A very common shoulder injury is a rotator cuff tear. Many tears will require surgery, but some will not. If you proceed non-operatively, you are probably wondering what does rotator cuff treatment look like?
Rotator Cuff Treatment Starts With The Scapula
In any shoulder rehabilitation, treatment starts at the scapula (shoulder blade). The position of the shoulder blade determines the position of the entire shoulder. If you watch someone shrug their shoulders, you will see their scapulae move up. If you see them reach forward, the scapulae may slide out to the side. The ability to control the scapula is a critical part of rotator cuff treatment.
The first move I make sure each of my shoulder patients can do is a “scap squeeze.” This name is not entirely accurate. Think of drawing your shoulder blades down and together, as shown in this video.
The next exercise for control of the scapula is a “Y” or a “V”. Stand up tall, and think of drawing the letter “V” in front of your body. In this video the hands go all the way up – this is not necessary. Only go as high as is non-painful for you.
Lastly, a movement called a “prone T.” Laying on your stomach with your target arm hanging off the bed, lift your arm straight out to the side. Your arm should be straight and your hand should be almost level with your torso. Slowly lower your hand back down and repeat. Make sure to keep your shoulder blade tucked down and in (“scap squeeze” mentioned above – this movement carries through all of your exercises!) for the entire movement.
Next We Calm Down The Rotator Cuff Muscles By Using Isometrics
An isometric muscle contraction is where the muscle is contracting without moving. Think of pushing into a wall or holding a squat position for some time – that is an isometric movement. We start with isometrics because they are usually non-irritating for the muscles.
Start by standing with a rolled up towel squeezed between your elbow and your body. The towel positions the rotator cuff in a comfortable position. With your arm at your side and your elbow bent to 90 degrees, gently press the back of your hand into the wall. You are applying a force of external rotation, but your arm will not move. The amount of force is very gentle and should be pain-free. Hold for 5-10 seconds, rest 5 seconds, repeat 12 times, for 3 sets. If this exercise is painful, either apply significantly less force, or hold off on this exercise until it is pain-free. The rotator cuff is already irritated – the goal is to avoid further injury and pain.
If the above exercise is easy and pain-free, you can try “walk-outs”. Keeping your arm in the same position as the previous exercise, attach a band to an anchor on the opposite side of your body as your injured shoulder. Step away from the band until there is some tension. Don’t allow your shoulder to shrug or move. Slowly step back towards the anchor, decreasing the tension on the band. Repeat. Try doing this for about 30 seconds, 3 sets.
Once Isometrics Become Easy, You Can Move Onto More Strengthening If Your Pain Isn’t Increasing
The next step: instead of doing the walk-outs, simply externally rotate your shoulder. You can see this here. Make sure to keep your shoulder blade tucked down and in, not allowing your shoulder to shrug. I suggest starting with 3 sets of 12 repetitions daily.
Lastly, do you remember those standing “y’s” you did early on? If you’re now able to move through the full range of motion, try performing it with 1-2 lbs in your hands. Make sure you perform the movement slowly and with control, especially on the way down. Again, as we proceed with rotator cuff treatment please abstain from performing exercises that are painful.
This Is Not A Comprehensive Guide to Rotator Cuff Rehabilitation
There are many additional exercises that I prescribe for rotator cuff rehabilitation. The amount of repetitions and resistance are dosed based on how my patients respond. These exercises are a good start, but they may not be enough. If you continue to have shoulder pain, please seek treatment as soon as possible so that your decline in shoulder function is minimized.
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