day. Every time you carry anything, use this movement to keep your scapulothoracic joint stable.

To strengthen your external and internal rotators of the arm these next two exercises are very important. To work the teres minor and infraspinatus we need to perform external rotation: fasten tubing to a doorknob or other stationary object, lock your 90 degree flexed elbow into your side, making sure your shoulders are “packed”, slowly rotate your arm outward, pause for 1 second, and then slowly come back to starting position. Repeat 10-12 reps for 3 sets.

To work the subscapularis perform internal rotation. The movement is reversed, as the force on the arm is coming from the opposite side. Start with your 90 degree flexed elbow hugging into your side, making sure your shoulders are “packed”. Slowly internally rotate your arm into the midline of your body, hold for 1 second, and slowly release back to starting position. Repeat 10-12 reps for 3 sets.

I recommend two lateral raise exercises that will help strengthen the supraspinatus, which is the muscle out of the four that gets injured the most. Performing a lateral raise that is 30 degrees forward of the side works the supraspinatus the best and keeps your scapula hugging on your back. Start with your arms at your side, making sure your shoulders are “packed”. Slowly raise your hands, slightly in front of you, thumbs up. Hold 1 second in the up position, and then slowly lower hands. Repeat 10-12 reps, 3 sets.

The next lateral raise is called scaption. With hands starting in front of you and making sure your shoulders are “packed”, raise your hands up and back, squeezing your shoulder blades together and depressing your shoulders even more when at the up position. Hold for 1 second and slowly lower your arms.

Another scaption exercise is called Y to W exercise. Lay your torso over a stability ball, with hands by the floor. With your shoulders packed, lift your arms into a Y position, slowly move to the W position, squeezing your shoulder blades together and down your back. Hold for 1 second, and slowly lower your arms. Repeat 10-12 reps, 3 sets.

The last exercise I suggest for the rotator cuff is the prone cobra. This exercise also works your erector spinae muscles (your back extensors, which is part of your core). Lie prone on a mat. Make sure your legs stay in a neutral active position, meaning toes and knees are pointing straight down and the legs are neither internally or externally rotating. Pack your shoulders and lift your torso off the floor, making sure you keep your blades squeezing together and down. Tuck your chin in slightly. Hold for 10 seconds and then slowly lower. Repeat 10 reps, 3 sets.

Shoulder Impingement Injury

Up until recently I was weight training 5 days a week. Using the body split training method. A typical workout week would consist of 75 minute training sessions broken down by body part, like this: Monday: shoulders and abs, Tuesday: legs, Wednesday: chest and triceps, Thursday: back and biceps, Friday: legs. I performed approximately 4 exercises per body part, 3 sets of 6-12 reps, going to failure every time (meaning: you lift weight heavy enough that when you get to the last rep you can’t lift it with proper form – please note then you don’t lift it, because you should only lift with proper form). In addition, I was running 25 minute sprints and participating in 1-2 spinning classes a week. My cardio was mainly high intensity every time.

This is the popular bodybuilding workout plan. I think it’s been the most used model for building muscle for years and years (since the 70s). Because I was so focused on studying for the NASM CPT exam, I didn’t have time to properly develop my own periodization program, and I was just following someone else’s. Speaking of studying, that wasn’t helping either as I would train hard at the gym, not have time to stretch, come home and cook healthy meals for myself and my family, and then hunker down on the sofa and study. I was in a slouch position for the rest of the day.

Needless to say, it was an overtraining injury waiting to happen. And it did. In August, two weeks before my exam I noticed a tight, uncomfortable muscle in my left upper back area. It would come and go, so often I would just massage it a bit and it would be fine. A couple days before my exam it decided to stay uncomfortable all the time, like waking up with a knot in your lower neck area. And then the day of my exam, it rebelled.

The supraspinatus muscle is part of the rotator cuff family. It lies above the scapula spine (top of your shoulder blade) and attaches, along with another rotator cuff muscle, on the head of the humerus (upper arm bone that inserts into your shoulder joint). And mine was so irritated it caused shoulder impingement. Ouch!

My NASM Corrective Exercise textbook writes: “Shoulder impingement syndrome (SAIS) is a common diagnosis broadly defined as compression of the structures that run beneath the coracoacromial arch, most often from a decrease in the subacromial space. The impinged structures include the supraspinatus and infraspinatus tendons, the subacromial bursa, and the long head of the biceps tendon. Repetitive compression of these structures with the overhead motions required of many sports and activities of daily living can lead to irritation and inflammation”.

Wow, you never really know how often you move your arm until your shoulder goes, and then every single moment and breath causes pain.

First thing to do is RICE. Rest, Ice, Compress, and Elevate. That ice felt soooo good. And it helped immensely. I knew I had to keep the shoulder mobile, so I would gently move my arm through the pain.

It took about a week for the intense pain to subside, but it eventually did. And during that time, I reflected on what went wrong. I do what I do best: I researched 🙂

I assumed my age had some responsibility for the injury. In Dr. Nicholas DiNubile’s book Framework for the Shoulder he writes “the wear and tear on body parts and the changes in tissue composition as time marches on. Friction takes it toil and collagen loses elasticity, so most adults over the age of 40 have rotator cuffs that have already started fraying.”

I know my studying posture didn’t help either. I would often be bent over my book, causing my front chest muscles to passively shorten, and my upper back muscles to excessively lengthen. Put in this lengthening position too long, my back muscles had a harder time activating and thus developed a weakness.

Around the same time, I came across a short Joe Rogan youtube video. In it Rogan’s guest, Firas Zahabi, talks about training consistency over intensity. He explains how training less intense—not lifting to failure—helps your body recover faster and so in turn you can train more often. He speaks against beating up your body every single time you are at the gym.

That fueled me to research more. And up comes the topic of periodization. “Killing it” (intense lifting for strength) in the gym definitely has its place. However, it needs to be developed and built around a properly designed periodization plan. Training at that intensity shouldn’t last more than 4 weeks. After that time, a recovery phase needs to happen, so your body can build and repair. Funny thing, I know this. I have known this for 20 years. And for my clients, I always plan for this. But for myself, I love to train hard, and so I was mindlessly following what is popular in the bodybuilding world.

A very popular trainer, Jay Ferruggia, who specializes in increasing men’s muscle size, writes often that the key to success is to train less (3-4x a week), and not always to failure. He writes “there are 7 main reasons people fail to get results: 1) no progressive overload, 2) using the wrong exercises, 3) too much volume—too many sets and reps, 4) too much cardio, 5) too much intensity—always training to failure, 6) low carb diets, 7) not enough rest and recovery”.

Now that my exam is finished I developed a better plan. I am currently on a 3x week weight training schedule, using complexes and large compound moves with upper/lower body super sets. I don’t train to failure each set, but almost to failure—where I stop when I feel like I have 2 more in the tank. I am working hard, smart, and still sweating puddles. I am amazed at the results! My goal is to increase muscle size (I am tall and skinny by God’s design, so for me to increase too much muscle is impossible), while maintaining or slightly losing my body fat percentage. I feel stronger and more muscular, and a surprising benefit is my core looks flatter and stronger. I love running, so I have kept running 30 minutes 2x week on my off days. For the rest of my cardio time, I walk for about one hour a day. I had to dial in my nutrition a bit more than I had to before. I notice keeping my calories slightly under 2000 is best, focusing on getting 25% protein, 50%-55% carbs, and the rest healthy fats (25%). My supraspinatus still bugs me a little, and I am focusing on building strength and activation in my rotator cuff muscles. I will write a post soon on what exercises I am using to build that.