Exercises for Preventing Shoulder Pain | Jeff Cavaliere & Dr. Andrew Huberman

Shoulder Health Introduction

00:00the shoulders. Um, I'm gonna knock on wood in a second because I I've been fortunate that my shoulders haven't given me issues, but that means it's probably just next. But perhaps that's also the consequence of having once again listened to your content and whenever possible, I've tried to get into external rotation, which is uh if I reference the fs, will anyone know what I'm talking about?

00:20So, thumbs out and uh you know, giving the thumbs up, but thumbs rotated away from the belly button, away from the midline. Could you explain where the shoulder tends to be most vulnerable and this business of internal thumbs pointing toward the belly button versus external rotation during all sorts of movements and also just daily life?

00:37Good point here too is on top of the thumbs is, you know, not just the flipping of the hand itself through supernation and pronation of the forearm, but literally letting the elbow kind of travel with that, right? So, you're letting everything move together cuz it's the it's the rotation that's happening in this joint, this ball and socket up top.

00:58Shoulders got to rotate out, right? So, we're not just we're not just talking about moving your thumbs away from your belly button out for those just listening. We're talking about getting the elbows in in a bit more. As those thumbs go out, the shoulders externally rotating as well.

01:13Yeah. Which is key. And and the the issue with internal rotation, external rotation is that it's in they're both motions of the shoulder, right? We're need we need both of them.

Controlling Internal Rotation

01:23We need to be able if you go back to the pitcher, he needs to be able to externally rotate and then of course internally rotate to throw the ball. I'm not saying that internal rotation is is is the devil. What we need though is the ability to control internal rotation.

01:36We need to be able the ability to have enough external rotation strength to hold that position for longer or to or to be able to control right the ex the eccentric control from the external rotators is what actually controls the internal rotation.

01:51the eccentric control from the internal rotator external rotators from the external rotators which controls internal rotation because as we're lengthening the external rotators we're controlling if we have good control the eentric control of that then we're slowing down the internal rotation or at least controlling it at a certain pace that's extremely important when it comes to pitching.

02:10we have this rapid internal rotation going on which is essentially the thumb is moving toward the midline to throw and so is the so is the elbow so is your shoulder. So if the external rotators are eccentrically strong they can control that and control the the pace of that and make sure that it's not outpacing what your your shoulder itself can can structurally protect.

02:33So it's important to have that too. But internal rotation in the world of the of of the non-athlete is particularly problematic if a you're posturally holding that position for way too long throughout the day and which is what we all chronically are suffering from whether we're texting, typing, not focusing ever on the external rotators of our, you know, in our training.

03:00You're just getting chronically tight and internally rotated. And then when you go to do even

Risks Of Shoulder Impingement

03:07basic things like lift your arm up over your head, you're creating an internal shoulder environment that's more prone to creating less space in inflaming tissues that wind up getting pinched in that position. That basically when you're tight internally, you get changes to the shoulder capsule itself, which is all the ligamentous structures that surround it that make you more internally rotated and tight.

03:31You can't get out of that position. And so now when I go to raise my arm up, there's just less room in here. For instance, I think I we might have done this before you and I, but if I were to have you just lean forward like this or slump your shoulder and then raise your arm as high as you could in front of you, you're going to that's as far as you get, right?

03:47And you're limited not because of anything that's necessarily tight right there, but structurally there's a little bony bump on the top of your humorris that's actually getting stuck on the upper portion of your shoulder joint there. So now Bring your arm down.

04:02Open up your chest as much as you can. Turn your arm out a little bit. Now raise it up overhead and it goes higher. Why? Because you just created external rotation inside the joint that allows it now to go up in a higher position. Well, what happens if you're chronically in this position of internal rotation and you go to raise your arm, you go to wash your hair, you go to get stuff out of the cabinet, you go to do all the things you do every day.

04:26Every time with there being less space in there, there's more likelihood to pinch on a super spinus tendon. There's more likelihood to be pinched on a bersa. There's more any and every time we pinch, we potentially inflame and cause more swelling inside that joint, which causes less joint space, right?

04:43So, you're inflaming those tissues, more more uh compression in that joint, and then more pain ultimately. And then that winds up causing down the road things like partial thickness tears and tears of the of the rotator cuff that we don't want.

Function Of Rotator Cuffs

04:58So internal rotation in this elevated position is not good. having external rotation abilities or strength that can help to centralize what it what it really does when people talk about rotator cuff training is yes you're working the external rotators but really what its main job is to actually keep that ball centered in the middle of the socket.

05:23I see. So as you go and you raise your arm up in an internally rotated dominated dominant shoulder, it will migrate up. Why? Because the deltoid pulls up. So as you're raising your shoulder up, the deltoid is pulling that humorous up and the internal rotation of the other muscles are already too tight, chronically tight or just keeping it in the front side anyway.

05:45So you're lifting your arm up and you're getting very little space. What the external rotators will do is they'll keep it centered so that as you raise instead of it migrating up, it's countering the force of the deltoid. So it's staying in the middle and it basically can rotate and stay right in the middle where it has to be.

06:02You're not getting this migration or pinching going on. So that's the real function of the rotator cuff is to maintain a more centralized position with less of this pinching. So you really have to focus on when we're talking about avoiding shoulder issues.

06:17The biggest thing you can do is start training the rotator cuff, not stop training the rotator cuff. And if you're doing a lot of heavy pressing or a lot of work with exercises that tend to internally rotate your shoulders now, then you have to do even more work for the rotator cuff to try to maintain that balance.

