Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Rotator Cuff Physical Therapy Guide

What Is A Rotator Cuff Injury

Injuries to the rotator cuff  muscles and tendons are among the most common causes of shoulder pain and dysfunction in adults, accounting for almost half (50%) of all major shoulder injuries in the US! A rotator cuff tear is a tear to the tendon insertion of either of the 4 rotator cuff muscles: Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. The most commonly injured muscle out of the 4 is the Supraspinatus tendon! A rotator cuff tear can either be acute or degenerative in nature. An acute rotator cuff tear usually occurs as a result of trauma such as falling onto an outstretched arm or lifting something heavy. Degenerative tears are much more common than acute tears due to the natural degeneration of muscles as we age. The shoulder joint as a whole is a very unique structure within the human body, it is the most mobile joint we have, no other joint can match it in the degrees of freedom it has. But, this mobility comes at a price, a reduction in its stability. The shoulder joint has to constantly maintain a balancing act between mobility and stability and sometimes this balancing act can go wrong.

What Causes A Rotator Cuff Injury?

A rotator cuff injury is the result of either a substantial injury to the shoulder or due to progressive degeneration and wear and tear of the tendons. There are many risk factors that can predispose you to developing a rotator cuff injury. These include:

  • Repetitive overhead activity
  • Heavy lifting over a prolonged period of time
  • Bone spurs in the bones around the shoulder may irritate or damage the tendon.
  • Reduced blood supply

What Are The Risk Factors?

Like all injuries there are many risk factors that increase your chance of developing a condition such as a rotator cuff injury, some of which are unavoidable. These include:

  • Age: The older you get, the higher your risk of developing a rotator cuff injury. Rotator cuff tears are most common in people over the age of 40.
  • Occupation: Certain jobs that involve repetitive over head work such as construction and farming are at a much higher risk of developing a shoulder tendon injury.
  • Genetics: There may be a family link involved in the development a rotator cuff injury, although this is unconfirmed.
  • Gender: Women are more likely to develop a rotator cuff injury!

What Are The Symptoms Of A Rotator Cuff Injury?

Shoulder pain is typically presented as pain on the outside of your shoulder, just below the end of your collar bone – the pain may also travel down your arm towards your elbow in more severe cases. The peak incidence is between the ages of 40 and 50 years old; however, the condition can affect any age group.

The most common symptoms are:

  • Pain when performing overhead movements and movements reaching away from your body.
  • Disturbed sleep, especially when lying on your affected shoulder.
  • Arm weakness and stiffness
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What Are My Treatment Options?

There are many treatment options available to people who suffer with a Rotator Cuff Injury! Your rehab programme and recovery time depend entirely on how severe the rotator cuff injury is. Make sure you get a full assessment from your health care professional before commencing your exercise programme.

Rest & Time

Initially, you need to cease all activity that caused the shoulder pain in the first place and prevent agitating it further.  Immediately following the injury you can commence the RIC(E) protocols:

  • Rest. It is vital that you take a break from any activity that may be increasing your shoulder pain.
  • Ice. Cold packs will assist in reducing any pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Don’t place ice directly on to the skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the shoulder with a compression sleeve or brace will help limit painful movements and improve recovery time. You can find our favourite shoulder brace here!

Physical Therapy

Although rest is a vital component of the recovery process, it doesn’t mean the affected shoulder has to be completely immobilised. In fact,  the rotator cuff tendons need to be placed under tensile loads to grow, recover and stay healthy.  The easiest way to place the muscles under tensile load? Exercise! 

Rotator Cuff Exercises

1) Isometric Shoulder Squeezes

Isometric exercises are the initial go-to exercise for Physical Therapists as they increase strength in the muscles without actually moving the painful muscle / tendon through range. The aim of these exercises is to complete all shoulder movements against a non moving resistance.

