My experience with rotator cuff exercises

Back in 2019 did an oopsie. I was at a party and saw someone teaching the human flag pole exercise/party trick and I wanted to give it a go. I kept bending my elbow which is apparently a big no-no and I caused a strain in the front of my right shoulder.

Since then I’ve had minor pain on and off, and relative weakness in my right (dominant) shoulder compared to my left. Particularly with overhead movements my right shoulder is more stiff and gives out quicker. That is unless I do some PT exercises before I work out.

I’ve noticed that when I’m consistent in doing a proper rotator cuff warmup I don’t get pain, and my strength is more similar between my left and my right. This warm up always starts with a little mobility work, essentially stretching. And is followed by the real key for me which is stability work: slow controlled external rotation of the shoulder in different positions.

Working the small stabilizer muscles in external rotation helps to support my shoulder in its proper position, and re-educate my body to keep proper shoulder joint positioning throughout my workouts. Generally the urge will be to turn too much internally and pinch upward, causing pressure on the supraspinatus or bicep tendon. The exercises prime the stabilizers around the shoulder to properly activate and hold the shoulder in proper positioning.

The most interesting bit to me, and the reason I’m writing all of this, is just my personal experience about the good and bad news of these exercises. For me, there isn’t a point in which I’ve fully “fixed it”. While I don’t have unprovoked pain away from lifting, if I try to use my right shoulder without warming up with these exercises, the pain always comes back.

I’ve tried a few times now working out without these exercises, and the pain always comes back, even 6 years after the incident, and about a year of regular rotator cuff work.

So, bad news is, it isn’t a fix. If I stop my exercises the pain will return. But the great news is, I can manage my shoulder issues on my own with just about 5-10 minutes work before I plan to lift anything heavy with my shoulders. That works for me.

For more details about some of the stuff I do, check out my favorite PT’s article on shoulder stability: https://squatuniversity.com/2018/10/06/stabilizing-the-shoulder-blade-joint/

Why the Gluteus Medius Matters in Rehabbing From Back or Knee Pain

Knee pain and low back pain often trace back to the same culprit: poor gluteus medius function. When this muscle isn’t firing well, the knee can collapse inward (valgus), stressing the joint and contributing to patellofemoral pain. At the same time, an underactive glute medius fails to stabilize the pelvis, forcing the lower back and surrounding muscles to take on extra work—often aggravating pain instead of easing it.

That’s why the gluteus medius is such a key player in both injury rehab and long-term resilience. Let’s look at what it actually does, and which exercises best restore its strength and stability.

🔑 Key Functions

Hip Stabilization (especially when standing on one leg)
The gluteus medius helps keep your pelvis level when you walk, run, or stand on one leg.
Without it, your pelvis would “drop” on the unsupported side—a condition called Trendelenburg gait.

Lateral Stability & Balance
It acts like a side anchor, keeping your hips, knees, and ankles in good alignment.
This protects against wobbly knees, ankle rolling, and inefficient force transfer when moving.

Hip Abduction
Moving your leg out to the side (like in side steps or kicking outward) is primarily the job of the glute med.
It also helps rotate the hip outward and inward depending on leg position.

Joint Health & Injury Prevention
A weak glute med often shows up as knee pain, IT band issues, or hip discomfort.
Runners, lifters, and athletes especially rely on it to prevent overloading other muscles and joints.

Athletic Power & Efficiency
Strong glute medius = better agility, cutting, lateral shuffling, sprint mechanics, and force transfer.
It’s a hidden powerhouse for acceleration and deceleration.

👉 In short: the gluteus medius keeps you upright, balanced, and protected, whether you’re just walking down the street or cutting hard on the basketball court. It’s a stabilizer first, mover second—and that’s what makes it so essential.

🏋️ Exercises to Strengthen Your Glute Medius

Here are three of the most effective exercises to strengthen your gluteus medius. They’re simple, but if you load or sequence them right, they hit hard:

1. Side Plank with Hip Abduction (Hold Variation)

How: Start in a side plank on your elbow. Lift the top leg just a few inches and hold it there for 5–10 seconds before lowering.

