Rotator cuff injuries, including tears, impingement or tendonitis, are very common, especially among active individuals.  Whether you have a tear or simply tendonitis, the focus should be on keeping all of your range of movement and boosting your rotator cuff strength.  While some people choose to self-treat with stretching and strengthening, this can be hit or miss and really cannot take the place of a hands-on examination and physical therapy.  Either way, understanding how your shoulder works will help you take care of it in the future...be sure to read our great article on shoulder mechanics and the rotator cuff for a nice background on the basics of understanding your shoulder.

The most common area of tightness in the shoulder is the back part of the capsule (ligament and tissue) holding the ball and socket together.  Tightness in this area changes the way the ball rotates in the socket, causing it to glide upward, pinching the rotator cuff tendons.  Addressing the mobility (the ability of the joint to move properly) and the flexibility (the ability of the muscles to stretch and allow the joint to move properly) is an important step in proper rehabilitation.  Many times, restoring proper mechanics through stretches will alleviate the pain and will then allow you to restore appropriate strength and muscular control to resume normal activities.  There are a couple of good ways to self-stretch this area that are easy and effective, however, if you have a partially torn tendon and the stretches are not done properly, it could make the tear worse.

First, while standing, raise the arm of the painful side straight in front of you.  Bend your elbow with your hand pointing across to your opposite shoulder.  With your other hand, grab behind your bent elbow and pull gently across your body.  This should create a stretch across the back of your shoulder and will sometimes cause a mild discomfort in the front of the shoulder as well.  As long as this remains mild and the stretch along the back is greater, hold for 10-15 seconds, relax the stretch slightly and gently pull across for another 10-15 seconds.  Repeat this stretch/relax cycle until you have completed 5 or 6 stretches.  This stretch can be adjusted if there is pain by lowering the angle of pull across the body to lower than the shoulder.

The second stretch is performed lying on the affected (painful) side, preferably on a carpeted floor rather than a soft bed or couch as it helps to stabilize the shoulder blade.  Angle your arm straight out from your shoulder and then bend your elbow so your fingers point up toward the ceiling.  With your ‘good’ hand, grasp the wrist of your ‘painful’ side and gently push down so that the palm of your hand goes toward the floor.  It is important to keep your elbow bent at 90 degrees as you push to the floor.  The stretch should be held for 10 seconds, after which you can relax the stretch.  Repeat for 5 full stretches.  As in the first stretch, you may feel some discomfort in the front of your shoulder, however, you should feel the most stretching in the back of your shoulder.

The strengthening part of the program focuses on the four muscles that make up the rotator cuff, commonly referred to as the SITS muscles (named for the first letter of each muscle):  Supraspinatus, Infraspinatus, Teres Minor and Subscapularis.  However, the shoulder is a very complex set of joints referred to as the shoulder girdle and any functional movement requires muscles to both stabilize and move the shoulder blade (scapula), arm (humerus) and collar bone (clavicle).  Because of this complexity, the exercise routine will include exercises that involve these other muscle groups and joints to insure that we get everything working together.

* once 3 sets of 10 repetitions with 1-2 pounds becomes easier for exercises 1-4, you can increase the weight by about 1 pound.  You can also add a few repetitions to any or all of the exercises to push a little more.

1. Lie at the edge of a bed on your stomach with your arm hanging straight down toward the floor.  Hold 1-2 pounds (can of soup/vegetables) in a way that your thumb is facing toward the bed.  Slowly raise your arm up toward the ceiling, straight out to the side (shoulder at 90 degrees).  Do not raise any higher than the height of the bed and stop before that if you have pain in your shoulder.  Slowly lower your arm back down toward the floor.  Repeat 10 raises (or less if your arm gets tired and you are struggling to raise it.)
2. Same position as #1 except turn your hand so that your thumb is facing away from the bed.  Slowly raise your arm up toward the ceiling, no higher than the height of the bed and slowly lower back toward the floor.  Most people find this position slightly easier than #1.  Repeat 10 raises (or less if your arm get tired and you are struggling to raise it.) 
3. Same position with your arm hanging down to the floor.  Let your elbow bend as you slowly pull your hand/weight up toward your hip, in a rowing motion and slowly lower it back down.  Repeat 10 repetitions, as is #’s 1 and 2. 
4. Same position as #3, except this time perform the ‘rowing’ motion straight out to the side (shoulder at 90 degrees).  When your elbow is raised toward the height of the bed, hold it there as you then raise your hand up toward the ceiling (don’t force the motion if it is too uncomfortable).  Slowly lower your hand and then your elbow until your arm is hanging toward the floor.  Repeat 10 raises.  Once you have finished 10 raises, switch back to #1, then #2, then #3 and finally #4 again until you have completed 3 sets of #’s 1, 2, 3 and 4.
5. Next…get up off the bed!  Standup and let your arm hang down by your side.  Turn your hand so that your thumb is facing inward toward your thigh and slowly raise your arm up, keeping your elbow straight, half way between the front of your body and straight out to the side.  Only raise your arm until it gets to about 5-6 inches below shoulder level.  Slowly lower it back down toward your side.  Repeat 10 repetitions.  Rest about 30 seconds, repeat 10 additional repetitions, rest about 30 seconds and repeat a final 10 repetitions. 
6. Next, stand in a corner with your back toward the corner and your feet about 12 inches from the wall.  Lean back into the corner with your body and raise your elbows up along either wall until they are about 8 inches below shoulder level.  Push through each elbow and push yourself out from the corner slowly and then lower yourself back into the corner slowly.  Repeat 10-15 times.  Walk around for about 30 seconds to rest and then repeat this routine for 2 more sets.
7. Lastly, stand facing a counter and place your hands about shoulder width apart on the edge of the counter.  Slowly take small steps back with your feet until you feel your arms supporting some weight (maybe about 2 feet).  Slowly let your elbows bend as you lower your body toward the counter, keeping your elbows about 5-6 inches from your sides.  Slowly push your body back away from the counter until your arms are straight again.  Repeat 10 times, taking a 30 second break in between sets and then finishing with a 3^rd set of 10. 

This rotator cuff exercise program represents a typical program that people with tendonitis, bursitis or impingement might be placed on.  Everyone has slightly different problems that are causing their pain and someone might require more specific stretches or mobilizations in order for this program to be more effective.

Other factors, such as work or sport activity, also commonly play into injuries.  Sometimes the problem is merely the number of repetitions being too great for the strength and endurance of the muscle(s) and as they fatigue they lose their ability to control the movement properly.  Other times, the problem may be poor technique that is leading to irritation and inflammation.  Either way, all factors need to be considered and addressed in order to have a successful outcome. 

I have attached a handout to this page that you can open and download to your computer (in PDF format). The handout is not exactly the same as the descriptions above...there are some additional ex's and some above were not included but I thought it was a good additional resource for you.