Outlined below are a number of exercises specifically for rotator cuff rehabilitation. Depending on how bad the injury is will determine when they can begin and how fast the patient will progress.
Exercises are separated into:
- Mobility / stretching
- Strengthening exercises
- Functional & sports specific
Rotator cuff exercises to improve shoulder mobility should begin as soon as the pain allows. The aim is to restore full, pain-free mobility to the shoulder joint. In some patients, mobility could already be good depending on how bad their injury is and therefore less time should be spent on these exercises before moving on.
Mobility should be done at least once a day and sometimes 2 or 3 times per days is recommended. If any of the exercises are painful do not do them or stay within the pain-free range of movement possible.
The aim of pendulum exercises is to increase mobility in the shoulder joint. If your injury was mild and the shoulder has not been immobile for very long then it is likely you will skip through these exercises relatively quickly and move onto more suitable flexibility and stretching exercises. Gently swing them in a circular motion whilst lying on your front or leaning forwards. Gradually increase the size of the circle to increase the range of motion. Try to relax the arm and use the momentum of the swing.
A long object such as a pole or broom handle can be used to assist the weak shoulder. Hold it in each hand, wider than shoulder width. Use the good arm to move the injured shoulder as high as you can comfortably manage, stop if it is painful. Try to relax the injured arm so it is not working. This can be done in a number of different positions. Repeat several times a day, trying to gradually increase the range.
Stretching exercises move on from mobility and should be done as soon as pain allows.
It is likely that if you have suffered a rotator cuff strain then the muscle involved may have gone into spasm or shortened and will need stretching.
Try to find the stretching exercises which feel like they are working and perform them regularly throughout the day.
Front of shoulder against a wall
Place one forearm against a fixed point (such as a doorway), with the elbow and shoulder at 90 degrees. Gently turn your body away to stretch the front of the shoulder and chest. Again, hold the position for 20 seconds and repeat 3 times. The athlete should feel a gentle stretch in the front of the shoulder but not pain.
Back of the shoulder stretch
Place one arm across your chest and pull it in tight with the other. The athlete should feel a gentle stretch at the back of the shoulder. Again, hold the position for 20 seconds and repeat 3 times. The athlete should feel a gentle stretch in the back of the shoulder but not pain
Muscle energy technique
The therapist will rotate the shoulder as far as it will go (without pain) one way (usually either medial or lateral rotation). They will then ask the patient to push against them at about 20% of their maximum force This contraction is held for 10 seconds. Then as the patient relaxes, the therapist gently applies a stretch to the muscles by increasing the range of motion. The process is repeated 3-5 times.
Strengthening exercises usually begin with isometric or static exercises, progressing onto dynamic exercises with resistance bands or dumbbells then finally more sports specific or functional exercises using medicine balls.
Isometric shoulder exercises
Static (or isometric) exercises are some of the first torn rotator cuff exercises to be done as they do not involve any movement. The patient pushes against a stationary object such as a wall, doorframe, or resistance provided by another person.
Because there is no movement, static exercises can be performed soon after injury, usually within 3-7 days, provided they are pain-free. If any exercises are painful, then do not continue with them. Rest for a longer period until they are comfortable. They can be done for a range of different shoulder movements to strengthen the muscles around the entire joint including adduction, abduction, flexion, extension, and rotation.
Scaular squeeze exercise
In a sitting position with the elbows by the side, the athlete squeezes the shoulder blades together, holding for 5-10 seconds. This strengthens the rhomboids and middle trapezius. The aim is to strengthen the muscles which stabilize the scapula or shoulder blades during the early phase of a rehabilitation program although can also be continued into the mid stages. The athlete squeezes the shoulder blades or scapulae together while ensuring the elbows are kept down.
These involve movement and can be done with a resistance band or dumbbell weights. They can be performed in many different positions and can easily be progressed as your strength improves. These exercises can replace the static exercises (above) as soon as pain allows (usually 7 days plus).
Lateral rotation in standing
Uses a resistance band to work the lateral rotator muscles in the shoulder. Attach a band to a fixed point and keeping the elbow close into the body rotate the shoulder so the arm moves outwards. Move through as large a range of motion as comfortable. This should be felt at the back of the shoulder after a few repetitions.
Lateral rotation in prone
The athlete lies on their front with the arm out to the side of the massage table or bench. The dumbbell is lifted as the shoulder rotates upwards. Try to go through as large a range of motion as possible performing the exercise in a slow and controlled manner. You should feel this working at the back of the shoulder.
Lateral rotation in abduction
The athlete stands holding the band with the elbow abducted in 90 degrees. The athlete elevates the arm, ensuring the elbow is also elevated. The shoulder is maintained at 90-degree abduction without horizontal adduction or abduction.
Standing 90/90 external rotation
The resistance band is anchored in front and the other end is held in the hand, with the arm raised and elbow bent as shown. The athlete rotates the arm so that the first points upwards. They then slowly return to the starting position and repeat.
Internal rotation in standing
Start with the band attached to a fixed point to your side. Hold another end of the band in one hand, with the elbow bent and upper arm by your side. Keeping the elbow by your side, move your hand towards your stomach as far as is comfortable. Slowly return to the starting position.
Standing 90/90 internal rotation
The athlete rotates the arm so that the forearm moves forwards, to a horizontal position. They then slowly return to the starting position. As strength develops the supporting hand can be removed.
Diagonal plane exercises
The athlete holds one end of a resistance band starting with the arm raised out to the side above shoulder height. The arm is pulled down across the body so that hand reaches the other hip. It is important the athlete maintains joint stability.
Functional rotator cuff exercises can be seen here.