Tips:

Keep hips stacked and core engaged so you don’t rotate forward or backward.
Focus on stability, not just swinging the leg.

Why: Builds glute med strength while training it in its stabilizing role, which carries over more directly to real-life movement.

Note: Variations like clamshells with a band or banded side planks are also great for learning to activate and stabilize the glute med.

2. Banded Lateral Walks (a.k.a. Monster Walks / Side Steps)

How: Place a resistance band around your thighs (just above knees or ankles). Get into an athletic quarter-squat and take wide steps sideways.

Tips:

Keep constant tension on the band (don’t let your feet snap together).
Stay low to keep glutes engaged.

Why: Teaches hip stability and strengthens glute med under load—fantastic for runners and athletes.

3. Single-Leg Glute Bridge / Hip Thrust

How: Lie on your back, one foot planted, the other lifted. Drive through your planted heel to lift hips off the ground.

Tips:

Actively keep hips level (don’t let one side sag).
Squeeze glutes at the top, control on the way down.

Why: Forces the glute med to stabilize pelvis while the glute max drives extension—mimics real-life one-leg stance mechanics.

Note: For those working with a coach or therapist, more advanced drills like the DNS star can build even deeper coordination, but most people will benefit from starting with these simpler exercises first.

⚡ Bonus progression: Once you’ve mastered these, add Bulgarian split squats or single-leg Romanian deadlifts. They hit the glute med hard as a stabilizer in functional patterns.

✅ Conclusion

Strong gluteus medius muscles don’t just build athletic power — they protect your joints, improve balance, and keep everyday movement smooth and pain-free. Whether you’re rehabbing from low back or knee pain, training for sport, or just looking to feel stronger on your feet, a little focused glute med work goes a long way.

Hip Airplane: Stop Letting Your Back Do Your Hips’ Job

What It Is

Category: Dynamic stability + active mobility drill
Focus: Strengthens glute medius/max, deep hip rotators, and core while actively improving hip internal/external rotation range.
Why It Works: You’re balancing on one leg, hinging forward at the hips, and then rotating your pelvis open/closed—forcing the stabilizers to work while moving through controlled ranges.

Why It’s Great for Stability + Mobility

Stability: Trains the glute medius to hold the pelvis level while dynamic movement happens above.
Mobility: Opens and closes the hip capsule actively, increasing usable rotation range (critical for deep squats, lunges, kicking, and acro).
Balance: Challenges proprioception
Core–hip connection: Forces the obliques, core and back muscles to stabilize the spine while the pelvis rotates.

How to Do Hip Airplanes

1️⃣ Setup

Stand tall on one leg (soft bend in knee).
Hinge forward from the hips into a single-leg RDL position — back leg extended behind you, torso roughly parallel to the ground.
Arms can go out like airplane wings for balance, or hands on hips to feel your pelvic rotation.

2️⃣ Movement

Open: Slowly rotate your chest and pelvis outward, so your hips are “stacked” (standing leg hip moving into external rotation).
Close: Rotate your chest and pelvis inward, so your hips are “square” or even slightly past square (standing leg hip moving into internal rotation).
Keep the knee of your standing leg pointing forward—don’t let it drift side to side.
Move with control, pausing briefly in each position.

3️⃣ Reps & Tempo

3–5 reps per side, each rep being open → closed → back to open = 1
Slow and controlled: ~3–5 seconds each way

Key Cues

Hinge, don’t twist the spine → all the rotation happens at the hip socket.
Standing leg stays strong → slight bend, knee over mid-foot.
Foot tripod → big toe, little toe, and heel stay grounded.
Think of “rotating your belly button” rather than swinging the leg.

Link to Back and Hip Pain

Back pain

Limited hip rotation or poor pelvic stability forces the lumbar spine to rotate more than it should, creating micro-twists with every step or bend.
Hip airplanes build rotational strength and mobility at the hip, reducing the need for your low back to compensate.

Hip pain

Weak glute medius/max can shift excess load onto the hip flexors, adductors, or deep rotators, leading to overuse and irritation.
Controlled rotation in hip airplanes improves joint alignment and muscular balance, which can reduce discomfort—especially in mild impingement cases (avoid during acute flare-ups).

