Compared to some of the other information on this site, this is going to be a nerdy post. For anyone reading this who has shoulder pain there are definitely some important pieces of information. However, there is a lot of anatomy talk in this that I realize not everyone is familiar with (or wants to be familiar with). Therefore, you may want to skip around and find what is most pertinent to you.
With that said, reading the entire thing will give some insight as to just how much thought process should go into selecting some of the exercises you do, as well as the exercises I select for my clients.
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The basis for this post is a study I found titled,
–Subscapularis muscle activity during selected rehabilitation exercises.
First off, what is the subscapularis?
The subscapularis is one of the rotator cuff muscles. You know, that thing your doctor told you is messed up? And he/she said just pull on an elastic band to make your shoulder feel better…yet you can still barely move your arm.
There are four muscles that make up the cuff, and the subscapularis is one of them.
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Why you care about it:
This muscle internally rotates the humerus (upper arm) and depresses the humeral head. In other words, when you move your arm the subscapularis helps keep the shoulder nice and snug in its socket.
One of the more common causes of shoulder pain I see with new clients is an overstretched and weak subscapularis. This is often visible to the eye: Ever see people where the front of their shoulders look really boney?
Or feel your own shoulder. There should be a little give when you touch the front portion of the joint. it shouldn’t be protruding, and it shouldn’t be tender. If it is, there is a good chance your subscapularis could use some strengthening, which will help with your shoulder pain. Or prevent it.

Right picture is bad, left is good. From: http://www.manualtherapymentor.com
So what exercises best strengthen it? Based on the paper above, for the exercises they looked at, they ranked the exercises they used as follows (for a detailed look at the exercises check out the paper; click for a clearer image):
While the author’s chart makes things seem pretty straight forward, there is more to what exercise one should select. It’s actually not as simple as this exercise has greater activity than that exercise, so pick that one.
As mentioned, often times the subscapularis becomes long and weak. When one muscle becomes long and weak, typically another muscle, or muscles, becomes tight and or overactive.
When it comes to muscular imbalances (and pain) we regularly want to strengthen the long and weak muscle(s) and get the tight and or overactive one(s) to calm down. So not only do we want to pick exercises that wake up the long and weak muscle, but we want to pick exercises that, if not simultaneously, calm down the tight/overactive one.
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What becomes tight/overactive when the subscapularis is long/weak?
Often times the tight/overactive muscles in this case are pectoralis major and latissimus dorsi. This is because the subscap isn’t internally rotating the humerus like it should be. So, other internal rotators, like pec major and the lat, pick up the slack. Infraspinatus and teres minor pick up the slack as humeral head depressors.
Therefore, when strengthening the subscap we want to pick exercises that elicit great activity in the subscap, but don’t elicit much activity in pec major, lat, infraspinatus, and teres minor.
That’s where this chart from the paper comes in:
In comparing the activity of the muscles I’m going to only look at the upper subscapularis in relation to the other muscles we’re looking at. This is because I’m really not sure how important the distinction between the two is. The authors go out of their way to talk about the importance of the subscap being separately innervated. However, they mention the upper subscap has been found to be dysfunctional in those with shoulder pain, but make no such mention of the lower subscap. I’ve also seen other authors make no distinction when it comes to the shoulder issues and simply stick with, “strengthen the subscap.”
Furthermore, the upper subscap is the portion of the muscle that consistently had the highest activity, and the exercises were ranked nearly identical in terms of effectiveness between the two sections. So again, while there may be a better approach, I’m just going to look at the upper.
All right, so from looking at the chart we can see exercises such as the diagonal would be a poor choice due to the fact that pec major is more active than the subscap. This is important as simply taking the authors data at face value could lead one to suggest the diagonal is a great exercise as it was ranked as the second best.
And we can tell an exercise such as IR High is a good exercise due to the fact the subscap is more active than pec major, infraspinatus, and the lat, which are all barely active at all.
So, changing the author’s original order in terms of best exercises for the subscap based strictly on activity to best exercises based on activity in relation to the other muscles, I’d do something more along the lines of:
1) IR High
2) Push-up plus
3) Dynamic Hug
4) IR Mid
5) Forward Punch
6) IR Low
7) Diagonal
I put the IR High first because it had the biggest difference between subscap activity and other muscles with at least a 38% difference. The push-up plus and dynamic hug are next as there was still a good sized difference between the subscap and other muscles, 16 and 12% respectively. These exercises get the serratus anterior involved too, which is often overstretched and weak also.
