Friday 1st May 2020
Rotator cuff injury is one of the most common causes of shoulder pain and dysfunction.
In fact, up to 85 per cent of shoulder problems relate to the rotator cuff. For people who experience reduced or significant loss of function this can be really debilitating and stressful. And from my own experience I know how frustrating a shoulder injury can be, especially not being able to do what you enjoy most.
The rotator cuff consists of the supraspinatus, infraspinatus, teres minor and sub-scapularis (SITS) muscles and tendons. These muscles act as important dynamic stabilisers of the glenohumeral joint. Balancing strength and mobility of the rotator cuff is key to ensuring optimal function of the shoulder girdle. Essentially, the rotator cuff adds stability especially when performing everyday activities like lifting objects and carrying shopping bags as well as playing sports like swimming, tennis, volleyball and baseball.
After 3 months of shoulder pain, my physiotherapist and I worked out a program that included strengthening these important areas. This has been very helpful for my own recovery as well as understanding the complexities of the shoulder.
During rehabilitation management principles of rotator cuff shoulder pain should include education, relative rest or modifying daily activities and a graduated exercise program ideally supervised by your physiotherapist.
Below are 4 exercises that can be used to strengthen the rotator cuff and scapular, however, these should be modified to suit your needs, condition, and stage of recovery. Typically, the focus of any rehabilitation program will include strengthening the external rotators, internal rotators, and addressing scapula weakness and or dysfunction.
1. External Rotation strengthening
The aim of this exercise is to strengthen and coordinate the rotator cuff to stabilise your shoulder joint. Tie a thera-band around a pole or doorknob. Stand side on and tuck your elbow into your side. Grasp the thera band and position the shoulder blades down (depress) and back (retract). Keeping the elbow tucked and wrist straight throughout the movement. Start gradually within a small range and progress through to a larger range working to fatigue.
An alternative progression could include working the rotator cuff in a seated position with a hand weight. Grasp a hand weight and bend your right elbow approximately 90 degrees. Place the opposite hand underneath your armpit. Gradually move your right arm towards your left knee and return to the starting position. Ensure you maintain elbow bend throughout and work to fatigue but the movement should not include any pain or clicking.
2. Scapula strengthening and stabilising
The aim of this exercise is to strengthen the scapula muscles and stabilise your shoulder. Start lying on your stomach with your forehead down on the floor and arms by your side with your palms facing down. Draw your shoulder blades down and back, creating space between your shoulders and ears. Lift the front of the shoulders off the floor trying to squeeze your shoulder blades together whilst keeping the forehead grounded. Hold this position for 5- 10 seconds and slowly return the shoulders to the floor. Keep a neutral spine throughout and ensure there is no pinching in the lower back.
To progress use a light hand weight (500 g to 2 kg) in each hand, when you lift your shoulders off the floor externally rotate your shoulders, maintaining shoulder depression and retraction throughout the movement, then return to the starting position.
3. Serratus anterior strengthening
Often imbalance and dysfunction of the shoulder can result in “winging” of the medial border of the scapula. The aim of this exercise is to strengthen the muscle (serratus anterior), which pulls the scapula forward. To address any “winging” start in a standing position grasp a thera band with the band tied around a pole. Set the shoulder blade down your back, move the shoulder forward (shoulder protraction) and back (shoulder retraction) using the resistance of the thera band.
Alternatively lie down on your back with your arm by your side. Start with no hand weight or a thera band, gradually progress to 500 g to 2 kg hand weight. Set your shoulder blade down against the floor. With a straight arm gradually lift your fist up towards the ceiling and return your arm back to the starting position. Repeat until gradual fatigue of the scapula stabilisers and anterior deltoid.
4.Internal rotation strengthening
The aim of this exercise is to strengthen the rotator cuff and stabilise the shoulder. Start on your back with your elbow out to the side between 0 to 90 degrees. Set your shoulder blade into position. Use a thera band or hand weight and move your hand backwards and down towards the floor. Then move the hand forwards towards the toe end of the floor. Initially start on slow concentric and eccentric contractions and build up gradually.
As always seek health professional advice before performing exercises. With regular and diligent practice, maintaining good technique and progressing gradually these exercises will help you to strengthen and stabilise the rotator cuff and scapula. Enjoy your exercise and aim to have a happy shoulder.
References
1.Mehta S, Gimbel JA, Soslowsky LJ. Etiologic and pathogenetic factors for rotator cuff tendinopathy. Clinical Sports Medicine. October 2003; 3(2): 96-99
2.Franklyn-Miller A, Falvey E, McCrory P, and Brukner P. Clinical Sports Anatomy. McGraw-Hill 2011
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