If you’ve ever programmed rotator cuff work, you’ve probably hit the same wall this week’s listener did. You start with the classic light band or dumbbell external rotations, everything progresses nicely for a few weeks, and then it just stops. Add a couple pounds and the movement falls apart. So you assume you’ve maxed out what these little muscles can do and go back to maintenance mode.
Here’s the question we got, and it’s a good one: the infraspinatus and teres minor are small muscles, so at some point linear progression seems to stop working. Do they respond to heavier loading like three sets of eight, or is there a ceiling because of their size?
It’s a smart question, and the answer starts by challenging a premise almost everyone believes. The idea that the external rotators are “tiny” muscles that can only handle light work is one of the most persistent myths in shoulder training, and it quietly shapes how most people program the cuff for years. Once you see the actual anatomy and understand what these muscles are really built to do in a throwing athlete, the whole approach to loading them changes.
So can you lift heavy for the rotator cuff? Should a performance athlete be doing sets of eight with real weight? And if linear progression has stalled, what’s the variable you should reach for before you just pile on more load? We get into the exact framework on this week’s episode, including why your progress probably stopped and the order we’d progress these muscles to break the plateau. Give it a listen.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 395: How to Progressively Load the Rotator Cuff
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Show Notes
• Eval And Treatment of the Shoulder Online Course
Transcript
Noah Taylor:
We have Scott from Connecticut. “Hey Mike, first off, let me say I love the podcast and really enjoyed your courses, and just became performance specialist certified with you. My question is this: how do you plan your rotator cuff strengthening, and then how do you progress load? Because infrateres are small muscles, at some point, linear progression seems to stop working. Given their size, are these muscles that will respond to heavier loads, such as three sets of eight? Thank you.”
Mike Reinold:
Awesome. Great job, Noah. Scott from Connecticut, that’s a great question. Man, why is there so much confusion about getting muscles strong? And we talk about the size of a muscle. My forearm muscles are pretty small, my ankle muscles are pretty small. It’s an interesting concept. I mean, there’s so much misinformation that we’ve had over decades of our profession. Remember when we used to say if you do a rotator cuff exercise more than five pounds, that the rotator cuff would just magically shut off and it would just be the deltoid somehow? Remember all that stuff? It’s crazy, some of the misinformation we have. I just put this on Instagram fairly recently, by the time this episode comes out, but I continue to see so many athletes. These guys are huge, huge athletes. They weigh 240 to 260 pounds of pure muscle mass, and they have weak rotator cuffs.
Why is that? And most of the time, they’re just doing their shoulder program wrong. It stinks. So it’s funny, Scott says at some point he feels like he stalls out with linear progression with that. We’ll talk about that. I think that’s interesting, but this is a really good concept for us. I think at Champion, we do a really good job at getting the rotator cuff strong, but let’s talk it through a little bit. Who wants to jump in and start talking about this from Scott, or to help Scott out a little bit here? Anthony, you want to jump in?
Anthony Videtto:
Yeah, I think this is such a good question to bring up because it really is shocking how often I see kids even in our clinic doing their rotator cuff program or their shoulder strengthening program, and they’re just doing it incorrectly or they’re using weight that is far too heavy than what they’re capable of using. So I think, to his point, they’re doing weight for the same program for a long period of time. So they’re doing sideline external rotation. They’re going from five pounds, then six, then maybe seven. Then there becomes a point where we’re just doing so much weight that those muscles might not be able to handle that certain stress at that certain point. So to think about it this way, I have kids who are doing 12 pounds of external rotation strength, or at least they think they can. And then what I see is they’re just using momentum, or they’re just rolling their scapula to really get these exercises completed.
So, what we tend to find is that form needs to be absolutely perfect when we’re trying to isolate these smaller muscles of the rotator cuff without letting lat or these bigger muscles take over. So that’s first and foremost. And then the second piece of this is that, yeah, if you have someone do a strengthening program for six weeks, let’s say, and they’re doing two sets of 10 for these exercises, at some point you will switch up maybe the rep scheme, as you would in the gym. So you wouldn’t do three sets of 10 for an exercise for three months in the gym for a squat. So at a certain point, you might go to four sets of six or four sets of five, whatever the case may be in the gym. So yeah, when we do two sets of 10 for six weeks, we might switch it up.
But what I find is if I wanted someone to get stronger and maybe change this program up, instead of going to that four sets of five, I might do two sets of eight with a three-second ISO hold at the top. And I feel like that’s going to do a little bit more than trying to have someone go to 20 pounds for their external rotation for five reps when I don’t think they’re going to be able to handle that with just their infrateres or whatever the case is. They’re really going to take over with those bigger muscles because the weight’s just too heavy. So what I think we find is that two sets of 10 does a really great job for an extended period of time, as long as we’re doing it correctly.
