16 Mar Exercises For Rotator Cuff Injury
Are you dealing with a rotator cuff injury? If you answered yes, don’t worry! Regardless of the severity of your rotator cuff injury, there is a solution out there for you. We have helped thousands of people with rotator cuff issues, it just comes down to quality education and exercises. In this article, you’ll learn about rotator cuff injuries, rotator cuff tests, and exercises that can help with any rotator cuff issue.
ROTATOR CUFF INJURY – WHAT IS IT?
A rotator cuff injury is an insult to the muscle or tendon associated with either the supraspinatus, infraspinatus, subscapularis and/or teres minor muscles. The most common complaints associated with rotator cuff issues are pain and weakness. If you see a doctor you might hear things such as a rotator cuff strain or tendinitis. If you end up getting imaging such as an MRI – you may read and hear things such as a full-thickness tear, partial-thickness tear, tendinosis of the supraspinatus tendon, or calcific tendinopathy. You may even hear things that seem unrelated such as bursitis, impingement, or muscle atrophy and fatty degeneration.
This can sound scary and make you feel completely overwhelmed. However, no matter what any doctor says or an MRI report says, you have options and you have reasons to be optimistic! Let me explain why.
- Degenerative changes in rotator cuff tendons that are labeled as tendinosis or partial-thickness tears on imaging are not that uncommon. It is very normal to have degenerative changes on an MRI report, especially the older you are. Degenerative changes do not equate to pain or the inability to function and perform at a high level!
- There is more to your shoulder pain than just an issue with the tissue – your rotator cuff. Often times it is not even your rotator cuff that is the pain generator! World Renown sports medicine surgeon Dr. James Andrew conducted a study and found 87% of pro baseball pitchers had abnormal rotator cuffs on MRI, yet they had no pain! Read what he had to say
- Rotator cuff strains, even rotator cuff tears can do very well with conservative management that consists of education and exercise. According to a study by Kuhn et al. in 2013, 75% of patients had success with physical therapy for non-traumatic rotator cuff tears with the biggest determining factor being program compliance – do your exercises and it will get better (we show you exercises later).
READ: WHAT IS THE ROTATOR CUFF
WHY YOU SHOULD ADDRESS IT NOW
Don’t brush this injury off though, the rotator cuff is really important for shoulder health. Dynamic shoulder stability is directly influenced by the rotator cuff muscles. When the rotator cuff muscles are activated, they contribute to shoulder joint stability via compressive and downward shear forces. The bigger muscles like your deltoid contribute to a lot of upward shear force that the rotator cuff has to work against. The easiest analogy to visualize this is to think of a golf ball on a golf tee. When you compress the golf ball against the tee with your thumb and fingers so it doesn’t fall off, you’re doing the work of the rotator cuff muscles!
A rotator cuff injury can lead to pain, which can inhibit the rotator cuff muscles from activating and doing their job. The loss of compressive and downward shear force can lead to excessive, unwanted motion of the humeral head in the shoulder joint and subacromial space that can stress other structures including bone, cartilage, ligaments, joint capsule, biceps tendon, or further damage to the rotator cuff muscles and tendons. This is why it is not uncommon for people with rotator cuff issues to develop subacromial pain syndrome (SAPS) and experience/report ‘impingement’ symptoms due to excessive upward movement of the humeral head.
HOW TO TEST YOUR ROTATOR CUFF
Below is a great video that you can watch and learn to test your rotator cuff injury. Craig goes over a sample shoulder pain case with Arash as his patient to discuss different presentations of rotator cuff injuries as well as demonstrate different movements and tests we use to investigate the rotator cuff. You’ll also learn exercises you can perform to determine if and what rotator cuff muscle tendon may be contributing to your issue.
DISCLAIMER: This video is purely for educational purposes. These tests and exercises are not fail-proof for diagnosing or fixing rotator cuff issues – it is more complex than this. Remember, a rotator cuff tear does not equate to pain 100% of the time. More importantly – you should invest your time and energy into addressing your functional limitations (which we cover below) as this will improve your shoulder versus searching for a label.
HOW TO MANAGE YOUR ROTATOR CUFF INJURY
Ultimately, what you decide to do depends on all of the contextual factors surrounding your injury and your situation. Like we mentioned earlier, you have options. Below we will outline a handful of the most common decisions you will have to make and actionable items you can begin with right now to start managing your rotator cuff injury.
- Get Educated – give yourself some credit, as you read this you’re already educating yourself on rotator cuff injuries. If you haven’t watched the full video above yet on how to test your rotator cuff, now is the time.
- Get A Consultation If Needed – If you’re concerned about a major rotator cuff injury where you can’t move or lift your arm and it is not improving at all, that is a sign to see a PT or doctor in person. Getting a thorough evaluation can help provide the answers and solutions you are looking for.
- Get Moving & Exercising – If you can move and use your arm, start doing it! If you don’t use it you lose it. Far too often we see weak rotator cuffs and dysfunctional arm movement because the person favored their opposite arm and over-protected their injured arm. Graded exposure to re-using your arm is crucial to your recovery, the tricky part is knowing what is ok to start with and what is the right dosing. That is why we created the Shoulder [P]Rehab Program! Take the guesswork out of your life and let us help you!
