Why should you strengthen the external rotators of the shoulder?

Do your shoulders hurt after going to the gym or lifting weights? 

Strength training can help to reduce the risk of injury, but it can also increase the risk of injury without a proper strength training program.

Many shoulder injuries occur due to training too hard too soon. The shoulder needs time to gradually adapt when lifting weights before progressing to the next level of resistance.

The external rotators of the shoulder need to be strong when lifting heavier weights at the gym; however, most people do not train their external rotators as frequently as they train other muscles of the shoulder.

Consequently, weakness in the external rotators of the shoulder is often involved with shoulder injuries. The external rotators of the shoulder should be strengthened regularly to keep the shoulder joint healthy and injury-resilient.

What are the external rotators of the shoulder?

As the name suggests, the external rotators are muscles that pull the shoulder into external rotation. The images below show the shoulder moving into external rotation.

Internal rotation

The should is in internal rotation.

External rotation

The shoulder is in external rotation.

The infrapinsatus and teres minor are the two main external rotators that attach on the outside of the shoulder.

At times, these muscles can become overstrained from excessive activity, repeated movement, or a traumatic injury such as a fall.

Pain from the external rotators often radiates down the upper arm. The pain may feel like a dull ache and people with injuries to these muscles often feel a dull ache in their upper arm when sleeping.

The external rotators are part of a group of muscles in the shoulder called the rotator cuff. The entire rotator cuff should be strong if you participate in activities that place a heavy demand on the shoulder.

Examples of these activities would include surfing, rock climbing, playing sports, sex, weight lifting, gymnastics, and other movements that require strong shoulders.

What is the rotator cuff?

The rotator cuff is a group of four muscles that provide stability to the shoulder joint. These four muscles form a cuff around the head of the humerus (upper arm bone).

The external rotators (infraspinatus and teres minor) are two out of the four rotator cuff muscles. The other two rotator cuff muscles are the supraspinatus and subscapularis.

The rotator cuff muscles work together to control movements of the shoulder – ultimately allowing your shoulder to do what you want it to do.

Why should you strengthen the external rotators of the shoulder?

The shoulder joint moves freely in multiple directions. Due to the high degree of motion available, the shoulder is susceptible to dislocations and injuries. 

Once the shoulder dislocates, ligaments stretch out and the shoulder is at greater risk of another dislocation. Therefore, it's important to control the movements of the shoulder.

Movements of the shoulder can be controlled by strong rotator cuff muscles. The rotator cuff muscles - including the external rotators - will provide the shoulder with stability during resistance training exercises.

If the rotator cuff muscles are weak, the shoulder will be less stable when lifting weights with heavy resistance.

The risk of injury when lifting weights can be managed better by training the rotator cuff muscles. There are many exercises that target the rotator cuff muscles and it may seem daunting to choose the right exercises.

A physical therapist can test the strength of your external rotators to identify weakness in these muscles. If weakness exists, then your physical therapist can prescribe specific exercises to isolate and strengthen the external rotators.

The exercise included in your strength training program should be performed in a specific sequence to avoid understimulating or overstimulating your rotator cuff.

The optimal stimulus will help to increase your strength without aggravating an old or current shoulder injury.

How should you strengthen the external rotators of the shoulder?

The strength and ability of each person may be different; therefore, the type of exercises and difficulty of the exercises will vary.

For example, one person may have a major weakness in the external rotators. Simple external rotation exercises without resistance may be more beneficial for this individual.  Another person may benefit from advanced external rotation exercises to prepare their shoulder for more challenging activities.

Exercise selection is a key part of what a physical therapist does. Factors such as age, fitness level, pain, mobility, strength, previous injuries, and other characteristics will play a role in exercise selection.

At a surface level, it may seem easy to choose exercises for the shoulder; however, there are many variables that need to be adjusted based on your response to the exercises. A structured strength training program can help you move closer to your goals without getting a shoulder injury.

Here are examples of 3 exercises to strengthen the external rotators of the shoulder. These exercises are advanced and challenging.

If you have shoulder pain, then consult with a physical therapist.

Examples of 3 external rotation exercises

For rehab, these types of exercises should be prescribed by a physical therapist after assessing your shoulder. The difficulty of the exercises can be increased or decreased by using a stronger resistance band.

Initially, practice these exercises without a resistance band to improve awareness and control of shoulder movements. Once you feel confident with the exercises, you can add resistance using a miniband.

As a side note, the external rotators fatigue very quickly and do not require a lot of resistance to get stronger. The light mini bands (yellow and green Evercore minibands) provide major resistance to the external rotators of the shoulder.

Assess your response to 3 sets of 10 reps with the yellow and green mini bands prior to using heavier minibands to avoid overloading the shoulder.