But then yeah, when we do change the rep scheme up like we would in the gym, I don’t think doing something like three sets of eight… Maybe three sets of eight works, but something like four sets of five, I don’t think that’s going to really do as much as something like two sets of eight with a little bit of an isometric hold to build some time under tension. And I think that helps a little bit more with those smaller muscles, as opposed to going for 20 pounds for that five reps. I just don’t think that’s going to get the same product there.
Mike Reinold:
Yeah, I completely agree. When we build our programs, we go more towards the pauses, the pause sets, the isometric holds, and it probably ensures that we’re getting a really good contraction. We’re not compensating. We’re not getting momentum involved with it. But man, you jump into a very high weight, you got to remember going from five pounds to six pounds is a 20% increase in load in one week. I mean, you wouldn’t do that with a bench press or something like that. So it’s very easy for these exercises to become compensation patterns. And I think that’s what happens, Anthony, when people… They’ll do a cable machine or something, they’ll try to get a big 20-pound rep in, they’re going to just immediately start compensating because they’re probably not strong enough for that. The funny thing about linear load, though, is everybody wants to jump to changing set rep schemes.
You can linear load something, and let’s just say the one variable we’ll manipulate with a linear load is load. So let’s say you keep the sets the same, two sets of 10, three sets of 10, whatever. You can linear load for a very, very long time, way longer than you think you can. You don’t have to mix it up in two to three weeks and start changing the set rep schemes. You can go up five, six, seven, eight, nine, 10, 11, 12 pounds. You can just keep going up over time with linear load. So I think that’s one mistake I see with people, is they jump too quickly to try to do more load, and they don’t understand that the percentage increase in load is huge. So, linear load as much as you can. But then to my point or to Anthony’s point, I think our next progression, once we get to a point where we’re starting to see maybe some compensation, is let’s work on quality of control with sets, and let’s be a little bit more strict with our shoulder program.
I think that’s what we see. Funny example: I’m talking to our friend Ian last night, and I’ve been working with Ian for 12 years, I don’t know, since he was a sophomore in high school and now he’s a big leaguer. So we’ve been through his whole career with him, and he’s like, “Yeah, my shoulder’s weak. It’s been sore.” This is a month ago, and I was like, “All right, well you got to get it stronger. Let’s work on it.” This kid’s always strong. And he texted me last night. He’s like, “I fixed it.” I’m like, “All right, this should be good. What’d you do?” He’s just like, “I was just compensating. I was cheating, so I just got real strict with my reps with sideline external rotation, and my strength shot up, and now I feel completely fine.” And we see that all the time.
All right, what else? I’m sorry, I can keep talking forever. Who else wants to jump in here? Dave, what do you got?
Dave Tilley:
My just quick thought is that I think it’s really important to do an objective strength assessment to figure out what specifically somebody has a deficit in, and then use research with EMG activity to get a little more volume. Because if you wanted to get your quad stronger… So say you’re an Olympic lifter and you wanted to get your quad stronger to squat heavier in competition, you wouldn’t do one exercise, three sets of eight, and that’s the only thing you do for your quads maybe twice a week. And if you think about some of the shoulder programs that we give people, I think sometimes they know sideline external rotation is important, but they’re literally doing one exercise that’s generically seen online. If you really want to target the posterior cuff, I think it’s good to have two to three exercises that are overlapping in EMG activity. So sideline, if you’re prone, if you can do it, you can change the scaption angle.
I think it’s important to mix in a couple different exercises in different planes for the highest EMG, and do those in more volume because you’re not going to add, to your guys’ point, you’re not going to just be like “only load ever” is the only thing I think about. I think volume density… That doesn’t really get thought about a lot with shoulder cuff exercises, but we give people programs that it’s five to six exercises, all straight through, in two or three sets in a row because we’re trying to build a lot of volume in a short amount of time. And I think that sometimes people just do one set or one exercise sideline ER twice a week, three sets of eight, and they’re like, “All right, why am I not stronger?” It’s like, “Well, if you squatted one set, three by eight, twice a week, you probably wouldn’t get true hypertrophy of quads.” So that’s just my thought.
Mike Reinold:
And I guarantee that person’s not linear loading that well either. I mean, they should be doing a lot of weight if they’ve been doing that for forever. They’re probably just doing the same weight over time. So why would you get strong? It doesn’t make sense. You’re not progressively overloading the muscle, just like anything else. To piggyback on Dave’s concepts a little bit here too, I agree with that completely. If you look at our shoulder programs, our arm care programs that we give our athletes, the ratio of external rotation to internal rotation is intentionally pretty close to three to one. So it’s sometimes two to one at the beginning, but three to one is intentional for ER to IR. We do that intentionally because that’s the bias we want to get them towards because that’s usually where their weakness is. If their ER or IR ratio is low, that’s how we start working on that.
But I would say, to Dave’s point, I completely agree, but resist the urge to just start getting creative right away. So for us, you have to earn strength at zero degrees before we go to 90 degrees, because what are you going to do at 90 degrees? You are going to compensate, I promise. And that’s why we don’t test in that position. That’s why we are not jumping right to 90 degrees, because that’s a more functional position. No, we get to 90 degrees when it’s appropriate. So you have to go sequential. It’s basic loading in a nice pattern that you can isolate. I know isolate is a really weird word, but you can decrease as much compensation as possible. Then you get to more challenging positions, then you get to more load, then you get to more speed, then you get to eccentric control. That’s down the road for us.
