The Best Rotator Cuff Strengthening Exercises

Rotator cuff tears are one of the most common injuries to the shoulder and the incidence is rising. Overall, there was a 141% increase in the number of rotator cuff repairs performed within the last decade (1). You most likely know someone or have experienced first hand the pain and limitations that accompany a rotator cuff injury. Rotator cuff pain can severely limit your activities such as tucking in your shirt, reaching into the top cabinet, putting on your seat belt, or simply reaching out in front of you. There is often pain at night when trying to sleep, pain with washing your hair, and even simple tasks such as driving are no longer pain-free and easy to execute. Have you tried to go a whole day with the use of only one arm? It’s extremely difficult! One of the best ways to both prevent and help recover from a rotator cuff injury to strengthen the shoulder. This post will demonstrate the best rotator cuff strengthening exercises to do at home.

How Common are Rotator Cuff Injuries?

The prevalence of a rotator cuff tear in each decade was 0-5% in the 20s to 40s, 10.7% in the 50s, 15.2% in the 60s, 26.5% in the 70s, and 36.6% in the 80s (2). Ultrasound scanning has demonstrated that 13% of the population in the fifth decade, 20% in the sixth decade and 31% in the seventh decade of life have a rotator cuff tear (3). Yamaguchi et al (4) demonstrated that more than half of asymptomatic rotator cuff tears will eventually continue to become symptomatic within 3 years. This makes it so much more important to protectively strengthen and slow down the progression of the asymptomatic tears before they becomes worse.

What is the Rotator Cuff?

The rotator cuff is a group of 4 muscles and their connecting tendons that work together to stabilize the shoulder. The general anatomy of the shoulder makes the joint more mobile and less stable due to the congruence when compared to other joints within the body. Therefore the shoulder is reliant on muscles, tendons, and ligaments to maintain stability through movement. That’s where the rotator cuff comes into play.  In the simplest of terms, they work together to control the head of the shoulder during complex movements.

Supraspinatus

• • Muscle inserts on told of the shoulder. Helps with lifting the arm

Infraspinatus

• • Muscle on the backside of the shoulder and helps with backward rotation

Subscapularis

• • Muscle on the front side of the shoulder that helps with forward rotation and attaches the shoulder to the shoulder blade

Teres Minor

• • The smallest of the rotator cuff assists the Infraspinatus in backward rotation and stabilization of the shoulder

Symptoms of a Rotator Cuff Injury

The symptoms of a rotator cuff will vary depending on the severity of the injury, location of the injury within that muscle, and also which of the 4 muscles are involved. A small tear in the Teres Minor will present much differently than a full tear of the Supraspinatus. Also there is a large difference in symptoms when there is an acute injury from a fall on an outstretched arm as compared with a long term wear and tear injury. With that being said there are some general common complaints that you should look for:

Risk Factors for a Rotator Cuff Tear

The risk factor for a rotator cuff tear within the general population are:

• Age – the more experienced at life you are the more likely you are to have a tear
  • (Doesn’t mean you have to have surgery!)
• Being male or having a Y chromosome
• Injury being on the dominant arm
• Working in a heavy labor profession or an overhead sport
• Having a history of trauma

Do I need to have Rotator Cuff Surgery?

The short answer is no, it is not always. The size, location of the tear, and your age are all very important factors for surgery and something you should discuss with your physician. Small and medium tears may be fine after a good physical therapy program and time to heal. The longer and slower the tear progressed, the more likely that your body has been able to adjust and compensate appropriately. You may be what’s called a “coper” and would benefit most from getting stronger, hence the exercises below.

Physical therapy and rotator cuff strengthening programs have been shown to be as effective as surgery in certain cases. See link below:

http://www.apta.org/PTinMotion/NewsNow/2014/3/12/RotatorCuffTears/?blogid=10737418615

Rotator Cuff Tear Size and Re-tear Rate (5)

This means even if you do have rotator cuff surgery, that if the original tear is greater than 4 cm in size the chances of re-tearing it is 30% or greater! So regardless, it is really important to try the conservative approach first and to maintain the strength if you have already had surgery. Here are the 6 best rotator cuff strengthening exercises.

6 Best Strengthening Exercises for a Rotator Cuff Injury

These are the 6 best exercises that you should perform if you have a rotator cuff tear. It is important to mention if you have pain with any of these obviously stop and don’t push it. Depending on how recent the injury occurred and the size of tear, you may not be able to perform all of these. Start with the first 3 exercises and then progress to the standing exercises as the pain and motion improves. The goal of these exercises are to hit most of the muscles involved with or have influence on the position of head of the shoulder (where the rotator cuff attaches) or the position of the shoulder blade.

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Disclaimer: Always consult your physician before beginning any exercise routine. This is for informational purposes only. 

Works Cited

1. Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National Trends in Rotator Cuff Repair. The Journal of Bone and Joint Surgery American volume. 2012;94(3):227-233. doi:10.2106/JBJS.J.00739.
2. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. Journal of Orthopaedics. 2013;10(1):8-12. doi:10.1016/j.jor.2013.01.008.
3. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 1999;8:296-9
4. Yamaguchi K, Tetro AM, Blam O, et al. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg 2001;10:199-203.
5. Wu, XL, Briggs, L, Murrell, GAC. Intraoperative determinants of rotator cuff repair integrity: an analysis of 500 consecutive repairs. Am J Sports Med. 2012;40(12):2771-2776
6. YAMAMOTO, A., TAKAGISHI, K., OSAWA, T., et al.: Prevalence and risk factors of a rotator cuff tear in the general population. J. Shoulder Elbow Surg, 19: 116-120, 2010.