Evidenced Based Expert Rotator Cuff Exercises

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What Are the Best Rotator Cuff Exercises?

The rotator cuff get so much attention these days, and rightfully so. It is so common to read in the sports section of any newspaper, or see on any sports website, a famous athlete having an injury or surgery to the rotator cuff. Some injuries can be season-ending while others limit the athlete for few days.  At any rate, shoulder pain is the third most common musculoskeletal disorder, after low back pain and neck pain.

Rotator cuff exercises: Be totally fit

Specifically, rotator cuff injuries as a whole represent greater than 90% of shoulder injuries.

This expresses a spectrum of disease, ranging from acute, reversible, tendinosis to massive, full thickness cuff tears, requiring surgical intervention.

Comprehensive rotator cuff pathology is diagnosed through a detailed history, a thorough physical exam and most often, diagnostic imaging.

Shoulder Cuff Anatomy

Evidenced Based Expert Rotator Cuff ExercisesAnatomically, the rotator cuff, mistakenly called the “rotary cuff” or the “rotator cup” is comprised of four main muscles which surround the head of the humerus, or upper arm bone.

Those muscles are the supraspinatus, infraspinatus, teres minor and subscapularis.

Interestingly, the shoulder joint itself is referred to as a ball-and-socket joint, however, it is not truly a complete ball-and-socket as once thought. The best example of a true ball-and-socket joint is of course the hip, which has a deep cup that fits the entire head of the femur.

The shoulder, on the other hand, does not receive the entire head of the humerus, and sacrifices stability for to be being more mobile.

This is why the cuff and its stabilizers on the scapula are paramount to proper function and performance of the shoulder.

If I had to think of an analogy to describe the shoulder joint, I would probably liken it to a golf ball on a tee or what I personally like to say, it is a like a seal balancing a ball on its nose.

These analogies are much more specific to the exact structure and function of the shoulder joint and its surrounding muscular function.

Purpose of Rotator Cuff

The major purpose of the rotator cuff is to help move the shoulder in all directions and provide stability to the humeral head.   What it critical to understand is that both the rotator cuff and its surround scapular stabilizing muscle allows movement and stability on every plane.

Now, we cannot begin to talk about the rotator cuff without directing attention to strength of the scapular muscles.  These muscles provide the girdle or foundation for shoulder movement.

In the physical therapy field, we say “proximal stability for distal mobility”.  By this we mean, don’t only focus on the muscles that move the arm but what stabilizes it too!

Injury can obviously happen to anyone of the rotator cuff muscles but there is selective injury among all four that must be addressed.

Rotator Cuff Injury

Hands down, the most common muscle in the cuff to be injured is the supraspinatus.  The muscle belly itself is not the culprit here, but rather the tendon that creates problems.

The part of any tendon that receives the most stress is usually at the musculo-tendinous junction, or where the muscle connects to the bone, but with the supraspinatus, injury happens in the “hypo-vascular zone” of the tendon.  This is the area of the tendon that innately has less blood supply secondary to the physics of how that muscle is situated over the head of the humerus.

Evidenced Based Expert Rotator Cuff ExercisesThe downward forces of the weight of the arm along with how the tendon wraps and hangs down on the humerus impedes its own blood flow thus the healing process as well.  The hypo-vascular zone is analogous to hanging a rope off the edge of a building.

The tension developed between the interface of the rope and corner/edge of building represents the hypo-vascular zone.  That’s why trainers and therapists alike use a towel under the arm when performing internal and external rotation exercise at zero degrees of shoulder abduction.

The towel simply creates more space for blood flow by literally pleating the tendon allowing more blood flow.

Understanding the anatomy and mechanics of the rotator cuff muscles can aid tremendously in the exercise prescription. Concomitantly, by studying the research and exploring a multi-functional approach will make a well-rounded training program.

Rotator Cuff Exercises

The exercises provided and the main focus of this article is to provide you with some of the evidenced based exercises we have to date for both scapular muscular recruitment and rotator cuff specific exercises.

One researcher named Bruce Mosley and his group out of Baylor College, designed a core scapular stabilizing program which is outlined below.  This program prescribes four main exercises that specifically recruit all eight of the major surrounding muscles required for scapular stability.

