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Shoulder Mobility Drills: How to Improve External Rotation (if you even need it)

Written on May 31, 2011 at 8:12 am, by Eric Cressey

Last summer, a college pitcher came up to Cressey Performance from the South to train for a month before his summer league got underway. He was seven months post-op on a shoulder surgery (Type 2 SLAP) and had been working his way back. Unfortunately, his arm was still bothering him a bit when he got up to see us.

After the first few days at CP, though, he told me that his arm felt as good as it’s felt in as long as he could remember. He’d been doing a comprehensive strength and conditioning program, but the “impact” stuff for him had been soft tissue work, some Postural Restoration Institute drills, an emphasis on thoracic mobility, and manual stretching into internal rotation, horizontal adduction, and shoulder flexion. From all the rehab, his cuff was strong and scapular stabilizers were functioning reasonably well – which led me to believe that his issues were largely due to tissue shortness and/or stiffness.

This realization made me immediately wonder what he’d been doing in the previous months for mobility work for his arm – so I asked. He then demonstrated the manual stretching series that every pitcher on his team went through every day on the table with their athletic trainer. Each stretch was done for 2x20s – and two of those stretches took him into extreme external rotation and horizontal abduction. I was pretty shocked.

Me: “You’re probably not the only guy on your team rehabbing right now, huh?”

Him: “No; there are actually too many to count.”

Me: “Elbows, too, I’m sure.”

Him: “Yep.”

Want to irritate a labrum, biceps tendon, or the undersurface of the rotator cuff? Stretch a thrower into extreme external rotation and simulate the peel-back mechanism. This also increases anterior capsular laxity and likely exacerbates the internal impingement mechanism over the long-term. To reiterate, this is a bad stretch!

Want to make an acromioclavicular joint unhappy? Stretch a thrower into horizontal abduction like this (again, this is a BAD stretch that is pictured):

Want to irritate an ulnar nerve or contribute to the rupture of an ulnar collateral ligament? Make sure to apply direct pressure to the forearm during these dangerous stretches to create some valgus stress. This is a sure-fire way to make a bad stretch even worse:

These stretches are very rarely indicated in a healthy population – especially pitchers who already have a tendency toward increased external rotation. The shoulder is a delicate joint that can’t just be manhandled – and when you’re dealing with shoulders that are usually also pretty loose (both from congenital and acquired factors), you’re waiting for a problem when you include such stretches. In fact, I devoted an entire article to this: The Right Way to Stretch the Pecs.

Everyone thinks that shoulder external rotation and horizontal abduction alone account for the lay-back in the extreme cocking position.

In reality, though, this position is derived from a bunch of factors:

1. Shoulder External Rotation Range-of-Motion – and this is the kind of freaky external rotation you’ll commonly see thanks to retroversion and anterior laxity:

2. Scapular Retraction/Posterior Tilt

3. Thoracic Spine Extension/Rotation

4. Valgus Carrying Angle

So, how do you improve lay-back without risking damage to the shoulder and elbow?

1. Soft tissue work on Pec minor/major and subscapularis – Ideally, this would be performed by a qualified manual therapist – especially since you’re not going to be able to get to subscapularis yourself. However, you can use this technique to attack the pecs:

2. Exercises to improve scapular retraction/depression/posterior tilt – This could include any of a number of horizontal pulling exercises or specific lower trap/serratus anterior exercises like the forearm wall slide with band.

3. Incorporate specific thoracic spine mobility drills – In most pitchers, you want to be careful about including thoracic spine mobility drills that also encourage a lot of glenohumeral external rotation. However, when we assess a pitcher and find that he’s really lacking in this regard, there are two drills that we use with them. The first is the side-lying extension-rotation, which is a good entry level progression because the floor actually limits external rotation range-of-motion, and it’s easy to coach. I tell athletes that they should think of thoracic spine extension/rotation driving scapular retraction/depression, which in turn drives humeral external rotation (and flexion/horizontal abduction). Usually, simply putting your hands on the shoulder girdle and guiding them through the motion is the best teaching tool.