THE SHOULDER [P]REHAB PROGRAM
A 16-week, 4-phase [P]Rehab Program to bulletproof your shoulders for life! Also included is a bonus 1-week long phase “get out of pain”
WHAT ABOUT SURGERY?
Sometimes surgery is the best option. There is nothing wrong with that, especially in certain cases of traumatic injuries with massive rotator cuff tears and significantly impaired arm function. However, in most cases, surgery is not and should not be the first and only option. This is why it is so important to get educated and to get 2nd opinions if you have any doubt or concern about the solution offered to you. More importantly, if you can move your arm relatively normal and you’re not dealing with significant weakness, it is in your best interest to exhaust conservative care first. Surgery is extremely inconvenient, especially a rotator cuff repair. Ask anyone that has had one done, on average the recovery can be anywhere from 6-12+ months. Until you have truly failed conservative care, you should think twice about surgery.
Unfortunately, surgery does not 100% guarantee anything either. The re-tear rate is higher than we’d like it to be (some suggest up to 25-35%). This is partly due to the normal tendon-bone insertion site is not regenerated following the repair. Furthermore, the injured tissue ends up being replaced with scar tissue, which is inherently weaker collagen and can result in future tears. However, through research trials, we are learning who are the best surgical candidates for rotator cuff repairs as well as risk factors and lifestyle habits that can lead to a poorer prognosis such as obesity, diabetes, and smoking.
The future of medicine is focused on regeneration versus repair. Check out the podcast below which dives into the exploration of biological solutions that are being developed and trialed in efforts to enhance tendon healing. You’ll learn some really cool info on rotator cuff repairs as well!
ROTATOR CUFF EXERCISES YOU CAN START WITH
If you’re looking for exercises to jump-start your rotator cuff injury recovery, you’ve come to the right place. Below you will find specific exercises that preferentially target each rotator cuff muscle. However, it is important to note we cannot 100% isolate just one rotator cuff muscle to work at a time and that is likely for the better. In fact, we want our rotator cuff to work as a unit as much as possible to provide optimal compression and dynamic stability to the shoulder joint (keeping that golf ball centered on the tee).
The supraspinatus is the most commonly injured and torn rotator cuff tendon due to its architectural design. As it covers the entire top of the humerus, it faces the most force with lifting and overuse with overhead activities. Additionally, poor shoulder mechanics and scapular control end up placing more force on the anterior portion of the tendon/cuff. The supraspinatus is responsible for the physiologic motion of shoulder abduction and external rotation. The best way to activate the supraspinatus is by working the arm in the scapular plane (30˚ from the midline, think of lifting your arms in a wide V pattern).
Our friends Mike Reinold, Lenny Macrina, and Kevin Wilk determined the best supraspinatus exercise with the highest EMG muscle activity was the open/full can exercise demonstrated below!
Lateral raises are another option for the supraspinatus. Yes, the deltoids will be working along with other muscles, but your supraspinatus and entire rotator cuff will be working as well!
The subscapularis is the strongest rotator cuff muscle due to the fact it has the largest physiologic cross-sectional area (PSCA) of muscle fibers compared to the others. It is the only rotator cuff muscle responsible for the physiologic motion of shoulder internal rotation because it is located anteriorly on the scapula. This is why performing internal rotation is always easier than external rotation (other bigger muscles like your pecs and lats also contribute to shoulder internal rotation)! Keeping it simple with isometric shoulder internal rotation is a great exercise to start with and it will definitely get your subscap working!
INFRASPINATUS & TERES MINOR
The infraspinatus is responsible for the physiologic motion of shoulder external rotation. At the shoulder joint, similar to the teres minor, it contributes to compression and inferior shear of the head of the humerus. There are plenty of people with partial or full-thickness supraspinatus tears that can get by without surgery (depending on contextual factors). However, if the infraspinatus and/or teres minor (referred to as the post cuff muscles) are also torn, dynamic shoulder stability and shoulder motion are going to be significantly compromised. The best exercise for the infraspinatus is going to be an isolated shoulder external rotation movement. Another article by our friend Reinold et al. in 2004 found side-lying shoulder external rotation to best one of the best exercises. When performed correctly, you will absolutely feel the burn in your post cuff muscles!
The infraspinatus and teres minor muscles also contribute to the physiologic motion of shoulder horizontal abduction. Side-lying shoulder flexion is one of my favorite exercises to give for a rotator cuff injury because it works isometric horizontal abduction and limits the common shrug sign we are always fighting against with arm elevation!
Not all rotator cuff injuries are equal (as you should know by now reading this article). However, getting educated and getting your arm moving and exercising again (if possible) is a great place to start! If you want to take the guesswork out of getting your shoulder healthy again, we definitely recommend checking out our Shoulder [P]Rehab Program!
DOWNLOAD A FREE ROTATOR CUFF [P]REHAB WORKOUT
Click HERE or the photo above to gain access to a free rotator cuff [P]Rehab Workout that features these exercises and more with specific instructions!
- Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 2013:Epub.
- Reinold MM, Macrina LC, Wilk KE, et al. Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. J Athl Train. 2007;42:464-469.
- Reinold MM, Wilk KE, Fleisig GS, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther 2004;34:385–94.