{"id":13365,"date":"2025-07-10T09:14:05","date_gmt":"2025-07-10T09:14:05","guid":{"rendered":"https:\/\/www.fitpro.com\/blog\/?p=13365"},"modified":"2025-07-10T09:14:30","modified_gmt":"2025-07-10T09:14:30","slug":"how-to-train-the-rotator-cuff","status":"publish","type":"post","link":"https:\/\/www.fitpro.com\/blog\/how-to-train-the-rotator-cuff\/","title":{"rendered":"How to train the rotator cuff – 5 exercises for your training programme"},"content":{"rendered":"

Jordan Smitham <\/strong>explores the anatomy, function and explains how to train the rotator cuff – with 5 rotator cuff exercises for use in training<\/h2>\n

The shoulder girdle consists of three bones: the scapula, clavicle and humerus. These bones connect via three joints: the glenohumeral joint (GHJ), the acromioclavicular joint (ACJ) and the sternoclavicular joint (SCJ). The GHJ is a ball and socket joint, consisting of the articulation between the head of the humerus and the glenoid of the scapula.<\/p>\n

There are two ball and socket joints in the body \u2013 the other being the hip joint. What differs between the two joints is that the hip is more of a ball in a socket joint, given lots of bony stability, whereas the shoulder is more of a ball on a socket joint, leading to less bony stability. This distinction is important as it gives us a greater range of motion which we need to function above our head \u2013 from reaching for the top shelf to serving in tennis and everything in between.<\/p>\n

To enable us to keep stability, we have static and dynamic stabilisers. The static stabilisers consist of that vacuum effect created by the pressures in the joint, the bony geometry of the joint, the capsule and the labrum.1<\/sup> The bony stability consists of the glenoid on the scapula and the head of the humerus. As we raise our arms in the air, our scapula will laterally rotate to enable the head of the humerus to be centred in the glenoid socket.<\/p>\n

The labrum is a fibrocartilaginous rim that conforms to the shape of the glenoid perfectly. It deepens the socket by 50% to increase contact in the joint. The capsule is thickened and forms the ligaments, which increases stability of the joint.1<\/sup> To allow for the great range of movement, the shoulder ligaments only get taut at the end of ranges.1<\/sup> The dynamic stability comes from proprioception and muscles.<\/p>\n

Proprioception is the body\u2019s awareness of where it is in space, how much force it needs to complete a task and how quickly it needs that force. Proprioceptors come from passive structures such as ligaments and the labrum and muscles. The muscles involved in the dynamic stability are known as the scapular muscles, which transfer the energy of the trunk through to the shoulder and the rotator cuff (RC).1<\/sup><\/p>\n

As soon as the arm is raised, the RC are in effect and have started to stabilise<\/em><\/strong><\/p><\/blockquote>\n

The RC is made up of four muscles: supraspinatus, subscapularis, infraspinatus and teres minor.2<\/sup> The rotator cuff muscles attach to various points in the scapula and insert into the humeral head, at the greater and lesser tubercle. However, to assist in the stability of the shoulder, the proximal attachments are not separated \u2013 they form a common, continuous insertion around the greater and lesser tubercles. Attachment points are seen below in Table 1.<\/p>\n

Table 1: The attachments of the four RC muscles2<\/sup><\/strong><\/p>\n\n\n\n\n\n\n\n
Muscle<\/strong><\/td>\nOrigin<\/strong><\/td>\nAttachment<\/strong><\/td>\n<\/tr>\n
Supraspinatus<\/td>\nSupraspinatus fossa<\/td>\nSuperior facet of greater tubercle<\/td>\n<\/tr>\n
Infraspinatus<\/td>\nInfraspinatus fossa<\/td>\nMiddle facet of greater tubercle<\/td>\n<\/tr>\n
Teres minor<\/td>\nLateral border of scapula<\/td>\nInferior facet of greater tubercle<\/td>\n<\/tr>\n
Subscapularis<\/td>\nSubscapular fossa<\/td>\nLesser tubercle<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Function<\/strong><\/h4>\n

Supraspinatus, infraspinatus and teres minor \u2013 known as the posterior cuff (PC) \u2013 are involved in external rotation (lateral rotation), and subscapularis \u2013 known as the anterior cuff (AC) \u2013 is involved in internal rotation (medial rotation).1,2<\/sup> As well as this function, they play a big role in stabilising the shoulder and keeping the head of the humerus in the centre of the glenoid to prevent translation.3<\/sup> They perform this force couple action around the humeral head during all shoulder movements.4<\/sup><\/p>\n

The PC plays a big role in stabilising forward movements such as bench press, incline press or throwing a ball.5<\/sup> The AC plays a big role in stabilising backwards motions such as rows.5<\/sup> When our arm goes into scaption or abduction, all the RC stabilises equally.6<\/sup> This can be seen well in Figure 1.<\/p>\n

\"How

Figure 1: Directional preferences of the RC during shoulder movements<\/em>5<\/sup><\/em><\/p><\/div>\n

As soon as the arm is raised, the RC are in effect and have started to stabilise.4<\/sup> The RC are involved in every type of movement and it is impossible to isolate one muscle. This is due to all four tendons wrapping around and conjoining around the humeral head.2<\/sup><\/p>\n

