Rotator Cuff Strengthening

Rotator cuff strengthening is all about shoulder pain and its rehabilitation.

This process is an integral part of the treatment of every injury, otherwise the body part will remain weak and prone to further, and often worse, problems.

This is is the name given to a group of four that act to stabilize the arm. Pain and the so called adhesive capsulitis often involve one or more of these key muscles.

These shoulder muscles allow you to raise your arm, turn it and move it into many different positions, each carefully controlled and coordinated, as in hitting a golf ball accurately, for example.

Unlike the hip joint though, the shoulder socket is very shallow to allow for a greater range of motion. This makes the upper arm more vulnerable to injury, leading to pain, strains and tears. 

Since the shoulder is non weight bearing, as are the hip and knee, it is much less prone to arthritis. An exception here is the AC joint, between the acromion and the clavicle. This joint that connects the collarbone to the shoulder blade is often injured in falls and, should it not be correctly managed with rotator cuff strengthening, it tends to becomes prone to immobilisation degenerative changes of the hyaline cartilage.

The acromioclavicular is second most arthritic joint in the body, after the thumb.

They are the

  • Subscapularis (which lies UNDER the shoulder blade), the
  • Supraspinatus (which lies ABOVE the spine of the shoulder blade), the
  • Infraspinatus (which lies UNDER the spine of the shoulder blade) and the
  • Teres Minor. To these four muscles we will add the
  • Biceps muscle for simplicity, since it also a common offender that needs strengthening.

Acromioclavicular joint

Acromioclavicular joint is pivotal to understanding the shoulder joint.

See if you can follow the thin clavicle, collarbone, at the top of the picture to where it joins with the shoulder blade, scapula, at the acromion. This acromio clavicular joint with its ligament is key to shoulder mobility. Chiropractic adjustment of the ac joint is very important.

The shoulder muscles are energised by nerves emerging from the lower neck. An old neck pain injury often lies at the root of shoulder pain. Have you perhaps been involved in a car accident or an old sporting injury?

The so called rotator cuff syndrome is a complex condition involving four shoulder joints, together with their capsules and ligaments, the shoulder muscles and their tendons, their nerve supply and the acromio clavicular joint.

In these shoulder syndromes, the muscles after being strained adhere to each other and the roof of the fossa which is formed by the acromio clavicular joint.

A sports oriented chiropractor will not only adjust your neck but focus on these peripheral sites of injury, the four shoulder joints, and a complete set of rotator cuff strengthening exercises.

Rotator Cuff Strengthening

Rotator cuff strengthening explains the syndrome and how is it treated?

The simplistic and safest rotator cuff strengthening exercises are the isometric exercises. A very good place to start, as Julie Andrews would say! Sound of Music ... (Sorry, a bit crazy this morning!) When you read you begin with A-B-C, when you sing ... when you strengthen your shoulder you begin with STRETCH-ISOMETRICS-DYNAMICS) These isometric exercises mean that the shoulder doesn't move! Here are six little exercises to start with. Whilst sitting in a chair, place your elbow against your side with the elbow at 90 degrees, and your hand straight in front of you. Using your other hand,

  1. grasp your wrist with the good hand, and press straight across, inwards, with your injured arm. Without movement! Against resistance from the good arm.
  2. Adjusting the fingers slightly, in the same position, now pull outwards, again without movement.
  3. Now pull your elbow straight against your chest.
  4. Reaching across, grasp the elbow of the painful shoulder, with your good hand. Now attempt to pull your painful arm away from the body, against the resistance of your fingers; without movement. Gently, because you're not eligible for the Olympics.
  5. Now press your elbow backwards against your chair.
  6. Lastly, make a fist with your sore arm. Keeping the elbow at your side, push straight forwards against the good hand, again without any movement.

Do about five to ten repetitions each and every time you take a tea break. Start slowly, particularly if these movements are painful; there is no rush.

Isometrics are more effective that dynamic exercises in the initial phase after injury when it comes to rotator cuff strengthening, but you must do it in different positions. When these six are painless, then do them with the shoulder flexed at forty five degrees, say, and then ninety.

Strengthening exercises with movement should then follow. Once you can do the isometrics without pain, then progress using this inexpensive apparatus. It's a simple affair with a small pulley,  and a cord with a handle at each end. Fix it in the door jamb, and pull away, changing the position.

Make your own arm exerciser for a fraction of the price; it's dead easy. 


Once you can do that without pain, then it's time to move your ROTATOR CUFF STRENGTHENING on to light weights. Holding any tin can of around 400 g (1 lb) in your hand, start moving the arm in these same directions. Always start with stretching and do it at least twice a day.

A used bicycle tube is excellent for Rotator Cuff strengthening. Hook it over some fixed point, and start doing gentle exercises against the resistance of the tube. Inwards, outwards, forwards ... you can use your imagination, but follow a routine, gradually expanding it as you feel the shoulder getting stronger.

Warm up routine of golfer Padraig Harrington

Whilst none of us amateurs would consider a routine like this before playing sport, if you are a professional sportsman, where fine-tuning makes a profound difference at the finish line, then you may wish to think about Padraig Harrington's preparation before a round of golf.

Padraig was missing four to five tournaments per year due to injury. So he hired chiropractor Dr Dale Richardson to go on tour with him. Now he misses no tournaments. This is the routine that his DC has given him.

  1. On arising in the morning, 45 minutes of stretching, stabilizing and core muscle exercise as a warm up for the day.
  2. Take a warm shower.
  3. Enjoy a hearty breakfast of his own choosing.
  4. Thereafter follows twenty minutes with Dr Richardson checking that all the joints and muscles needed by a professional golfer, every one in the body, are working correctly; then more stretching.
  5. An hour at the range hitting shots to warm up further.
  6. Four to five hours on the golf course.
  7. This is followed by another hour with Dr Richardson giving treatment and cool down procedures.
  8. Gym work in the late afternoon for ultimate strength and endurance needed by any professional sportsman.

For a professional sportsman, Harrington's words are interesting.

One thing I know from my own experience is that my body needs constant attention, even when I take a few weeks holiday; because I can see even though I would be injury free for say a month, I can feel tightness and pain building up. I never used to pay much attention to  those early signs; it wasn't long before that translated into bogeys on the golf course.

The basic principles here are:

  • Stretching, warmup and checking that muscles and joints are working correctly.
  • After sport stretching and cool down apply whether you are going to spend the day gardening, preparing for a game of squash, or even just going for a hike.

Frozen shoulder and chiropractic help

Chiropractic help is for those who really have not desire to go under the knife for their shoulder pain.

The frozen shoulder is one of the most painful conditions faced in the chiropractic clinic. Prevention is the name of the game.

Two of the early signs are difficulty taking off a T shirt, for example, and placing the hand behind the back as in removing a back pocket wallet and fitting your bra.

When that starts to happen, do not delay; get chiropractic help sooner rather than later. A frozen shoulder, or adhesive capsulitis, can take three years and more to thaw.


Having read this page, should you want to read more about shoulder anatomy, (did I hear you exclaim, "four! shoulder joints?") and see some diagrams, then for more info about Rotator cuff syndrome and the Frozen Shoulder please click here:

» Rotator cuff strengthening

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

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