If you want to improve your rotator cuff, you need to focus on strengthening the muscles that support the shoulder joint through targeted exercises and movement.
The rotator cuff is a group of muscles and tendons that due to overuse, injury, or simply aging, can become weakened or injured. Symptoms include pain, weakness, and limited mobility.
Fortunately, there are steps you can take to improve the rotator cuff. In this post, we’ll outline four key strategies for strengthening and supporting this crucial area of your shoulder, so you can keep moving with confidence and ease.
The term “rotator cuff injury” is kind of a blanket statement that doesn’t tell you all that much about what’s going on in the shoulder. And in some cases, it can lead to a watered-down, excessively shoulder-centered rehab path that doesn’t deliver any long-lasting progress.
That being said…
An assessment is key to finding out which positions or muscles might be weak and causing you trouble.
If you are experiencing pain, it’s a good idea to see a physical therapist first to get a proper assessment of the shoulder.
You can then dial in the program to focus on the specific findings.
If you would like to have a full assessment by Ian, we can make that happen virtually by starting with a 15-minute consult.
Our approach to improving your rotator cuff is built on integrating mobility and strength to get your shoulder feeling better and pain-free. With the added bonus that your shoulder will likely be stronger than before the rotator cuff issues started.
With our “4 Keys To Improving Your Rotator Cuff” video, we dive into the crucial steps you can take to improve and protect the health of your rotator cuff.
Whether you’re looking to rehab from an injury, prevent future issues, or simply optimize your shoulder performance, this video is for you.
Step 1. Dynamic Ribcage
With most issues going on with the musculoskeletal system, it’s not enough to only focus on the area of the symptoms. Unfortunately with shoulders, it’s still common practice to zoom in on only the rotator cuff.
It’s often the failure to address the rib cage that’s the culprit for recurring shoulder issues.
Having a dynamic ribcage that can move in all directions, expand 360 degrees and maintain intra-abdominal pressure in training and sports is crucial for optimal shoulder health.
That way the ribcage can adjust to the demands of the shoulder which then helps to keep the humerus centered in the socket.
Breathing Is Important To Improve Your Rotator Cuff
We need good breathing mechanics and intra-abdominal pressure to create a stable core that acts as a foundation for the movement we want to see in the ribcage (or the hips for that matter).
Use the exercises in this video as a starting point.
Learn to move the ribcage
Once you have your breathing and intra-abdominal pressure up to scratch, use standing thoracic Controlled Articular Rotations (C.A.R.S.) to practice moving the ribcage in all directions in a controlled manner.
Step 2. Daily Shoulder C.A.R.S To Improve Your Rotator Cuff
Taking your shoulder (or any joint for that matter) through its full range of motion is similar to brushing and flossing your teeth: a daily practice that improves your health. For rotator cuff injuries, doing C.A.R.S. helps bring nutrients and fluid into the joint so it can recover faster.
Constantly carve the range that you have to own it. Going slow and taking your shoulder through a full range of motion every single day for at least five reps.
With the shoulder C.A.R.S., it’s important to know and respect your shoulder’s current mobility. That means keeping the C.A.R.S. within your current range of mobility instead of compensating and therefore ending up working for a whole lot of nothing.
The goal with shoulder C.A.R.S. isn’t to replicate someone else’s effort
But to explore and strengthen your own shoulder mobility within the range you have. Pushing through pain can set you back when you want to improve the rotator cuff.
We’re big on super-setting shoulder C.A.R.S. with the internal and external cable exercise we’ll cover next.
A quick shoulder anatomy refresher
Okay, let’s break it down. Your shoulder has a lot of different muscles and tendons that help you move it in different ways.
When you rotate your arm out, away from your body, a few specific muscles do the work, like the infraspinatus, teres minor, and part of the deltoid muscle.
And when you rotate your arm in, towards your body, different muscles help, like the subscapularis, latissimus dorsi, teres major, pectoralis major, and another part of the deltoid.
It’s kind of like a big team of muscles working together to help your arm move!
It’s common to be strong in the midrange of the shoulder rotation while noticing weakness in the end ranges. This strength imbalance leaves the shoulder joint more vulnerable to injuries in the areas where the forces to the shoulder are more likely to exceed the force you can generate.
To improve the shoulder rotation strength, we like to start with the elbow sitting next to the ribs instead of at shoulder height. Simply because it’s easier to control the shoulder in that lower position.
Most people don’t have the shoulder flexion or control to start at the higher position.
Step 3. Stronger Shoulder Rotation
There’s no healthy shoulder without first having a strong internal and external rotation. The glenohumeral joint rotates in every movement that you demand from it. That’s true even if you’re trying to improve your shoulder extension or flexion.