We can manipulate load through the rotator cuff by having the arm unsupported or supported. In an unsupported position, there is increased recruitment of the surrounding scapular and RC muscles. For example, in external rotation at mid-level unsupported abduction, there is more recruitment of supraspinatus and the scapular muscles to stabilise the arm as infraspinatus performs external rotation.7<\/sup> In a supported position, the weight of the arm reduces so there is less recruitment. This can be used to regress or progress shoulder load in our clients.<\/p>\n

We can also manipulate load through the RC through using open chain or closed chain. Open chain exercises mean the hand is not fixed and can move freely, like a shoulder raise, whereas a closed chain exercise involves the hand being fixed, like a push-up. Closed chain positions require less of a stabilising role of the RC, allowing for an exercise option with reduced forces through the RC.8 <\/sup><\/p>\n

This is consistent with data found on open chain exercises, showing that these exercise options consistently had higher levels of activation through the RC in comparison.9<\/sup> This tells us that closed chain exercises could be an option to offload the RC.<\/p>\n

Training – how to train the rotator cuff<\/strong><\/h4>\n

A training programme that encompasses shoulder movements in all directions will therefore also train the rotator cuff. A training programme that consists of a normal push (bench press), overhead push (shoulder press), a row (pendlay row), a fly (cable fly), a raise (lateral raises) and a reverse fly (cable reverse flies) will train the RC. Research shows the strength and power outputs are greater for pushing movements than pulling movements10<\/sup>, therefore we should consider a push:pull ratio of approximately 3:2.11<\/sup><\/p>\n

Sometimes, due to injury, we have specific weaknesses in the RC. In this case we need to target the RC in more specific directions and loads. Before we train this though, we need objective measures to:<\/p>\n

    \n
  • prove there is a weakness that needs to be worked on<\/li>\n
  • track progress to ensure the progress is being made.<\/li>\n<\/ul>\n

    The isokinetic machine has been shown to be the gold standard for testing strength for over 40 years12,13<\/sup> and has shown excellent reliability with assessing shoulder strength.14,15<\/sup> Unfortunately, isokinetic machines are very expensive and are not often available to all of us. Other options include the handheld dynamometer (HHD). This is a much cheaper, handheld piece of equipment that can be used to track strength. HHD has already been shown to be a valid and reliable way to track rotator cuff strength.16,17<\/sup> The HHD will give us a peak force score in kilogrammes of force. To make this a more reliable measure, we will want to normalise this to bodyweight (BW).18<\/sup><\/p>\n

    With HHD testing, we would want our clients\u2019 external rotation strength to be 20-25% of BW, with internal rotation being a little higher.19,20<\/sup> If we don\u2019t have this equipment, then testing 3RM using cable machines is the next best option. Possibly using reps in reserve testing or failure testing can be a substitute for strength, either by looking at increasing the reps before failure or by using an equation to calculate 1RM.21<\/sup><\/p>\n

    Once we have our initial numbers, then we can use this data to create an exercise programme for our clients. We can train our rotator cuff in an unsupported and a supported position, depending on what our goals are. For example, there is more supraspinatus activity when training external rotation in an unsupported position.3<\/sup> This may suggest that less demanding supported rotator cuff exercises could be considered before progressing to a more demanding unsupported position. Another method of programming could be to use sets and repetitions to target a strength phase, if tolerated. In an unsupported position, it may be easier to lift more weight, therefore it could be a better position for high-load, low-rep strengthening.<\/p>\n

    The cuff works through range, so we need to ensure we train it in many positions<\/em><\/strong><\/p><\/blockquote>\n

    As already stated, the cuff works through range, so we need to ensure we train it in many positions. The simplest specific RC exercise is external rotation and internal rotation at the cables, starting with arms by your side in 0\u02da \u00a0of abduction. We can then look to manage the load by doing these rotational movements in different angles of flexion or abduction to encourage higher activation of the RC and surrounding muscles.22,23<\/sup><\/p>\n

    One of these positions is end range external rotation in abduction, known as open position, where the shoulder is most vulnerable to dislocations. Therefore, in this position, it is critical to have good control and strength. It is the same as the cocking position during a throw. We can improve the dynamic stability and strength of the shoulder in this position in both supported and unsupported positions. For example, an unsupported position would be freely using a dumbbell or cable machine, in comparison to a supported position where the elbow would be rested on a bench at 90\u02da \u00a0of abduction. Like any programme, we want to ensure that it is progressive and testing and we ensure that weights\/reps\/sets\/time under tension always increase.<\/p>\n

    Finally, we may need to also train rate of force development (RFD). This will be more specific for our clients who compete in sports that require fast movements, often requiring tasks that are performed at 150m\/s or faster, such as hitting a ball, throwing a ball or combat\/collision sports. There is a suggestion that slower activation of RC is present in throwers with shoulder pain.24<\/sup><\/p>\n

    Edel Fanning also showed no direct correlation between ER and IR peak torque and performance markers of explosive tests, suggesting that RFD has to be trained separately.25<\/sup> This can be done by focusing on fast-paced movements through relevant ranges for the client depending on their sport.<\/p>\n

    How to train the rotator cuff –\u00a0 5 exercises for your training programme<\/h4>\n