The rotator cuff is a group of four muscles – supraspinatus, infraspinatus, teres minor, and subscapularis – and their associated tendons that keep the ball or head of the humerus (upper arm bone) in the shoulder socket and form a cuff over the top of the bone – hence the name. The rotator cuff keeps the shoulder stable and helps you rotate and lift your arm.
If a persistent, troublesome, or sometimes crippling pain in your shoulder has led to a diagnosis of rotator cuff injury, you must be looking for effective, sustainable remedies. Rotator cuff injuries and the subsequent pain are not that uncommon. Even a minor injury or inflammation in the shoulder area can flare up this muscle group. An injury or inflammation could occur because of sudden falls and accidents, when you turn or lift your shoulder beyond its natural range, or if you move your shoulder roughly and repetitively. It might also result from a sport or work-related injury or even a health condition that forces you to use your arm and shoulder to bear your body weight, say while rising from a seated position. Sometimes, even sleeping too long on one side can give you a shoulder pain.1
Exercise restores flexibility, increases your range of motion, and strengthens the muscles that support the affected joint, effectively easing the pain and stiffness and making them less likely to be injured.
So, what are your options if you have rotator cuff pain? For any kind of joint pain, pain relief medicines, hot and cold packs, and other quick fix measures may offer temporary relief but to be pain-free, you need something long-lasting. That is where a good exercise routine fits right in. While it may seem counterintuitive to move the part that hurts, regular exercise can strengthen the joint and even help you postpone or avoid surgery on a joint that has been troubling you for a long time. Your doctor will be able to confirm how soon and how often you should exercise if you have injured your shoulder.
Combine Stretching And Strengthening Exercises For A Perfect Antidote To Pain
So what kind of routine should you be looking at with rotator cuff pain? Your painful shoulder’s flexibility and range of motion can be best improved with stretching exercises. These need to be followed by strengthening exercises that will fortify the muscles supporting the shoulder. Strengthening exercises can help keep your shoulder joint stable and reduce your chances of future injury. Stronger muscles can also limit and manage pain, given that stronger muscles are more difficult to injure. Over time, the limitations you were beginning to live with because of the pain will slowly ease.2 3
Unless your injury is serious and requires complete immobilization of the part, a trained physiotherapist will sign off on a routine that helps ease your pain. But never jump into a new exercise routine for pain relief without proper guidance, especially if it is a severe or chronic pain or if you are recovering from surgery. The physiotherapist will analyze your degree of pain, your abilities, and limitations, and design an appropriate exercise routine. You will be made aware of the precautions you should take, proper and effective exercise techniques, and soreness and pain you should not overlook.4 In all likelihood, your routine will combine some of the stretching and strengthening exercises we’ve listed here.
Warm Up Before You Start Your Routine
If you are are recovering from shoulder surgery or cannot do standing exercises for any reason, many of the exercises listed below can be done lying down. However, make sure you exercise under medical supervision if you are in your post-surgery period.
A proper warm-up routine raises your core body temperature and warms up your muscles. That not only loosens stiff muscles, but also improves performance, muscle coordination, and muscle elasticity and contractibility. A good warm-up also makes your respiratory and cardiovascular systems function more efficiently. Skipping warm-up increases your chance of injury – not something you want to reckon with when you are already in pain! Also, if you stretch before you warm up, your muscles become tired early and easily.5
For an effective warm-up,
- You could walk or ride a stationary bicycle for about 5–10 minutes.
- You could take a warm bath or shower for 10–15 minutes. That will warm up your shoulder area as well.6
Start With These Stretching Exercises
Take care to stretch to the point of tension but stop before you experience any pain.
Stretching can help boost flexibility and increase your range of motion. It makes the muscles more supple and ready for the additional stretching that results from any exercise.7
It is always advisable to exercise both shoulders though only one may be affected. That way you can prevent injury to the unaffected shoulder.8
The exercises listed below are not in any particular order. They are exercises that will stretch the shoulder and back muscles so that you can regain your range of motion and get the muscles ready for the strengthening exercises.
1. Pendulum Exercise
On average, do the stretching exercises 4 times across the day, with 4–5 repetitions on each side.
