The 7 Best Exercises For Rotator Cuff Tendonitis
Let me guess: one day, you wake up, and for some weird reason, your shoulder hurts. It is now painful to lift your arm over your head or perform movements like Bench Presses, Strict Presses, Pull-ups, or even everyday activities.
There is likely no identifiable instance where you can remember injuring your shoulder. You just began noticing it hurting, and it has progressed from an annoyance to a severe pain, preventing you from training or using your arm like you want to.
As a physical therapist, I hear this story all the time. This type of situation is often diagnosed as Rotator Cuff Tendinopathy, a Rotator Cuff injury characterized by inflammation, degeneration, and/or damage to the tendons of the rotator cuff muscles.
Rotator Cuff Tendinopathy can be caused by various factors, such as rotator cuff muscle performance deficits, pec muscle tightness, and posture abnormalities. (1)
I have been there myself and remember that in a matter of weeks, I went from being able to press heavy over my head and pull my body weight up over the up bar to quite literally not being able to perform one push-up without significant pain in my shoulder.
Fortunately, through my Physical Therapist and Strength Coach training, I could rehab my Rotator Cuff muscles and return my shoulder to full strength and press without pain.
In this article, I will be diving into Rotator Cuff Tendinopathy and my seven best exercises for rotator cuff tendonitis so you can alleviate your pain and get back to full strength!
What Are The Best Exercises For Rotator Cuff Tendonitis?
There is no single best exercise to fix rotator cuff problems, and various approaches can improve symptoms and function. (2) I have found that treating the damaged tendon starts with avoiding movements that initially cause rotator cuff pain.
This is followed by exercises that strengthen the individual rotator cuff and shoulder muscles to improve tendon capacity and shoulder mechanics to reacclimate the muscles to functional movement.
If you’re struggling with an injured rotator cuff, try incorporating these exercises into your training. Consistency and progression can enhance your rotator cuff muscle strength and decrease your pain.
Isometric Exercises
Isometric exercises are characterized by high muscle activation but without actual muscle shortening. Thus, they are static exercises, and no actual movement occurs.
There are two types of Isometric Exercises: Yielding Isometric Exercises, where you are trying to resist movement, and Overcoming Isometric Exercises, where you are attempting to move an immovable object, such as trying to rotate your hand into a door frame. (3)
Concentric Exercises
Most people think of concentrated exercises when exercising. Concentric exercises involve shortening and lengthening muscles with consistent speed throughout the motion.
These types of muscle contractions are great for building all types of qualities such as motor control, strength, and endurance and are effective for rehabbing both Rotator Cuff Tendinitis and Tendinosis but may not be the most effective for either.
Eccentric Exercises
Eccentric Exercises are exercises where you move the load using a concentric muscle contraction but intentionally lower it slower than typically seen in a concentric exercise. In this instance, the rotator Cuff muscles lengthen at a slower rate as they fire and contract against the load and the pull of gravity.
For Rotator Cuff Tendinitis, you should begin with less damaging forms of strengthening exercises.
In this phase of Rotator Cuff Tendinopathy, there is quite a bit of inflammation and pain, so the use of Isometric Exercises will allow for a gradual increase in the strengthening intensity of the Rotator Cuff muscles without further increasing inflammation in the area due to the exercise response.
Also, isometric exercises are more easily modulated in intensity because the magnitude of the contraction is dictated by your mid-set and not the load you pick.
The treatment for rotator cuff tendinosis will mainly consist of Eccentric and concentric exercises.
Eccentric exercises or training that elongates the concentric and eccentric phases of a lift are prioritized for tendinosis because they are the most effective at restoring the resiliency of the Rotator Cuff muscles. (4)
This is due to the increased time under tension and increased muscle breakdown due to lengthening under a load. (4)
Below are some examples of exercises to include in your exercise program for each kind of muscle contraction. For many of them, all you need is a door frame, cable column, or resistance band.
Isometric Exercises:
External Rotation Into Door Frame
Internal Rotation Into Door Frame
Concentric / Eccentric Exercises:
Side Lying Dumbbell External Rotation
Elbow On Knee External Rotation
You can see that concentric and eccentric exercises are the same; however, how you execute them will be different. As I mentioned, the only difference between the two types of exercises is their speed and emphasis on a specific portion of the lift.
