The Brookbush Institute (BOC AP# P10038) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of {{credits}} hours/ Category A CEUs. ATs should claim only those hours actually spent in the educational program.

Board Of Certification

Canadian Fitness Professionals

Athletics and Fitness Association of America

Provider #1315 Home Study and Credits: {{ncbtmbCredits}}

National Certification Board for Therapeutic Massage & Bodywork

International Sports Sciences Association

American College of Sports Medicine

NASM Provider #737 and 1 Credit = 0.1 NASM CEUs

National Academy of Sports Medicine

Providers of Approved Continuing Education

World Instructor Training Schools

Completion of this course will earn you {{credits}} non-contact hours of continuing education in "Anatomy and Physiology" with Yoga Alliance

Yoga Alliance

CIMSPA

ACE Course ID: {{aceId}} and Credits: {{aceCredits}}

American Council on Exercise

This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2309052TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas.

Texas Physical Therapy Association

New York Physical Therapist just a disclaimer The Brookbush Institute (B2C Fitness) is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education.

New York State Education Department's State Board for Physical Therapy

The Brookbush Institute is an AOTA Approved Provider of professional development. PD activity approval ID# {{aotaCourseApprovalNumber}}. This distance learning-independent activity is offered at {{aotaCredits}} CEUs {{aotaLevel}} {{aotaCategory}}.  AOTA does not endorse specific course content, products, or clinical procedures.

American Occupational Therapy Association

Approved for {{credits}} CEUs by CPTA #CPTAAP-36

California Physical Therapy Association

Approved by CATA and 1 course contact hour = 0.4 CATA CEUs

Canadian Athletic Therapists Association

Massage Therapist Association of Saskatchewan, Inc.

Approved as a primary activity CEUs.  1 credit = 2 primary hours

Massage Therapists’ Association of Nova Scotia

Shoulder External Rotator Exercises (Activation) Audio

Infraspinatus and teres minor (posterior rotator cuff) exercises for improving movement dysfunction, posture, shoulder pain, shoulder impingement, forward head, rotator cuff injury, and sports performance. Great infraspinatus and teres minor activations for the posterior rotator cuff.

Shoulder External Rotator Exercises (Activation)

Access to all courses with monthly membership

Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

Home

Courses

Human Movement Specialist

This course describes infraspinatus and teres minor exercises, commonly referred to as shoulder external rotator activation. Performing external rotation, with the addition of flexion and adduction of the shoulder joint, may improve recruitment (isolation) of this important muscle. The infraspinatus and teres minor act as stabilizers and external rotators of the glenohumeral (shoulder) joint. It is common to include these exercises in a program designed to address shoulder dysfunction. Addressing these signs has been correlated with improving and reducing the risk of shoulder pain, rotator cuff injury, shoulder impingement syndrome, shoulder instability (hypermobility), thoracic kyphosis, scapular dyskinesis, lateral epicondylitis, and improving sports performance. Movement professionals (personal trainers, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding these exercises to their repertoire with the intent of improving patient/client outcomes from their integrated exercise programs and therapeutic (rehabilitation) interventions.

External Rotation Progression at 90 degrees of Flexion + Scapular Stabilization

Deep Cervical Flexor Activation and External Rotator Activation

Last, it is important to integrate the increase in infraspinatus and teres minor activity into functional exercise. The Brookbush Institute accomplishes this with intrinsic stabilization subsystem and posterior oblique subsystem integration. Some example movements for these purposes include:

Human Movement Specialist (HMS) Certification

Pre-approved for Continuing Education Credits for:

Dr. Brent Brookbush Demonstrating External Rotator Activations

Course Description: Infraspinatus and Teres Minor Exercises (Activation)

Shoulder External Rotator Exercises (Activation) Course Study Guide

Study Guide: Shoulder External Rotator Exercises (Activation)

Shoulder External Rotators In Postural Dysfunction And Movement Impairment

 have a propensity to become inhibited and under-active (relatively weak during activity). This reduces our ability to eccentrically decelerate shoulder internal rotation and flexion, and maintain shoulder alignment during daily activity and sport. This impaired function may result in dyskinesis (movement dysfunction) of the shoulder and scapula and is often paired with over-activity of the

. Infraspinatus and teres minor inhibition may reduce performance, increase the risk of future injury and dysfunction, and is correlated with pain and dysfunction of the shoulder, neck, and upper body extremities.

Dr. Brent Brookbush demonstrating arms fall in an overhead squat assessment

Signs of Under-Activity & Length in Weak Infraspinatus and Teres Minor Muscles

Introduction to Infraspinatus and Teres Minor Exercises

Muscles that commonly become synergistically dominant when the external rotators of the shoulder are inhibited – Release and stretch prior to activation and cue joint motion to reciprocally inhibit these muscles during activation exercise.

