Latest / The Ask Mike Reinold Show / How to Progressively Load the Rotator Cuff - #AMR395
Transcript
- 0:50SPEAKER_03: On this episode of The Ask Mike Reinhold Show, we talk about how to progressively load the rotator cuff.
- 0:56SPEAKER_02: The Ask Mike Reinhold Show.
- 1:00SPEAKER_02: Helping people feel better, move better, perform better.
- 1:13SPEAKER_03: Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training.
- 1:20SPEAKER_03: If you want to learn how to get started optimizing and enhancing performance, this is the course for you.
- 1:26SPEAKER_03: Head to micrenault.com slash performance to sign up today.
- 1:30SPEAKER_03: Welcome back, everybody, the latest episode of the Ask Micrown Show.
- 1:32SPEAKER_03: We're here at Champion PT Performance up in Boston, answering your questions.
- 1:35SPEAKER_03: Anything you want to talk about, sports PT, performance, career advice, we're here for you.
- 1:40SPEAKER_03: Head to micronaut.com, click on that podcast link and ask a question.
- 1:43SPEAKER_03: Let's see, who do we have today?
- 1:44SPEAKER_03: We have well we have Noah Sprinkle joining us today.
- 1:47SPEAKER_03: What up, Noah?
- 1:48SPEAKER_03: Good to see you again.
- 1:49SPEAKER_03: Brendan Gates, Dave Tilley, Anthony Vedetto, and Lenny McCrina.
- 1:53SPEAKER_03: Len, we've got three lovely students today.
- 1:56SPEAKER_03: Who's uh who's on the show today?
- 2:02SPEAKER_05: It's very lovely.
- 2:03SPEAKER_05: We have Noah Taylor.
- 2:05SPEAKER_05: Noah Taylor from Kentucky University, our good friends in the South.
- 2:08SPEAKER_05: We have Kali Luca from Northeastern University, our friends of the Huskies, kind of rivals of my B student, my BU background.
- 2:16SPEAKER_05: And Emma Armstrong.
- 2:17SPEAKER_05: Fun fact about Emma from Duquesne University.
- 2:19SPEAKER_05: She played softball at Towson State University.
- 2:23SPEAKER_05: Townsend State.
- 2:24SPEAKER_05: And in Italy, everybody.
- 2:26SPEAKER_05: And she played softball in Italy.
- 2:30SPEAKER_03: Among other places, but uh really, really good softball athlete.
- 2:35SPEAKER_03: Uh Len, is Northeastern B really a rival or is that just something BU people say?
- 2:40SPEAKER_03: Um, I don't know.
- 2:40SPEAKER_05: We won a lot of bean pots.
- 2:42SPEAKER_05: I think you guys are still chasing us.
- 2:44SPEAKER_05: Oh, I wasn't sure what you're referring to, but anyway.
- 2:47SPEAKER_03: All right, who's up for today with our question?
- 2:49SPEAKER_03: What do we have?
- 2:51SPEAKER_01: We have Scott from Connecticut.
- 2:53SPEAKER_01: Hey Mike, first off, let me say I love the podcast and really enjoyed your courses and just became performance specialist certified with you.
- 3:00SPEAKER_01: My question is this how do you plan your rotator cuff strengthening and then how do you progress load?
- 3:06SPEAKER_01: Because infrared are small muscles.
- 3:09SPEAKER_01: At some point, linear progression seems to stop working.
- 3:12SPEAKER_01: Given their size, are these muscles that will respond to heavier loads, such as three sets of eight?
- 3:18SPEAKER_01: Thank you.
- 3:19SPEAKER_03: Awesome.
- 3:19SPEAKER_03: Great job, Noah.
- 3:21SPEAKER_03: Uh Scott from Connecticut, that's a great question.
- 3:23SPEAKER_03: Um, man, what why is there so much confusion about getting muscles strong, right?
- 3:30SPEAKER_03: And you know, and we talk about the size of a muscle, right?
- 3:33SPEAKER_03: Like we can my forearm muscles are pretty small, right?
- 3:36SPEAKER_03: My ankle muscles are pretty small.
- 3:37SPEAKER_03: Um, you know, it's an interesting concept.
- 3:39SPEAKER_03: I mean, there's so much misinformation that we've had over decades of our profession, right?
- 3:43SPEAKER_03: Remember when we used to say if like you do a rotator cuff exercise more than five pounds, that the rotator cuff would just like magically shut off and it would just be the deltoid somehow, right?
- 3:52SPEAKER_03: Remember all that stuff?
- 3:53SPEAKER_03: Um, it's it's crazy some of the misinformation we have.
