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Robert Wolf
04-23-2004, 01:04 PM
For your consideration:

Which is better to strengthen the rotator cuff, isolated or complex exercises?
(4/9/2004)

The rotator cuff traditionally has been strengthened by using isolated
movements. But can complex multi-joint movements strength the rotator cuff just
as well? Researchers at Democritus University of Thrace in Komotini, Greece
recently compared the effects of isolated and complex exercises on rotator cuff
strength.

Thirty-nine males participated in this 6-week study. After initial isokinetic
testing of internal and external rotation strength, the subjects were divided
into 3 groups. The experimental isolated group performed internal and external
dumbbell rotation exercises, the experimental complex group performed pull-ups,
overhead presses, reverse pull-ups, and push-ups, while the control group
performed no exercises. Both experimental groups performed 3 – 7 sets of 8 – 15
repetitions with 2 – 4 minutes rest between sets.

Both experimental groups increased rotator cuff strength, with the complex
training group having a significantly greater improvement in both arms. The
isolated group only had a significant improvement in the non-dominant arm, and
this improvement was less than the complex group achieved in the same arm.

The authors of the study do not recommend replacing isolated movements with
complex movements to strengthen the rotator cuff. Instead, they recommend a
combination of both methods. The authors suggest that a program begin with
isolated movements to better stimulate weak muscles, but after strength has been
improved, switching to complex exercises that will provide greater improvements
in strength.

Giannakopoulos K, Beneka A, Malliou P. (2004). Isolated vs. complex exercise in
strengthening the rotator cuff muscle group. Journal of Strength and
Conditioning Research, 18(1):144 – 148.


I think it is fascinating that they recomend isolation movements at all. No data to support the action in ANY study comparing compound vs multi joint movements. I suspect it is a CYA move on their part. Phase out isolation movements over several years and perhaps no one will notice. Reminescent of the new food pyramid.
Robb

bill fox
04-23-2004, 01:46 PM
Exactly the results i would suspect both in terms of complex movements being the fix and the half assed recommendation of the establishment.

Great post Rob.

Lincoln Brigham
04-23-2004, 02:13 PM
"The authors of the study do not recommend replacing isolated movements

So they ran the study, came up with a result that contradicted conventional thinking, and then refused to make a recommendation that matched the results? Gee, no bias there....

Larry Lindenman
04-24-2004, 05:32 AM
Once again real life experience beats out "science".

Brian Hand
04-24-2004, 07:27 AM
Obviously swimming upstream here, but I think their conclusions are okay. Before I go any further, let me tell you that I agree wholeheartedly with Crossfit's advocacy of compound movements over isolation work in general. I have since long before there even was a Crossfit. I spent the 1980's doing cleans, squats, chins, dips, deadlifts, etc. in gyms full of cheeseballs in big baggy clown pants and spaghetti string tank tops. I was old school when it wasn't even that old.

For one thing, it is not sensible to throw out all preceding results based on one study of 39 men over six weeks and a couple of dumbbell exercises. Suggesting that sort of conclusion not only overstates the findings of the study, but it drastically oversimplifies the situation.

I think the main thing is, they are applying the results of this study, done on healthy people, to the setting in which specific rotator cuff work is usually considered, rehabilitation. In this context, their conclusions are sensible and progressive, not backward and dogmatic.

Ironically, I think Crossfit is in danger of a reverse-dogmatism here. With all due respect, anyone who thinks direct rotator cuff work has no place in an athlete's life has their head in the sand. This isn't preacher curls, folks.

John Frazer
04-25-2004, 05:01 AM
I think Brian has a good point. I'm currently rehabbing a 5-year-old shoulder injury, and I'm definitely noticing that the rehab exercises (such as L-flyes) are working disproportionately weak external rotators.

The Crossfit repertoire is wonderful, but there are few compound movements that truly address this area, IMO. In fact, I'm pretty sure I got hurt not from dreaded, evil isolation movements but from pushup variations (wide stance, narrow stance, and "dive bombers") along with lots of swimming a few years back.

Robert Wolf
04-27-2004, 11:56 AM
Brian/John-

Your points are good but I have been hard pressed to find situations in the rehab setting in which isolation work is indicated.

We have completely switched our facility over to a crossfit type protocol and where once it required 12-15 visits to rehab a given shoulder injury we are getting them done in 9.

Windmills:
http://jva.ontariostrongman.ca/WINDMILLS.htm

are the clossest thing we are doing for shoulder rehab.

I can guarantee this: whatever utility isolation movements confer the stilulus is greatly enhanced by the systemic stimulus of compound movements. More often than not however these isolation movements are nothing more than a gateway for new products.

If one outfitted a physiotherapy clinic with: a pool, rings, p-bars, kb's/db's, some judo mats and perhaps a harness for sled drags....an aluma lite bar and standard Olifting set you will spend less than $3000 and get results which make the standard of care look very weak indeed. One is also in a pefect position to offer excelelnt after-care opportunites to your patients....
Robb

Brian Hand
04-27-2004, 01:59 PM
Robb, I can't argue with better results, and I would never suggest that compound exercises won't fix some shoulder problems. However, they won't fix all shoulder problems, and some of those problems can be resolved with direct rotator cuff work.

I also should re-emphasize that I am not suggesting that the bulk of effort over time should not be spent on the many compound exercises we know and love.

The obvious example is the athlete that developed his problem using compound movements. Athletes on sound, balanced strength programs develop problems due to weaknesses and imbalances in the rotator cuff all the time. Clearly you can't tell this person to do more pushups, chinups, etc. and expect the condition to improve. If one part of the rotator cuff is too weak to support proper movement in compound exercises, compound exercises might just make things worse.

The shoulder is incredibly complex, and once the delicate balance of the rotator cuff and the other muscles in the area is upset, compound movements cannot be performed properly. You can't tell someone, "Hey, your left subscapularis isn't firing when you press, more left subscap there."

You can, however, do the right exercises to strengthen the subscapularis and thus help restore normal movement. Some of the rehab exercises that people do for the subscap are a joke, EMG testing has proven this. However other exercises have proven very effective. Many athletes who have added a little targeted cuff work to their generally sound programs have gotten rid of shoulder problems and improved performance - too many to discount the effectiveness of direct rotator cuff work.