Why working the Rotator Cuff in the high reps & low weight range? Isn't that wrong?
I can understand that the muscles of the Rotator Cuff group are small and therefore I could understand the recommendation of using much lighter dumbbells in relation to other exercises. But almost in any site I have found, the recommendation is to always work them with the lightest pink dumbbells and in the >15 rep range.
Isn't that wrong? Why not to strengthen that small muscles by working them with sets of 5 reps too with increasing weight?. For instance, a rule of thumb such as "use one tenth of the weight you use for the overhead press" or something similar would be very interesting.
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What I've heard--and this is mere hearsay, I'm no medical professional--is that any attempt to use heavier weights (and thus lower rep ranges) with the small muscles of the shoulder is nigh-impossible, because the larger muscles, the prime movers, take over after a certain weight. Keeping the weight very low allows the stronger prime mover muscles to hang back while the smaller muscles carry the load.
Mike Reinold describes how this is the case for almost everyone who is just starting out with rotator cuff work:
Imagine you had a pretty weak rotator cuff during an exercises such as side lying external rotation. You can comfortably perform the exercise with 3 pounds. If I were to give you a 15 pound weight, I bet your form would be awful and you would just sling your arm back using your posterior deltoid and trapezius muscles. That is obviously not good, any time you overload a weak muscle you will get compensation. That applies to every muscle in the body.
But that doesn’t mean that you can’t slowly work your weight up to over 5 pounds as you get stronger. Why would you stop at 5 pounds? What if that isn’t challenging anymore? What is the point of that? Would you stop loading your squat at a certain weight and just sit there forever?
I routinely get patients into weight over 5 pounds when working the rotator cuff, some even in double digits. If you are compensating and using larger muscle groups, you may just not be strong enough for that weight.
So more weight might be called for after you've been doing the light weight for some time with impeccable form and are not challenged by it.
I'm also not a medical professional. I had minor shoulder problems in my early 20's, and was put on rotator cuff exercises (plus a basic strengthening program). And it worked, and I did rotator cuff exercises fairly consistently (along with regular weight lifting and sports) for about 10 years.
What I found when I tried to go any heavier than the lightest weights is that my elbow was very weak in that position (bent at 90 degrees, torquing in and out), and I got a distinct impression that I'd develop elbow problems if I tried to push rotator cuff exercises into heavier weights. I don't know how common that is, but I never saw anyone else doing them at heavier weights, so I didn't worry about it.
I was using a standing cable pull machine to do internal / external rotator cuff exercises. I'm not sure if that would directly translate into a dumbbell weight, and I'm not sure if everyone is going to have the same exact limit as I do. But I never did more than a 2 or 3 plates on any cable pull machine, and that was after years of doing 1 or 2 plates.
RTC Strengthening
You may want to link to some of the programs you reference that “always work them with the lightest pink dumbbells and in the >15 rep range”. I suspect that the RTC exercises referenced are rehab exercises for RTC injuries. Injured tissue is exercised differently than normal healthy tissue and often specific muscles are worked in isolation, which are two of the reasons lower weights may be used.
Sport Specific
Other, RTC exercises can be specific to sports rather than an injury. They may emphasize eccentric contractions to address the deceleration phase of pitching for instance. They may use PNF patterns to achieve control in functional movement patterns. They work on neuromuscular control and not just muscle strength.
Tendon vs Muscle
An RTC injury generally involves the tendon(s) rather than the muscle. Because the RTC’s job is to properly set the head of the humerus (the ball) in the glenoid (the socket), and in the proper relationship to the scapula, if the RTC has tears or degeneration and is not working correctly, any attempt to overload the RTC muscles can cause additional damage to the weakened tissue rather than strengthen the muscles.
Shoulder and Scapular Positioning
The posture of the shoulder/scapula is important when doing exercises to strengthen the RTC. If the shoulder is in the rounded position (from tight pecs or weak scapular muscles) it can put more strain on the RTC tendons, especially when raising the arms overhead. The cuff can become impinged between the acromion and the head of the humerus.
Since it sounds like you are presently doing rehab for RTC inflammation, your therapist can direct you as to the proper shoulder/scapula positioning, the range and the level of resistance that is suitable for your condition.
Posture
You can check this q/a for general postural exercises and ask your therapist which, if any, would be appropriate to help you improve your overall posture and reduce stress on the shoulder and RTC. Strengthening the lower traps and rhomboids, for instance, are important to good posture, but also in stabilizing the shoulder/scapula so that the RTC muscles have a stable base from which to work.
Once your injury is fully rehabilitated with free weights, resistance bands or cables, and the RTC and scapular muscles are able to stabilize your shoulder joint(s), then general strengthening exercises like farmers walk or deadlifts should recruit more muscles and further strengthen your shoulder/scapular muscles, as long as you increase your weights gradually. And you can continue specific isolated RTC muscle strengthening exercises, increasing the weight as your shoulder tolerates.
Mark Rippetoe and Starting Strength don't advise sticking to light weights for rotator cuff work.
He says that your rotator cuffs will strengthen in the appropriate amount if you just press correctly.
Pressing actually strengthens the rotator cuff muscles.
When you press overhead and finish the lockout correctly, all of the muscles of the shoulder are tight and contracted. As the weight goes up over time, the strength of the finish must increase and the force produced by all the contracting muscles must therefore increase as well.
Since the press uses the rotator cuff muscles isometrically to stabilize the lockout position at the top, and since proper form ensures that they are active in this capacity as well as safe relative to a position of impingement, it seems as though the logical way to strengthen the cuff muscles — even cuff muscles weakened by injury and surgical repair — is to press correctly.
In the correct press lockout, the weaker muscles are supported by the healthy ones, and as the injured muscles heal, they are able to resume an increasing amount of their normal functional load if correct technique is utilized with weights light enough to permit it.
In this way, the injured muscles can be brought back to normal function while performing their normal function, in effect given no choice but to heal by doing what they normally do.
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