What are some home exercises and tips to help patients manage rotator cuff injuries and pain?
Shoulder pain from rotator cuff disease is a common problem affecting many adults. It is estimated that over 80% of shoulder pain presenting to a primary care physician’s office is related to the rotator cuff. Individuals who perform repetitive overhead reaching, pushing, or lifting with outstretched arms are at risk for rotator cuff tendinitis. Athletes involved in overhead sports, such as swimming, tennis, throwing, golf, weightlifting, volleyball, and gymnastics, also are at risk. It is important to be aware that pain referred from the rotator cuff is experienced distal to the shoulder, most often in the mid-lateral humerus or mid-biciptal area, which can be confusing to patients when you point to the subacromial region as the cause of their problem.
This condition can be successfully managed with a combination of ice, over-the-counter analgesics, avoidance of aggravating activities, and a series of simple home exercises. Physical therapy is recommended if the patient has obvious limitations in range of motion.
A simple tip I have found to be quite effective is to tell patients to “keep their hands were you can see them.” Any exercise or daily activity that places their hands out of frontal view puts the tendons at risk for impingement. I then demonstrate the motion of reaching behind to get something out of the back seat of a car, a frequent offending action that many patients readily recognize as causing pain.
Home exercises for rotator cuff pain focus on strengthening not only the cuff muscles themselves, but the scapular stabilizers (Figure, page 20). The latter are critical to maintaining normal scapulothoracic rhythm, which is essential for normal shoulder function. Exercises can be staged into 2 groups, with patients moving from the first group of exercises to the next after he or she can perform Group 1 for one week with little discomfort. It has been shown that home exercise compliance is enhanced when the patient has no more than 5 exercises to perform.
Joseph J. Ruane, DO