The rotator cuff is a network of muscles and tendons that support the movements of the shoulder while stabilizing the ball of the shoulder within its socket. While the shoulder is the most mobile joint in the body, its mobility often compromises its stability. This complicates the rotator cuff's task, by creating a conflict between movement facilitation and movement control. Rotator cuff tears may result from this conflict. When prescribing a therapy program, the physical therapist must strike a balance between strength and flexibility exercises.
The subscapularis, supraspinatus, infraspinatus and the teres minor form a cuff at the top of the arm, and support shoulder internal and external rotation -- thus the name "rotator cuff." Rotator cuff tears, advises the American Academy of Orthpaedic Surgeons website, result from overuse and are common to baseball players, tennis players, weight lifters and rowers. Before designing an exercise program, your therapist will ask you about your sports participation and typical movement pattens. She will then identify potential muscle imbalance and design a program based on your specific needs.
Physical therapists divide rotator cuff therapeutic exercise programs into two or three phases, depending on their client's needs. Progressing to the next phase depends strictly on the individual's progress and does not follow any set protocol. Stretching and mobility exercises characterize the first treatment phase. A typical stretch may involve bringing the injured arm across your chest, cradling it with the opposite forearm and holding the stretch for 30-second intervals. To perform active flexibility or mobility exercises, bend at the waist and swing your arm in a pendulum motion. The therapist introduces strengthening exercises in the second treatment phase, and prescribes them according to her patient's specific muscle weaknesses. The third phase, which involves plyometric activities such as tossing a medicine ball, is optional and is most relevant to athletes.
The supraspinatus is the most frequently injured rotator cuff muscle. If you tear this muscle, you will feel pain when performing exercises such as a lateral raise, an overhead press or an upright row. The side-lying lateral raise may be part of your therapeutic exercise program. Lie on your side with your knees bent and your top leg resting on top of your bottom leg. Hold a light weight with your top hand, positioning it so that it is front of your navel. Slowly raise your arm toward the ceiling and lower it with control. Perform three sets of 10 repetitions. Infraspinatus weakness may cause you to feel pain when throwing a ball or performing a bench press. Your therapist may prescribe external rotation exercises. Lie on your side with your knees bent. Hold a light weight with your top hand. Bend your elbow, stabilize it against your waist and lower your forearm toward the floor. Externally rotate your shoulder to raise your forearm. Return with control and perform three sets of 10 repetitions.
Types of Equipment
Lightweight dumbbells, resistance bands and medicine balls are common therapeutic exercise tools for rotator cuff injuries. Some therapists have attachment devices for the bands, which secure them to an immovable object. The medicine balls facilitate plyometric and mobility exercise. An athletic patient may throw the ball against a mini trampoline and catch it on the rebound. Patient can mobilize their rotator cuffs by placing the medicine ball against the wall, rolling it up and down and making small circles.
Rotator cuff tears are complex injuries and require a physician's diagnosis. Many other injuries, such as a separated shoulder, share the same symptoms but may require an entirely different treatment. Never attempt any type of therapeutic exercise without a doctor's approval.
- American Academy of Orthopaedic Surgeons: Rotator Cuff Tears
- Wheeless Textbook of Orthopaedics: Anatomy of a Rotator Cuff
- American Family Physician: Management of Shoulder Impingement Syndrome and Rotator Cuff Tears
- Sports Injury Clinic: Rotator Cuff Rehabilitation
- Cleavland Clinic; Rotator Cuff Tears: Surgery and Exercise
- Steadman Clinic: Shoulder Anatomy