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Gain without pain

Shoulder injuries are among the most common in the gym. Physiotherapist Graham Burne explains how to avoid the common pitfalls of working this complex joint.

The shoulder is the most flexible joint in the body, but the flip side is, it’s also one of the less stable.

I say “joint,” but it is not actually a single joint. It is the articulation between the head of the humerus bone on the upper arm and the glenoid fossa socket on the shoulder. It’s often likened to a golf ball resting on a rather large tee. The joint is designed for maximum mobility to allow a broad spectrum of upper-body movement, but this inherent instability is at the root of many problems.

The rotator cuff is crucial because it stabilises the shoulder. Most shoulder injuries affect the rotator cuff, and the purpose of most rehab work is to strengthen it.

The rotator cuff consists of four muscles that can be remembered by the acronym SITS: supraspinatus, infraspinatus, teres minor and subscapularis. These muscles originate from different parts of the scapula (shoulder blade) and insert into the humeral head, converging together into a tendinous “cuff” around the joint.

Problems usually occur when tight internal shoulder rotators pull the humeral head forward and inwards. If the external shoulder rotators are weak, they’re unable to counteract this force, and this leads to pain in the rotator cuff.

There is an obvious mismatch between the internal and external shoulder rotators. Blokes who hammer their pecs and lats are potentially storing up problems by overtraining their internal rotators and neglecting their external rotators.


1 / Do not ignore shoulder pain. Training through it will lead to more serious injury, which will require longer and more invasive treatment. If you experience pain, incorporate rest and a modification period into your program to keep the muscles from grating and teach them how to be exercised safely.

2 / Be wary of exercises that require excessive internal rotation of the shoulder, such as front raises, lateral raises with thumbs down and upright rows. These moves put the supraspinatus muscle in a potentially compromised position.

3 / Strengthen your middle and lower trapezius and rhomboids to increase shoulder blade stability. Try reverse flyes with straight elbows to hit the middle traps.

4 / Keep external rotators strong and internal rotator muscles flexible to avoid a poor internal/external strength ratio, which results in the humeral head pulling forward. Regular stretching after workouts helps.


If you search for rotator cuff exercises on the internet, a plethora of generic moves appears. The exercises here don’t cover everything, but they are the most effective moves for men looking to improve their range of motion and the strength of their rotator cuff and scapula.

The rotator cuff is composed of a similar number of slow- and fasttwitch muscle fibres, so your aim should be to increase muscular endurance, and you should vary the tempo. Resist the urge to go heavy: this program is about preventing injury rather than hypertrophy, so it’s a short-term measure that will allow you to gain without pain afterward.

Incorporate the following exercises into your routine for four weeks. They will greatly increase your chances of avoiding injury and allow you to blast your delts safely in the months to follow.

In Weeks 1 and 2, do 3 x 30 reps and adopt a slow tempo of 3 seconds up, 3 seconds hold, 3 seconds down.

In Weeks 3 and 4, do 4 x 20 reps, adopting a fast tempo of 1 second up, 0 second hold and 2 seconds down.

GRAHAM BURNE has bachelor of science degrees in physiotherapy and sports science. He is a clinical specialist and physiotherapist working in private practice and elite sport. @GrahamBurneWHL


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