- Stand near a counter, a table, a chair back, or a railing. Lean forward, placing one hand on the table or counter for support. Let the other arm hang free.
- Swing the arm gently forward and backward. Next swing it side-to-side, and then in a circular motion.
- Repeat the same sequence with the other arm.
Remember not to lock your knees or round your back when you do this stretch. Avoid the exercise if you have back pain.9
There is another way to do the pendulum exercise.
- Bend your knees and use one knee to prop up your hand. Essentially, you bend over at the waist to rest one arm on the knee on the same side. For example, place your right arm on your right knee, making sure the arm is straight and sturdy.
- Now gently swing your left arm forward and backward, and in a circular motion.
- Change sides and swing the other arm gently.10
2. Passive Internal Rotation
You will need a light stick to do this stretching exercise. This will stretch the front of your shoulders.
- Without bending your arms, hold the stick behind your back with both hands.
- Pull the stick horizontally to one side, hold for 30 seconds, and then relax. You must pull the stick without twisting or leaning over. When done right, your shoulder will be passively stretched and you will feel a pull without any pain.
- Repeat the step on the other side.11
3. Passive External Rotation
This will stretch the back of your shoulder. You will again need a light stick.
- Hold the stick in front. Hold one edge firmly with one hand while you use the other hand to lightly grasp it on the other side
- Now push the stick sideways, toward the side that you have just lightly grasped, until you feel the stretch without pain. While doing this, don’t twist your body and make sure your hips face forward.
- Hold the stretched position for 30 seconds. Then relax for another 30 seconds.
- Repeat the sequence with the other arm.12
4. Crossover Arm Stretch
This will also stretch the back of your shoulders. You can sit or stand to do this exercise.
- Begin by relaxing your shoulders.
- Pull one arm across your chest as far as possible, and hold the upper arm with the other arm until you feel a gentle stretch across your shoulder.
- Hold for about 30 seconds, then relax for another 30 seconds.
- Repeat the sequence with the other arm.
- Be careful not to pull hard or put extra pressure on your elbow while doing this.13 14
5. Towel Stretch
This exercise stretches most of your muscles in the upper back. You will need a three-foot-long towel for this stretching exercise.
- Hold one end of the towel and drape it over your good shoulder.
- Hold the bottom of the towel with your affected arm.
- Now pull the towel toward your lower back.
- Next, use your good arm to gently pull the affected arm upward to your maximum pain-free point. Hold for 20–30 seconds and gently release.
- You can also repeat this on the other side.15 16 17
6. Finger Walk
This will help increase the flexibility of your shoulder joint, which in turn will help reduce pain.
- Stand about three-quarters of an arm’s length away from a wall.
- Stretch out your affected arm and with your fingertips, touch the wall at waist level.
- Keeping the elbow a little bent, walk your fingers up the wall. Continue until your arm is raised as much as it possibly can without pain.
- Slowly walk down.
- Repeat the sequence several times and on the other side as well.18 19
Follow Up With Strengthening Exercises
Add strengthening exercises to your routine as your range of motion increases. Don’t forget to first warm up and stretch. As mentioned earlier, the strengthening exercises will make your muscles strong and prevent future injury, reducing your chances of rotator cuff pain.
7. Standing Row Exercise
You will feel the effect of this exercise at the back of your shoulder and upper back. The exercise requires an elastic stretch band that will offer you comfortable resistance. If you are exercising in a fitness center, you can use a weight machine instead of the band.
- Make a three-foot-long loop with the elastic band. Tie the ends together and loop it over something stable such as a doorknob or handle.
- Hold the band with your elbow bent and held against the side of your body.
- Now pull your elbow straight back, all the while keeping your arm close to your body. While pulling your elbow, remember to squeeze your shoulder blades.
- Return to the starting position slowly.
- Repeat the sequence at least three times at first, slowly increasing the number.
This exercise has several variations with different effects.
In the external rotation exercise, step 1 remains the same.
- Stand such that the doorknob is on your right side, assuming it is the unaffected side.
- Now bend your left elbow and hold it close to your body. Grasp the band with your left hand.
- Still keeping your elbow close to your side, push your arm outward. Hold for a few seconds. While pulling your elbow, squeeze your shoulder blades.