06:35If you're doing all kinds of delt work, you're never doing it rotator cuff work, you're just creating more and more of that imbalance. So I think the biggest thing you can do is maintain mobility of the shoulder, mobility of the shoulder girdle itself.

06:47So the the the scapula being able to rotate and then having strength of the muscles of that shoulder girdle which are the rotator cuff. Those are the three main things you can do to keep that shoulder functioning well and staying out of this domination of internal rotation with elevation.

07:00What's

Banded External Rotation Exercise

07:02your favorite uh external rotator exercise? My favorite is just simply attaching a band to a stable. could be a stair uh like a a stair post or it could be in the gym just a rack, right? And you you step away. You you put the band in your hand from the anchor point.

07:21You're going to step out until there's good tension on the band. If you were to let it relax, you would pull your your hand towards your chest, towards your belly. You externally rotate to about back to neutral or a little bit beyond if you can.

07:36A little bit beyond your torso. Yep. Yeah. A little beyond your torso if you can. That's even better if you have that range of motion. Sometimes people don't. And when you get it there, you again hold it, right? You hold it for a second just so you know that you actually muscled it out there.

07:46You didn't just swing it out there. The number one thing people do here to cheat, and we talk about this, we talked about it in the gym quite a bit. Your body knows how to compensate. Like, if you ever want to know what you're doing wrong, just look at yourself in the mirror and then look and see what your body's trying to do.

08:01You'll realize the compensation is the direct opposite of what it's not doing, what the job is is is avoiding. So when the rotator cuff is trying to externally rotate the shoulder, the way I can avoid that is just lift my elbow away from my side.

08:15I can get my hand from here to here if I raise my arm out to the side. But now I'm using my delt to do it and not the rotator cuff. Keep that elbow pin. You got to keep the elbow pinned to the torso. So the easiest thing you can do is just put something underneath your arm, a little towel.

08:29Fold the towel, put it underneath there, and then do the exercise. And if you find that your towel is dropping to the floor, it's obviously that because you're lifting your shoulder, your elbow away from your body and you're using the wrong muscle.

08:42Do this as a warm-up. Do it at the end of the workout. How many sets, how many reps, how many times a week?

Warmups & Training Frequency

08:47There's different applications of it. You can do it before a workout. So, if I'm going to press, like, let's say bench press, I could use this as a good warm-up before I go press almost as a neuroactivation technique to make sure those muscles are alert and firing so I can make sure that they're working when I go to press to keep my shoulders back in in a better position.

09:04And especially as I raise my arms up in an overhead press, I can make sure that they're alert, they're fired up, they're they're willing to contribute to keep that head centered when the arm's going up overhead. So, I like to do them on pressing days as a neuroactivator before I train.

09:20And it's serving as a warm-up, too, or on other days. Again, treating it as my special program, which is what I have to do because of all the issues that I've had with my shoulders. Again, not from this one didn't come necessarily from bad training, but just dumb decisions trying to throw a baseball back with the Mets.

09:34Um, I lost a bet. It's kind of famous at this at this point, but like a player bet me that I couldn't throw the ball from Well, let's rephrase that. I bet that I could throw the ball from right field to third base on the fly because it just looked rather short from where I was, but it's actually a lot longer and only the better arms in baseball can actually do that really easily.

09:56So, I have no idea why I thought I could, but I did. And literally the the moment I let that ball go, I feel like my lab went with it and maybe landed somewhere near second base because it just felt like a burning zipper pain in my shoulder and I've had to deal with it ever since.

10:13Did the ball get to the third base? Oh, no. No way. No. I think it landed with the labor bat at like second base, you know, like no way. So, you know, I learned my lesson, but the fact is it's something that you can you can adopt pretty easily as a special programming type thing.

10:31Um, there's things you could do too to make it a

Advanced Shoulder Stability Variations

10:35little bit more interesting. Like once you get into position where you could do the actual repetition, you can then hold it in a neutral position. The neutral for this exercise would be not in, not out. So where your fist is pointing straight ahead.

10:48And then then take a big giant step away from the band. So you're increasing the resistance of the band dynamically, but still having to keep yourself in that same position. So elbow still locked to the side, fist out in front of you. You're holding the band.

11:00There's tension. Step away from the bar that the band is fixed to. So there's additional tension. Yeah. And it's going to want to pull your hand back, but you keep it right where it is. And then the fun part of it is that I could then take it even further.

11:11I could jump out there. So now it becomes a little bit more ballistic and dynamic. [clears throat] So I can be in this position and then jump. And if I jump quickly, now it really wants to pull me in, but I have to still keep that same position here.

11:22So it's mimicking a little bit more of a of a ballistically dynamic force. So I could do that. I could start to change the angle. I could be here in this position now facing facing the the the anchor point and it still wants to pull me into internal rotation.

11:38So band in front of you, not to the side, right? Okay. And I could jump back and see if it pulls me down this direction. Internal external rotation is is is is is done so many different ways. Again, I could be in this position here. I'm just reaching my arm out in front of me and turning my my my arm all the way, thumbs down to the floor, all the way back past the sky, and then thumbs out towards my side.

12:01Right? That's internal external rotation. I don't even have a bent elbow, right? Because we're talking about a shoulder movement, not an elbow movement. But when we when we do it, we could do it down low is going to be easier for people to start.

12:11And the more things you start to do with external rotation, internal rotation with the arm elevated, the more challenging it starts to become. So you progressively move towards movements where you're internal or externally rotating against resistance in a higher and higher arm position.

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