Cues and progressions for the shoulder rotation
Make sure the movement is actually coming from the shoulder rotation
We like to use a rolled-up towel or something similar between the ribs and the elbow as a reminder to keep the shoulder in place.
Have the elbow “locked” at 90 degrees and the band/cable horizontal
Those struggling with getting the movement right might want to reduce the elbow angle. That often helps keep the movement focused on the rotation instead of moving the scapula.
Start by strengthening the end ranges with isometrics
Find the deepest position you can control and maintain in the internal/external rotation. Keep the grip tight and the palm perpendicular to your body. Aim for 3x30s isometrics per side.
Move on to the dynamic control
Aka, full range control. A good tempo here is a 3s concentric and 10s eccentric for each rep. Try to keep the first 5s of the eccentrics in the end range to further strengthen the weaker ranges. Perform 6-10 reps per side.
Stick within the range you have. Trying to work outside of your mobility often leads to faking the rotation with scapula protraction and retraction.
Add in dynamic grooving
If you or your clients are returning to sport, you can further increase the resiliency of the shoulder with heavy eccentrics. This means choosing weights that are too heavy for concentric movement. And then using two hands to bring the weight to the end of the concentric part of the lift, followed by 10s eccentric with a single arm as you did in the earlier progression.
Only then progress to rotation with a flexed shoulder
Cues and progression for shoulder rotation in flexion
Set the cable height based on your available internal rotation
If you can internally/externally rotate your shoulder ≤90 degrees in the flexed position: set the cable at shoulder height.
If you can internally/externally rotate your shoulder >90 degrees: set the cable sternum height (or lower) to get a stronger pull into the end range.
Maintain a tight 90-degree angle at the elbow
Pay attention to not shrug the shoulder to the ear.
For external rotation, think about punching your hand into the ceiling vs just rotating
Most people find this cue makes it easier to keep their elbow leveled at shoulder height instead of flying all over the place.
Follow the steps from the previous rotation progression
End range isometrics 3x30s -> Dynamic control 6-10 reps -> Dynamic grooving 10s eccentric
Progress to the dumbbell variations
With these, you can strengthen the full range of motion with load and easily maintain and even improve your mobility without having to organize your whole upper body training around your shoulder injury.
Just do a set of 10 of one of these dumbbell variations as a part of your workout. We cover the three variations of these at the end of the strength training video below.
You can also use all of these internal and external rotation exercises as part of your warm-up to fire up the rotation. Or bake them into your upper body program and pair them with C.A.R.S. to reinforce your shoulder mobility and strengthen the weaker ranges.
Step 4. Strength train within the range of motion you have
This is still part of the rotator cuff rehab, but it’s starting to look very similar to the usual upper-body strength training. Because that’s exactly what it is. If you want to improve the rotator cuff, you need to train strength.
Just like with the ribcage, the importance of range-specific strength training gets often overlooked during rehab. Either that it gets ignored altogether in favor of “rehab movements”. Which leaves people feeling better but still weak.
Or that folks go to the other extreme and keep doing what they’ve always done with their strength training, regardless of the discomfort. And no amount of rehab will help make the rotator cuff better when it’s constantly being aggravated.
The key to working through your rotator cuff and shoulder limitations is to understand how much range of motion you currently have. And then training like a monster within that range.
Do at least some parts of your strength training close to the end range of your current mobility. This will help you improve your mobility over time as you strengthen the weaker areas mentioned earlier.
Diagonal cable rows and landmine presses are great for building strength in shoulders with limited flexion. We like to superset these in the first part of the workout while things are still fresh so it’s easier to hone in the technique.
Cues to get the most out of the strength exercises
Keep the rib cage packed on top of the hips to avoid faking shoulder mobility with low back
Don’t shrug the shoulder to the ear
Slow, controlled 3-second eccentrics
Don’t water down upper body training to compensate for rotator cuff issues
Good things happen when you adjust your strength exercises to match your current range of motion and integrate the shoulder mobility and rotation exercises as part of your strength program. While also working on achieving and maintaining that dynamic ribcage.
In most cases, reclaiming a strong rotator cuff and a more robust and mobile shoulder doesn’t have to be any more complicated than that.
If you’re struggling with shoulder issues and want to improve your shoulder health with a proven, structured program that we use with all our in-person and online clients, check out our Shoulder Mobility Guide.
If you’re a coach or a trainer with clients who struggle with shoulder issues, you should join other high-flying fitness and movement pros by signing up for Mobility Coach Plus. That’s where we teach coaches and trainers how to help their clients build strong, pain-free shoulders. Without turning the whole thing into a mobility rehab circus.