- Return slowly to the starting position and repeat the sequence.
In the external rotation with arm held abducted at 90 degrees, step 1 again remains the same.
- Grasp the band with one hand. Now bend your elbow at 90 degrees and raise the arm to shoulder height.
- Pull the band such that your elbow and shoulder are level, and your raised arm is in line with your head. Remember, your elbow must remain in line with your shoulder throughout.
- Return slowly to the starting position and repeat the sequence.
The internal rotation exercise works on your shoulder and chest. The first step again remains the same.
- Hold the band with your elbow and stand such that the doorknob is on your affected side.
- Keeping your elbow close to the body, pull the band while bringing your arm across your body to the unaffected side. Pull about 2–3 inches and hold for a few seconds. Make sure you keep your elbow pressed to your side throughout.
- Return slowly to the starting position and repeat the sequence.20 21
All the four exercises can also be done lying down, with or without a band.22
8. Wall Push-ups With One Or Both Arms
This will stretch as well as strengthen your shoulder joint.
- Stand in front of a wall with your arms raised to shoulder level and both hands and feet shoulder-width apart.
- Lead with your forehead (and not your chin) and perform a push-up on the wall. Keep your hands on the wall at all times and your shoulder blades aligned.
- Repeat the push-up sequence 5–10 times and try and do 2–3 sets in a day.23
9. Elbow Flexion
You will feel the effect of this exercise at the front of your upper arm. You will need weights that you can lift comfortably without pain to complete at least three sets.
- Start by standing tall such that your weight is distributed evenly between both feet.
- Keeping your elbow close to your body, slowly raise the weight forward to your shoulder level.
- If you can, raise the weight up to eye level and then above your head. Take care not to swing your arm or do the exercise very quickly.
- On reaching your desired level, hold for about 2 seconds and then slowly lower your arm.
- Repeat the sequence 5–10 times per set.
- Once your shoulder gets stronger, you can increase the weight in increments of 1 pound. It is best not to exceed 5 pounds.24 25
A follow-up of this is the elbow extension.
- The first step of this exercise is the same as that of the elbow flexion.
- Keeping your elbow close to your body, slowly raise the weight backward as far as you can without bending forward.
- Hold at the farthest point for a few seconds and then slowly return to the starting position.
- Repeat the sequence 5–10 times per set.26
A variation of the elbow extension affects the back of your upper arm. The first step of this exercise is the same as that of the elbow flexion.
- Raise your arm and then bend your elbow so that the weight is behind your head. You can use the other arm to support the raised arm.
- Slowly straighten your elbow and hold the weight above your head for a few seconds. Don’t arch your back and make sure your abdominal muscles are tight.
- Lower your arm again behind your head with the weight.
- Repeat the sequence 5–10 times per set.
- Once your shoulder gets stronger, you can increase the weight in increments of 1 pound. It is best not to exceed 5 pounds.27
10. Scapular Retraction/Protraction
With this exercise, you will feel the effects in your upper back at your shoulder blade. You will again need weights that you can lift comfortably without pain to complete at least three sets.
- Begin by lying on your stomach on a table or bed, with your affected arm hanging down.
- Keeping your elbow straight, slowly lift the weight by squeezing your shoulder blade toward the other side. While lifting the weight, don’t shrug your shoulder toward your ear.
- Hold the furthest position for a few seconds and slowly return to your starting position.
- Repeat. Once your shoulder gets stronger, you can increase the weight in increments of 1 pound. It is best not to exceed 5 pounds.28
A variation of this exercise is the bent-over horizontal abduction. Step 1 is the same.
- Keeping your arm straight, raise the weight up to eye level.
- Hold the furthest position for a few seconds and return to the starting position. Lower the weight carefully without any jerky movements.
- Repeat about 5–10 times per set.
- Once your shoulder gets stronger, you can increase the weight in increments of 1 pound. It is best not to exceed 5 pounds.
There are many more exercises, with variations, that can stretch and strengthen your rotator cuff and help manage the pain. Our list is by no means exhaustive but it is a compilation of some of the most recommended exercises. And remember, the old adage “no pain, no gain” is not always true. Stretch and strengthen only until you feel no pain!