Do You Need More Internal Rotation?

One of the most common questions I receive in reference to the shoulder is, “Do I need more internal rotation?” The answer is, “It depends.”

More mobility isn’t always a good thing, especially when it comes to overhead athletes who often have excess motion at this joint. On top of that, we can’t assume someone that lacks internal rotation needs to stretch to gain more motion. Instead we need to assess and address how and why there is a lack of internal rotation in the first place. Let me explain.

In a prior blog, I described a simple screen to assess your level of active shoulder internal rotation. While sitting by a wall with your arms in a 90-degree “L” position, rotate your shoulders and forearms as far towards the ground as possible without your shoulder blades popping off the wall. Ideally most should have the ability to rotate their forearms to a parallel position (relative to the ground) if not further.

If you were able to easily pass this screen, congratulations. You likely have sufficient shoulder internal rotation. You do not need the flexibility and mobility exercises described below. In fact, performing stretches to create more motion could lead to instability, potentially furthering shoulder joint issues.

However, if you were unable to pass the motility screen, you must then ask yourself, “was the motion painful or stiff?”

A loss of shoulder internal rotation can be due to many factors such as limited muscular flexibility (stiff or tight soft tissues), excessive tightness in the joint capsule, or poor alignment of the shoulder complex (such as poor posture and muscular imbalances). Limited shoulder motion can be associated with many different types of shoulder injuries (such as shoulder impingement). However, deficits in shoulder internal range of motion can be caused by adaptations from sports (such as baseball throwing).

For example, research has shown that many life-long baseball players have been shown to develop a backwards “twist” of their humerus bone (called humeral retroversion) over time due to the forces sustained during the repetitive overhead throwing motion.^1,2 Much like twisting and wringing out a wet towel, the humerus twists backwards at the growth plate causing a permanent adaptation to the bone structure. This change creates a situation where the athlete shows excessive shoulder external rotation and very limited internal rotation. This however is not pathological or harmful!

Regardless of what may have caused the limitation, if moving into active internal rotation created pain, the last thing we want to do is try and stretch into that range. Doing so will only continue the pain cycle and further irritate the symptomatic tissues. Instead of trying to stretch a painful shoulder into more internal rotation, I recommend focusing your attention on addressing other factors that contribute to your symptoms (such as muscular imbalances).

However, if the screening process was pain free and only limited due to stiffness you must then consider which lifts you will be performing in the weight room and whether or not they require a good amount of shoulder internal rotation.

While limited internal rotation may not hinder your bench press, squat or deadlift technique, it can have a dramatic effect on the quality of your Olympic lifts. For example, sufficient internal rotation of the shoulder is needed in order to keep the barbell close to the body during the later phases of the pull into the turnover (especially with the snatch lift). If an athlete is missing this motion, they will often compensate in one of two ways.

The first is an exaggerated looping of the bar away from the body, killing the efficiency of the lift and causing most to miss heavy attempts forward. In an effort to combat this obvious technique fault and keep the bar close to the body, athletes will often compensate for a lack of internal rotation by then rolling their entire shoulder complex forward (by excessively moving their shoulder blade). In this context, working to improve limited internal rotation is recommended for optimal mechanics and performance.

Finding The Right Stretch

If performing the Olympic lifts is a goal of yours, and you have found yourself to have limited internal rotation motion due to perceived stiffness and not pain, it then comes down to choosing the right exercises to address this deficit. One of the most popular stretches prescribed to fix internal rotation deficits is the classic “sleeper” stretch. This exercise is in fact so popular that I have had a number of medical doctors ask specifically for this stretch for some patients. However, I’m not a big fan of this exercise and I caution you against using this stretch for a few reasons.

The first reason is that the stretch is easily performed incorrectly. I’ll often see athletes roll too far onto their shoulder and aggressively crank their hand towards the ground. In doing so, they place excessive stress on certain tissues of the joint (posterior capsule) which can lead to more problems down the road.

The stretch also looks very similar to a test we use to confirm shoulder impingement injuries called the Hawkins-Kennedy test. Internally rotating the arm in this position closes off the available room for rotator cuff and biceps tendon in the joint, impinging the structures in some and provoking pain. If you took a photo of the test being performed and flipped it on its side, it is a mirror image of the sleeper stretch. Physical therapist Mike Reinold argued that the sleeper stretch closely mimics the Hawkin’s Kennedy special test which is designed to elicit pain in someone who has anterior shoulder pain.³ So he recommends AGAINST using the sleeper stretch in general for many athletes.

Even if you could do this stretch correctly, I think there are other alternatives that may be more effective and is generally less irritable for the shoulder.

For example, a 2007 study published in the Journal of Orthopaedic & Sports Physical therapy compared the sleeper stretch to a simple cross-body stretch.⁴ They found the cross-body stretch was actually more effective in eliciting improvements shoulder internal rotation.

To perform this stretch, grab your arm with your opposite hand (around the elbow) and pull it across your chest. Doing so should bring out a stretch to the back side of your shoulder. To make this stretch even more efficient, stand in a doorway and wedge the side of your shoulder blade against the wall to keep it from moving as you pull your arm across your body.

Another helpful way to improve shoulder internal rotation is to perform soft tissue mobilization with a small ball (such as a tennis or lacrosse ball). Stand next to a wall and pin the ball between the wall and the back side of your shoulder. Slowly roll the ball around the area until you find any tender areas. Pause on these areas while you slowly pull your arm across your body.

Final Thoughts

We must always consider an individual’s needs, problem areas and goals in lifting when considering whether or not they require more shoulder internal rotation. You can find yourself in a bad position if you blindly perform internal rotation stretching without doing the appropriate screening.

Athletes require just enough mobility to meet the demands of their sport and the required movements. Athletes with extreme mobility walk a thin line (much like teetering off the edge of a cliff) between normal and dysfunction. “Just enough” mobility provides endless movement options and can maximize performance, while pushing “too much” can create instability leading to uncontrolled movement and a fast track to injury.

The questions you must always ask yourself are:

1. Do I have sufficient internal rotation?
2. If limited, is it due to pain or stiffness?
3. Do the activities and lifts I participate in require more internal rotation?

If you can correctly answer and navigate yourself through those simple questions, you’ll be in a much better position to answer the question, “Do I need more internal rotation?”

Until next time,

With

References

1. Chant CB, Litchfield R, Griffin S, Thain LM. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. J Orthop Sports Phys Ther. 2007;37(9):514-20
2. Mihata T, Hirai H, Hasegawa A, Fukunishi K, et al. Relationship between humeral retroversion and career of pitching in elementary and junior high schools. Orthop J Sports Med. 2017;5(7 suppl6)
3. Reinold M. (2019) 5 reasons why I don’t use the sleeper stretch and why you shouldn’t either [Blog Post] Retrieved from https://mikereinold.com/why-i-dont-use-the-sleeper-stretch/
4. McClure P, Balaicuis J, Heiland D, Broersma ME, et A randomized controlled comparison of stretching procedures for posterior shoulder tightness. JOSPT. 2007;37(3):108-114