Equipment needed for these exercises:

• One light Evercore miniband

yellow miniband

Exercise #1: External rotation with the miniband.

Exercise 1 - start

Starting position: Start in a standing or siting position with the elbows at your side, palm up, and wrist in line with the belbow.

Exercise 1 - end

Ending position: The elbow should remain against your side and the wrist should be outside of the elbow.

Instructions:  Place a light Evercore miniband around the wrists. Press the elbows against your side, keep the hands facing up, and move the wrists outward.

 Helpful Tips: Keep the elbows at your side the whole time. You should be pivoting at the elbow as the shoulder externally rotates.

Where should you feel it? You will feel this on the side of the shoulder. You will likely feel a burn in the shoulder within a few repetitions. Try not to do too many at first or you will be sore the next day.

Why should you do it? This exercise strengthens the external rotators of the shoulder. Two of the four rotator cuff muscles are external rotators and they are important to stabilize the shoulder joint during movement.

Exercise #2: Drivers with the Evercore miniband.

Exercise 2 - start

Starting position: The arms should start at the 12 and 6 o’clock positions.

Exercise 2 - end

Ending position: The arms should switch at the 12 and 6 o’clock positions.

Instructions:  Place a light Evercore miniband around the wrist. Keep the arms straight and pull the band apart slightly. Start with the arms in the 9 and 3 o’clock position and move the arms to the 12 and 6 o’clock positions.

 Helpful Tips: Maintain tension against the Evercore miniband as the arms are moving.

Where should you feel it? You will feel all the muscles in the shoulder. Your shoulders will likely burn after 20 seconds so go easy until you get stronger.

Why should you do it? This exercise strengthens the external rotators of the shoulder during different positions of the shoulder. The rotator cuff muscles need to be strong at different angles if you want to maximize the performance of your shoulder.

Exercise #3: Shoulder elevation with the Evercore miniband.

Exercise 3 -start

Starting position: Arms are shoulder width apart with the elbows bent.

Exercise 3 - end

Ending position: Elbows stay bent and the arms should be raised overhead.

Instructions:  Place a light Evercore miniband around the wrist. Keep the elbows bent and pull the band apart slightly. Raise the arms overhead while keeping tension in the band.

Helpful Tips: Keep the wrist in line with the elbows as the arms are elevated. Weakness in the rotator cuff will lead to the wrists drifting inward.

Where should you feel it? You will feel the muscles on the side and back of your shoulders. There is no doubt this exercise will burn.

Why should you do it? This exercise strengthens the external rotators of the shoulder during shoulder elevation. If you use your arms overhead, then you should do this exercise.

Does your shoulder continue to bother you while lifting weights?

Currently, you may be dealing with a nagging pain in your shoulder. The pain may be minor, but every now and then, it becomes aggravated when you lift too much weight at the gym.

There may be a "pinching" feeling in your shoulder when you lift your arms overhead or a dull ache in your shoulder when sleeping. If this sounds like you, then it is possible you may have a rotator cuff strain.

It's good to be aware of potential shoulder injuries, but it's best to have your shoulder assessed by your doctor or physical therapist rather than guess your diagnosis if the pain is persistent.

As we age, the blood supply to the rotator cuff muscles decreases, and the shoulder is more susceptible to injuries. At a younger age, we have greater potential to recover from shoulder injuries and an opportunity to improve the long-term health of the shoulder with specific exercises to increase the injury resilience of the rotator cuff.

These exercises will improve the load tolerance of your rotator cuff muscles and help to decrease excessive inflammation that may be delaying your recovery. Excessive inflammation can counteract the benefits of loading tendons with exercise. For inflammation, many people benefit from eating an anti-inflammatory diet.

If you enjoy lifting weights and going to the gym, then it's smart to think about your long-term shoulder health to avoid an injury that can delay your fitness goals or force you to stop lifting weights.

In spite of the risks of weight lifting, there is no reason to fear a shoulder injury if you take action to rehab your shoulder with a structured strength training program, pay attention to your form, training techniques, and manage inflammation properly.

We love weight lifting as much as you do and our goal is to help your shoulders love your weight lifting routine for many years without an injury.

How can you recover from shoulder injuries and improve the long-term health of your shoulder?

A strength training rehab program from a physical therapist will focus on detailed aspects of your shoulder health including mobility, strength, exercise selection, and training progressions specific to your injury.

As you complete the exercises in your rehab program, your physical therapist can re-assess you as needed to update your program to minimize setbacks and push you closer towards your goals.

A rehab program can help you recover from shoulder injuries and prevent shoulder injuries. If you have persistent shoulder pain, then you will benefit from taking the next step to begin a personalized program. I recommend you find a good, local physical therapist for a strength training rehab program.

If you don’t know of a good physical therapist, then send us an email at marc@evercorelife.com for additional guidance.

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