The shoulder is a relatively large and complex joint. The upper arm bone, also known as the humerus, sits in a cup-like structure formed by the shoulder blade, also known as the scapula. A greater range of motion in this joint also makes it more vulnerable to injury. In particular, rotator cuff injuries are common, especially in certain sports and other fields that require repetitive shoulder movement. The rotator cuff is a set of muscles and tendons that support the head of the humerus in its proper position. A thorough rehabilitation regimen for rotator cuff injury or weakness should include both strengthening and flexibility exercises for the various muscles in the rotator cuff and the general shoulder area to improve joint support [1-3].
The four muscles forming the rotator cuff, in addition to tendons and ligaments, are the teres muscle, supraspinatus, infraspinatus, and subscapularis [1,3]. Other relevant muscles include the trapezius, deltoid, rhomboid, bicep, and tricep [1]. There are three degrees of rotation possible within the shoulder joint; a set of strengthening exercises should include all three. Individuals should start with lighter resistance and higher repetitions then progress to heavier resistance and lower reps as they become stronger [1,3].
Active and passive external and internal rotation is an excellent exercise for the rotator cuff that focuses on a type of rotation that is likely weaker for many individuals. For external rotation, the elbow should be kept against the torso while the forearm is raised to be at a 90-degree angle with the upper arm. Then, the upper arm should be rotated such that one’s hand moves away from the torso. Active external rotation involves pulling against resistance to complete the movement, such as a resistance band, to increase strength while the passive version involves gentle force being applied to generate the movement and create a stretch. Internal rotation is the opposite movement in the same position [1-3].
Rows are also a beneficial strengthening exercise for the rotator cuff. The basic principle of a row is that one’s hand starts farther away in the front of the body and then pulls in against resistance. A row can be front to back, down to up, or on a diagonal, each of which emphasizes different muscles [1,3].
The reverse fly or horizontal shoulder abduction is a strengthening exercise for the back of the shoulder and the back. The starting position is leaning over with a straight back or lying on your stomach, with the arms pointing toward the ground. Pulling against resistance, the arms should then be slowly raised outward until nearly flat with the shoulders. Push-ups and bicep curls also strengthen muscles that help support the shoulder [1-3].
Stretching exercises are as important for shoulder and rotator cuff health as muscle-building exercises. Three in particular are easy to do anywhere: the pendulum stretch, arm crossover, and doorway stretch. For the first, lean slightly forward so that the target arm is hanging freely toward the ground. Gently swing the arm forward and backward, side to side, and in circles. For the second, bring one arm across the chest and use the other to pull it closer. For the third, place your hands on either side of a doorway, then lean forward or step forward until you feel a light stretch in your chest and the front of your shoulders. This exercise can be adapted with just a wall as well, stretching one arm at a time [1-3].
Consistent efforts with rotator cuff strengthening are essential for improving function and reducing the risk of future injury. Each person’s starting point is different, so consulting a physical therapist will help establish an individualized rehabilitation regimen. It is also important to find a balance between exerting enough effort to increase strength and flexibility and not overexerting yourself.
References
- AAOS (2012). “Rotator Cuff and Shoulder Conditioning Program.” OrthoInfo | American Academy of Orthopedic Surgeons. Available online: https://orthoinfo.aaos.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/
- NIH (2021). “Rotator cuff exercises.” MedlinePlus | National Library of Medicine. Available online: https://medlineplus.gov/ency/patientinstructions/000357.htm
- Healthline (2016). “5 Exercises for Rotator Cuff Pain.” Healthline. Available online: https://www.healthline.com/health/rotator-cuff-injury-stretches