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The rotator cuff is a group of small muscles that often get injured in everyday life or at the gym. You can fix them with rehab and prehab exercises, in conjunction with working on posture and strengthening the shoulder generally.

Your rotator cuff governs humeral rotation.  Hold your arm out to the side, and turn the palm over.  Go palm up, then palm down.  That’s your rotator cuff, controlling the rotation of your humerus – the bone of your upper arm – in the socket of your shoulder. 

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The rotator cuff is made of four small, delicate muscles in the upper back, plus one of the muscles in the chest that’s often involved in rotator cuff problems but isn't technically part of it.  

Because it’s strongly influenced by posture the rotator cuff is easy to damage by chronic bad movement patterns and because it’s tendinous and hard to get at, it can be hard to rehab.

There are four rotator cuff muscles, the supraspinatus, infraspinatus, teres minor and subscapularis. The first two are named for their position in the back relative to the spine of the scapula – the part of the shoulderblade you can feel with your fingers, standing proud of the rest.  The supraspinatus runs above it, the infraspinatus below it and the subscapularis begins on the underside of the scapula, between your shoulder-blade and ribs, and ends on the pint of your shoulder. The teres minor starts on the outside of your shoulder-blade and ends on the point of your shoulder.

People blow their rotator cuffs out all the time. Blows and falls, twists and wrenches, can all damage the fragile muscles. An arm is a lever, and that works both ways. Supraspinatus is particularly easy to damage with shearing blows to the shoulder or with poor head, neck and shoulder posture.

We’ll go through some methods to improve mobility in the neck and shoulder area, as well as a couple of good general exercises to free up the rotator cuff.  We’ll cover the basic rehab material that most physios don’t tell their clients.  Then we’ll look at how to make your shoulders so strong and mobile that you never again have any rotator cuff problems.

Many rotator cuff injuries are caused by poor posture.  Rounded shoulders and heads extended forward leave the rotator cuffs doing the jobs of bigger muscles, things they aren’t designed to do. 

We’ll go over a couple of exercises to correct that.

Shoulder Pinches:

Shoulder pinches simply consist of using the scapular retractors and depressors to drag the cervical spine upright and stretch out the upper chest, a notoriously difficult area to stretch. Stand upright and engage your glutes and core. This will help prevent your low back from deforming to accommodate your movement so it’s important. Now, extend your arms, palms up on either side of you with the thumbs facing back. 

Roll your shoulders up, back and back down, and then bend your elbows slightly until they’re about half bent and half extended.  Holding your arms in this position, and with your neck in neutral, you’re going to try to pull your shoulder-blades as tight together as you can and then hold them there for a count of five seconds.  Relax, and repeat four or five times. Try to increase the time you can hold the position to fifteen or twenty seconds. 

Glute Bridges:

Bridges are a glute exercise, but they can also be used to stretch out a tight upper back. Lie on your back and bring your heels up under your glutes.  Drive your heels into the floor and push your pelvis up, at the same time pressing your upper back into the floor. While this doesn't work for some people, for others it affords immediate relief and allows you to stretch out your shoulder and neck area while bridging. Plus, anything that makes your glutes stronger is good.

Strength and mobility in the shoulder areas frees up the pressure on the rotator cuffs.

Anything that makes the trapezius inferior and lats stronger will pull your shoulder-blades down your spine and lengthen and relax your upper cervical spine and neck.  Try these moves to improve your shoulder function:

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Deadlifts:

As much as deadlifts are THE strength exercise, they’re also a good way to begin to strengthen the shoulder area. There’s no movement through difficult ranges of motion but a deadlift strengthens the lats and traps and builds spinal erectors. Where you can’t work on the rotator cuff directly you’re best served to focus on building its support structure and that means carefully improving your shoulder health in general. If you’re deadlifting on a shoulder injury, the main thing you should think about is: if it hurts, stop doing it immediately. Don’t try to lift huge weights to start off with: instead, use it as an opportunity to really focus on form. Go for a long spine, a strong arch in your back and a tight, retracted shoulder.

Swings:

Swings are helpful for similar reasons to deadlifts but they work across a slightly larger range of motion.  Swing from the hips, don’t try to raise the weight in front of you with your arms, and always be pulling the weight back towards you.

The reasons these moves work is because they focus on scapular retraction and building the muscles that hold the rest of your shoulder together.  They help with rotator cuff problems because the major cause of rotator cuff problems is asking the rotator cuff to do things that are really the job of other muscles. 

A stronger upper back will help to allow your rotator cuff to recover or stay strong. 

Therefore this set of exercises is directed at training the scapular system of muscles to take the stress away from the rotator cuff, rather than targeting the rotator cuff directly.

If you have a shoulder problem already, do what you can of the moves outlines above, then try implementing these into your program:

Cuban Press

The Cuban Press hits the scapular retractors and depressors – but it also places a big load on the humeral external rotators, the teres and more importantly the infraspinatus.  Hold a barbell in a snatch grip and raise it until your elbows are bent at 90º.  Then hold your elbows in position and rotate your arms around the elbows to raise the bar until it’s level with your forehead and press it out overhead.  

Use a light weight – this is not something to go for PRs or show off with.  It targets a weak muscle so it will always be a light lift.  But you can significantly improve rotator cuff function with it.

Side lying dumbbell raise:

Lie on one side and raise a dumbbell with the other hand.  Start with the weight touching your leg, move slowly and concentrate on keeping your scapula in place.  Stop at 45º and return to the start position.  This move hits all of the rotator cuff except the teres and is especially good for rebuilding the suprapsinatus, the most commonly injured rotator cuff muscle.

The best way to make sure you have no rotator cuff injuries is to keep on top of general shoulder mobility and strength. 

Good posture and good movement patterns might keep you from ever having to find out whether surpaspinatus tendinitis really is more painful than a broken collarbone!

 

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