IR High is also ranked above these as preventing the head of the humerus from moving is much easier to do than with other exercises, like the push-up plus or dynamic hug. I’ll show an example of this later.
The IR Mid and Forward Punch both favored the subscap as well, but with very small differences. The IR Mid, similar to IR High, is a better choice in my mind though because of the ability to prevent the head of the humerus moving forward.
IR Low and the Diagonal both favored the overactive muscles, thus would be contraindicated for people looking to strengthen their subscapularis.
This means if you are trying to strengthen your rotator cuff and keep your shoulder healthy, performing internal rotation with your arm by your side (IR Low) could cause you to spin your wheels, if not make things worse. This is because you are strengthening pec major just as much, if not more, than the subscap. In other words, get rid of this exercise:
And switch to this one:
You’ll notice the opposite hand is pressed down on the shoulder joint. This is to make sure the humerus does not glide anteriorly during the movement. This is crucial because the whole point of doing this exercise to get the shoulder to stop protruding.
Performing IR High already helps a lot to make sure this doesn’t happen since the muscles that cause anterior glide are primarily dormant, however, it can still happen. Therefore, putting the hand on the humerus and pushing it down and back only helps. Also, it gives the client a better understanding of why we are doing this particular exercise, as well as how we are going about ceasing their shoulder pain. This can be hard as hell to do with an exercise where a lot more is going on e.g. push-up plus.
Lastly, the IR High can be performed in the prone position as well. I’m not sure why this wasn’t examined in the study, but people who really know their stuff, such as Shirley Sahrmann and Mike Reinold, are advocates of this.
I’ll say getting people to perform the exercise prone has proven to be more difficult for me, so I tend to go with the standing version first. If you go with the prone variation make sure 1) You can see your elbow to make sure it’s not moving forward and backward (sign you are using the deltoid/lat instead of the subscap) and 2) That the humerus is not moving anteriorly.
If you look closely at the humerus here you can see how it glides toward the mat:
Again, this is exactly what we want to avoid. Putting something under the humerus can help get rid of this movement:
Just make sure whatever is put under the shoulder does not block the person’s ability to see their elbow.
Again, I tend to go with the standing variation first. It’s a bit easier to learn and there is a much greater range of motion involved. Both seem to get the job done though.
Check out some information on the law of repetitive motion for a related post.
Chris McDanel
August 2, 2016
My subscapularis is definitely involved in my shoulder problem. I’ve been dealing with it for years. I thin I could either have it being too weak, or too tight/strong… but I can’t seem to figure out how to determine this! Sometimes, when I lie on my elbows on my bed I will feel a stretch in my armpit which made me believe it was tight.
How can I make sense of the first set of pictures in this article, and determine whether my internal rotator is too weak or if my external rotators are? I would appreciate any advice immensely!!!
reddyb
August 4, 2016
Hey Chris,
You may want to reread the words before the third picture:
You can also watch the second to last video. Is the humeral head gliding anteriorly during a movement like that for you? That’s a sign the subscap needs some work.
compoundliftsvsplitroutines
January 11, 2017
Hi Brian can you forward me some links to IR mid exercises as I have been interested n what you have been posting but can not find any of these exercise details.
reddyb
January 13, 2017
But with no pad: https://www.youtube.com/watch?v=vMxD9KQLEEY
But resisting internal rotation rather than external: https://www.youtube.com/watch?v=I1TYkAl1fzw
compoundliftsvsplitroutines
January 18, 2017
Hi Brian and thanks for your reply. I will look into these over the next few days.
reddyb
January 20, 2017
You’re welcome.
Alx
April 15, 2017
hey Reddy just found your blog, wow great information. im having this issue that throughout my rotator cuff exercises the posterior capsule is tightening up after each set and then I have to keep doing sleeper stretch to reset it. Does this mean subscapularis isnt working and that my external rotators or overactive? Also how would I go about stretching lat dorsi amd pec major as I have anterior instability. Huge thanks
reddyb
April 18, 2017
Hey Alx,
-Tough to know about the posterior capsule. If you’re finding exercise isn’t getting the job done though, then that’s where I like to look carefully at daily activity. In other words, what are you doing to cause it to keep tightening up? (What are you doing during the day promoting anterior instability?)
-For stretching the lats and pec major, you’d want to stretch those areas without allowing humeral anterior glide to happen. Some examples more aimed at the lats: https://b-reddy.org/2013/09/05/a-progression-to-lifting-your-arms-overhead-pain-free/
David
June 18, 2017
Interested to read about the subscapularis.
