The rotator cuff is a group of four muscles spanning from the shoulder blade to the upper arm or humerus bone. These four muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. The primary role of these muscles is to center the ball (end of the humerus) in the socket (shoulder blade). A poorly functioning rotator cuff can result in pain, weakness, altered movement, and disability.
The tendons of the rotator cuff muscles can become injured or torn by trauma such as a fall. However, many tears do not involve any trauma. The incidence of rotator cuff tears increases with age. The prevalence of tears has been reported between 20% and 30% in those 60 to 80 years old. However, many individuals with tears of all sizes do not have any symptoms.
The torn tendons of the rotator cuff may not fully heal themselves. Even after being repaired by surgery, many tendons re-tear. Although as high as 20% to 30% of rotator cuff repairs may re-tear, functional outcomes are typically very good following surgery. However, surgery may not be a viable option for some individuals. Many with rotator cuff tears seek non-operative solutions. Exercise has been shown to be an effective non-surgical treatment option for many with small and large tears.
Research Supporting Exercise to Manage Rotator Cuff Tears
A recent study out of Denmark, showed 5 months of exercise improved function by nearly 50% in patients with irreparable rotator cuff tears. Strength, range of motion, pain, and quality of life also showed significant improvements in these patients who were judged not to be surgical candidates. Another study from researchers at Vanderbilt University showed 75% of patients with full-thickness tears respond well to exercise. After two years, only 25% of patients in this study chose to pursue surgery. These studies support the role of exercise as an alternative to surgery for those with symptomatic tears.
So we know exercise can be effective but what are some of the best exercises to strengthen the shoulder in those with a rotator cuff tear? Recall, the primary role of the rotator cuff is to center the ball in the socket to allow the arm to function. A secondary role is to produce rotational movements of the upper arm. These rotational movements are necessary and occur along with other functional movements such as reaching overhead or behind the back. Therefore, exercises which preferentially activate the rotator cuff and those which involve coordination with other muscles should be performed.
Sidelying external rotation is one important exercise which preferentially activates the rotator cuff. In particular, this exercise targets the posterior rotator cuff. These muscles are the infraspinatus and teres minor. This exercise should be performed with very light weights or perhaps only the weight of the arm at first. Another lower level exercise which can be incorporated is the standing row or any of its variations. The row activates all rotator cuff muscles at a low level along with strengthening the muscles of the shoulder blade. Rows can be performed with a cable, resistance bands, or light dumbbells.
After proficiency with these baseline exercises has been achieved, more advanced exercises may be incorporated. However, not everyone will need to progress to these more challenging exercises. Arm raises lying in prone preferentially activate the supraspinatus and infraspinatus muscles along with the muscles of the shoulder blade. The supraspinatus is the most commonly torn tendon. Also, diagonal movements train coordination of all rotator cuff muscles along with the muscles of the upper arm and shoulder blade.
Rotator cuff tears can be effectively managed through exercise in many individuals. There is no one-size fits all exercise program suitable for everyone with tears. An individualized exercise program should be developed by an exercise professional. The exercise program should be based on a detailed interview and physical examination. Exercises should then target the specific areas of weakness and goals of the individual.
- Christensen BH, Andersen KS, Rasmussen S, Andreasen EL. Enhanced function and quality of life following 5 months of exercise therapy for patients with irreparable rotator cuff tears – an intervention study. BMC Musculoskeletal Disord. 2016;17(252):1-8. doi:10.1186/s12891-016-1116-6.
- Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: A multicenter prospective cohort study for the MOON Shoulder Group. J Shoulder Elbow Surg. 2013;22:1371-1379. doi:10.1016/j.jse.2013.01.026.