I was asked by Women’s Health Magazine this week to answer a few questions about the rotator cuff, what it is, what it does, and how to protect it. As this is also one of the most common questions I’m asked both in person and online I have collated all my answers below:
- What is your rotator cuff?
The rotator cuff is a group of four small muscles that cross the Gleno humeral joint, which is one of the two joints that make up the shoulder complex (the other being the scapula-thoracic joint)
It consists of the supraspinatus, infraspinatus, teres minor and subscapularis. These four muscles are often described as having four distinct roles in articulating the humeral head (the ball) within the glenoid fossa (socket). However, I think trying to view the rotator cuff muscles as separate entities with separate roles in motion is actually quite misleading. The true role of the rotator cuff group is to maintain congruency of this notoriously unstable joint – in other words keeping the ball in the socket.
- What are the best exercises to strengthen your rotator cuff and why?
15 is way too many to be honest – the most effective ways to train the cuff are to train it all together so really its 5 main exercises – I have ordered them here with greatest EMG activity in the cuff first 9more isolated activity) through to more general ‘functional ‘ work that better relates to how our bodies move.
– side lying external rotation
– face pulls
– standing band pull aparts
– kettlebell screwdrivers
– unstable object training (inverted kettlebell holds, maces, vipers, sandbags)
- How might you injure your rotator cuff?
the cuff is actually most commonly injured by two quite different but very related mechanisms:
When we raise our arms overhead what should happen is the shoulder blade should rotate on the ribcage to as the arm raises, what this does is move the acromium up and out of the way of the humerus (upper arm bone) – effective meaning that we are moving the socket to follow the path of the ball, allowing it to remain centred whilst also enjoying a greater range of motion that a rigid socket would allow.
However, if for whatever reason the shoulder blade doesn’t move adequately on the ribcage, then at some point we will run out of anatomy – and the humerus will start to be pressed against the acromium and compressing whatever structures run between them. Some of the structures that runs between them are the delicate tendons of the rotator cuff which become injured when punched between the two bones
A rotator cuff strain can occur when the shoulder goes to a position it is not used to, and it cannot control. If this happens and we lose congruency of the joint (keeping the ball in the socket) then the cuff muscles can all of a sudden be put under a sharp and sudden load and be subject to a strain or even a tear
- How can exercise help with a rotator cuff injury?
Consistently strengthening any muscle can reduce the likelihood and severity of an injury, and also improve recovery time should an injury occur. However, there his much more to rotator cuff rehab (recovery) or more importantly prehab (injury prevention).
Working to improve and maintain optimal joint alignment at the shoulder means working on improving and maintaining optimal mechanics of the shoulder blade, so that the socket can articulate along with the ball.
However, the shoulder blade can only move adequately along a ribcage if the ribcage is correctly positioned beneath it. The shoulder blade has a concave anterior aspect (front side), and the ribcage should have a corresponding convex posterior (rear) aspect. If the rib cage is not correctly positioned then the shoulder blade quite simply has nowhere to sit and will be a little lost in space. If the shoulder blade isn’t correctly positioned then the ’socket’ isn’t oriented the way it should be or moving the way we need it to. If we don’t know where the socket is, we really have no hope of orienting the ball correctly within it.
One of the most common errors I see in truing to address shoulder pain and function is focussing too much on the movements of the upper arm relative to the torso, and forgetting that we have to first correctly position that torso.
Understanding all of this we can see that rotator cuff and shoulder health actually depends upon ribcage position and therefore core control – so an effective rotator cuff injury prevention or rehabilitation must include 360 degree core training.
- What exercises might aggravate a rotator cuff injury?
Pressing overhead is the most notorious cuff botherer. Few people actually have the core control required to stabilise the ribcage whilst pressing overhead – this means that the movement is often completed by arching the lower back and consequently losing control of the ribcage, shoulder blade position, and ball / socket congruency putting its at his of both impingement and strain – which combined with heavy external load is a perfect t storm for a cuff injury
This video gives a little insight into mu thoughts on how position of the shoulder blade is vital for safe and effective movement of the shoulder joint: