Hinge Rows and Rotator Cuffs

I have had a left rotator cuff tear 20 years ago from throwing javelins. This was repaired with surgery successfully by a top shoulder surgeon in Europe at the time. I never returned to throwing competitively.

I have just completed my first week of foundation 1 and noticed that the hinge rows are causing some subtle pain in the left rotator cuff that is lingering. I have just started seeing a physio and osteo and will mention it to him when i see him in a few days. But i wanted to hear any wisdom from the crowd here also. It's difficult to diagnose from a pain only but what is anyone else's experience? My feeling is that even though i am able to complete the sets that the hinge rows are too great a load to start with.

Previously, Coach has recommended a couple of regressions for this row for cases such as yours.

- Working up to 5x 60s hold at the top of the row. Work to appropriate intensity as per advice from your pt  (and some of the good advice from Mark and Wes will probably help too)

- Slow (ideally 10s) negative reps with the same disclaimer

If necessary, you could also scale as far down as first working static top hold with glutes on the floor.  Then negative hinge rows with glutes on the floor.  And then segue into the static top hold with the normal hinge row position and so on as Jon mentioned.

Yours in Fitness,

Coach Sommer

Make sure you work in a pain free range so as to not aggravate the shoulder. The scaled options above are great for waking up the weak posterior shoulder muscles.

Hello Antony,

Your physiotherapist will probably provide you with useful guidelines and you should definitely follow the advice of professionals like your physiotherapist and the coaches above. My (humble) personal experience has lead me to put some emphasis on warming up the shoulders before each workout. The following link could give you ideas.

http://orthoinfo.aaos.org/topic.cfm?topic=A00663

Thank you all for the advice. Doing the hinge rows as a static hold with glutes on the floor feels about right. I will report back after my next hinge row session. However, i will see what my physio recommends also. Perhaps he can do a general shoulder function test for me to see what i should/shouldn't be doing.

I will endeavour to stay in the pain free zone. What was odd was that the movement felt ok until afterwards. So my first week, on the face of it, seemed successful. But that was obviously not the whole story.

Olli, thank you for the link. That is a great resource. These are much of what i have done in rehab in the past but largely forgotten.

Thanks again. Antony

I have just returned from my session with my physio/osteo. Had a really interesting conversation with him about my shoulder. I showed him the movement i am making with the hinge rows and he mentioned that i am essentially blocking the shoulder movement at the end of my range of motion. The humerus reaches its end of range and then i am attempting to move it further, but not by the opening the shoulder girdle, but by trying to move the humerus further. This will be putting a lot of stress on the labrum. He tried to show me the extra range comes from the opening the shoulder girdle, which as a habit seems totally unfamiliar to me.

Perhaps the most significant thing he put to me was to think of a movement as a whole complex system and to not dissect the mechanics into a bunch of separate muscles (a strong habit i have as a trained physicist and mathematician). He suggested not to isolate training/stretching to certain muscles as that will not serve any neuromuscular purpose. Doing/training the movement will be what enables its dynamic function.

So in relation to the hinge rows, i was thinking that doing the movement would be good. Certainly with my glutes on the ground. And to not try and push past my range of motion but to let that come over time. I perhaps see a risk in doing the static holds in the upright position if my habit is to over extend the humerus.

Any further thoughts?

"Muscles" hate working alone. That's how they get hurt, when the rest of their friends are not pitching in the action.

Quit the habit of over-extending the humerus! Make noticing a new more global movement "engram" you priority in your upper back, shoulders, between shoulder blades and the support that comes from below: core, hips, legs AS ONE.

4 minutes ago, Antony Stanley-Clarke said:

Perhaps the most significant thing he put to me was to think of a movement as a whole complex system and to not dissect the mechanics into a bunch of separate muscles (a strong habit i have as a trained physicist and mathematician)... Doing/training the movement will be what enables its dynamic function.

You got it! Now implement. 

Having free movement through the entire shoulder girdle should be considered as a standard for good physical health.

Anatomy is a great interest of mine and the shoulder girdle is classically regarded as the shoulders, scapulae, clavicles and associated muscles. Most texts will focus discussions on these elements only (perhaps the lower cervical spine and upper ribs and thoracics).

I personally consider the shoulder girdle to include the neck and entire ribcage  and when I work with patients who have shoulder issues we give focus (as a minimum) to this entire region. Assessments, hands on therapy and exercise.

Even with your history, I would expect you to be able to master the hinge rows with little trouble, as long as you take your time with the above suggested modifications and in conjunction with other aspects of F1 and the stretch series. Bridge work including tables and twisting bears, HS work such as dislocates etc all combined will develop that freedom of movement throughout the shoulder girdle (my interpretation of it).

90 degrees abduction of the humerus is the most unstable position of the humerus in the glenoid fossa and the rotator cuff will be working hard to stabilise throughout hinge rows. This is why they are such a great exercise, of course when coupled with all the other myriad movements the programme takes us through. Perhaps you should try hinge rows after a few table holds to see if this helps.

Antony I have just realised that you are based in Bristol. 

I am based in Stroud (not far at all) and you have Forma, currently the only GB Affiliate in Europe almost on your doorstep. Come and try some classes with us! Coach Sommer will also be here in July for Seminars 

Thanks for your support everyone. It's really helpful.

Hi Wesley. I noticed the other day that Coach Sommer will be there in July. Unfortunately, finances won't stretch to take advantage of that opportunity. But i didn't look at the venue at all. Amazing to see that you are doing classes there. I'd love to come along sometime. Particularly noticed the Shoulder Prehab classes.

It's a shame no one is doing anything like this in Bristol. Although close, Stroud is a bit of a stretch for me given that i don't drive. With an awareness that some future foundation elements will involve stall bars i have struggle to find a gym anywhere that has some fundamentally simple equipment like that. There's obviously the gymnastic training centre in Bristol, but again to make things work for me i need something closer by. Do you know of any other spaces in Bristol that do have these things?

I haven't yet signed up to the stretch or handstand series, though this is my intention for the future, so i have not heard of table holds or twisting bears.

Would you advise against focused work on specific rotator cuff muscles like those in the link posted by Olli earlier in favour of working a more complete movement that involves more of the shoulder girdle?

Antony, I thought you might enjoy this study about the continuity of tissue in the human body:

http://www.ncbi.nlm.nih.gov/m/pubmed/26522465/

Thanks Eva. I will have a read of the article tomorrow. I have just started reading Anatomy Trains. Looks like it's in a similar vein.

I have tried playing around with the hinge rows, which have brought up a few questions. Should i am to use my rhomboids to retract the scapula or is the shoulder semi protracted or no attempt to protract at all? In the technique video Hannah's shoulders don't look protracted. And should i make sure that my elbows go no further back than the line straight through the humerus, through the chest and through the other humerus to the other elbow?

Antony, why not try Bristol gymnastics centre?, I see they have adult classes 4 times a week, so after a warmup you could use the equipment (ladder bars for example).

Ha, great book! I have the old edition. I studied with Tom and he's da man when it comes to fascia anatomy. Even if one doesn’t agree with his theoretical model (terminology, number of trains, etc), there’s merit to revealing the fascial continuity by turning the scalpel sideways!

- For those who may not know Tom: http://www.anatomytrains.com/hnts/fatatw/2.pdf 

Yes, aim to integrated rhomboids, mid traps, infra and supraspinatus, trees minor, lower fibers of lats to depress scapulae (or avoid elevation), serratus anterior... You cannot stop naming muscles because they're all participating – All doing different things in different planes, at different times! We don't think about naming pecs for hinge rows, but If we didn't have pecs, we could not do hinge rows. See what I mean? The good think is that we don’t have to think about this. 
 

To your questions: 

1) At the top of the row when torso is upright you’re not protracted. Scapulae should be fully retraced. Think 90º/90º angle above and below the humerus. @Zach Armijo has hilarious art (infographics) on this point.

2) Initially, or at least until you get more comfortable with this move, I wouldn’t let the elbows peak behind the frontal plane too much. That's just my opinion. Because IF you are not stabilizing the joints sufficiently (properly), and your arms end up pushing forward for some reason (which we don't want)
the retraction action could mistakenly be accompanied with humerus internal rotation and shoulder extension (the direction you don’t want to go…). Since that area is probably weak, better to err on the safe side. However, IF towards the end-range of scapulae retraction, you can squeeze your elbows back in tandem with your scapulae (picture horizontal straight line from elbow to spine), then you’ll avoid that mistake. Aghh, sorry hard to explain. Maybe others can explain better. 

Also, you can find great tips from all coaches in others people’s threads. Here’s mine. I have to praise Zach again for his meticulous guidance:
https://www.gymnasticbodies.com/forum/topic/23970-rc-pe2-–-form-check/?do=findComment&comment=209293

found it:

Hi Piotr. I have been before some years ago. Although the facilities are great, the classes didn't really work for me. They weren't so much of a class as a free-to-use-what you-want session with 2-3 coaches on hand when you want. This wasn't structured enough or technical enough to satisfy me. A quiet space where i can get on with what i want or a fully supported class like those appear to be in Stroud is what i am looking for. Travel time is an imperative given my busy schedule. Bristol Gymnastics Centre is just too far. I might be able to twist the arm of Bristol Athletics club, where i coach the throwers, to invest in some other kit. In the meantime, there has to be somewhere with basic gymnastics kit around. It's not urgent for now but in future months the advancing elements will require some more kit.

