Traditionally rotator cuff (RTC) exercises have consisted of internal(IR) and external rotation (ER), rows, shoulder extensions, T/Y/W’s, and maybe if your PT was adventurous, and there was no impingement, bicep curls. But just looking at what “movements” the rotator cuff muscles do is definitely not enough; the FUNCTION of these four small muscles are what truly need to be examined for proper rehabilitation. The main functions of the RTC are:
1. Depressing the arm bone (humerus) in the shoulder joint so you can raise your arm above shoulder level
2. Stabilizing the shoulder joint so proper scapulo-humeral rhythm can be maintained
3. During closed chain exercises, assisting in the stabilization of the scapula and humerus to allow for mobility in the shoulder
4. Oh yeah, ASSISTING with internal and external rotation.
The rotator cuff muscles can be remembered by the acronym SITS.
Supraspinatus – most commonly torn
If you look at the functions above, you don’t see a heavy emphasis for the rotator cuff muscles being the prime movers of the arm. They are role players, part of the supporting cast, and that is how they should be rehabbed and trained. When rehabbing a rotator cuff injury I will often surprise my patients by only using bands to provide variations of the following exercises, or for warm ups involving PNF rotary movements such as D1/D2 flexion and extension. I will definitely do internal and external rotation in this WARM UP, but only if it can be performed with proper scapular positioning and control, which is more difficult than you think.
- The Farmer’s Walk – What better way to get your RTC contracting than to perform an exercise designed to rip your arm out of your shoulder joint. No joking, these should be done with heavy weight. Leave the 5 pounders on the rack. Your weakness with this exercise should be your grip strength if anything. Shoulders are down and back (packed), chin is packed, and arms are straight. To prevent your arms from being torn from your sides, those four muscles above have to work their hearts out to stabilize the shoulders. And an added bonus; to prevent your scapula from comic forwards your other periscapular muscles need to fire like crazy!
- Deadlifts – Once again leave the tiny weights at home. The deadlift pulls on your arm like a Farmer’s walk, but also requires mobility within your shoulder. Shoulders blades should be back, chin is packed, elbows are locked, back is straight, and your feet should have arches. Use your glutes to lift the weight, not your back or arms (your shoulders will passively move properly if your form is good).
- Arm Bars – Traditionally, these are done with a kettle bell while laying on the floor, but because my patient population can have some difficulty getting up from the floor I will use a heavy band. This is once again a progression on the previous two exercises because it requires more mobility from the shoulder but continues to require stability in the shoulder blade. Grab the band with your elbow locked, and keep your shoulder blade down and back through the entire exercise. Your fist should always face the anchor of the band, and then you rotate your body/chest away from the anchor point and then return to the start. The heavier the band the better.
I would love to include Turkish Get Ups on this list, but their complexity and fact that it requires getting on on the floor prevent me from including this in many peoples’ rehab programs.
Obviously proper prep work needs to be done prior to performing any of these exercises as well. Mobility work where it’s needed in the thoracic spine, AC joint, shoulder, and accompanying musculature, as well as making sure the client even possesses the motor control to retract their shoulder blade needs to be done.
One final thought for those of you having patients do IR/ER or those of you who actually are the ones doing IR/ER. When performing these exercises I want you to try to keep your shoulder blade stable (not in a rolled forwards position) to allow the RTC to perform true IR and ER. You will see that these muscles get fatigued even easier this way, and it also works on scapular control.
Hope you are starting to take a new look at how you train or rehab. Remember that it is not always how a muscle moves, but actually what a muscle does that should be addressed with your rehab/training.
Always Evolve (your rotator cuff rehab),