A progression on the side-lying extension-rotation is the side-lying windmill, which requires a bit more attention to detail to ensure that the range-of-motion comes from the right place. The goal is to think of moving exclusively from the thoracic spine with an appropriate scapular retraction/posterior tilt. In other words, the arm just comes along for the ride. The eyes (and head) should follow the hand wherever it goes.

Again, these are only exercises we use with certain players who we’ve deemed deficient in external rotation. If you’re a thrower, don’t simply add these to your routine without a valid assessment from someone who is qualified to make that estimation. You could actually make the argument that this would apply to some folks in the general population who have congenital laxity as well (especially females).

4. Throw!!!!! – Pitchers gain a considerable amount of glenohumeral external rotation over the course of a competitive season simply from throwing. Sometimes, the best solution is to simply be patient. I really like long toss above all else for these folks.

In closing, there are three important things I should note:

1. You don’t want to do anything to increase valgus laxity.

2. You’re much more likely to get hurt from being “too loose” than you are from being “too tight.” When it comes to stretching the throwing shoulder, “gentle” is the name of the game – and all mobility programs should be as individualized as possible.

3. Maintaining internal rotation is a lot more important than whatever is going on with external rotation. In fact, this piece could have just as easily been named “The Two Stretches Pitchers Shouldn’t Do, Plus a Few That Only Some of Them Need.”

To learn more about testing, training, and treating throwing shoulders, check out Optimal Shoulder Performance: From Rehab to High Performance.

Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!

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17 Responses to “Shoulder Mobility Drills: How to Improve External Rotation (if you even need it)”

  1. Stephen Thomas, PhD, ATC Says:

    Eric nice post. It is interesting when you are examining throwers external rotation ROM with and without the scapula stabilized. With the scapula stabilized I commonly don’t see excessive amounts of external rotation. I contribute this to, like you discuss, tight pecs. I especially see this in college players that are doing too many pressing exercises. This could be very problematic causing scapular dyskinesis and internal impingement.

    I was glad to see you discussing the multiple sources of the external rotation you see when throwing. This often gets over looked and people think that every player has anterior instability. I don’t believe that it is true instability but either a genetic or acquired laxity that is required to throw 90 mph fastballs.

    With shoulder tightness I think the real culprit is GIRD (glenohumeral internal rotation deficits). I recently published a paper in JSES showing that GIRD is correlated with posterior capsule thickness (http://www.ncbi.nlm.nih.gov/pubmed/21167742). There is still more research that is required but this suggests that joint mobs may be more beneficial for improving internal rotation in throwers.

  2. Paul Says:

    Seems like nobody talks about trap rehab. That is part of the shoulder. Any ideas? More of an ache, starts just inside and behind the shoulder joint and works its way up to the side of my neck.

  3. george greenberger Says:

    Eric,
    Do you have any recommendations for stretches or exercises for degenerative arthritic shoulders? I have been weight training for over 40 years, and having learned the old school way, I did things like behind the neck presses to the base of the neck and other similar exercises.And I am paying the price. I have modified my workouts and I don’t plan to quit training. I would appreciate any advice you might have.
    Thanks,
    George

  4. Sam Leahey Says:

    Joint-by-Joint.

  5. Ethan Says:

    Ironic that this blog just got posted. I am a college baseball pitcher and this past week I started doing some external rotations stretches like seen above, thinking I’d help me generate some more velocity. Obviously that wasn’t smart and I definitely am sore and feel some irritation on the back of my shoulder like your post said. I was wondering what you would recommend to calm this down and if that may be a sign of some undiagnosed pathology in my throwing shoulder?

  6. Eric Cressey Says:

    Ethan,

    I’d get it checked out if it doesn’t calm down in the next 5-7 days. You never want to mess around with posterior shoulder pain.

  7. Eric Cressey Says:

    George,

    It’s hard to say without knowing exactly how your shoulders move. I’ve known of folks with both degenerative problems and arthritis who have great mobility – but need more stability. I’ve seen others who are the exact opposite. So, it needs to be address on a case-by-case basis.