I'm also having some difficulties with hinge rows, and I think my external rotation is quite poor.  I think I'm doing the exact same thing as the OP and trying to find a mental cue I can use.  Is it fair to say that there should be no movement without scapular retraction?  In other words, fully retract the scapula and stop the rep? 

If you are limited in mobility to get to the correct top position, with the elbows back and shoulders crunched up, then pay attention to pec minor, as it could be particularly problematic and restrict scapular retraction. Stretch it often, it takes time until you'll see improvement.

If you are getting pain behind the shoulder, and into the lat area while doing this, a) the pain should dissipate as pec minor lengthens out, and b) consider spending some time stretching out your shoulder/back/lat area before getting into RC work sets.  RC/PE2-im , using only 1 arm at a time, provides a really good generic rear shoulder stretch (rotator cuff muscles). Find the tight areas and hang out there for a bit, take your time and make it worth your while.

When my shoulder was really bad it would lock up in the middle of doing bench presses. I could mitigate that in the short term by doing this shoulder/lat stretch immediately before performing the set, it helped a ton and set me in the right direction towards actually making changes. Remember the shoulder joint is almost entirely muscle with tiny bone articulations holding it together. if your shoulders suck than find the tight muscles and beat them up and hammer them out, fix it as a priority. If you can't get the proper range of motion than you shouldn't even sign yourself off on mastering 3x3, IMO.

 

Jared makes a very good point as to pre-mobilizing the neighboring tissues, if you know which ones are restricted. My preference is to do it dynamically as the proprioceptors respond to rhythmic oscillations, going in and out with bounces, reaches, circles, etc. which turns them on and gets them ready for the work ahead.

Definitely check into pec minor as it could be one of the probable suspects!

As we know, the body always follows the path of least resistance, in effect, altering the optimal arthrokinematics of a joint, when we're unaware of pre-existing muscular imbalances. And when we know yet fail to do take appropriate corrective action. Great post!

I was looking for shoulder rehab/rotator cuff/tendonitis topics and found this thread. Great feedback throughout.
@Antony> Did things improve? What worked well for you?

I have to deal with similar problems after overtraining in boxing and a recent shoulder injury on top of several older injuries. Issues accumulated over the years. Getting different diagnosis from doctors here (living in Taiwan and don't speak the language sufficiently),  I was told I suffered a supraspinatus tear, tendinitis and beginning arthritic issues in my right shoulder. Another Dr. supposed none of the above but bursitis...meh. I still think they missed some detail or misinterpreted the mri(s). 

Anyways, I'm taking a break from boxing and started gst a few months ago.
I can already see a lot of improvement esp regarding mobility. But I'm not sure about some does n don'ts in my routine in order to rehab my shoulder. I've read some things like "don't stretch rotator cuff w. tendinitis" etc.
Maybe I can get your guys feedback about what s good n what's to be cautious about?!
My main issue seems to be teres minor weakness in the right shoulder. Most movements/exercises are ok to do, but coming out of it/releasing the tension hurts in teres minor/major and sometimes supraspinatus and top of triceps.  I can feel how I tend to lean on my stronger side e.g. doing push ups.
 
Exercises I do for my shoulder (mixing it up though, not doing all of it each time - and I also do some flex band exercises) >
dead hangs 
tables 
shoulder extensions 
dislocates (pull up grip is ok, dorsal is really hard)
wall extensions (struggling!)
hinge rows
incline rows 
straight arm/one arm planche (sometimes get a tingling sensation up to numbness in my fingertips if I protract as hard as I can) 
weighted shoulder flex pull

Thanks! 

On 28/10/2016 at 8:53 AM, Bas Albinus said:

I was looking for shoulder rehab/rotator cuff/tendonitis topics and found this thread. Great feedback throughout.
@Antony> Did things improve? What worked well for you?

I have to deal with similar problems after overtraining in boxing and a recent shoulder injury on top of several older injuries. Issues accumulated over the years. Getting different diagnosis from doctors here (living in Taiwan and don't speak the language sufficiently),  I was told I suffered a supraspinatus tear, tendinitis and beginning arthritic issues in my right shoulder. Another Dr. supposed none of the above but bursitis...meh. I still think they missed some detail or misinterpreted the mri(s). 