Rethinking Back Pain: The Role of Fascia

Today I want to talk about something I’ve seen as a primary source of pain in countless patients—yet it’s rarely mentioned in medical school or by most doctors. While I’m still exploring the best ways to keep fascia healthy over the long term—through stabilizing exercises, muscle balancing, and movement practices—I’ve consistently found that massage, cupping, and acupuncture can bring meaningful relief.

For now, let’s start with the basics: what fascia is, and more specifically, the type I most often hear patients describe as the exact spot of their pain—the thoracolumbar fascia.

What Is Fascia?

Fascia is a type of connective tissue in your body—it’s kind of like a full-body spiderweb made of collagen that surrounds and supports everything: muscles, bones, nerves, blood vessels, and organs. It’s not just passive packing material—it’s dynamic, sensitive, and deeply involved in how your body moves and feels.

🧠 Key Facts

Structure: Tough but flexible, fascia is made mostly of collagen fibers arranged in a multidirectional web.
Function: It holds things in place, transmits force, reduces friction, and allows structures to slide smoothly over each other.
Layers:
- Superficial fascia: just beneath the skin, often containing fat.
- Deep fascia: wraps around muscles and bones.
- Visceral fascia: encases internal organs.

Fascia can get tight, stuck, or inflamed, contributing to pain and mobility restrictions—even far from the original source. It’s richly innervated, meaning it plays a major role in proprioception and pain perception. Manual therapies (like massage, myofascial release, or acupuncture) often aim to restore its glide and elasticity.

🧱 Thoracolumbar Fascia (TLF)

The thoracolumbar fascia (TLF) is a major fascial structure in your lower back—like a thick, multilayered tension bridge connecting your upper and lower body. It’s central to stability, movement, and force transmission, especially through your core and spine.

📍 Location

The TLF spans from the thoracic spine to the sacrum, stretching laterally to the ribs and hips, and includes three layers:

Posterior layer: Just under the skin and superficial muscles like the latissimus dorsi.
Middle layer: Between the deep back muscles (e.g., multifidus) and quadratus lumborum.
Anterior layer: Deepest, lying in front of quadratus lumborum and connecting to the psoas.

🏋️‍♂️ Function and Importance

Core Stability:
Acts like a natural weightlifting belt by anchoring key muscles:
- Latissimus dorsi
- Gluteus maximus
- Transversus abdominis
- Internal obliques
  These muscles create tension through the fascia to stabilize the spine.
Force Transmission:
Transfers power between upper and lower body—especially important in walking, running, lifting, and rotation.
Back Pain:
Adhesions or tension in the TLF can reduce mobility and contribute to chronic or mechanical low back pain.
Sensory Function:
Fascia is packed with sensory nerves. Dysfunction here doesn’t just feel tight—it can generate real pain and disrupt body awareness.

🔧 Clinical Implications

Manual therapies (massage, cupping, acupuncture) can reduce tension and improve glide between fascial layers.
Engaging muscles like the transversus abdominis through exercises (planks, dead bugs, etc.) strengthens the fascial tensioning system.
Dysfunction in the glutes, lats, or obliques can create asymmetrical pulls, affecting spinal mechanics via the TLF.

🧩 Summary

The thoracolumbar fascia acts as a central tension system for the torso, tying together posture, movement, stability, and sensation. If something’s off in your core, hips, or back, chances are the TLF is part of the story.

Back Pain Prevention – The 3 Exercises Spine Experts Trust

The McGill Big 3 are a trio of core stabilization exercises developed by Dr. Stuart McGill, a leading spine biomechanist. These exercises aim to build core endurance and protect the spine by training the muscles that support it — without placing excessive stress on the lower back.

They are especially popular in rehab, physical therapy, and strength coaching communities for people recovering from low back pain or looking to prevent it.

