Non-operative Rehabilitation for Rotator Cuff Tendonitis/Tears

Non-operative Rehabilitation for Rotator Cuff Tendonitis/Tears

Rotator Cuff Home Exercise Program

This is a general conditioning program that provides a wide range of exercises.

Your doctor, athletic trainer, or physical therapist can help guide you through this program, which is broken up into 3 parts:

Range of motion - you should do this every day to help get your motion back.

Flexibility - you should do this every day to help stretch tight tissues.

Strengthening - you should do this 3 or 4 days each week to help get your strength back.

Length of program: This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your shoulders. Performing the exercises two to three days a week will maintain strength and range of motion in your shoulders.

Getting Started

Warmup: Before doing the following exercises, warm up with 5 to 10 minutes of low impact activity, like walking or riding a stationary bicycle.

Stretch: After the warm-up, do the stretching exercises shown on Page 1 before moving on to the strengthening exercises. When you have completed the strengthening exercises, repeat the stretching exercises to end the program.

Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising.

1. Pendulum

Main muscles worked: Deltoids, supraspinatus, infraspinatus, subscapularis

Equipment needed: None

Repetitions: 2 sets of 10
Days Per Week: 5 to 6

Step-by-step directions 

· Lean forward and place one hand on a counter or table for support. Let your other arm hang freely at your side.

· Gently swing your arm forward and back. Repeat the exercise moving your arm side-to-side, and repeat again in a circular motion.

· Repeat the entire sequence with the other arm.

Tip: Do not round your back or lock your knees.

2. Crossover Arm Stretch

Main muscles worked: Posterior deltoid
You should feel this stretch at the back of your shoulder 

Equipment needed: None

Repetitions: 4 each side
Days Per Week: 5 to 6

Step-by-step directions 

· Relax your shoulders and gently pull one arm across your chest as far as possible, holding at your upper arm.

· Hold the stretch for 30 seconds and then relax for 30 seconds.

· Repeat with the other arm.

Tip: Do not pull or put pressure on your elbow.

3. Passive Internal Rotation

Main muscles worked: Subscapularis
You should feel this stretch at the front of your shoulder 

Equipment needed: Light stick, such as a yardstick

Repetitions: 4 each side
Days Per Week: 5 to 6

Step-by-step directions 

· Hold a stick behind your back with one hand, and lightly grasp the other end of the stick with your other hand.

· Pull the stick horizontally as shown so that your shoulder is passively stretched to the point of feeling a pull without pain.

· Hold for 30 seconds and then relax for 30 seconds.

· Repeat on the other side.

Tip: Do not lean over or twist to side while pulling the stick.

4. Passive External Rotation

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in the back of your shoulder 

Equipment needed: Light stick, such as a yardstick

Repetitions: 4 each side
Days Per Week: 5 to 6

Step-by-step directions 

· Grasp the stick with one hand and cup the other end of the stick with the other hand.

· Keep the elbow of the shoulder you are stretching against the side of your body and push the stick horizontally as shown to the point of feeling a pull without pain.

· Hold for 30 seconds and then relax for 30 seconds.

· Repeat on the other side.

Tip: Keep your hips facing forward and do not twist.

5. Sleeper Stretch

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in your outer upper back, behind your shoulder 

Equipment needed: None

Repetitions: 4 reps, 3x a day
Days Per Week: Daily

Step-by-step directions 

· Lie on your side on a firm, flat surface with the affected shoulder under you and your arm bent, as shown. You can place your head on a pillow for comfort, if needed.

· Use your unaffected arm to push your other arm down. Stop pressing down when you feel a stretch in the back of your affected shoulder.

· Hold this position for 30 seconds, then relax your arm for 30 seconds.

Tip: Do not bend your wrist or press down on your wrist.

6. Standing Row

Main muscles worked: Middle and lower trapezius
You should feel this exercise at the back of your shoulder and into your upper back 

Equipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.

· Stand holding the band with your elbow bent and at your side, as shown in the start position.

· Keep your arm close to your side and slowly pull your elbow straight back.

· Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together as you pull.

7. External Rotation With Arm Abducted 90°

Main muscles worked: Infraspinatus and teres minor
You should feel this exercise at the back of your shoulder and into your upper back 

Equipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.

· Stand holding the band with your elbow bent 90° and raised to shoulder-height, as shown in the start position.

· Keeping your shoulder and elbow level, slowly raise your hand until it is in line with your head.

· Slowly return to the start position and repeat.

Tip: Make sure your elbow stays in line with your shoulder.

8. Internal Rotation

Main muscles worked: Pectoralis, subscapularis
You should feel this exercise at your chest and shoulder 

Equipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.

· Stand holding the band with your elbow bent and at your side, as shown in the start position.

· Keep your elbow close to your side and bring your arm across your body.

· Slowly return to the start position and repeat.

Tip: Keep your elbow pressed into your side.

9. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper back 

Equipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Make a 3-foot-long loop with the elastic band and tie the ends together.

· Attach the loop to a doorknob or other stable object.

