What Is The Best Way To Strengthen Your Rotator Cuff?
This is a common question I get asked from patients.
The rotator cuff describes the four muscles that stabilise the shoulder joint. The shoulder joint is my favourite joint in the body. I am biased of course because shoulders are my special interest area.
The rotator cuff consists of the supraspinatus, subscapularis, infraspinatus and teres minor.
Firstly, if you don’t work out which muscles are the problem you’re going to waste time strengthening the wrong ones!
So let’s learn a bit more what can cause pain so we can make sure we select the right exercise.
There Are Two Main Types Of Rotator Cuff Injury.
Traumatic injuries tend to occur when the person has had a fall or experience some kind of accident. To damage the rotator cuff requires significant force. This type of injury tends to occur in young athletes or people who have fallen, caught something heavy or throwing a ball.
Degenerative rotator cuff tears are also common. These tend to occur in the over 40s and are often due to repetitive strain over time.
It is important to remember that 72% of elite baseball players will have a rotator cuff tear with no pain or symptoms. Many people in older population would also have asymptomatic rotator cuff tears. This means we can’t just MRI it because, even if we see a tear, this doesn’t necessarily mean it’s the source of your pain.
How Do The Muscles Work Together?
In a physio assessment we will look at how the rotator cuff work together to control the shoulder movements. Sometimes pain is occurring, not because of weakness, but because the coordination between the muscles is not efficient. With these cases often we can see a reduction in pain within just one or two sessions.
So how do you tell if the pain is coming from a tear or from poor biomechanics of the shoulder?
All assessment we will look at the relative strength of the opposing rotator cuff muscles. We will rule out other pathology that may be causing symptoms that present as a rotator cuff to. We will also rule out any red flags that may require immediate MRI or investigation.
Once this has been done we can start strengthening the rotator cuff.
How Can We Start Strengthening The Rotator Cuff?
The following section is for information purposes only. Without assessing you we can not be sure these are the right exercises for you so please seek the advice from your healthcare professional of book a virtual consultation here.
In the beginning the aim is to start with exercises that are performed within the ‘safe zone’.
We know that the easiest exercises to begin with are proprioceptive exercises for the rotator cuff and isometric exercises with a shoulder in a neutral position by your side, with the elbows bent to 90°.
Some examples may be:
- Ball rotations against wall or desk
- Mini press ups against wall for scap position
- 4 point kneeling weight transference
- Isometric ER/IR/FLEX/EXT
Isometric means that you resist the movement but the arm remains in a static position. Please check out our you tube, facebook and instagram to see videos of these individual exercises.
Through Range Rotator Cuff Exercises
We would then look to make sure that your shoulder has full range of movement and look to address any restriction in your range of movement. The muscle of the rotator cuff may not be weak itself but the range may be restricted by tightness in their pec major or latissimus dorsi muscle.
Once we have checked that you can tolerate proprioceptive exercises and isometric rotator cuff exercises with your shoulder in a safe zone we would then look to increase that range of movement and strength when the shoulder is positioned in more challenging positions.
Some examples may be
- Scap retractions in prone ( arms by side)
- ‘Aeroplanes’ or T’s in prone
- ‘Y lifts in prone.
- 90/90 rotations in prone
Rotator Cuff Through Range : Challenging Position
We then move on to positions that hold the arm further out to the side or above your head would be exercise progressions.
- ER/IR/FF/EXT in standing with band resistance if needed
Finally we would look at exercises that look at the full kinetic chain and then return to sport activities.
- Forward flexion shoulder with opposite lunge
- Push ups off bosu balls
- Sport specific throws
- Quick band work.
Hope that has been helpful for you! Please share with anyone it may help 🙂
Through selection of exercises we may give to patients see below. We cannot give individual advice as your injury or strength deficit may not represent the exercises we have given. If you would like expert advice on what is relevant for you to help resolve your pain then click the link below and book your virtual consultation for just £40.