💪 The McGill Big 3

Curl-Up
- Target: Rectus abdominis (front of the core)
- How to do it:
  - Lie on your back with one leg straight and the other bent (foot flat).
  - Hands go under your lower back to maintain a neutral spine.
  - Gently lift your head, shoulders, and chest slightly off the floor — just enough to engage the abs — then hold for 10 seconds.
  - Avoid flexing the spine like a crunch. Keep the neck in a neutral position.
- Purpose: Builds abdominal endurance without stressing the spine via flexion.
Side Plank
- Target: Obliques and lateral stabilizers
- How to do it:
  - Lie on your side with your elbow under your shoulder, legs straight, top foot in front of the bottom.
  - Lift hips to form a straight line from shoulders to feet.
  - Hold for 10 seconds (or longer, if trained), then switch sides.
- Modifications: Beginners can bend knees or use a hand for assistance.
Bird Dog
- Target: Posterior chain (low back, glutes, shoulders)
- How to do it:
  - Start in tabletop position (hands and knees).
  - Extend one arm forward and the opposite leg back.
  - Keep hips and shoulders square — no twisting.
  - Hold for 10 seconds, then switch sides.
- Focus: Controlled movement, minimal spinal motion.

🔁 Programming Notes

McGill suggests: 3–5 reps per side, 10-second holds, multiple sets if needed.
Quality > quantity: These exercises emphasize stability and control, not brute strength or fatigue.
Often used as a warm-up or daily core routine, especially in rehab settings.

For more information and visuals visit:
https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-core-stability/

Lifestyle: The Third Pillar of Health

The Broad Strokes of Lifestyle

Lifestyle encompasses a range of habits and behaviors:

Movement: Regular physical activity supports cardiovascular health, maintains muscle mass, and boosts mental well-being.
Sunlight and Nature: Exposure to natural light and green spaces can improve mood and regulate circadian rhythms.
Substance Use: From alcohol to cannabis to medications, how we engage with substances affects our sleep, hormones, and resilience. Occasional, intentional use may not be a problem—but chronic use often comes at a cost.
Stress Management: Managing stress isn’t only about breathwork or meditation—it’s also about how we relate to our thoughts, reframe challenges, and regulate emotions under pressure.
Social Connections: Engaging with a community provides emotional support and has been linked to longer life expectancy.

While each of these elements plays a role, let’s delve deeper into a critical cornerstone of lifestyle: movement.

Exercise: The Cornerstone of a Healthy Lifestyle

Shared Benefits: Cardio & Resistance Training

Not all movement is the same, but much of it leads to similar outcomes. Whether you’re lifting weights or going for a run, both resistance and cardiovascular training offer a wide range of overlapping benefits:

Improved metabolic health: Both forms of exercise help regulate blood sugar, increase insulin sensitivity, and support healthy body composition.
Better mood and mental health: Regular physical activity reduces symptoms of depression and anxiety, improves stress resilience, boosts feel-good brain chemicals like endorphins and dopamine, and helps regulate the nervous system.
Cognitive support: Movement increases blood flow to the brain and stimulates the release of brain-derived neurotrophic factor (BDNF), which aids memory, focus, and long-term brain health.
Hormonal balance: Exercise can improve testosterone, estrogen, and growth hormone levels, while helping regulate cortisol when practiced consistently and mindfully.
Lower inflammation and biological aging: Studies show that both resistance and cardio training reduce markers of chronic inflammation and can even slow biological aging.

But while they share a lot, they also each bring something unique to the table.

Cardiovascular Exercise: Building Endurance from the Inside Out

Cardio exercise is especially valuable for:

Heart and circulatory health: Aerobic activity strengthens the heart, lowers blood pressure, and improves overall circulation—helping reduce the risk of cardiovascular disease.
(CDC)
Mitochondrial function and metabolism: Steady-state cardio, especially Zone 2 training, enhances mitochondrial health and supports long-term metabolic efficiency.
(Peter Attia, MD)
Brain health and cognitive protection: Regular cardio is linked to greater hippocampal volume and slower age-related cognitive decline, supporting memory and mental clarity.
(Harvard Health)
Accessibility and adaptability: Activities like walking, swimming, and cycling are low-barrier and easy to sustain. Even short sessions can deliver benefits, and interval training offers similar gains in less time.
(Harvard Medical School)

Resistance Training: Building Strength for Life

Resistance training is especially valuable for:

Muscle and bone health: It preserves lean mass, prevents frailty, and supports bone density—key factors in aging well and maintaining independence.
(NIH source)
Glucose control: While both cardio and strength training help, resistance work is especially effective by increasing muscle mass, which improves how your body stores and uses blood sugar—even at rest.
(Harvard Health)
Posture and injury prevention: Strong muscles support alignment, reduce back pain, and improve movement patterns that protect joints and reduce fall risk.
(Mayo Clinic)
Resilience and longevity: Grip strength and muscle mass are strong predictors of lifespan—arguably more useful than weight or BMI in older adults. Just 90 minutes of resistance training per week has been shown to slow biological aging by up to four years.
(Prevention.com)

Crafting a Sustainable Exercise Routine

Building a lasting exercise habit doesn’t require drastic measures. Start with manageable goals:

Consistency Over Intensity: Regular, moderate workouts are more sustainable and beneficial than sporadic intense sessions.
Find Activities You Enjoy: Whether it’s dancing, hiking, or sports, engaging in activities you enjoy will help you stick with the practice.
Pair It with Routine Anchors: Linking your workouts to an existing habit—like a walk after work or lifting before your shower—makes the behavior easier to stick with over time.

Bringing It All Together

Whether you’re lifting weights, walking in the woods, dancing in your kitchen, or easing into a gentle swim, the goal isn’t perfection—it’s momentum.

Start where you are. Pick something that feels doable. Keep showing up, and over time, even small choices compound into something strong, steady, and life-giving.

The Basics of Physical Therapy: What I Tell My Patients Most Often

Disclaimer: With this and any other blog post, please note that nothing written here is a substitute for getting specifically tailored advice from a specialist/provider.

Much of the physical therapy information I share with patients comes from Dr. Aaron Horschig of SquatUniversity.com. While the information is geared towards lifters, I find his information to be well researched and widely applicable.

The main idea is that pain often comes down to mobility and stability issues that can be corrected over time with consistent use of proper stretches and stabilization exercises.

While specific evaluation of a patient is necessary to gear a treatment plan for someone, there are some broadly applicable themes for most cases.

Let’s look at the shoulder for instance. Stiffness and tightness around the shoulders might be due to stuck or spasmed muscles around the shoulder such as the trapezius (trap) or latissimus dorsi muscles (lats). Alternatively, you might be dealing with the very common issue of under-trained or underactive rotator cuff muscles, which are meant to stabilize the shoulder joint.

It’s entirely possible to have both going on at once. If so you might practice different mobility/stretching work for the shoulders first, or even a foam roller lat release. Then after your body is moving properly, you might practice some kind of external rotation stabilization exercise at the shoulder, making sure to pause for at least 5 seconds at the most challenging part of the movement.

Essentially certain prime movers/big muscles can often overpower our smaller stabilizer muscles.

So first we work to loosen up these overpowering muscles before getting the stabilizers to do the job they were meant for. It’s important to note that pure strength of the stabilizers is not the goal. We need the body to get into this subconscious habit of turning on the stabilizers when we move, not to just contract them strongly with specific exercises, and be ignored otherwise.

Often the progress is a combination of fast and slow. It’s fast because when you get the right combination of exercises, and properly mobilize and stabilize the shoulder joint, you can do relatively light weight pain-free movement immediately in some cases. However, the pain will likely return automatically without consistent effort to retrain the body into this new mode of movement.

Another common painful area that can respond well to physical therapy is the lower back. However, the lower back can be more complex to evaluate and treat. The root of the problem might originate all the way down at the foot—or anywhere in between, especially the ankles, knees, or hips.

The overall principles are the same though: evaluate which areas aren’t moving properly, and then what stabilizer muscles aren’t activating properly, loosen/move the former and train the latter, usually in a more static movement-resisting fashion.

There are a couple different options for making this information more specific to you. Squatuniversity.com has a ton of videos all over the internet you can search for that go over specific problem areas, so that’s an easy way to get started looking into your own challenges. You can always work directly with a physical therapist on these issues. I’m also happy to point you in the right direction during our sessions.

Feel free to send me a text at 919-809-9355 to get started.