Any Concentric exercise can be turned into an Eccentric exercise by intentionally slowing down the portion of the exercise where you are lowering the weight to the midpoint of the exercise.
Transition To Functional Movements
The final piece to treating Rotator Cuff Tendinopathy is to take this newfound strength and resiliency of your Rotator Cuff tendons and incorporate it back into functional exercises.
Specifically, you’ll want to incorporate any overhead movements or horizontal pressing that caused your pain before beginning your strengthening protocol. Muscles rarely work in isolation, and thus, if you want to get back to training with heavy weights or performing your sporting activity without pain, this is a crucial last step in the process.
There are many ways to incorporate these Rotator Cuff exercises into an exercise program by manipulating repetitions, sets, weights, and the frequency at which you perform them.
How To Use Strengthening Exercises For Rotator Cuff Tendonitis
Determining how to treat Rotator Cuff Tendinopathy states with an evaluation and then a systematic approach.
The framework I use when treating Rotator Cuff Tendinopathy includes four phases: Assess, Isolate, Stimulate, and Integrate.
Assess Your Movement
The assessment is where I will have you move through the painful motions to see how you perform the movement.
Isolate The Dysfunction
This includes evaluating any range of motion limitations and strength deficits in the Rotator Cuff Muscles.
Stimulate The Dysfunction
This is where the actual therapeutic exercises of the individual Rotator Cuff muscles take place with an exercise program to strengthen any weak points found in the above two phases.
Integrate Back Into Functional Movement
In this last phase, you use your newfound strength and rehabilitated muscles into the once-painful motion using functional exercises.
The process of testing these muscles and ranges of motion can have its own article. We will remain focused on the actual strengthening protocols in the stimulate and integrate phases after each group of muscles has been assessed and isolated.
The Role of The Rotator Cuff Muscles
The Rotator Cuff is important in stabilizing the shoulder blade during overhead movements. Additionally, it is responsible for keeping the humeral head centralized on the Glenoid Fossa of the shoulder blade so the Rotator Cuff tendons do not become pinched between the bones of the shoulder joint due to superior translation during movement, as occurs in Shoulder Impingement Syndrome. (2)
A way to conceptualize how vital having robust Rotator Cuff muscles is to avoiding painful shoulder movements is to envision a golf ball on a tee. This is what the bones of the shoulder joint, or the “shoulder girdle,” look like.
If you do not have the standard function of the Rotator Cuff muscles, having malalignment of the humeral head and eventual Rotator Cuff injuries can be easy. Hence the high prevalence of shoulder pain.
The 4 Rotator Cuff Muscles of The Shoulder Blade
Below is a quick overview of the Rotator Cuff Muscles that stabilize the shoulder blade so that you know which ones I am referring to when I mention them for the rest of the article.
Supraspinatus
Most active during abduction of the shoulder
Infraspinatus
Most active during external rotation of the shoulder with the arm positioned at the side of your body
Teres Minor
Most active during external rotation of the shoulder with the arm positioned at shoulder height at a 90-degree angle
Subscapularis
Most involved with internal rotation of the shoulder, compressing the hand to the front of your body, or lifting your arm off the back side of your body.
Signs and Symptoms of Rotator Cuff Tendinopathy
The signs and symptoms of Rotator Cuff Tendinitis and Tendinosis are very similar. The main symptoms include inflammation of the tendons of the Rotator Cuff muscles, pain when overhead lifting or reaching behind your back, weakness in the shoulder and scapula, and a limited range of motion due to stiffness or pain.
If left untreated, Rotator Cuff Tendinopathy can lead to more severe conditions such as a Rotator Cuff tear. This is why it is essential to recognize these symptoms as soon as possible and seek care from a Physical Therapist as quickly as possible to avoid further complications.
Prevalence of Shoulder Tendonitis
Rotator Cuff Tendinopathy is arguably the most common cause of shoulder pain with it accounting for 30% and 70% of shoulder pain in the general population. (5)
It is even more common in athletes or people who train or have jobs that require repetitive overhead movements, such as Baseball, Tennis, and Swimming, and fitness athletes like CrossFit or Olympic Weightlifting.
If you combine these two statistics, you will be over 60 and engage in any of the activities or something similar above. You will probably experience Rotator Cuff Tendinopathy at some point.
Fortunately, it can be rehabbed back to full strength like I did.