Furthermore, Hal Townshend out of the Centinela Biomechanics lab in California, described most of the initial core exercises for the rotator cuff proper.

The exercise recommended below have been researched and confirmed with indwelling electrodes and testing dozens of exercises. This list does not cover every exercise out there for the rotator cuff nor would we say it is comprehensive.

This research and its applications should simply lay the foundation to a full shoulder rehabilitation protocol or preventative fitness regimen.  One must realize exercise creation is limited only by your imagination.

Core “4” Rotator Cuff Exercises

1. Supraspinatus = Supraspinatus is not only an initiator of abduction, but acts throughout the range of abduction of the shoulder. It has equal abduction power as deltoid and lies in the scapular plane. This is defined as 30 degrees anterior to the frontal or coronal plane. SCAPTION

Exercise = Prone external rotation to 120 degrees of horizontal abduction, or Open Can Exercise

2. Infraspinatus = As one of the four muscles of the rotator cuff, the main function of the infraspinatus is to externally rotate the humerus and stabilize the shoulder joint.

Exercise= Side-lying external rotation at zero degrees of abduction.

3. Teres Minor = as part of the rotator cuff, it helps hold the humeral head in posteriorly in the glenoid fossa of the scapula. The Infraspinatus and Teres Minor work in tandem with the posterior deltoid to externally (laterally) rotate the humerus.

Exercise = Side-lying External Rotation with Zero degrees of Abduction.
The infraspinatus and Teres minor are fused together anatomically.  Surgically and clinically they function as one major muscle or unit and both treatment and exercises are the same.

4. Subscapularis = Subscapularis is the main internal rotator of the shoulder. It is the largest & strongest cuff muscle, providing 53% of total cuff strength. The upper 60% of the insertion is more tendinous and the lower 40% is more muscle. Two different exercises are warranted here.

Exercise = 1. Push Up Plus / 2. D2 Flexion Pattern or Dynamic Hug Thumbs Facing.

“Core-4” Scapular Stabilizer Exercises

Evidenced Based Expert Rotator Cuff Exercises 21. Trapezius – The trapezius is one of the major muscles of the back and is responsible for moving, rotating, and stabilizing the scapula (shoulder blade) and extending the head at the neck.

Exercise:

    • Middle Trap = Rowing
    • Lower Trapezius = Scaption 90-150 degree arc
    • Upper Trapezius = Scaption >120 degrees

2. Rhomboids Major. & Minor = The main function of both rhomboids (major and minor) act to retract the scapula, pulling it towards the vertebral column.

Exercise:  Rowing

3. Pectoralis Minor = Pectoralis minor is a scapular depressor and accessory muscle of respiration aiding in inhalation

Exercise: Dip Plus or Press Up

4. Levator Scapula = Works as a scapular elevator and also rotates and flexes the cervical spine laterally.

Exercise: Scaption and Rowing

5. Serratus Anterior = The serratus anterior is occasionally called the “big swing muscle” or “boxer’s muscle” because it is largely responsible for protracting the scapula needed when a punch is thrown. It also helps apply the scapula to the thorax or ribcage of the body.

Exercise:

  • Upper Fibers = Dynamic Hug & Push Up Plus
  • Lower Fibers = Dynamic Hug & Push Up Plus

1. Scaption – Scapular plane elevation is 30 degrees of the coronal or frontal plane.

2. Rowing – Palm down or pronated grip, abduction to 90 degrees with shoulder extension.

3. Push-Up Plus – Perform regular push-up and add an extended reach. That extra reach is extreme scapular protraction.

4. Press-Up – This is a seated dip plus extra scapular depression.

Wrap-Up

If you are looking to improve the strength and health of your rotator cuff, start implementing these expert rotator cuff exercises.

We are only as strong as our weakest link, so be total-body fit!

References

Moseley JB, Jr., Jobe FW, Pink M, et al. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20:128–134 [PubMed]

Reinold MM, Wilk KE, Fleisig GS, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther. 2004;34:385–394 [PubMed]

Townsend H, Jobe FW, Pink M, Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med. 1991;19:264–272 [PubMed]

Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970 Aug;52(3):540-53.

Dr. Scott Weiss