ACC Sports Sciences Feature: Quality of the Exercise
March 31, 2005
By Kevin Blaske MS, ATC/L
As the weather turns warmer and grass begins to green it is time for baseball. Spring training is open, college, high school and even little league seasons are opening. Anyone who has been involved with baseball for any period of time has seen or heard of shoulder exercises. Whether one knows them by "Jobe's shoulder exercise", or "Thrower's 10", or by another name they are all similar exercises with similar goals of strengthening the rotator cuff. Doing the exercises is good for any individual, but the problem that arises is with all human nature after repeating anything whether it is a story or an exercise, the concept becomes distorted to either change the story or change the exercise into something totally different than what was originally demonstrated.
In this article I wish to address proper mechanics and the reason for using these mechanics while doing the exercises. As with throwing a baseball, proper mechanics is essential. But how many of us are taught how to properly throw as a youngster? Instead we learn from practice whether the mechanics are right or wrong we reinforce this movement.
The same happens in exercises for the rotator cuff in the shoulder. Most people are not taught how to properly do the exercise so we learn it from someone whose brother had shoulder problems and these were the exercises he was instructed to do for strengthening. As an athletic trainer, when I see players who are doing exercises incorrectly, it takes time to make an adjustment. For if you tell them straight out they are doing the exercises incorrect they will become defensive and fight the changes all the way. One must approach the athlete with a sense of positive reinforcement. To do this start with the exercises he/she is doing and make changes that will cause the most damage, then continue to make adjustments to his/her program until all faults have been adjusted. Continual monitoring must be maintained with adjustments made as necessary.
Now let's say that you are fortunate enough to begin with a blank slate. How should you start the individual out and what type of proper form should one look for while doing the exercises. First you need to remember to keep things simple. The easier the exercises are to perform the more likely the athlete will continue to do them. Also with a simple looking exercise there is less chance for to many changes to be made by the athlete over time.
For an example let's look at a standard internal/external rotation using rubber tubing or band. Start by positioning the athlete correctly. He/she should be standing upright with no forward lean, no lean to the side and when looking from the back there should be a straight line between both shoulder. Place the elbow at a 90 degree bend. This is a simple item that is not followed. If the bend is greater than 90 degrees you will use more of the bicep and not the rotator cuff. If the bend is less than 90 degrees then the triceps comes into more play. You may place a small pillow between the elbow and the side of the body to place the shoulder in better alignment. I have found that you can get the same effect of placing a pillow between the elbow and the body by contracting the scapular stabilizers. To do this one needs to pull the scapula (shoulder blade) back and down. Watch carefully because when a person is told to pinch the scapulas together he/she has a tendency to use his/her trapezius muscles and pull the shoulder and the scapula upward. This is a common movement especially when one gets tired.
Now that the individual's body position is correct it is time to place the band. Have the band adjusted so that it is parallel to the ground when held in the athlete's hand. Again this seems to be a simple and not important item but if the band is placed too high or too low it will change the force during movement which will change the muscles being used. Now that positioning is done it is time for movement. Make sure the movement is smooth. Weakness will show by a jerky movement or the athlete will try to jerk the band hard and let momentum carry him/her through the movement. The biggest reason for these improper mechanics is that the band is too strong for the individual. With competitive individuals it is tough to convince them to do a lighter band because they believe it shows weakness.
As an athletic trainer, I try to explain that we are interested in quality and not quantity. In fact throughout the exercise I may have the athlete change strength of bands between sets and even during sets. This is important to monitor because until the athlete becomes acceptant to making change and decreasing strength of bands you must make the changes for him/her. Other items to watch for are the flexing of the wrist on internal rotation, rotation of the hips and upper body, and the elbow coming away from the body on external rotation. With all these little items that need to be watched for and corrected it is important that the athlete be monitored closely and corrected immediately. This feedback will allow him/her to have a feedback as to what is right and what is not.
Now the same principals can be applied to numerous exercises for the shoulder. In the standing free weight exercises stated by Jobe, the stabilizing of the scapula should be applied. Why this principal is used is very simple. The rotator cuff muscular attach to scapula. If one has weak scapular stabilizers, then there is no anchor to allow the rotator cuff to work properly, and no matter how many exercises one does they will not get any stronger. In fact many orthopedic surgeons are putting more stock into strengthening the scapular stabilizer muscles first. Then once the athlete has a solid base developed, he/she may begin rotator cuff strengthening. With the standing free weight exercises, it is even more important to explain that quality of the exercise is more important than quantity of the weight. If the exercise is done correctly very few individuals can do the exercises with over 7 pounds. This can be a problem especially with large male athletes whose pride will be hurt when they are only able to start with 2 pounds and become fatigued quickly and must move down to 1 pound or no weight to finish the sets and repetitions of the exercise.
Once the "simple" exercises have been mastered the athlete can be moved up to more "complex" exercises. These exercises involve the use of the physioball, plyometrics and the combination of several body parts. It is important that the athlete have adequate strength in all muscle groups involved before beginning. But always remember to never sacrifice the quality of the exercise for quantity, whether it is in the amount of weight or the difficulty of the movements.
Finally there is the boredom factor. This is when one has to do the same exercise over and over he/she will lose interest and the quality goes down as well as compliance. Remember to add variety into the athletes program. This is tough to do when the athlete has just started the exercises and is performing simple movements, do your best but do not sacrifice building a solid base by trying to progress too fast. Once the exercises become more complex do not be afraid to continue mixing in "simple" exercises to maintain the base. Also one needs to work all the areas surrounding the shoulder and not just the rotator cuff. Other areas that need to be included are the forearm and wrist, the scapula, the traps, latisimus dorsi, serratus anterior, abdominals, low back, and legs. All of these parts play an important role in throwing and if one it weak it will put undo stress somewhere else which will lead to injury.
Though this article did not deal with specific exercises for the shoulder its purpose was to educate about the importance of doing exercises correctly. There are hundreds of exercises out there for the shoulder; some are the same with just different names. It is important for the young athlete to start with the basics and progress as he/she is able in a safe manner. It is also important to take these exercises seriously and pay attention to the details. Remember to keep things simple and concentrate more on the quality of the exercise and not make them a competition on how many can be done or how much weight can be used. And continue to rotate the exercises to reduce the chance of boredom which will lead to improper technique or noncompliance. Also as an athletic trainer it is very important that I continue to monitor the athletes while they do their exercises to make little adjustments before major adjustments are needed. And finally remember to work out the entire body in strength training and cardiovascular training to maximize one's potential.