To strengthen the most common rotator cuff muscle to tear you should perform
side-lying external shoulder rotations, 3 sets of 15 reps for at least 3 months.
Why side lying?
I find people are most likely to perform the exercise consistently and correctly in this position. It can be done standing with bands or cables but is more difficult to perform correctly, the elbow tends to drift and then the Deltoid does more of the work. Or compliance decreases because you did not make it to the gym, or don’t have that machine at home. Avoid this common mistake – Standing and using a weight is not helpful (for this) because gravity is pulling towards your feet, not resisting external rotation.
How do I do it?
The rotator cuff is made of 4 muscles. Supraspinatus is the most common tear. This is likely because modern life very commonly have us hunched forward over devices. This forward flexion dominant posture and common exercise routines reciprocally inhibit the external rotators. Our medical providers find the Deltoid is the big muscle that sits on top of our shoulders and does a lot of the work. Supraspinatus, in combination with Infraspinatus, works to counteract the upward pull of the Deltoid and keeps the ball of our Humerus centered in the socket of our scapula (glenoid fossa. If these muscles are not strong enough the deltoid will pinch the supraspinatus tendon into the coracoid process causing.
Why do both sides?
You have two arms. You tend to use one more than the other. When your dominant arm is hurting you still need to do things, so you start doing them with the arm that does not hurt.
When to avoid this exercise and see a provider?
- Consistent pain with this motion.
- A painful clunk with this motion could indicate a labral tear.
- If pain increases with this exercise and lingers for longer than 5 minutes afterward.
- Confirmed full-thickness tear of supraspinatus and infraspinatus.
- The pain started with trauma (fall, car accident, hit with bat, shot, etc.)
Are you consistently doing this exercise?
Side lying external rotations 3 sets of 15 reps daily for three months straight are my recommendation. It takes six weeks of placing a load for the muscles to respond and build more muscle. Improvement prior to six weeks are structures you already have improvements in their efficiency. 5lbs is a good goal to build to, but I do not expect most people to go much higher. There is a strong mechanical advantage for these muscles and it is more important that they have the endurance to work all day every day. Supraspinatus is located inside a bony groove. There is not much room available for it to become massive.
My shoulder hurts now, is there anything I can do?
T- rex arms – following the link to the exercise is a way to wake up the external shoulder rotation muscles and get them to engage and decrease pain. Icing is also helpful in decreasing pain. Follow this link for proper icing instructions.
Is this the only thing I need to do for my shoulders?
Absolutely not. Shoulders are very complex and there can be a lot of issues. Weakness in these muscles is a common finding even in otherwise very strong individuals. Even if you have gone through a successful physical therapy program you may not have spent enough time focused on this specific exercise. If this muscle group is not strongly keeping the head of your humerus firmly in the socket of the glenoid fossa you will have problems with your shoulder again in the future.