Rehab guide · Vital Chiropractic
Rotator Cuff Rehab Guide
A general guide to the stages of rotator cuff rehab, from settling pain to getting back to the things you love. Use it alongside the program your practitioner has given you.
← Back to Rehab LibraryAbout the rotator cuff
Four muscles, one team
The rotator cuff is a group of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. Their tendons wrap around the ball of your shoulder joint, keeping it centred while you lift and rotate your arm. Supraspinatus, across the top of the shoulder, is the tendon most commonly affected.
Because these muscles work together, most rehab programs train them as a team. Your practitioner may change the emphasis depending on which tendon is involved, how irritable it is, and your goals.
Common rotator cuff problems
Rotator cuff problems range from irritated, painful tendons (tendinopathy) to partial or full-thickness tears.
Many tears, particularly those that develop gradually over time, are managed with a structured, progressive exercise program. Some, such as a sudden tear after a fall or injury with significant weakness, may need prompt review by an orthopaedic specialist. Your practitioner will help you understand which applies to you.
Before you start
This guide is general information. If you have been diagnosed with a rotator cuff injury, follow the specific exercises, amounts and timeframes your treating practitioner gives you, as these may differ from what is shown here. Move slowly and with control, and never force a movement.
A simple pain guide
Some discomfort during rehab exercise is common. As a general guide, keep pain at or below about 3 out of 10 while you exercise, and it should settle back to your usual level by the next morning.
If pain goes higher or lingers, ease back on the weight, range or number of repetitions, and let your practitioner know.
Phase 1
Settle and move
The early focus is calming the shoulder down while keeping it gently moving. These are usually done daily, often in the first few weeks.
1
Pendulum swings
30–60 seconds, 2–3 times a day
Lean forward, supporting yourself with your good arm on a table. Let the sore arm hang relaxed and gently sway your body so the arm moves in small circles. Let gravity do the work rather than your shoulder muscles.
2
Scapular setting
10 holds of 5 seconds
Sit or stand tall. Gently draw your shoulder blades back and slightly down, as if sliding them towards your back pockets. Use light effort (about a third of your maximum), keep breathing, and avoid shrugging.
3
Thoracic extension over a towel
8–10 slow repetitions
Lie on your back with a firmly rolled towel across your upper back and your hands supporting your head. Gently let your upper back arch over the towel, then return. Move the towel up a few centimetres and repeat. Keep your lower back relaxed.
4
Isometric outward press
5 holds of 20–30 seconds
Stand side-on to a wall with your elbow bent to 90° and tucked by your side. Place a folded towel between the back of your hand and the wall, then gently press outwards into the wall without moving your arm. Start at a comfortable, moderate effort.
5
Table slides
10 slow repetitions
Sit beside a table with your hand resting on a towel. Slide your hand forward along the table as you lean your body forward, then slide back. Only go as far as feels comfortable.
Phase 2
Build strength
Once everyday pain is settling, the focus moves to gradually strengthening the rotator cuff and the muscles around your shoulder blade. These are often done 3–4 times a week, increasing resistance slowly.
1
Band external rotation
3 sets of 10–15
Anchor a resistance band at elbow height. With your elbow bent to 90° and a small towel roll tucked under it, rotate your forearm outwards away from your belly, then return slowly.
2
Band internal rotation
3 sets of 10–15
Same set-up, facing the other way. Rotate your forearm in towards your belly, then return slowly, keeping your elbow by your side.
3
Band rows
3 sets of 10–15
Hold a band anchored in front of you at chest height. Pull your elbows back towards your ribs, gently drawing your shoulder blades together without shrugging. Return slowly.
4
Raise to shoulder height (thumbs up)
3 sets of 8–12
With your thumbs pointing up, raise your arms at a slight angle in front of your body (between straight ahead and out to the side) up to shoulder height, then lower slowly. Start with no weight and add a light weight once it feels easy.
5
Wall slides
2–3 sets of 8–10
Stand facing a wall with your forearms resting on it. Slide your arms up the wall as far as is comfortable, letting your shoulder blades glide around your ribs, then slide back down.
Phase 3
Return to everyday activities
The final stage builds strength in higher and more demanding positions, so your shoulder is ready for work, home life and sport. Your practitioner will guide when you are ready to progress.
1
External rotation at shoulder height
3 sets of 8–12
With a band anchored in front of you, lift your elbow to shoulder height with the elbow bent to 90°. Slowly rotate your forearm up and back, then return with control.
2
Overhead press progression
3 sets of 8–12
Start seated with light weights, pressing overhead within a comfortable range. Progress to standing and gradually heavier weights as your strength and control improve.
3
Wall push-up plus
3 sets of 8–12
Do a push-up against a wall. At the top, push a little further so your shoulder blades spread apart around your ribs. As it gets easier, progress to a bench or kitchen bench.
4
Practise your own activities
Build up gradually
Reintroduce the tasks that matter to you, like reaching to high shelves, lifting children or shopping, swimming or throwing. Start light and short, then build up over time.
Everyday tips
• Sleep on your other side, or on your back with a pillow under the sore arm.
• Keep reaching and lifting tasks close to your body early on.
• Break up long periods of overhead or repetitive work.
• Keep generally active, such as walking, while your shoulder recovers.
• Little and often is usually better than a lot at once.
When to seek prompt medical review
• You suddenly can't lift your arm after a fall or injury.
• Your shoulder looks deformed after an injury.
• You have fever, redness or heat around the shoulder.
• Numbness, tingling or weakness spreads down your arm.
• Pain is severe at night and getting worse.
• Shoulder or arm pain comes with chest pain, shortness of breath or sweating. Call 000.
This resource is general information only and is not a substitute for individual assessment and advice. If you have a shoulder injury, follow the program from your treating practitioner. Prepared by Dr Emma Cormack (Chiropractor), Vital Chiropractic, Mona Vale.
Need help with your shoulder?
Book an appointment with Dr Emma at Vital Chiropractic in Mona Vale for an assessment and a rehab plan tailored to you.
Book nowVital Chiropractic
Suite 4, 1767 Pittwater Road,
Mona Vale NSW 2103
emma@vitalchiropractic.com.au
Vital Chiropractic
Founded by Dr Emma Cormack, an Australian registered chiropractor and kinesiologist.
Suite 4, 1767 Pittwater Road, Mona Vale NSW 2103
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