How to do it:

  • Flexion: Stand facing a wall or work surface. With a straight arm put your hand on the surface. Push upwards towards the ceiling and hold this contraction for 10 seconds. You should feel your shoulder bulging / contracting. 
  • Extension: Standing facing away from the wall. With a straight arm behind you touch the wall. Try and push your arm backwards against the wall without moving your body, holding the contraction for 10 seconds.
  • Abduction: Standing parallel to the surface. Move your straight arm to the side of your body against the resistance. Try and push your arm up towards the ceiling and hold this contraction for 10 seconds.

Repeat for 10 reps, 3 sets, twice a day.

2) Scapula “Clock” Stabilisation 

The scapula is the base on which all rotator cuff muscles originate. If you suffer from a rotator cuff injury, you more than likely have poor scapular stabilisation as a result, it is therefore very important to start completing functional stability exercises to progress your rehabilitation! For this exercise you will need a exercise / yoga ball! Our favourite can be found here!

How to do it:

  • Stand facing a wall with your arm raised to 90° in front of you, pushing the yoga ball into the wall with a straight arm.
  • Envision a large clock on the wall in front you.
  • Slowly move your arm in a clockwise and counter clockwise direction, moving the ball along the wall.

Repeat 5 rotations each direction, three times a day.

3) Press Ups

Another favourite shoulder rehab exercise is the good old press up. Press ups are a great all round upper limb strengthener. It is a closed chain exercise so has advantages in providing increased joint proprioception and cuff co-contraction. It also has multiple variations and simple adaptations can be made to change and progress the exercise.

How to do it:

  • Get into a high plank position with your hands firmly on the ground, directly under your shoulders.
  • Slowly lower your body, keeping your back flat until your chest grazes the floor.
  • Push back up.
  • Too difficult? Place your knees on the floor.

Repeat 10 reps, 3 sets, 3 times per day.

4) Arnold Shoulder Press

Also known as the rotating shoulder press, it is a fantastic shoulder stabiliser and rotator cuff strengthener! This exercise is for more advanced people who are months in to their rehabilitation and have no pain performing the movements! The name is coined by Arnold Schwarzenegger, and who can deny his strength training advice. It is a complicated exercise, check out a video tutorial here!

How to do it:

  • Sit on a bench with back support and hold two dumbbells in front of you at about upper chest level with your palms facing your body and your elbows bent.
  • Raise the dumbbells towards the ceiling and rotate the palms of your hands until they are facing forward.
  • Continue pressing the dumbbells until your arms are extended above you in straight arm position.
  •  Slowly lower the dumbbells to the original position by rotating the palms of your hands towards you.

Repeat 10 reps, 3 sets, twice daily.

5) Prone Y Raises

The prone Y lift is a simple posterior cuff exercise that is fantastic for shoulder stability training.

  • Lie down on your front on your bed with your arm hanging over the edge of the bed.
  • Lift the arm up and out to raise it above your head whilst keeping it straight, keep your thumb pointing upwards to ensure the shoulder is externally rotated.
  • For the best results your shoulder should be raised at approximately 120° of abduction
  • Slowly lower your straight arm back down to the floor.

Repeat for 10 reps, 3 sets, three times per day.

Deep Massage

Deep massage of the shoulder and rotator cuff muscles will help speed up the recovery process of tendon injuries like this, which is often used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep friction massage is to maintain the mobility and flexibility of the soft tissue structures of the tendons and prevent adherent scars forming. The movement encourages realignment and lengthening of the rotator cuff muscle fibres and will improve your recovery rate!

Many professionals find it preferable to use foam rollers, lacrosse balls or Muscle Stick rollers, which can be found here!

Rotator Cuff Injury Prognosis

Rotator cuff injuries are notoriously very difficulty to rehabilitate, and can be the bane of Physical Therapists everywhere! Your prognosis depends on the severity of your rotator cuff injury, but pain typically lasts anywhere between 3-12 months depending the severity of the injury and also how well you complete your rehabilitation programme. If you have a severe tear or it simply isn’t recovering your health progressional may recommend surgical intervention if your pain does not improve with nonsurgical methods.