  8. Eric Cressey Says:

    Paul – Usually (at least in my experience) when you see trap/neck pain, it’s a compensation for poor function of the scapular stabilizers or rotator cuff.

  9. Eric Cressey Says:

    Hi Stephen, thanks for your contribution. I used to measure ER with the scapula stabilized, but after working more and more with Mike Reinold, I’m convinced that we’re better off not stabilizing it during ER, as the hand position impacts the arthrokinematics of the joint and can alter readings. I think the #1 thing is consistency in measurement, though; do it one way, and stick with that way.

    Thanks for the link to the study. Have you seen this piece on the topic?

    http://www.ncbi.nlm.nih.gov/pubmed/16002489

    Some of the thickest posterior capsules had the most translation. Makes me think that there is correlation, but not causation. Like you said, more research is certainly needed.

    Thanks for your contributions!

  10. Tim Says:

    Eric,

    It’d be interesting to see what the Texas A&M trainers are doing with their baseball players. Two years in a row top draft picks go down with labrum related issues. Baret Loux a year ago and now John Stilson, a projected first rounder. I know there could be a number of confounding variables, but it makes you wonder if they’re prescribing their pitchers these damaging stretches.

  11. dominic Says:

    Has anyone considered the impact the subtalar joint might have on external rotation? Could stiffness in the feet cause reduced ER in the functional throwing position?

  12. Casey Says:

    Eric,

    How do I know if I need to do the Thoracic spine mobility exercises?

  13. Jason Says:

    Overall, nice article.

    The “dangerous stretches” described above are being performed incorrectly – therein lies the primary danger. Safer and more effective versions are taught in several forms of stretching technique, including PNF, AIS, CRAC, etc.

    I disagree with the methods you propose for addressing the pectoral muscles, as it is easy for an overzealous athlete to cause pain/damage to those tissues. There are less injurious stretching methods that I recommend instead, but I do agree with the need to address the pecs as a part of the shoulder complex.

    The shoulder/thoracic mobility drills presented are interesting. Prior to engaging in the versions presented in your article, athletes (and everyone else) should gently practice a variety of arm circles in multiple planes while in a standing/seated upright position. If this is tolerated well and can be done with excellent control, the sidelying versions presented in your article might be reasonably safe.

    The parts of your article that I most appreciate are your emphases on the facts that shoulder mobility is a result of many factors and that sometimes just throwing can be a tremendous help in developing that mobility.

  14. Martin Says:

    Hi,

    I wonder if you can help me..

    I have a pretty serious shoulder movement issue.

    It all started when I had a severe contact related accident playing Rugby, when I was an 18 year old lad.

    23 years later and I still suffer from it. I had surgery to try to correct this problem back in February this year…they took some scare tissue out…I believe…it seemed to help mobility a bit.

    However, I still have the same issue…namely.

    I cannot move my right shoulder….press upwards when my shoulder is externally rotated and my palm is facing towards me, as in an Upper-cut, shoulder press motion, at all.

    Obviously this is a disability now..but I wonder if it could be corrected by exercise or other treatment, so that I can restore full mobility and strength..I would like to press a dumbell using the movement, all ready mentioned by I just can’t even move my arm. And that’s without resistance.

    Can you suggest anything or a solution?
    Or do I have to just accept that this injury is not repairable by medical or physiotherapy means..

    Kind regards,

    Martin

  15. Eric Cressey Says:

    Martin,

    You just need to find a good physical therapist!  Where are you located? I might know someone near you.

  16. Sherry Driskill Says:

    My daughter is a college softball catcher who had shoulder stabilization surgery the end of May having difficulty with gaining external rotation any thoughts?

  17. Eric Cressey Says:

    Sherry,

    This is one you’d have to discuss with her physical therapist, as post-surgery cases are unique.  The anterior capsule may have been intentionally tightened for a reason.

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