The Shoulder, Part III

By Sue Hitzmann, MS
Apr 30, 2004

SUGGESTED EXERCISES

The rotator cuff muscles are not balanced in their ability to internally or externally rotate the humerus. The external rotators, which are significantly weaker than the internal, should be exercised through range of motion (ROM). However, some of the exercises listed are specifically designed to encourage the stabilizing mechanics of the rotator cuff in its entirety. Rotation can be exercised in the open chain as a movement and the closed chain as a stabilizing component.
There are many products specifically designed to enhance the neurological components of this region of the shoulder. The design of your programs will largely depend on your training environment, your client’s current ability and movement potential, and your accessibility to specialized products. The most basic and practical exercises are described here, but there are many others.
General muscle testing for weakness should be done before designing the client’s program. Fully understanding the shoulder’s firing patterns and optimal ROM will also help you create an effective program.
Ideally, a functioning human body should be able to:

  • move the scapula independently of
    the arm and vice-versa
  • move the neck independently of the
    shoulder girdle and vice-versa
  • differentiate one joint from another
    when creating movements involving
    the entire shoulder girdle, neck or both.

Exercises Using a Resistant Band

1. Standing External Rotation

  • Client begins with right arm hanging
    and relaxed at her side, elbow bent
    into 90-degree angle.
  • Cue and assist her to maintain good
    shoulder girdle position, relaxed but
    with collar bones “wide” and shoulder
    blades “heavy.”
  • Place one end of a resistant band in
    her right hand and secure the other
    side by tying it to a sturdy pole. The
    band should be in front of her chest,
    about waist high.
  • Place a towel under her elbow to main-
    tain a proper angle at the shoulder joint.
  • Client externally rotates her arm from
    0 degrees (anatomical position) to as
    far externally as possible (up to 80
    degrees without excess compensatory
    movement from the entire girdle).
  • Hold at end range and slowly return
    to beginning position.
  • Repeat 8 to 12 times, alternating
    right and left arm.
  • Make client aware of imbalances.
  • To make the movement easier, client
    should stand closer to the band’s
    stationary point.
  • To increase resistance, client should
    stand farther away from the band’s
    stationary point.
  • This exercise can also be performed
    on a cable machine.

    2. Standing Internal Rotation

  • Use same set-up as in previous exercise.
  • Place one end of a resistant band in
    client’s right hand and secure the
    other side by tying it to a sturdy pole.
    The band should be at her right side.
  • Cue her to internally rotate her arm
    from 0 degrees to as far internally as
    possible without moving the entire
    shoudler girdle.
  • Hold at end range and slowly return
    to beginning position.
  • Repeat 8 to 12 times with each arm.
  • To make the movement easier, client
    should stand closer to the band’s
    stationary point.
  • To increase resistance, client should
    stand farther away from the band’s
    stationary point.
  • This exercise can also be performed
    on a cable machine.

    Exercises Using a Stability Ball
    Stability Ball Presses (Push-up Position)

  • Client stands with hands on the
    stability ball.
  • Cue her to move her feet away from
    ball until her body is at an approxi-
    mate 45-degree angle from the floor.
  • Hold this “push-up” position for 10
    to 20 seconds; repeat until form fails.
    Progressions
  • Add movements—such as a basic
    push-up on the ball—which not only
    challenge the rotator cuff as a stabilizer
    but also challenge the chest, shoulder,
    triceps and back.
  • Increase difficulty by gently bumping
    the ball for greater instability and
    increased reflex demand.
  • Have client try lifting one leg off
    the ground as she holds her body at
    45 degrees.

    Exercises Using Weights
    1. Prone Shoulder External Rotation at
    90 Degrees

  • Client lies face down on a massage
    table and begins with the exercising
    arm dangling off of the edge, from
    the elbow joint, weight in hand. Upper
    arm (humerus) should be on the table.
  • Place a rolled-up towel under the
    anterior portion of the shoulder to
    take any unnecessary strain off of the
    clavicular head of the pectoralis
    muscles.
  • Client may turn her head toward the
    exercising arm for a more comfort-
    able and relaxed neck position. (If a
    face cradle is available, client can
    rest head in a neutral position.)
  • Cue her to externally rotate the humerus
    at the shoulder joint until the knuckles
    of the exercising arm are angled at
    approximately 80 degrees, or as level
    with the head as possible.
  • Slowly return to start position.
  • Cue client to exhale as she moves her
    arm, and inhale at end ranges.
  • Reinforce slow, controlled movements
    and watch for compensatory action at
    the shoulder girdle.
  • Perform 8 to 10 times; repeat on
    opposite side.

    2. Prone Shoulder Internal Rotation at
    90 Degrees

  • The set-up is the same as in the
    previous exercise, but with movement
  • in the opposite direction (internal
    rotation up as far as the client can
    move the arm without compensatory
    action or increased range from the
    muscles that provide scapular motion).
  • Slowly return to beginning position.
  • Cue client to exhale as she moves her
    arm, and inhale at end ranges.
  • Reinforce slow, controlled movements
    and watch for compensatory action at
    the shoulder girdle.
  • Perform 8 to 10 times; repeat on
    opposite side.

    Note: The previous two exercises can be combined into a single full-range movement (from full external to full internal rotation).

IDEA PERSONAL Trainer MAY | 2004 4 fine anatomy

IDEA PERSONAL Trainer MAY | 2004

Sue Hitzmann, MS

Sue Hitzmann, MS

"Sue Hitzmann, MS, is the creator of the MELT Method®, a simple self-treatment that offers anyone the ability to get out and stay out of chronic pain, improve performance, and eliminate the stress of active living and exercise. Sue is a nationally recognized educator, manual therapist and founding member of the Fascia Research Society. She is a presenter for IDEA, ECA and PMA, and a CEU provider for ACE, AFAA, NASM, PMA and NCBTMB. She has trained instructors from over 20 countries and is the author of the New York Times bestseller The MELT Method, which has been translated into eight languages, as well as the recent book MELT Performance."

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