I have been getting wretched pain in the rear delt region when pressing – whether bench or overhead. After my set I get a nasty pain that lasts 2-3 minutes and limits my EXTERNAL humeral rotation. I tried some prone and high cable INTERNAL rotations and after a few reps I stopped she tried to externally rotate in neutral and BOOM, same pain and temporary range limitation external rotation.
If however this means my subscapularis is weak (?), is it ok to try and strengthen it with prone or high cable IR if they give me pain for 2-3 mins post set? Is subscapularis pain when pressing common? Amazing website. Thanks!!
b-reddy
June 20, 2017
Hey David,
Thank you for the nice words.
Strengthening the subscapularis can be helpful here, but you also want to be looking more into humeral anterior glide. https://b-reddy.org/?s=humeral+anterior+glide
When strengthening the subscapularis, you’d want to be sure anterior glide wasn’t happening.
External rotation tends to cause anterior glide. Before attempting overhead pressing, you’d want to be sure you can get into an external rotation position without excessive (painful) glide happening. That is, usually some is ok and natural. It’s when it’s excessive it becomes painful. One example of working on this: https://www.youtube.com/watch?v=ILwZXd5Kftw
Where it might take time until you can get back enough into an overhead press position.
(Another example: https://www.youtube.com/watch?v=Yr9W20OcTZk .)
Said another way, the subscap might not be weak. It could be underactive. Where you have a habit that needs correcting, not just strengthening. You don’t want to merely be working the hell out of the muscle all in the name of strength.
None of this should be painful. If you have pain with the rotations, you’re excessively anteriorly gliding. Sometimes that’s because of not paying attention to preventing glide, but it can also be from trying to go too far or using too much weight.
(More about how posture can play a role: https://b-reddy.org/2013/02/06/example-of-a-postural-assessment-2/ .)
Jason Clement
July 21, 2017
I love how frequently I have to revisit some of your articles.
I recall doing the high IR with good results about 6 months back. Then I stopped, in favor of dedicating more time to lower trap activation (Tired of my computer posture)…
My posture looks marginally better, but i feel like I need to retrain myself to fire my right lower trap every single day.
I’m thinking, since you say decreased subscap often facilitates pec/teres/lat etc… which all oppose (at least partially…?) lower traps… I might have shifted my focus to much away from subscap.
That and I have had some resumed popping in my shoulder – although nothing like I experienced before I had initially started using the High IR exercise.
If I was to blindly listen to the internet, I’d be stretching my subscap for an hour every day. Thank you for your wonderful info as always.
b-reddy
July 24, 2017
How I would phrase it is scapular anterior tilt often goes with humeral anterior glide. Where it’s best to try and improve both rather than only one. (If you oddly only were going to change one thing though, you tend to want to start proximal, so you’d go with the scapula in this case.)
The lower trap / scapular anterior tilt has had a fair amount of confusion around it. Have another article coming where that gets hit on.
Thanks again for the nice words!
Jason clement
July 24, 2017
Thank you. I will continue to work both! Looking forward to the new article.
careyjames
July 25, 2017
What do you think of a lying version kepping shoulders retracted and depressed as if bench pressing, making sure shoulder are pineed back to the ground instead of using your hand as with standing?
Here’s a video
https://youtu.be/b3dbLPy830o
b-reddy
July 28, 2017
Unlikely a need to depress or retract the shoulder blade -during bench pressing or shoulder rotations- the thing you’re looking to avoid is anterior tilt of the scapula and or anterior glide of the humerus, but I like a supine version: https://b-reddy.org/2012/09/09/another-exercise-for-the-subscapularis/
Matt
March 26, 2018
Hi Brian,
2 questions for you:
What do you say to those who say that the scubscap is usually overworked already in weightlifters, and that it’s always the external rotators that need work? People who have seen me doing internal rotations have often felt the need to throw their 2 cents in about that.
In the past I’ve had success with low IR, but with some modifications: I hold the elbow of the rotating arm relatively snug to my waist with a cord and concentrate on keeping my shoulder blade depressed, the combination of which seems to help prevent any anterior glide during the internal rotation, and I think it helps to uninvolve the pec and lat.
much thanks,
-Matt
b-reddy
March 27, 2018
My experience with weightlifters e.g. bodybuilders and powerlifting types is they are typically very stiff in their pecs and lats- both internal rotators. So, if you have them do an external rotation motion, such as the shoulder rotations described in this post, they often won’t be able to get to 90 degrees, primarily due to pec tightness. (Lats aren’t as stretched when the shoulder is abducted 90 degrees.)