- 3:56SPEAKER_03: Um, I just put this on Instagram fairly recently by the time this episode comes out, but I continue to see so many athletes.
- 4:02SPEAKER_03: These guys are huge, huge athletes.
- 4:04SPEAKER_03: They weigh 240 to 260 pounds of pure muscle mass and they have weak rotator cuffs.
- 4:10SPEAKER_03: Why is that?
- 4:11SPEAKER_03: Right.
- 4:11SPEAKER_03: Um, and most of the times they're just they're just doing their shoulder program wrong.
- 4:14SPEAKER_03: It stinks.
- 4:15SPEAKER_03: Um, so you know, it's funny, you scott says, you know, at some point he feels like he stalls out with linear uh progression with that.
- 4:22SPEAKER_03: We'll talk about that.
- 4:23SPEAKER_03: I think that's interesting, but this is a really good good concept for us.
- 4:27SPEAKER_03: 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.
- 4:32SPEAKER_03: Who wants to jump in and start talking about this, like from Scott, or to to help Scott out a little bit here.
- 4:38SPEAKER_03: Anthony, you wanna you wanna jump in?
- 4:39SPEAKER_04: Yeah, um, I I think this is such a good question to bring up because it it really is shocking how often I see kids like even in our clinic doing their rotator cuff program or their shoulder strengthening program, and they're just doing it incorrectly, or um they're using weight that is far too heavy than what they're capable of using, right?
- 4:58SPEAKER_04: So I think, you know, to Scott's, you know, to my his point, it's um, you know, they're they're doing weight for, you know, the same program for a long period of time, right?
- 5:06SPEAKER_04: So they're doing sidelining external rotation, they're going from five pounds, then six, then maybe seven, then there, you know, there there becomes a point where we're just doing so much weight that those muscles might not be able to handle that certain stress or that, you know, for at that certain point.
- 5:21SPEAKER_04: So to think about it like this way, like I have kids who are doing, you know, 12 pounds of external rotation strength, um, or at least they think they can.
- 5:29SPEAKER_04: And then what I see is they're just using momentum or um they're just rolling their scapula to really, you know, get these exercises completed.
- 5:37SPEAKER_04: So what we tend to find is that form needs to be like absolutely perfect when we're trying to isolate these smaller muscles of the rotator cuff without um letting like flat or these bigger muscles take over.
- 5:48SPEAKER_04: So that's like first and foremost.
- 5:49SPEAKER_04: Um, and then the second piece of this is that, yeah, if you have someone do a 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, right?
- 6:03SPEAKER_04: So you wouldn't do three sets of 10 for an exercise for three months in a gym like for a squat.
- 6:07SPEAKER_04: Uh-huh.
- 6:08SPEAKER_04: 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.
- 6:12SPEAKER_04: So yeah, when we do two sets of ten for six weeks, we might switch it up.
- 6:16SPEAKER_04: But what I find is like if I wanted someone to get stronger and maybe change this program up, instead of going to that four sets of five, uh, I might do like two sets of eight with a three-second ISO hold at the top.
- 6:28SPEAKER_04: And I feel like that's gonna 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 gonna be able to handle that with just their infra arteries or whatever the case is, they're gonna take over with those bigger muscles because the weight's just too heavy.
- 6:44SPEAKER_04: 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.
- 6:51SPEAKER_04: 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, you know, maybe three sets of eight works, but something like four sets of five, I don't think that's gonna 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.
- 7:08SPEAKER_04: And I think that helps a little bit more with those smaller muscles as opposed to, you know, going for like 20 pounds for that five reps.
- 7:15SPEAKER_04: I just don't think that's gonna get the same product there.
- 7:17SPEAKER_03: Yeah, I I I completely agree.
- 7:19SPEAKER_03: I mean, that's it when we build our programs, we we go more towards the the pauses, right?
- 7:24SPEAKER_03: The pause sets, the isometric holds.
- 7:26SPEAKER_03: And it's it probably assures that we're getting a really good contraction.
- 7:30SPEAKER_03: We we're not compensating, we're not getting momentum involved with it.
- 7:33SPEAKER_03: But man, like you you jump into you know a very high weight.
- 7:37SPEAKER_03: You got to remember going from you know five pounds to six pounds is a 20% increase in load in one week.
- 7:43SPEAKER_03: I mean, you wouldn't do that with a bench press or something like that.
- 7:45SPEAKER_03: So it's very easy for these exercises to become compensation patterns.
- 7:50SPEAKER_03: And I think that's what happens, Anthony, when people like, you know, they'll do like a cable machine or something, they'll they'll try to get, you know, a big 20-pound rep in.