Tendinitis vs Tendinosis
It is essential to distinguish between the two categories of Rotator cuff Tendinopathy because they require different approaches to treatment using strengthening. These terms are often used interchangeably, even by healthcare providers such as Physical Therapists. However, they are quite different based on what occurs in the tendons of the Rotator Cuff Muscles.
Rotator Cuff Tendinitis refers to inflammation of the Rotator Cuff tendons caused by an acute injury or overuse, such as too frequent repetitive arm movements, poor management of training workloads, or improper mechanics or posture during training.
Any instance of Rotator Cuff Tendinopathy that lasts between 1 and 3 weeks is often classified as Tendinitis rather than tendinosis.
Rotator Cuff Tendinosis refers to the actual degeneration of the tendons of the Rotator Cuff Muscles and is often without significant inflammation. With Rotator Cuff Tendinosis, degeneration is usually associated with microtears, collagen disorganization, and tissue breakdown due to repetitive stress or aging.
Rotator Cuff Tendinosis is often the result of delayed treatment of Rotator Cuff Tendinitis. Thus, it is essential to work with a Physical Therapist like myself or begin a program on your own to address these symptoms as quickly as possible.
Learn more about joining my 1:1 Pain-Free Performance Program today. You can get back to pain-free training in under 12 weeks, guaranteed!
Signs and Symptoms of Rotator Cuff Tendinopathy
Rotator cuff tendinopathy is characterized by pain and tenderness in the shoulder, particularly around the shoulder blades and the affected shoulder. Individuals often experience a dull, aching pain that may worsen with overhead movements or when lying on the affected side. The pain can also radiate down the arm, making it challenging to pinpoint the exact location.
Due to the pain and stiffness, daily activities such as reaching, lifting, or even dressing can become difficult. The affected shoulder may feel weak, limiting the range of motion and making it hard to perform routine tasks.
In some cases, there might be a sensation of cracking or catching when moving the shoulder. Early intervention and appropriate treatment are crucial to managing symptoms and preventing further deterioration.
Final Thoughts on Exercises For Rotator Cuff Tendonitis
Understanding and effectively treating rotator cuff tendinopathy is essential for anyone experiencing shoulder pain, particularly those engaged in repetitive overhead activities. By incorporating the appropriate exercises, you can rehabilitate your shoulder, alleviate discomfort, and prevent further injury. Start with isometric exercises to reduce inflammation, followed by concentric and eccentric exercises to build strength.
Addressing this medical condition early can make a significant difference in your recovery process, helping you return to your regular activities with less pain and greater ease.
If you’re struggling with shoulder pain due to a rotator cuff injury or overuse injury, don’t wait to seek help. Book a free consultation for my 1:1 Pain-Free Performance Program, designed to help lifters get back to pain-free training in under 12 weeks, guaranteed. Take the first step towards a pain-free and fitter you today!
References:
1. Seitz, A. L., McClure, P. W., Finucane, S., Boardman, N. D., 3rd, & Michener, L. A. (2011). Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?. Clinical biomechanics (Bristol, Avon), 26(1), 1–12. https://doi.org/10.1016/j.clinbiomech.2010.08.001
2. Heron, S. R., Woby, S. R., & Thompson, D. P. (2017). Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy, 103(2), 167–173. https://doi.org/10.1016/j.physio.2016.09.001
3. Schaefer, L. V., & Bittmann, F. N. (2017). Are there two forms of isometric muscle action? Results of the experimental study support a distinction between a holding and a pushing isometric muscle function. BMC sports science, medicine & rehabilitation, 9, 11. https://doi.org/10.1186/s13102-017-0075-z
4. Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. The American journal of sports medicine, 43(7), 1704–1711. https://doi.org/10.1177/0363546515584760
5. Oliva, F., Piccirilli, E., Bossa, M., Via, A. G., Colombo, A., Chillemi, C., Gasparre, G., Pellicciari, L., Franceschetti, E., Rugiero, C., Scialdoni, A., Vittadini, F., Brancaccio, P., Creta, D., Buono, A. D., Garofalo, R., Franceschi, F., Frizziero, A., Mahmoud, A., Merolla, G., … Maffulli, N. (2016). I.S.Mu.L.T – Rotator Cuff Tears Guidelines. Muscles, ligaments and tendons journal, 5(4), 227–263. https://doi.org/10.11138/mltj/2015.5.4.227