However, they often have pain going into internal rotation, due to the anterior glide issues (and excessive scapular anterior tilt) mentioned in the post. In general, the internal rotation muscles do not need work. Specifically though, avoiding anterior glide / properly engaging the subscapularis does. That doesn’t necessarily mean it’s weak though. If I remember correctly, there are even studies out there showing one of the biggest predictors of lifting success is subscapularis size.
Furthermore, plenty of these people can do the motion properly, albeit with also potentially less ROM, if coached correctly. It’s not like they necessarily need 4-6 weeks to get stronger. (The external rotation ROM limitation does usually need some time.) That said, we’re talking a comparatively puny muscle compared to the lats / pecs. Some dedicated strengthening only helps.
Long story short, there’s nothing that says a person can’t have issues going both directions. In fact, with internal / external rotation with the shoulder abducted 90 degrees, in those with a weightlifting background, it’s rather common to have issues going both ways.
Hope that makes sense. This could be an article itself; one I should probably write!
Matt
March 29, 2018
Yup, this is pretty much how I’ve always felt about internal and external rotations; that which one you do isn’t necessarily as important as doing them with a centered humerus that doesn’t glide. I feel like (and I might be wrong) that the sleeper stretch or other IR stretches can be really helpful for a deficit of internal rotation, unless of course, when you do them you’re letting the humerus glide and the scapula tilt anteriorly.
Please correct me if I’m wrong on any of that, because I might still be over generalizing some of these principles…
b-reddy
March 30, 2018
The thing about the sleeper stretch is it’s just so hard to do it with proper scapular positioning, I don’t bother with it. Some exercises can be made ok, but when it’s so hard to do so, I chalk that up to a not worthwhile exercise. If say, 7 out of 10 just can’t grasp it quickly, then I blame the exercise rather than the people trying it.
Plus, a fair amount of sensitive shoulders don’t love laying on them. For instance, these people know they can’t sleep on that shoulder, or they’re going to wake up in pain.
If we’re going to work on IR or ER, I pretty much always start people with this: https://www.youtube.com/watch?v=Yr9W20OcTZk
That way we get some work in both directions. Granted, IR gets more work resistance wise (having to overcome gravity), but ER is there.
Matt
March 31, 2018
I’ll def try the IR/ER combo with a light weight.
I have a shoulder pillow arriving Tuesday (from Amazon – the Shoulder Relief Support System). It mimics how I sleep with my pillow arrangement, so it’ll be interesting to see how that works.
If I look at my shoulders while doing a double biceps pose in the mirror, my bad shoulder is much less round, and only gets the same roundness at my good shoulder if I force it into bit of additional external rotation. I’ll been lacrosse balling my pec major (and what I can of minor) and making a big effort and no having a forward head posture while working at my desk – but my shoulder still feels locked into internal rotation after lacrossing against the wall.
I’m wondering if the opposite of the sleeper stretch is what I need, to help unglue my subscap a bit.
Your commentary is gold btw.
b-reddy
April 3, 2018
Those types of subtleties are where an assessment comes in. Feel free to check this out: https://b-reddy.org/the-remote-client-process/
Glad you like the comments!
Asif Rashid
August 19, 2020
Hi Brian
Hope you are well
2 years ago i injured my subscap from bad form on the incline barbell bench
2 years If i put my arm behind my back and extend to do the subscap test i can pass it however i feel the teres minor is really tight and contracting. Perhaps it is working over time to depress the humerus. I also occasionaly feel the bicep tighten for no apparent reason and the chest (maybe pec minor) tighten up
I looked at your article and can see i was doing the low IR which may of caused of me to be training the chest instead of a higher level of the subscap.
So today i foam rolled the teres minor and i did the push up plus and lying down IR. Now the teres minor tightness has gone though my subscap feels a little tight. I will do some active release on it. My teres minor was tight for up to 3 months on and off until i read your article.
Are their any tips you can give me based on the info i have provided
thanks
Asif
b-reddy
August 21, 2020
Hey Asif,
Based on what you’re saying so far, no other ideas come to mind. Sorry about that. If you want me to take a closer look (for instance, I’d want to know more about your training routine), this where to start: https://b-reddy.org/the-remote-client-process/