Rotator Cuff Rehab: Are We Getting It Wrong?

Posted By: Andy Barker

There are a LOT of people with shoulder problems and even more shoulder exercises to prescribe.

Yet, this area of the body continues to prove problematic for both patients and New Grad therapists.

Pain persists, patients are often unable to return to normal function, particularly active patients who enjoy sport and especially the gym and can result in BIG frustrations as a therapist, when despite your best efforts your patients continue to struggle with shoulder pain.

Rotator cuff exercises are often a staple rehab exercise given for almost any patient with shoulder pain.

But, do they work?

Are they the best exercises to give your patient, or is there a better way?

In this blog you will discover the ‘real’ role of the rotator cuff and learn how knowing this can help you prescribe the best shoulder exercises, that actually work the rotator cuff and help you get the results you want with patients you treat with shoulder pain.

Shoulder Issue = ‘Cuff’ Exercises

Do you sometimes find yourself falling into the trap of prescribing the same shoulder rehab exercises for patients you treat with shoulder pain?

Like those theraband lateral cuff exercises…

Or banded scaptions….

Maybe you even have a favourite scapula stability exercise.

You probably pick these because they’ve worked in the past with other patients with similar issues.

But I’m sure you are starting to realise that this doesn’t always work.

No two patients are ever the same, regardless of how they make seem so similar in their presentation.

Your patients’ story and their desired goals, hobbies, interests and their past medical history are highly unlikely to be the same even if their objective assessment results do.

It’s easy to allow yourself to fall into this trap and deliver the same rehab prescription.

I don’t mind admitting that as a New Grad that I did the same.

But once you understand the true role of the rotator cuff, then the way you view your shoulder rehab programming will change…

…And at the same time allow you to get quicker and long-lasting results with your patients struggling with shoulder pain.

The ‘Real’ Job Of The Cuff

The role of the rotator cuff is to centre the ball in the socket – to keep the humeral head centered in the glenoid.

Whilst the rotator cuff muscles do contribute to shoulder internal and external rotation, this is NOT their main role.

So many shoulder rehab programmes focus on shoulder exercises that include internal and external rotations, like those banded theraband exercises, often with the shoulder in a poor position (poor meaning not centred well in the socket).

In this case it doesn’t matter how many internal or external rotations your patient completes, if they are starting from a poor position, they will load in a poor position and not get out of the exercise what you think they may be doing.

Additionally, it is very hard for your patient to ‘activate’ these cuff muscles because of the other muscles that are also involved in the same actions.

Take shoulder internal rotation.

If you think you are primarily working subscapularis, then you are wrong.

The lats and pectorals are shoulder internal rotations and for most will dominate the motion of loaded internal rotation.

The body and brain will always pick the easiest way to complete a task and if it given an option to use a small stabilising muscle (subscapularis) or a big, strong prime mover like the pectoralis major or latissimus dorsi, then there will only ever be one winner.

So how do you stop this?

Another Way To Train The ‘Cuff’

We know the main role of the cuff is to centre the humeral head in the glenoid and that loaded internal and external rotation may not be the best way to activate the rotator cuff muscles.

So, it could be fair to say that this may be a good reason why many traditional shoulder rehab programmes are often ineffective at helping patients overcome shoulder pain.

An alternative way to train the rotator cuff are farmers carries.

The weight on the arm causes a distraction force and as such gives the rotator cuff no option but to contract, to try keep the humeral head centered in the socket.

Farmers carries not only get the cuff working as it should, but are also really shoulder friendly as these can be prescribed with almost any shoulder patient, even in very acute presentations, as the arm is by the side of the body and as such requires no shoulder movement.

The only population that you wouldn’t use this exercise with is patients with inferior laxity, but these patient groups are relatively uncommon.

A bonus, a farmer’s carry also doubles up as a great core exercises for the obliques.

So, ditch the theraband and rehabilitate the ‘cuff’ in a way that it is supposed to be used…

Key Points

A patient’s rehab should reflect their subjective and objective results and no patient should be given ‘cookie cutter’ shoulder rehab

The real job of the rotator cuff is to centre the ball in the shoulder socket and NOT to produce internal and external rotation

Farmers carries serve a great way to ‘activate’ the rotator cuff

PS. I go into detail about shoulder rehab in my New Grad Physio Upper Limb Course.

I’m just finalising the venues for my course dates for 2020 and to make sure you don’t miss it, join my waiting list at

Not only will you be the first to hear about the course dates as soon as they are released but you will also get exclusive access to the first batch of tickets, including discounted ticket prices.