Rotator Cuff Tears: Manage with Exercise

The rotator cuff is a group of four muscles spanning from the shoulder blade to the upper arm (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.  Thankfully, the right exercises can help.

Rotator Cuff Anatomy

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 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 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 all 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 large 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 tears.

Strengthening Exercise

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 that preferentially activate the cuff and those which involve coordination with other muscles should be performed.

Sidelying external rotation is one important exercise that preferentially activates the rotator cuff.  In particular, this exercise targets 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 that 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 the coordination of all rotator cuff muscles along with the muscles of the upper arm and shoulder blade.

 

 

Closing Thoughts on Rotator Cuff Exercise

Rotator cuff tears can be effectively managed with an individualized exercise program.  There are no one-size-fits-all exercise programs suitable for everyone with tears.  An individualized exercise program should be developed by your physical therapist.    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.  Contact us if you have questions about how to get started.


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