- 7:58SPEAKER_03: They're they're gonna just immediately start compensating because they're probably not strong enough for that.
- 8:03SPEAKER_03: Um, you know, the funny thing about linear load though is like everybody wants to jump to like changing set rep schemes.
- 8:09SPEAKER_03: You can linear load something, and let's just say the one variable we'll manipulate with a linear load is load.
- 8:14SPEAKER_03: So let's say you keep the sets the same, two sets of 10, three sets of 10, whatever.
- 8:17SPEAKER_03: You can linear load for a very, very long time, way longer than you think you can, right?
- 8:23SPEAKER_03: You don't have to mix it up in two to three weeks and start changing the set rep schemes, right?
- 8:27SPEAKER_03: You can go up five, six, seven, eight, nine, ten, eleven, twelve pounds.
- 8:30SPEAKER_03: Like you can just keep going up over time with linear load.
- 8:34SPEAKER_03: So I think that's one mistake I see with people is they they jump too quickly to try to do uh like more load.
- 8:41SPEAKER_03: And they don't understand that the percentage increase in load is huge.
- 8:44SPEAKER_03: So like linear load as much as you can, but then to my point, like to or to Anthony's point, I mean, um 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 paw sets and let's be a little bit more strict with our shoulder program.
- 9:01SPEAKER_03: I think that's what we see.
- 9:02SPEAKER_03: You know, funny example.
- 9:03SPEAKER_03: I'm talking to our friend Ian last night, and you know, he's you know, I've been working with Ian for 12 years, I don't know, since he was like a sophomore in high school, and now he's a big leader, right?
- 9:15SPEAKER_03: So, you know, we've been through his whole career with him, and he's like, Yeah, my shoulder's weak.
- 9:19SPEAKER_03: It's been sore.
- 9:19SPEAKER_03: This is like a month ago, and I was like, all right, we gotta get stronger, let's work on it.
- 9:23SPEAKER_03: This kid's always strong.
- 9:24SPEAKER_03: And he texts me last night, he's like, I fixed it.
- 9:26SPEAKER_03: And I'm like, all right, this should be good.
- 9:28SPEAKER_03: What'd you do?
- 9:29SPEAKER_03: He's just like, I was just compensating, I was cheating.
- 9:31SPEAKER_03: So I just got real strict with my reps with sideline external rotation and my my strength shot up, and now I feel completely fine.
- 9:37SPEAKER_03: Um, and and we see that all the time.
- 9:39SPEAKER_03: So um, all right, what else?
- 9:40SPEAKER_03: I'm sorry, I can keep talking forever.
- 9:42SPEAKER_03: Who else wants to jump in here?
- 9:43SPEAKER_03: Dave, what do you got?
- 9:44SPEAKER_00: 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.
- 9:55SPEAKER_00: Because, like, if you wanted to get your quad stronger, so say like you're an Olympic lifter and you want to get your quad stronger to squat heavier in a competition, you wouldn't do one or one exercise, three sets of eight, and that's the only thing you do for your quads, maybe twice a week, right?
- 10:07SPEAKER_00: And if you think about some of the shoulder programs that we give people, I think sometimes they know sideline extra rotation is important, but they're literally doing like one exercise that's generically seen online.
- 10:15SPEAKER_00: If you really want to target the posterior cuff, I think it's good to have two to three exercises that are overlapping in the EMG activity.
- 10:21SPEAKER_00: So sideline if you're prone you, if you can do it, like you can change the scaption angle.
- 10:25SPEAKER_00: Like, I think it's important to mix in a couple different exercises in different planes for like the highest EMG and do those in more volume because you're not going to add like to your guys' point.
- 10:34SPEAKER_00: You're not gonna just be like, you know, only load ever is the only thing I think about.
- 10:38SPEAKER_00: I think like volume, density, that doesn't really get thought about a lot with shoulder cuff exercises, but we give people programs that it's like 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.
- 10:50SPEAKER_00: And I think that like sometimes people just do like 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?
- 10:57SPEAKER_00: Or it's like, well, if you squatted one set three by eight twice a week, you probably wouldn't get true hypertrophy of quads, you know?
- 11:02SPEAKER_00: So that's just my thoughts.
- 11:03SPEAKER_00: Yeah.
- 11:04SPEAKER_03: And I I guarantee that person's not linear loading that well either.
- 11:07SPEAKER_03: I mean, they should be doing a lot of weight if they've been doing that for forever, right?
- 11:10SPEAKER_03: They're probably just doing the same weight over time.
- 11:13SPEAKER_03: So why would you get strong, right?
