Exercise Therapy in the non-operative treatment of degenerative rotator cuff tears: which exercises should we prescribe?


Ann Cools, Clinical Pearls / Friday, January 11th, 2019

Recent studies have shown that patients with degenerative rotator cuff (RC) tears have similar good results from an exercise program compared to surgical intervention (Jeanfavre M et al. IJSPT 2018). In the conservative treatment of RC tears, it is advised to use function-based rather than structure-based exercises. In other words it is much more important to increase the patient’s ability to raise the arm above shoulder height than to individually strengthen the muscles involved. In the exercise choice we should even aim for minimal RC load during these elevation exercises in order to avoid excessive tensile load on the RC

Based upon recent literature regarding EMG activity of the rotator cuff muscles during a variety of commonly used shoulder rehabilitation exercises, we recommend to use “low load” closed chain exercises (minimal body weight on shoulders) such as the “bench slide” (video 1) and “wall slide” (video 2) exercise, as well as open chain exercises with a approximation component in the glenohumeral joint and focus on deltoid activation (video 3) These exercise show low activity in the rotator cuff muscles.

Video 1 Bench Slide
Video 2 Wall slide
Video 3

References:

Edwards PK, Ebert JR, Littlewood C, Ackland T, Wang A. A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair. J Orthop Sports Phys Ther. 2017 Dec;47(12):931-944. doi: 10.2519/jospt.2017.7271

Jeanfavre M, Husted S, Leff G. Exercise therapy in the non-operative treatment of full-thickness rotator cuff tears: a systematic review. Int J Sports Phys Ther. 2018 Jun;13(3):335-378.

Written by: Ann Cools

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