Anyways, I'm taking a break from boxing and started gst a few months ago.
I can already see a lot of improvement esp regarding mobility. But I'm not sure about some does n don'ts in my routine in order to rehab my shoulder. I've read some things like "don't stretch rotator cuff w. tendinitis" etc.
Maybe I can get your guys feedback about what s good n what's to be cautious about?!
My main issue seems to be teres minor weakness in the right shoulder. Most movements/exercises are ok to do, but coming out of it/releasing the tension hurts in teres minor/major and sometimes supraspinatus and top of triceps.  I can feel how I tend to lean on my stronger side e.g. doing push ups.
 
Exercises I do for my shoulder (mixing it up though, not doing all of it each time - and I also do some flex band exercises) >
dead hangs 
tables 
shoulder extensions 
dislocates (pull up grip is ok, dorsal is really hard)
wall extensions (struggling!)
hinge rows
incline rows 
straight arm/one arm planche (sometimes get a tingling sensation up to numbness in my fingertips if I protract as hard as I can) 
weighted shoulder flex pull

Thanks! 

Hi Bas. To your first two questions, fortunately things did improve for me quite quickly actually. My osteo suggested that the pain I was describing was more of an activating and i shouldn't worry about it. This seems to be quite true as after 2-3 weeks it all felt fine and was able to move through the progressions without any pain at all. On reflection much of it felt related to a tight pec minor, which my osteo worked on from some weeks.

With regard to do's and don't's, I think think a simple rule of no to anything that is aggravating it. Your body is giving you the signals. To some degree I have really put my faith in what Coach Sommer has devised and am prepared to be infinitely patient with that. I am giving myself the time (so far 6 months) to see how the F1 elements are changing my system and giving up on the thoughts that I should be further down the line than I actually am. Perhaps this really will take longer than expected and/or the changes you thought might happen won't and it will be something you didn't expect.

Things that have helped me outside of F1 have been using a Lacrosse ball for getting in and around the scapula to help mobilise it and getting it in the rotator cuff. Pain is a friend here but no sharp pains. I found Kelly Starrett to be particularly useful with tthis in this area. You can search him on YouTube.

As for other things, I still don't have the stretch courses, which I'm sure will really help. I am still healing a broken wrist so any pressing (thoracic bridge) is off for me.

Wall extensions are something I have begun to incorporate into my workouts 3 times a week. I think they're hard and I'm way off being able to have my arms straight above my head.  But I love how they work the rotator cuff at the same time as encouraging the pec muscles to open. I'm not necessarily noticing any major changes right now in terms of restructuring (it's been about 3 weeks of doing them consistently) but I'm sure that will come. 

Hope that provides some insight. Have you access to physiotherapists? And has surgery been mentioned ? 

Thanks for the feedback! I hear ya regarding Coach's advise about being patient...it's just not easy. Going from "all-in" to "start-from-scratch" is a humbling experience. I heard Coach say sth like "after years of messing up your body you also need some time to fix it - real results will show after 8-9months". So I'm trying to be patient. 
I guess I just thoroughly messed up my shoulder in the past by not resting long enough after the latest injury. I kept on training through pain for months. Also my right shoulder has always been my weak spot after I dislocated it 20years ago.
Taking a break from boxing and starting GST has already changed things a lot. After just  a few months I'm already seeing a major increase in mobility  and core strength. Just the shoulder is still bugging me. And I'm not sure if it's due to certain exercises or despite. That's why I posted my questions on your thread.
While I'm trying not to push too hard I think a moderate degree of pain when stretching or mobilizing joints is adequate. 
E.g. getting started with tables was very painful and I went through several new unpleasant sensations my body wasn't used to. By now and several progressions later  they are much much easier and not painful at all.
On the other hand, I heard so many recommendations about daily deadhangs to fix your shoulders, but they seem to aggravate my teres minor.
and so on and so on...

I'm also using a foam roller and LaCrosse ball once in a while to roll out my scapulae and shoulders. The physio therapy I received here so far was total bs. I kind of gave up on it and tried to figure out what works and what doesn't by myself with stretches, mobilization, flex bands etc...maybe not the most productive way :/
Anyways, looking forward to things getting better so I can get started with handstands next!

 
  

@Antony Stanley-Clarke finally surgery scheduled for next month. Suspected tear of the labrum amongst other issues.
I hope it will put an end to that shoulder pain. Looks like I'll have to start from scratch with f1 rows after physio...well, there's worse than that.

5 hours ago, Bas Albinus said:

@Antony Stanley-Clarke finally surgery scheduled for next month. Suspected tear of the labrum amongst other issues.
I hope it will put an end to that shoulder pain. Looks like I'll have to start from scratch with f1 rows after physio...well, there's worse than that.

Hi Bas. Sorry to hear that. But better it gets sorted for good so that you can then build from a reliable foundation. Good luck with the surgery. Hope it goes well.

It would be good to hear how it's all going in the coming months. Keep posting.

Antony