The Rotator Cuff Conundrum

Jul 18, 2014

By Julio Salado, Private Trainer at Sports Club/LA - Chestnut Hill

The term “rotator cuff” is usually preceded by someone explaining the pain they’re enduring, their lack of range of motion, or how they had to give up their favorite sport or activity. Unfortunately, we’ll all have some sort of rotator cuff pain in our lifetime.


The key is to heed the warning signs of a rotator cuff injury and apply some preventive measures to avoid it becoming chronic. For example, do you experience pain when you’re putting on a shirt overhead? That’s a warning sign. A more extreme example is pain when brushing your teeth based on how you’re holding your arm up. This is called shoulder impingement.

And ladies – don’t think you’re in the clear because you may not lift heavy weights. Carrying a heavy purse or handbag on one side for prolonged period of time or engaging in repetitive movements that force you to lean forward (like typing) can also cause rotator cuff issues. An obvious cause is constantly exercising with poor form or not giving the rotator cuff enough recuperation time. Participating in overhead athletic sports, such as baseball and even boxing, without learning proper form can lead to this issue. Adrenaline can mask a lot pain and discomfort during your exercise, but the pain increases when the adrenaline wears off!

What does the rotator cuff do?

The rotator cuff allows you to lift your arm in all anatomical planes of motion. Where you lift your arm will dictate the primary rotator cuff muscles responsible. The scapula also plays a major role in stabilization along the middle part of the spine, which is called the thoracic spine. All muscles work together in one way or another to provide mobility, stability and strength.

Causes of rotator cuff pain:

  • Kyphosis – a condition from a lifestyle of poor posture. Literally an exaggerated “hump” in the upper mid-back of the spine. Rounded shoulders are one indicator of this.
  • Past trauma, such as a fall that injured or bruised the shoulder, may be a cause of your ailment.
  • Hip health is also a contributor to poor shoulder mechanics. Think of your core muscles as a corset thatruns from your hips to your shoulder girdle. If there’s one hip that’s “hiking” or uneven from the other side, then your shoulder girdle/scapulae must compensate on the opposite side. This means your opposite shoulder will turn in more.

Tests to identify the source of the pain

If you cannot lift your arm up without pain, then seek medical attention. These tests are primarily to see if your muscles are inflamed, but only a health professional can confirm the extent of your injury.

For these tests, extend your arm out in front of you with your palm facing in.

  • Have someone “gently push down” on your wrist – hold isometrically (straight out). If there’s pain, your supraspinatus (small muscle in your upper back) and infraspinatus (thick triangular muscle that stabilizes the shoulder joint) may be compromised.
  • Have someone “gently push to the side” on your wrist – as if they are pushing it inward. If there’s pain, your teres minor and infraspinatus may be compromised.
  • Have someone “gently push on the inside” on your wrist – pushing outward. If there’s pain, your subscapularis may be compromised.

Rotator cuff strengthening exercises
Do three sets of 12-15 repetitions.

  • Internal rotation. Lie on your side keeping your arm bent 90 degrees on your ribs. Lift your arm up only with your elbow. You can use a 1-3 pound weight or a can of soup. Your elbow must stay in a 90-degree angle.
  • External rotation. Lie on your side and slowly lower the weight from the high angle in three counts, then go back up. Your elbow must stay in a 90-degree angle.

  • Post cuff. Find a door stall that’ll bring your elbow to shoulder height. With the weight, rotate to horizontal position, then reverse movement until the weight lines up with your ear. Again, your elbow must stay in a 90-degree angle.

  • Drawn sword. Place your right hand in front of your left pocket. Slowly, without bending your elbow, lift your arm up diagonally as if you’re emptying a can over your shoulder leading with the thumb. Reverse movement back down.

To progress these movements, try standing on the round or flat side of a BOSU and use a cable machine with 3-5 pounds of resistance. This will work your core while addressing your rotator cuff health.

Scapular strengthening exercises:
Do three sets of 12-15 repetitions.

  • Start with arms extended out in front of you, palms facing up. Slowly extend through your finger tips and open up your chest by bringing your arms back as if your thumbs are going to touch the wall behind you. Exhale as you do the movement and focus on pinching your shoulder blades instead of shrugging.

  • Start with arms extended out in front of you, palms together. Slowly extend your right arm diagonally upward and your left arm diagonally downward. Palms should be opposites – right palm facing up and left palm down. Extend through your finger tips and imagine your right thumb is going to touch the wall behind you and your left pinky finger the wall below. Exhale as you do the movement and focus on not shrugging your shoulders.

  • Start with your back against the wall – heels, tailbone and back of head touching the wall. Have your elbows pressed against your ribs with palms facing up. Without removing your elbows from your ribs, try to bring your thumbs out to touch the wall. Keep arms at the same height of as your waist. Reverse the movement.

Whenever you’re encountering discomfort, do these drills to prevent injury. You can always incorporate these drills into your warm-up routine. Training is not linear – you’ll encounter peaks and valleys. By utilizing these simple exercises, you may find your peers in awe at how you just keep on going – without pain!