 (inhibit w/ adduction and flexion into the scapular plane)

An image of the supraspinatus, a commone overactive muscles associated with upper body dysfunction

Overactive Synergists

, external rotator activation should follow 

 but should precede other upper body isolated activation exercises. Generally speaking, the exercises used for external rotator activation are more "isolated" than the exercises used for 

 That is, the exercises used for serratus anterior and trapezius activation also require a significant contribution from the external rotators. For those individuals with 

, isolated activation is best performed in the following sequence:

Best Practice (Optimizing Motion)

There is a relatively small amount of research on the function of the shoulder external rotators (

), their activity relative to movement impairment, and the effect exercise may have on enhancing strength, endurance, hypertrophy, and recruitment.

 present with limitations in shoulder flexion and abduction, and a resting 

 that includes excessive humeral internal rotation. This would imply that the infraspinatus and teres minor were 

, and that activation and strengthening techniques may improve 

 and motion. Strengthening techniques for the shoulder external rotators are common, as demonstrated by the comparative studies of various external rotator strengthening techniques conducted by Ha et al. (16) and Reinold et al. (15). Adding to the hypothesis that the shoulder external rotators are 

. The Ha et al. study (16) even aimed to determine the external rotator activation technique that resulted in the least amount of 

In a study by Scovazzo et al. (17), swimmers with painful shoulders showed an increase in infraspinatus activity during “pull through” when compared to those swimmers without shoulder pain, contradicting the 

 hypothesis. In fact, the effect pain and dysfunction have on 

 may imply opposite changes in the length and activity of the shoulder external rotators (

). In a study by Lawrence et. al. (18), pain and dysfunction did not result in superior 

 (which is commonly thought of as a component of shoulder impingement syndrome), but an increase in anterior 

 during abduction. Based on fiber direction, EMG studies, and investment in the posterior capsule, the infraspinatus and teres minor likely contribute to inferior and anterior 

Some of the difficulty in labeling the maladaptive length and activity of the shoulder external rotators in 

 may originate from an attempt to view the shoulder independently of other joints. Several studies have shown a strong correlation between shoulder dysfunction and scapular dyskinesis (1-8), shoulder/scapular dyskinesis and cervical dysfunction (9-11) and a study by Otoshi et al. showed a link between shoulder impingement and thoracic kyphosis (12). External rotation strength has been linked to scapular dyskinesis as well (18). In essence, the shoulder functions as part of an integrated system of joints that include the shoulder, scapula, cervical and thoracic spine, and likely the joints of the ribs (costovertebral and sternocostal).

It is the Brookbush Institute's stance that addressing shoulder external rotators with activation exercises is most often beneficial, including modifications that assume the 

 is synergistically dominant for an inhibited 

. In cases of glenohumeral hyper-mobility, specifically anterior laxity, it may be beneficial to release the external rotators prior to activation techniques. In the study by Reinold et al., exercises similar to those in progression 1 were shown to result in less posterior deltoid and 

 recruitment, relative to the recruitment of the 

 (7 commonly used exercises were compared) (15). Further in a study by Ha et al. external rotation at 90° of flexion was shown to further increase 

 activity (16); however, absolute infraspinatus activity may decrease with arm elevation angle (17).

Dr. Brent Brookbush demonstrating an external rotator activation exercise to a patient

Research on Infraspinatus and Teres Minor Muscle Exercises

Unilateral External Rotator Activation with Modifications

External Rotation Progression at 90° of Flexion with Scapular Stabilization

Chest Out/Thumbs Out

Best Exercises for Infraspinatus and Teres Minor Isolated Activation

Single-leg Standing Cobra 

Single-leg Standing Cobra to Balance to Calf Raise

Single-leg Alternating Abduction

Integrated Stabilization

Trapezius and Shoulder External Rotator Reactive Activation

Body Blade Reactive Activation

Trapezius and Shoulder External Rotator Reactive Activation 

Reactive Activation

: In a study by Kaya et al., shoulder taping was found to be more effective for the treatment of shoulder pain than electric stimulation or ultrasound (19).

External Rotator Facilitation Taping:

50 yo male, former athlete, complaints of anterior shoulder pain the day after chest or shoulder exercises.

Thoracic Spine Mobilization: Posterior-to-Anterior and Transverse

Mobility Program: Self-administered Techniques

Teres Major and Latissimus Dorsi Self-Administered Static Release

Subscapularis Self-Administered Static Manual Release

Posterior Shoulder Self-Administered Static Manual Release

Self-Administered Thoracic Spine Rotational Mobilization

Self-Administered Thoracic Spine Mobilization

Light to Moderate (60 - 85% of 1-RM), focus on form and ROM

 Circuit training, 1 min rest between exercises

 5 - 15 minutes (excluding mobility interventions)

Shoulder External Rotator Isolated Activation

Serratus Anterior Isolated Activation Progressions

External Rotator (Body Blade) Reactive Activation

Single Leg Touchdown with Scaption to PNF Carry Away

Sample Activation Circuit: Infraspinatus and Teres Minor Exercises 

Ha, Sung-min., Kown, Oh-yum., Cynn, Heon-seock., Lee, Won-hwee., Park, Kyue-nam., Kim, Si-hyun., & Jun, Do-young. (2012) Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. 

