External Rotation for Rotator Cuff

As we have learned last week, the four rotator cuff muscles work as a unit to move the arm and to maintain the head of the humerus centered in the glenoid fossa during all arm movements. As such, these muscles are not power muscles, but endurance muscles. When doing rotator cuff strengthening exercises, we need to do a lot of repetitions under low load. With some exercises, this equates to about 20–25 repetitions done 4–5 times a day, so roughly 100 reps a day. It may sound like a lot, but for anyone with a shoulder injury, this will help him or her create a new movement pattern that is well-supported by muscles that do not fatigue so quickly.

Another important element is the set up of the head and shoulders before doing the exercises, especially if it is a standing exercise. It is very important that the skull is aligned over the shoulders correctly and that the client has a broad and open chest, as pectoral tightness decreases the ability of the external rotators (the teres minor and insfraspinatus specifically) to contract properly.

Here are two preparatory exercises that are important to master before diving into rotator cuff strengthening.

Preparatory Postural Exercises


Chin Tuck at the WallCervical Retraction-s

  • Stand with your back to a wall
  • As you bring your head back to the wall, draw the back of your skull gently up the wall to tuck your chin down. Imagine your head is being pulled up by a string
  • Hold for 5 seconds, then release
  • Do 10 reps or until slight burning/fatigue
    • Make sure you feel some slight muscle burn in the front of your neck, just in front of your throat
    • If you are doing this correctly, you should also feel a slight stretch sensation at the base of your skull

 

Scapular Squeeze

  • Stand with your back to the wallShoulder Blades-s
  • Maintain chin tuck position with your head
  • Slide your shoulder blades together and hold for 5 seconds, then release.
    • Make sure you do not flare the ribcage forward and up or shrug the shoulders up around the ears as you do this
    • It should feel as if you are squeezing the bottom ends (near your bra strap) of your scapulae together

 

Exercises to Isolate the Rotator Cuff Muscles 

 

External Rotation with a TheraBandRotator Cuff External Rotation from back

  • Set your head and scapula
  • Tuck a rolled towel under your arm
  • Grab a TheraBand, as shown, and bend the elbow to 90 degrees. Slowly externally rotate the shoulder to maximum external rotation
  • Hold for a count of 3 and slowly releaseExternal rotation with theraband from front
  • Do 20–25 reps
  • The resistance should be small enough to do this many reps with good form

 

 

 

Internal Rotation with a TheraBandInternal Rotation for Rotator Cuff

  • See above instructions for external rotation, but stand on the other side of the anchored end of the band, as shown,  to do internal rotation
  • Do 20–25 reps
    • Internal rotation is generally stronger than external rotation; you may need to intensify the resistance load.
    • Try not to let the working shoulder round forward while doing this exercise

 

Scaption (Abduction in the Plane of the Scapulae)Lateral arm arcs with weights-s

  • Stand with head and shoulders properly positioned, as with the foundation exercises shown above
  • Hold light hand weights or step on a Theraband and hold the ends to add resistance
  • Start with arms beside body, palms facing forward
  • Slowly abduct arms out into a wide circle around your body, keeping arms slightly forward so you can see them in your peripheral vision
  • Keep the scapulae close to the back ribs as you do this exercise
  • Make sure the resistance is light.  If it is too heavy, you will feel this exercise in your neck, not in your shoulders

Pilates Exercises

These Pilates-based exercises are more complex and require more control and coordination than the exercises shown above.  Make sure your client is able to do the above exercises with good form and without pain. The Pilates exercises are more advanced because they involve multiple body parts moving in conjunction with one another. Coordinated muscle recruitment of the core muscles as well as the muscles of the trunk and often the lower extremity are necessary to move with integrity in these poses. If any of these exercises cause pain or have a faulty movement pattern, observe where the issue is coming from and work those in isolation first before returning to these exercises.

Prone Robot ArmsProne Robot Arms

  • Lie on your front with your arms out to the sides and your elbows bent at 90 degrees
  • Gently draw the upper arm bones into the sockets and slightly down towards your hips
  • Contracting your upper back muscles, lift both arms off the floor
  • Hold for a count of 5, then lower the arms down
  • Do 10 reps, or until fatigue

 

Side bridge-s

Lateral Rib Shift

  • Lie on the left side with your elbow, left hip and feet in one line
  • Gently slide your left elbow toward the right hip (as if you could slide it into your back pocket)
  • Keeping your core muscles engaged, press your elbow down to lift your ribcage off the ground
  • Make sure to maintain firm downward pressure through the grounded elbow and forearm, and prevent the ribs from flaring
  • Hold for a count of 5, then lower the ribs down
  • Do 10 reps, or until fatigue

 

 

 

Scapular Stability with Towel CirclesQuadruped towel glide

  • Start in quadruped position with a towel under your hand
  • Keep your abdominals gently braced and your pelvis in a neutral position
  • While maintaining your neutral head position, circle your arm on the floor but keep the scapula of the working arm stable on your back ribs
  • Do as many reps as needed to feel some burning or fatigue in your shoulder blade