03 Oct 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 for rotator cuff injury!
What Is The Rotator Cuff? Why Is It So Important?
The rotator cuff is a group of four muscles that is intimately associated with our main shoulder joint. The rotator cuff primarily exerts a compressive and downward shear force at the glenohumeral joint. The compressive force is vital to keep the head of the humerus centered within the glenoid fossa. The downward shear force is vital in preventing the head of the humerus from migrating upwards. The area between the humeral head and the coracoacromial arch of the scapula is known as the subacromial space.This space is extremely tiny, between 9-10mm! In this small space lie some very important structures, including the supraspinatus tendon, biceps long head tendon, subacromial bursa, and superior labrum. Normally, this 10mm of subacromial space is maintained as we move our shoulder throughout its range of motion through the stabilizing actions of a strong and intact rotator cuff.
Muscles of The Rotator Cuff
There are four rotator cuff muscles. As previously mentioned these muscles work in unison with one another to create a compression mechanism at the shoulder joint, allowing for optimal stability as you move your shoulder in different planes of movement. If these muscles are not working with one another the right way, that is when we may have issues of pain and/or potential injury.
- Supraspinatus: This is often the culprit of rotator cuff injuries, as it takes on the most load in comparison to the other rotator cuff muscles. It works in tandem with your deltoid muscle to stabilize the shoulder joint as you lift your arm!
- Infraspinatus: This is a muscle on the back side of your shoulder that performs external rotation of the shoulder joint
- Teres Minor: This works with the infraspinatus muscle to also perform external rotation of the shoulder joint
- Subscapularis: This muscle is situated on the front side of your shoulder, and performs internal rotation of the shoulder joint
Rotator Cuff Muscles
A Key Stabilizer For Our Shoulders!
A strong and competent rotator cuff provides the stability that the shoulder joint, with its extreme range of motion, demands. Even if you aren’t experiencing any symptoms, RC strengthening should definitely be incorporated into your workout regime. A recent 2015 systematic review published in Manual Therapy further supports the use of RC strengthening and stretching as an effective treatment for subacromial impingement. Any internal or external rotation exercises of the glenohumeral joint will target the RC and improve glenohumeral joint stability.
As the rotator cuff fatigues from excessive use, weakness, or lack of endurance, the shoulder joint becomes progressively less stable and the subacrominal space decreases. This can cause any of the above structures to become impinged between the humeral head and the coracoacromial arch. This leads to inflammation, pain, and ultimately an injury if left untreated. Weakness of the rotator cuff is very commonly associated with a host of shoulder pathologies, such as shoulder impingement, rotator cuff tendinitis, sub-acromial bursitis, biceps tendonitis, and rotator cuff tears. Common symptoms for rotator cuff/impingement pain include shoulder pain in the front and back of the shoulder, pain with overhead activities, and pain when lifting your arm to shoulder height, with or without weakness.
Dealing With Shoulder Pain? Bulletproof Your Rotator Cuff!
Your shoulder relies on a healthy rotator cuff, whether you are fixing things around the house, exercising, or just going about your daily life using your arms. This is why managing rotator cuff injuries the right way from the getgo is extremely important. Our Rotator Cuff [P]Rehab Program is exactly what your shoulder needs because the attention to specific details found in our program is crucial for rehabbing your shoulder. Learn more HERE.
What is a rotator cuff injury?
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).
Begin Exercises For rotator cuff injury
Don’t brush this injury off though, the rotator cuff is really important for shoulder health. Movereover, there are easy and effective exercises for rotator cuff injury that you can perform from the comfort of your own home! 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!
Non-Operative Rotator Cuff Injury Exercises WorkoutGet a completely FREE Non-Operative Rotator Cuff Injury Exercises Workout including the exact parameters on these exercises + more for by inputting your email below!
What about surgery for rotator cuff injury?
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!
- HOW: Get a band set-up under your feet while you’re in a standing position holding the ends of the band in each hand. While keeping your elbows straight, staying strong in your shoulder blades, and thumbs pointing up, raise your arms to head height while forming a wide ‘V’ shape with your arms. Slowly lower down to starting position and repeat.
- FEEL: You should feel the outside muscles of your shoulder and shoulder blade muscles working in this exercises. It is ok to feel a deep muscle burn as your muscles begin to fatigue.
- COMPENSATION: Do not shrug your shoulders, do not lean or arch backwards, do not bend your elbows. It is important to keep your shoulders and shoulder blades strong and in position throughout this exercise.
Lateral Deltoid Raise
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!
Shoulder Internal Rotation Walk Out
- HOW: Anchor a resistance band about wrist height onto a stable surface. Keep your hand directly in front of you, then walk out as far as you feel comfortable to create tension on the band. Keep your shoulder blade pulled back while performing this.
- FEEL: You will feel muscles on the front of the shoulder work with this exercise.
- COMPENSATION: Avoid moving the arm with this exercise, this is designed to be an isometric exercise.
Shoulder Internal Rotation – Band
Shoulder Internal Rotation – 90/90 Band
Infraspinatus And Teres Minor Exercises
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 for rotator cuff injury. When performed correctly, you will absolutely feel the burn in your post cuff muscles!
Sidelying Shoulder External Rotation
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 when compiling various exercises for rotator cuff injury because it works isometric horizontal abduction and limits the common shrug sign we are always fighting against with arm elevation!
Shoulder External Rotation Walk Out
Similar to the shoulder internal rotation walk out exercise for the subscapularis, you can do the same movement for the external rotators as well! This can be a great place to start if someone is demonstrating weakness and/or some discomfort with active shoulder external rotation.
Exercises For Rotator Cuff Injury: Sidelying Shoulder Flexion
Not all rotator cuff injuries are equal (as you should know by now reading this article). It is important to not only understand what the rotator cuff is, but also conceptualize specific exercises for rotator cuff injury that can help you maximize your own outcomes. Getting educated and getting your arm moving and exercising again (if possible) is a great place to start!
- 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.
- Hill et al. “Prevalence and correlates of shoulder pain and stiffness in a population-based study: the North West Adelaide health study.” Int J Rheum Dis 2010; 13: pp. 215-222