· Stand holding the band with your elbow bent and at your side, as shown in the start position.

· Keeping your elbow close to your side, slowly rotate your arm outward.

· Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together when you pull your elbow back.

10. Elbow Flexion

Main muscles worked: Biceps
You should feel this exercise at the front of your upper arm 

Equipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Stand tall with your weight evenly distributed over both feet.

· Keep your elbow close to your side and slowly bring the weight up toward your shoulder as shown.

· Hold for 2 seconds.

· Slowly return to the starting position and repeat.

Tip: Do not do the exercise too quickly or swing your arm.

11. Elbow Extension

Main muscles worked: Triceps
You should feel this exercise at the back of your upper arm 

Equipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Stand tall with your weight evenly distributed over both feet.

· Raise your arm and bend your elbow with the weight behind your head.

· Support your arm by placing your opposite hand on your upper arm.

· Slowly straighten your elbow and bring the weight overhead.

· Hold for 2 seconds.

· Slowly lower your arm back down behind your head and repeat.

Tip: Keep your abdominal muscles tight and do not arch your back.

12. Trapezius Strengthening

Main muscles worked: Middle and posterior deltoid, supraspinatus, middle trapezius
You should feel this exercise at the back of your shoulder and into your upper back 

Equipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.

Repetitions: 3 sets of 20
Days Per Week: 3 to 5

Step-by-step directions 

· Place your knee on a bench or chair and lean forward so that your hand reaches the bench and helps support your weight. Your other hand is at your side, palm facing your body.

· Slowly raise your arm, rotating your hand to the thumbs-up position and stopping when your hand is shoulder height, with your arm parallel to the floor.

· Slowly lower your arm to the original position to a count of 5.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

13. Scapula Setting

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back, at your shoulder blade 

Equipment needed: None

Repetitions: 10
Days Per Week: 3

Step-by-step directions 

· Lie on your stomach with your arms by your sides.

· Place a pillow under your forehead for comfort, if required.

· Gently draw your shoulder blades together and down your back as far as possible.

· Ease about halfway off from this position and hold for 10 seconds.

· Relax and repeat 10 times.

Tip: Do not tense up in your neck.

14. Scapular Retraction/Protraction

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back at your shoulder blade 

Equipment needed: Begin with a weight that allows 2 sets of 8 to 10 repetitions and progress to 3 sets of 15 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.

Repetitions: 2 sets of 10
Days Per Week: 3

Step-by-step directions 

· Lie on your stomach on a table or bed with your injured arm hanging over the side.

· Keep your elbow straight and lift the weight slowly by squeezing your shoulder blade toward the opposite side as far as possible.

· Return slowly to the starting position and repeat.

Tip: Do not shrug your shoulder toward your ear.

15. Bent-Over Horizontal Abduction

Main muscles worked: Middle and lower trapezius, Infraspinatus, teres minor, posterior deltoid
You should feel this exercise at the back of your shoulder and into your upper back 

Equipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.

Repetitions: 3 sets of 8
Days Per Week: 3

Step-by-step directions 

· Lie on your stomach on a table or bed with your injured arm hanging over the side.

· Keep your arm straight and slowly raise it up to eye level.

· Slowly lower it back to the starting position and repeat.

Tip: Control the movement as you lower the weight.

16. Internal and External Rotation

Main muscles worked: Internal rotation: anterior deltoid, pectoralis, subscapularis, latissimus.
External rotation: posterior deltoid, infraspinatus, teres minor
You should feel this exercise in the front and back of your shoulder, your chest, and upper back 

Equipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.

Repetitions: 3 to 4 sets of 20
Days Per Week: 3 to 5

Step-by-step directions 

· Lie on your back on a flat surface.

· Extend your arm straight out from the shoulder and bend the elbow 90° so that your fingers are pointed up.

· Keeping your elbow bent and on the floor, slowly move your arm in the arc shown. Bring your elbow down to a 45° angle if you experience pain at 90°.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

17. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper back 

Equipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.

Repetitions: 2 sets of 10
Days Per Week: 3

Step-by-step directions 

· Lie on your side on a firm, flat surface with your unaffected arm under you, cradling your head.

· Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.

· Keep your elbow against your side and slowly rotate your arm at the shoulder, raising the weight to a vertical position.

· Slowly lower the weight to the starting position to a count of 5.

Tip: Do not let your body roll back as you raise the weight.

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18. Internal Rotation

Main muscles worked: Subscapularis, teres major
You should feel this stretch in the front of your shoulder 

Equipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.

Repetitions: 2 sets of 10
Days Per Week: 3

Step-by-step directions 

· Lie on a firm, flat surface on the side of your affected arm.

· Place a pillow or folded cloth under your head to keep your spine straight.

· Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.

· Keep your elbow bent and against your body and slowly rotate your arm at the shoulder, raising the weight to a vertical position.

· Slowly lower the weight to the starting position.

Tip: Do not let your body roll back as you raise the weight.

Rotator Cuff Home Exercise Program