Wong CK, Coleman D, diPersia V, Song J, Wright D. (2010). The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. 

Cools, A.M., Witvrouw, E.E., Declercq, G.A., Danneels, L.A., Cambier, D.C. (2003) Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. 

Tsai NT, McClure PW, Karduna AR. (2003). Effects of muscle fatigue on 3-Dimensional scapular kinematics. 

Ludewig P.M., Cook, T.M. (2000) Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. 

Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. 

journal of orthopaedic & sports physical therapy

Fayad F, Roby-Brami A, Yazbeck C, Hanneton S, Lefevre-Colau MM, Gautheron V, Poiraudeau S, Revel M. (2008). “Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder.” 2008 

Suzuki, H., Swanik, K. A., Huxel, K. C., Kelly, J. D., & Swanik, C. B. (2006). Alterations in upper extremity motion after scapular-muscle fatigue. 

Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. 

Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. 

Journal of electromyography and kinesiology

Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. 

Journal of Electromyography and Kinesiology

Otoshi, K., Takegami, M., Sekiguchi, M., Onishi, Y., Yamazaki, S., Otani, K., Shishido, H., Shinichi, K., Shinichi, K. (2014). Association between kyphosis and subacromial impingement syndrome: LOHAS study. 

Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. 

José Miota Ibarra, Hong-You Ge, Chao Wang, Vicente Martínez Vizcaíno, Thomas Graven-Nielsen, Lars Arendt-Nielsen. Latent Myofascial Trigger Points are Associated With an Increased Antagonistic Muscle Activity During Agonist Muscle Contraction. 

 Volume 12, Issue 12, December 2011, Pages 1282–1288

Reinold MM, Wilk KE, Fleisig GS, Zheng N, Barrentine SW, Chmielewski T, Cody RC, Jameson GG, Andrews JR. Electromyographic Analysis of the Rotator Cuff and Deltoid Musculature During Common Shoulder External Rotation Exercises. J Orthop Sports Phys Ther. 2004 Jul;34(7):385-94

Ha, S., Kwon, O., Cynn, H., Lee, W., Kim, S., Park, K. (2013). Selective activation of the infraspinatus muscle. 

Daisuke Uga, Yasuhiro Endo, Rie Nakazawa, Masaaki Sakamoto. Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles. J Phys Ther Sci. 2016 Jan; 28(1): 154–158

Daisuke Uga, Rie Nakazawa, Masaaki Sakamoto. Strength and muscle activity of shoulder external rotation of subjects with and without scapular dyskinesis. J Phys Ther Sci. 2016 Apr; 28(4): 1100–1105.

Kaya, E., Zinnuroglu, M., Tugeu, I. (2010) Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clinical Rheumatology. (30) 201-207

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Shoulder External Rotator Exercises (Activation)

Related Courses:

Course Description: Infraspinatus and Teres Minor Exercises (Activation)

Study Guide: Shoulder External Rotator Exercises (Activation)

Introduction to Infraspinatus and Teres Minor Exercises
1 Sub Section

Overactive Synergists

Best Practice (Optimizing Motion)

Research on Infraspinatus and Teres Minor Muscle Exercises

Best Exercises for Infraspinatus and Teres Minor Isolated Activation
3 Sub Sections

Integrated Stabilization
3 Sub Sections

Reactive Activation
2 Sub Sections

External Rotator Facilitation Taping:

Sample Activation Circuit: Infraspinatus and Teres Minor Exercises

Bibliography

Related Courses:

Comments

Guest

Shoulder External Rotator Exercises (Activation)

Related Courses:

Course Description: Infraspinatus and Teres Minor Exercises (Activation)

Study Guide: Shoulder External Rotator Exercises (Activation)

Introduction to Infraspinatus and Teres Minor Exercises1 Sub Section

Overactive Synergists

Best Practice (Optimizing Motion)

Research on Infraspinatus and Teres Minor Muscle Exercises

Best Exercises for Infraspinatus and Teres Minor Isolated Activation3 Sub Sections

Integrated Stabilization3 Sub Sections

Reactive Activation2 Sub Sections

External Rotator Facilitation Taping:

Sample Activation Circuit: Infraspinatus and Teres Minor Exercises

Bibliography

Related Courses:

Comments

Guest

Introduction to Infraspinatus and Teres Minor Exercises
1 Sub Section

Best Exercises for Infraspinatus and Teres Minor Isolated Activation
3 Sub Sections

Integrated Stabilization
3 Sub Sections

Reactive Activation
2 Sub Sections