A Physiotherapist’s Guide to the Rotator Cuff

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, and are essential for shoulder stability and movement. In this article, we will take you through the anatomy of the rotator cuff, its function, how to warm up and strengthen the rotator cuff, and exercises you can do to improve its health.

Anatomy of the Rotator Cuff

The rotator cuff is composed of four muscles and their tendons that connect the scapula (shoulder blade) to the humerus (upper arm bone). These muscles include:

Supraspinatus

Located on the top of the shoulder blade, it attaches to the top of the humerus. Its primary function is to lift the arm away from the body, especially in the first 15 degrees of abduction. This muscle is responsible for preventing the humeral head from moving upward during arm movement.

Infraspinatus

This can be found on the back of the shoulder blade, attaching to the back of the humerus. Its primary function is to externally rotate the arm, allowing the hand to reach behind the body or to the opposite shoulder.

Teres minor

Below the infraspinatus, you can find Teres Minor which also attaches to the bottom of the humerus. Its primary function is to externally rotate the arm and to assist in adduction and extension of the arm.

Subscapularis

Last up, the subscapularis is located on the front of the shoulder blade and attaches to the front of the humerus. Its primary function is to internally rotate the arm, allowing the hand to reach behind the back. This muscle also acts to prevent the humeral head from moving forward.

Function of the Rotator Cuff

The rotator cuff muscles work together to help stabilise the shoulder joint, allowing for proper shoulder movement and function. Specifically, the rotator cuff muscles help with shoulder abduction (lifting the arm away from the body), internal and external rotation (turning the arm inward and outward), and shoulder extension (moving the arm backward). When the rotator cuff muscles are weak or injured, you may experience pain or weakness in your shoulder, difficulty lifting your arm, or reduced range of motion.

Top warm up exercises for your Rotator Cuff

Shoulder circles

Stand with your feet shoulder-width apart and your arms at your sides. Slowly lift your arms out to the sides and make large circles with your shoulders, both clockwise and counterclockwise.

Scapular retraction

Stand with your arms at your sides and your shoulders relaxed. Squeeze your shoulder blades together and hold for a few seconds before releasing.

Arm swings

Stand with your feet shoulder-width apart and swing your arms back and forth, allowing them to cross in front of your body and behind your back.

Wall angels

Stand with your back against a wall and your arms at your sides. Slowly raise your arms up and out to the sides, keeping them in contact with the wall, and then slowly lower them back down.

Top strength exercises for your Rotator Cuff

External rotations

With a resistance band or light weights, stand with your arms at your sides and your elbows bent to 90 degrees. Keeping your elbows close to your sides, rotate your arms outward.

Internal rotations

With a resistance band or light weights, stand with your arms at your sides and your elbows bent to 90 degrees. Keeping your elbows close to your sides, rotate your arms inward.

Scaption

With a resistance band or light weights, stand with your arms at your sides and your palms facing in. Raise your arms out to the sides and up to shoulder height.

Prone horizontal abduction

Lie on your stomach with your arms at your sides and your palms facing down. Lift your arms up and out to the sides, keeping them in line with your shoulders.

Y-T-W-L

Lie face down on a bench with your arms hanging down. Lift your arms up and out to form a Y shape, then move them back to form a T shape, then move them down to form a W shape, and finally move them back to form an L shape.

_{It is advised that these exercises are educated and trained by an experienced professional that can assess the user’s competency and technique, as well as review and set their training programmes to incorporate these exercises making sure that adequate rest and nutrition is planned.}

References:

1. ‍American Academy of Orthopaedic Surgeons. (2019). Rotator Cuff Tears. OrthoInfo.
2. ‍Kukkonen J, Joukainen A, Lehtinen J, et al. (2015). Treatment of non-traumatic rotator cuff tears: A randomized controlled trial with one-year clinical results. Journal of Bone and Joint Surgery, American Volume. 97(21): 1729-1737.

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