It takes me months for my athletes to start doing advanced eccentric exercises at 90 degrees. Yet you’ll see people do this week two with a new patient with shoulder pain, and then you wonder why their strength doesn’t go up. You just jump right to eccentric. So you jump right to 90 degrees. It’s too fast. So anyway, sorry, who else here? Len, did you have something? Brendan, I knew somebody raised their hand. What’s up, Brendan?
Brendan Gates:
Yeah, I mean, I just wanted to bring up quickly: I don’t know if it drives you guys as crazy as it does me, and it might just be clickbait, but the videos on Instagram would say ditch the banded external rotation or ditch the sideline external rotation and do this crazy exercise that maybe late stage is pretty good. But I think I just wanted to highlight, for the listeners, if we are doing the simple things well, I think that’s really important, as you just said. Outside of momentum, how many times do you guys see someone on their sideline ER roll back a little bit so they change the momentum of the weight? There’s so many things, but I think highlighting some of those things is important. Momentum, the changing the position, not squeezing the towel, not retracting your scap. So I think it’s important to look for all of those.
But I guess just a quick question for you guys would be, if you have a kid, let’s say we have a high school kid who just, like Dave said before, wants to play Fortnite and play hockey or something. Let’s say this kid wants to play Fortnite and play baseball, and they have a shorter attention span, and they’re getting bored. How much value do you guys put into giving them a little bit of novelty within their program to almost keep their attention, but then almost keeping the consistent basic exercise that they really need as the bulk of their program? Is it more just, are you guys just erring on the education side and telling them, “Hey, I know this is boring, this is what you need to do,” or do you try to give them something to scratch the itch a little bit to keep them invested?
Mike Reinold:
That is a great program. I’ll answer first, then I’m going to want to hear from Anthony. I want to do this intentionally because I’ll start with I’m old and grumpy, so you either do it right or you don’t do it. I’m not here to entertain you. I’m not here to give you a circus act kind of thing to do with that. What we do is we just… I think people come to us knowing that we know what we’re talking about, and I tell them, “Look, this is monotonous, this is boring, but this is the bread and butter that you need to establish. Look at the wall. You see all these jerseys on the wall? That’s what they all do. Is that what you want to do?” And you have to do that. I caution you to resist the urge to either mix it up or to get fancy because you’re worried about their attention.
I just think you’re going to waste time, or you’re going to get them tired and not strong. And that’s just my biggest precaution. I know with you, Gates, I think what you’re saying is do the basics and then give them a couple of cool things on top of it. Sure, we do that. You know that. That’s what we do. So that’s a good lesson to say, but you can’t forego the basics. Now, Anthony, from a younger clinician, I’m just grumpy. I just yell at people now, but how do you nicely get that across in a way when you care about relationships with your patients?
Anthony Videtto:
I think if you asked me six months out of school, I would’ve been like, yeah, I switch up the exercises every week to keep them happy, but I think I’ve grown a little bit since then, and I think I’m transitioning to something that’s a little bit more equivalent to what you tell people, and I think that’s a good thing. I find myself giving that same exact example that you just gave, which is “You see all the jerseys on the wall? I give the same program to those guys that I’m going to give you. And if you want to get to that position one day, then you need to do the basics really well.” And I think that just gets enough buy-in right off the bat. So I find that that’s a good strategy. But yeah, you might have a 13-year-old who doesn’t love doing a shoulder program, and I might give them one or two fun exercises so that it keeps their attention span to the point.
But yeah, generally speaking, I feel like I’m becoming old and grumpy a little bit earlier on in my career than maybe I would’ve anticipated. It’s probably for the best though.
Mike Reinold:
We talk about that with mentorship a lot of time, is that by getting somebody to help mentor you, you get to get where they are in space a little faster. So unfortunately, you’re getting older and grumpier faster than the normal clinician. And I apologize, but anyway, hopefully it works out for you. But anyway, great question, Scott from Connecticut. I think that’s good. You know what? There’s a lot of ways to hit this. I think we can summarize it with this. People, for some reason, are just sloppy and lazy with these small muscle exercises, and they can respond just like anything else. Load them up more than you think. Resist the urge to get fancy just to get fancy. They have to earn the right to get fancy. I think that’s an important part. And trust me, you’ll get a lot stronger. We post this on Instagram all the time.
We have graphs of our dynamometer testing. You see our patients going up 20, 25, 30% in external rotation strength by following the program. It’s not hard. You just have to do it. So, great question. If you have anything like that, head to mikereinold.com. Click on that podcast link and be sure to subscribe on Spotify, Apple Podcasts, whatever you listen to, and we’ll see you on the next episode. Thanks so much.
