Rotator Cuff, Part 4 – Therapeutic Exercise for Rotator Cuff Tendinopathy
The blog, Rotator Cuff Part 3 discussed the physical therapy treatment for rotator cuff tendinopathy and degenerative rotator cuff tears. This blog will detail some of the common exercises for rotator cuff tendinopathy and degenerative tears and their purpose. It is important to note that in physical therapy, exercises are individually chosen based on the patient’s physical examination. Stretching and strengthening should be pain free, so exercises are modified or delayed if there is pain.
Tightness in the pectoralis minor contributes to a mal-positioned shoulder blade and socket. Normally, when you raise your arm, the shoulder blade needs to tilt backwards. A tight pectoralis minor holds the shoulder blade forward, contributing to impingement. A common pectoralis minor stretch is the corner stretch.
Posterior shoulder tightness is common in patients with rotator cuff pathology. There are different theories as to its contribution to the shoulder joint’s faulty movement. It’s possible that it contributes to the mal-positioned shoulder blade and socket or that it contributes to the ball not sitting congruently in the socket. Common stretches are the sleeper stretch or the cross body stretch.
The serratus anterior muscle stabilizes the shoulder blade against the rib cage. Weakness creates “winging” of the shoulder blade. As well, the function of the serratus anterior is to upwardly rotate and backwards tilt the shoulder blade, important movements necessary when raising the arm. Common strength exercises are the wall push up plus or the serratus punch.
The lower trapezius muscle also stabilizes the shoulder blade and contributes to upward rotation movement. The best exercises to target the lower trapezius muscle position the arm overhead, which can be painful during the early stages of rotator cuff rehabilitation. Early in the rehabilitation process, a modified chair press exercise or retraction exercise are used. Later in rehab, a more advanced exercise is lying on the stomach, raising the arm from a diagonal overhead position (part way between flexion and abduction).
The muscles around the shoulder blade control the position of the socket. Other common shoulder blade stabilization exercises may include: pull down, prone abduction in external rotation, weight bearing on the upper extremity (such as all 4’s or planks), or ball wall circles.
The rotator cuff stabilizes the ball of the shoulder joint in the socket and depresses it down in the socket, away from the coracoacromial arch as the arm raises up. Common strengthening exercises are external rotation and internal rotation against elastic resistance with arm held by your side.
Recall that a slouched posture affects the position of the socket and the mechanics of the shoulder. So, rehabilitation of rotator cuff problems often includes practicing proper postural alignment, sitting up or standing straight starting from your core or abdominals.
Kuhn JE. Exercise in the treatment of rotator cuff impingement : A systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg 2009; 18: 138-160.
Ludewig PA, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 2009;39(2): 90-104.