How To Avoid Rotator Cuff Injuries

Have you ever suffered from shoulder discomfort after working out? I am referring to aching or sharp pain experienced in the front of the shoulder or lateral upper arm that is felt with overhead activities, reaching behind the back or even laying on the shoulder. These symptoms are often indicative of rotator cuff inflammation. This is a common problem for many people who perform resistance training on a regular basis. It is also a problem that can easily be prevented by modifying the following “dangerous shoulder exercises.”

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 (loose joints) or history of subluxation / dislocation are also at increase risk for rotator cuff injury or labral (shoulder cartilage) damage. Furthermore, you also have the potential to rupture the pectoralis tendon 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.

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 person’s 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, 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. You must watch to avoid arching the low back and it is best to use a bench with back support to prevent this.

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.

Dumbbell Lateral Raise – In my opinion, 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 from being perpendicular to 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. In my opinion, this is 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!

We would like to thank Brian Schiff, PT, CSCS for this excellent article on way to avoid Shoulder (Rotator Cuff) injuries. Please check our Brian's site for more information www.BrianSchiff.com