Traditional Physical Therapy rehabilitation of the shoulder has focused intently on strengthening the rotator cuff as means to improve function and decrease pain and disability. While this is often times needed, particularly post-op and with strains, it is often time just one small piece of the puzzle. In order to understand the rehab process, you must first understand the difference between stabilizers a.ka. the rotator cuff (in regards to the shoulder) and prime movers.
The rotator cuff attaches very close to the shoulder joint, as all stabilizer muscles do throughout the body. It cannot be seen by the naked eye but it functions to stabilize the head of the humerus in the socket (glenoid). The problem with rigorously strengthening them with exercises such as the standing external and internal rotation is that you are working them in a prime mover sort of fashion (think of a concentric muscle contraction with muscle shortening). True functional activation of the rotator cuff occurs in an isometric fashion. A good way to think of this is to picture all of the rotator cuff muscles stiffening without changing length to keep the head of the humerus centered in the socket.
A few isolation rotator cuff exercises will be initiated if the cuff is determined to be weak as identified in the assessment. In addition, at Performance you will find our patients doing such exercises that emphasize their true function. True functional reactive engagement of the rotator cuff happen with glenohumeral compression and distraction. Therefore they should be trained ‘functionally’. A few examples of compression include the bird- dog, Kettle bell carry variations or turkish get ups. A few examples of distraction include deadlift, or farmer walks or pull ups/hangs.