- 11:14SPEAKER_03: It doesn't make sense.
- 11:15SPEAKER_03: You're not progressively overloading the muscles just like anything else.
- 11:18SPEAKER_03: Um, you know, to piggyback on Dave's concepts a little bit here, too.
- 11:22SPEAKER_03: Like, um, I I agree with that completely.
- 11:24SPEAKER_03: 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.
- 11:32SPEAKER_03: So it's sometimes two to one at the beginning, but three to one is intentional of ER to IR.
- 11:37SPEAKER_03: We do that intentionally because that's the bias we want to get them towards, because that's usually where their weakness is.
- 11:42SPEAKER_03: If their ERIR ratio is low, that's how we start working on that.
- 11:46SPEAKER_03: But I would say today's point, I completely agree, but resist the urge to just start getting creative right away, right?
- 11:52SPEAKER_03: So for us, you have to earn strength at zero degrees before we go to 90 degrees.
- 11:56SPEAKER_03: Because what are you gonna do at 90 degrees?
- 11:58SPEAKER_03: You are going to compensate, I promise.
- 11:59SPEAKER_03: And that's why we don't test in that position.
- 12:01SPEAKER_03: That's why we're not jumping right to 90 degrees because that's a more functional position.
- 12:06SPEAKER_03: No, we we get to 90 degrees when it's appropriate.
- 12:09SPEAKER_03: So, like you have to go sequential, right?
- 12:12SPEAKER_03: It's basic loading in a in a nice pattern that you can isolate.
- 12:16SPEAKER_03: I know isolate's a really weird world word, but you can decrease as much compensation as possible.
- 12:21SPEAKER_03: 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, right?
- 12:29SPEAKER_03: That's down the road for us.
- 12:30SPEAKER_03: It takes me months for my athletes to start doing like advanced eccentric exercises at 90 degrees.
- 12:37SPEAKER_03: Yet you'll see people do this week two with a new patient with shoulder pain, and then you wonder why they don't, their strength doesn't go up.
- 12:42SPEAKER_03: You just jump right to eccentric.
- 12:44SPEAKER_03: So you jump right to 90 degrees, it's too fast.
- 12:46SPEAKER_03: So, anyway, sorry.
- 12:47SPEAKER_03: Well, who else here?
- 12:48SPEAKER_03: Len, you wanted to have something, Brennan?
- 12:50SPEAKER_03: I knew somebody raised their hand.
- 12:51SPEAKER_03: What's up, Brennan?
- 12:52SPEAKER_06: Um, yeah, I mean, I just wanted to bring up quickly, like, I don't know if it drives you guys as crazy as it does me.
- 12:58SPEAKER_06: Uh, and it might just be quickbait, but the videos on Instagram say, like, you know, ditch the bandit external rotation or ditch the sideline external rotation um and do this crazy exercise that maybe late stage is pretty good.
- 13:10SPEAKER_06: But I think, you know, I just wanted to highlight for the listeners, if we are doing the simple things well, uh, I think that's really important, as you just said.
- 13:18SPEAKER_06: Um, outside of momentum, like how many times do you guys see someone on their sideline ER roll back a little bit so they change the moment arm of the weight?
- 13:26SPEAKER_06: Uh you know, there's so many things, but I think highlighting some of those things is important, you know, momentum, the changing the position, not squeezing the towel, not retracting your scap.
- 13:35SPEAKER_06: So I think it's important to look for all those.
- 13:37SPEAKER_06: But I guess just a quick question for you guys would be if you're if you have a kid, let's say we have like a high school kid who just, like Dave said before, wants to play fortnight and play hockey or something.
- 13:47SPEAKER_06: Let's say this kid wants to play fortnight and play baseball, uh and they have a shorter attention span and they're getting bored.
- 13:51SPEAKER_06: Um, 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?
- 14:03SPEAKER_06: Is there is it more just, you know, are you guys just airing on the education stuff and telling them, like, hey, I know this is boring, this is what you need to do, or do you try to give them something to scratch the edge a little bit to keep them uh invested?
- 14:15SPEAKER_03: That is a great program.
- 14:17SPEAKER_03: Um, I'll I'll answer first, and I'm gonna want to hear from Anthony.
- 14:19SPEAKER_03: I want to do this intentionally because I'll start with I'm old and grumpy, right?
- 14:23SPEAKER_03: So like you either do it right or you don't do it.
- 14:26SPEAKER_03: I'm not here to entertain you, I'm not here to to like give you a circus act kind of thing to kind of do with that.
- 14:31SPEAKER_03: I what you know, what we do is we just you know, I think people come to us with knowing that we know what we're talking about.
- 14:36SPEAKER_03: And you know, I do I tell them like look, this is monotonous, this is boring, but this is the bread and butter that you need to establish.
- 14:42SPEAKER_03: Look at look at the wall.
- 14:42SPEAKER_03: You see all these jerseys on the wall, that's what they all do.
- 14:45SPEAKER_03: Is that what you want to do?
- 14:46SPEAKER_03: Right.
- 14:46SPEAKER_03: And and you you have to do that.
- 14:48SPEAKER_03: I it I I caution you to resist the urge to either mix it up or to get fancy because you're worried about their their attention.
- 14:56SPEAKER_03: Um, I just think you're going to waste time or you're going to get them tired and not strong.
- 15:02SPEAKER_03: And that that's just my biggest precaution.
- 15:04SPEAKER_03: I know with you, Gacy, I I think what you're saying is do the basics and then give them a couple of cool things on top of it.
- 15:09SPEAKER_03: Sure, that we do that.
- 15:11SPEAKER_03: You know that.
- 15:11SPEAKER_03: Like that's what we do.
- 15:12SPEAKER_03: So that's a that's a good lesson to say, but you can't forgo the basics.
- 15:16SPEAKER_03: Now, Anthony, from a younger clinician, yeah, I I'm more just I'm just grumpy.
- 15:21SPEAKER_03: I just yell at people now.
- 15:22SPEAKER_03: But what how do you how do you nicely get that across in a way when you know you care about relationships with your patients?
- 15:29SPEAKER_04: I think if you I think if you asked me six months out of school, I would have 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.
- 15:38SPEAKER_04: And uh I I think I'm I'm I'm transitioning to something that's a little bit more um equivalent to what you tell people.
- 15:45SPEAKER_04: And I think that's a good thing.
- 15:47SPEAKER_04: Um, I 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 that I'm gonna give you.
- 15:56SPEAKER_04: And if you want to get to that position one day, um, then you need to do the basics really well.
- 16:01SPEAKER_04: And I think that that just gets enough buy-in right off the bat.
- 16:05SPEAKER_04: So um I find that that's a good strategy.
- 16:07SPEAKER_04: But yeah, you might have like a 13-year-old who doesn't love doing a shoulder program and I might give them one or two like fun exercises so that it keeps their attention span kind of you know to the point.
- 16:19SPEAKER_04: But um, yeah, generally speaking, I feel like I'm becoming grow old and grumpy grumpy uh a little bit earlier on in my career than maybe I would have anticipated.
- 16:28SPEAKER_04: It's probably for the best, though.
- 16:29SPEAKER_03: That dude, you know what?
- 16:30SPEAKER_03: That's one of the that we talk about that with mentorship a lot of time, right?
- 16:33SPEAKER_03: Is that you, you know, by by getting somebody to help mentor you, you get to kind of get where they are in space like a little faster.
- 16:40SPEAKER_03: So unfortunately, you're getting older and grumpier faster than the normal clinician.
- 16:44SPEAKER_03: And um, I apologize.
- 16:46SPEAKER_03: But uh, but anyway, hopefully it works out for you.
- 16:49SPEAKER_03: But uh anyway, great question, Scott from Connecticut.
- 16:51SPEAKER_03: I think that's good.
- 16:52SPEAKER_03: I you know what?
- 16:52SPEAKER_03: There's a lot of ways to hit this.
- 16:54SPEAKER_03: I I I think we can summarize it with this.
- 16:56SPEAKER_03: People for some reason are just sloppy and lazy with these small muscle exercises, and they can respond just like anything else.
- 17:04SPEAKER_03: Load them up more than you think, resist the urge to get fancy just to get fancy.
- 17:08SPEAKER_03: They have to earn the right to get fancy.
- 17:10SPEAKER_03: I think that's an important part.
- 17:11SPEAKER_03: And trust me, you'll get a lot stronger, right?
- 17:13SPEAKER_03: We post this on Instagram all the time.
- 17:15SPEAKER_03: You know, we have our graphs of like our dynamometer testing.
- 17:18SPEAKER_03: You see our patients going up 20, 25, 30% in external rotation strength by following the program.
- 17:24SPEAKER_03: You know, it's not hard.
- 17:25SPEAKER_03: You just have to do it.
- 17:26SPEAKER_03: So uh great question.
- 17:27SPEAKER_03: If you have anything like that, head to microno.com, click on that podcast link, and be sure to subscribe on Spotify, Apple Podcasts, whatever you listen to.
- 17:33SPEAKER_03: And we'll see you on the next episode.
- 17:35SPEAKER_03: Thanks so much.