About rotator cuff issues
In my practice, shoulder complaints may be the most common patient presentation. And if not, these complaints certainly give low back pain and knee injuries a healthy run for their money! In this blog we discuss a rotator cuff exercise protocol for at home use!
For our purposes we define rotator cuff injuries as muscle or tendon disruption of the supraspinatus, infraspinatus, subscapularis or teres minor muscles. I personally also like to throw in biceps tendon injuries. I affectionately call the biceps tendon the “5th Beatle of the rotator cuff” since the biceps is also an important shoulder stabilizer (and mover!).
Rotator cuff injuries are impactful pains in the butt. When caused by repetitive strain they onset for what seems like no reason at all. They can be frustratingly painful and long lived. The daily impact in terms of restricted activity not to mention the pain can cause emotional stress that adds to the overall crummy experience.
Shoulder pain is multifaceted and is informed by a lot more than just damaged tissue. Our fears and anxieties around injury inform (and aggravate) the experience of pain. Hypervigilance, and anxiety over an injury can unfortunately sensitise the nervous system to the perception of pain, which is a real bummer! Sensitisation is characterised by an expansion of the painful area from a focused local site to a larger, more diffuse regional pain. In addition, the triggers of pain may expand to include things that wouldn’t typically be painful, things like innocuous movements or benign touch become painful in an unexpected and outsized manner.
One goal of therapy in this situation is to “retrain” the nervous system about normal movement and touch. We can do this by introducing a range of sensory input. For example, different temperatures could be applied in the form of a warm bath or ice massage. Massage therapy could provide varied pressures and textures.
Similarly, exploring a variety of exercises helps to (besides the obvious strengthening) normalise sensory perception across a range of movement patterns, muscle tensions and joint positions. All of this can treat the chronic painful shoulder experience.
About various interventions (and especially about exercise!)
“Well that’s great” you are likely saying to yourself, “but what exercises should I do to treat my shoulder? What an outstanding question!
There are different approaches advocated. Some suggest that focusing on deep control of the small muscles that stabilise the shoulder. Others suggest focusing purely on strength of the whole shoulder girdle. Some researchers tell us that it’s the coordination of various muscles and the positions we adopt through movement that needs to be trained.
So it can be confusing.
The good news though is that there is a body of research suggesting varied approaches to shoulder exercise can produce equally good results. In other words There is no standout “right way” to do rehabilitative exercise. One explanation for why this is may be that exercise is a multidimensional treatment that may intervene across many elements of health, including psychosocial constructs like self efficacy and quality-of-life in addition to those physiological markers like strength and stability.
From this perspective it seems better to simply find something that you enjoy doing regularly and that you can fit to your schedule.
A rotator cuff exercise protocol for at home use
In the attached video I demonstrate a varied approach to rehabilitative shoulder exercise. Some exercises are focused on controlled movement of the scapula. Other exercises are more focused on the strength of the rotator cuff. While still others stress involvement of the larger global muscle groups that power the functional shoulder movements you’d use in daily life.
The protocol as a whole is short and to the point, ringing in at about 20 minutes. The idea is to provide a program that is quick and easy to access wherever and whenever you like.
We do use a light resistance band, as well as some other “equipment” that anyone will have lying around the house. If you don’t have a resistance band you can easily find it online. If you are shopping local and in person, TheraBand is also found at many home healthcare stores.
Should I experience pain with exercise?
My rule is that a little bit of pain is acceptable during exercise for rotator cuff injury. Remember we are not trying to blast the barn doors open here, minor discomfort only please. I like to think of it as “flirting” with your discomfort.
And use the “24 hour rule”, meaning that if it’s the next day and you can still feel the effect of “that exercise”, then you’ve done too much and we need to modify the exercise in some manner. True, It’s a lagging indicator, but can still act as a guiding principle.
This is a rotator cuff exercise protocol for at home use on shoulders with rotator cuff pathology or subacromial impingement. It can also be useful for other injury types like AC joint sprains or labral injuries. Having said that, there are, of course, injury types that require additional, or completely different types of care than that shown here. If you are unsure about your diagnosis, you should check with your physiotherapist (click here to book with James 😉 or another appropriate professional to confirm these exercises are appropriate for you.
Further reading (if you really want to impress your friends!)
Bury, J., West, M., Chamorro-Moriana, G., & Littlewood, C. (2016). Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: a systematic review and meta-analysis. Manual therapy, 25, 35-42
Dominguez-Romero, J. G., Jiménez-Rejano, J. J., Ridao-Fernández, C., & Chamorro-Moriana, G. (2021). Exercise-Based Muscle Development Programmes and Their Effectiveness in the Functional Recovery of Rotator Cuff Tendinopathy: A Systematic Review. Diagnostics, 11(3), 529.
Maenhout, A. G., Mahieu, N. N., De Muynck, M., De Wilde, L. F., & Cools, A. M. (2013). Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized, clinical trial. Knee surgery, sports traumatology, arthroscopy, 21(5), 1158-1167.
Powell, J. K., & Lewis, J. S. (2021). Rotator Cuff–Related Shoulder Pain: Is It Time to Reframe the Advice,“You Need to Strengthen Your Shoulder”?. journal of orthopaedic & sports physical therapy, 51(4), 156-158.
Smart, K. M., Blake, C., Staines, A., Thacker, M., & Doody, C. (2012). Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (±leg) pain. Manual therapy, 17(4), 336-344.
Vallés-Carrascosa, E., Gallego-Izquierdo, T., Jiménez-Rejano, J. J., Plaza-Manzano, G., Pecos-Martín, D., Hita-Contreras, F., & Ochoa, A. A. (2018). Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome. Journal of Hand Therapy, 31(2), 227-237.