Thursday, 16 May 2013

Preventing Rotator Cuff Injuries: Advice and Exercises (Updated)

I've now updated this post, based on some training I attended last week:

Today's post is based on the rotator cuff, and ways to, hopefully, prevent injuries via regular exercises and advice.

First off, as always, I will discuss the anatomy involved.

The space between the acromion and humeral head is where the rotator cuff tendons get impinged, especially when performing overhead activities.

What does the rotator cuff do?

The rotator cuff muscles internally and externally rotates the humeral head. These muscles help support and secure the head of the humerus into the glenoid fossa.
This means that the rotator cuff muscles are key to stabilizing the shoulder joint.

Preventative Exercises

Often, rotator cuff strengthening exercises are given as shown below, with internal and external rotation being strengthened in standing or in lying.


These exercises do strengthen the rotator cuff, but not in a functional way applicable to climbing, as the predominant movements involved in climbing are above head actions, therefore the rotator cuff should be strengthened in a similar manner.

It is the same movements as described, but with the arms above the head as shown. 

These movements can be performed in either standing, as above, or in lying, as below. They can be done using resistance bands, or free weights. The movements should be performed in a slow, controlled manner, ensuring the 90 degree angle at the elbow is maintained throughout.

Other exercises that can be performed to work the rotator cuff in a similar, over-head manner are displayed below. Again, these exercises should be performed in a slow, controlled manner, paying particular attention to the positioning of your scapula.

Important note: When performing any of these exercises, it is imperative that the shoulder complex as a whole is in the correct posture.... most climbers adopt the thoracic kyphosis posture, due to overtraining of the forward flexors. 
This also applies to when performing the exercises, if the shoulder blades don't stay pulled back and become rounded and forward while performing these exercises, with the head of the humerus becoming more anteriorly located (moves forward), either drop the weight, or perform the exercises without the arms above the head, as described at the start of this post.


So other preventative measures for looking after your rotator cuff muscles and shoulder joint in general, are such methods:
  • climbing technique - remember to use your feet, don't stretch too far for the next hold, rather work your way up to it, to reduce the load on the upper limbs
  • flexibility - there may be a lack of spinal flexibility, especially around the thoracic area, as this can cause lack of movement around the scapula; tight posterior shoulder capsule or posterior rotator cuff muscles may also do the same (see below for stretch that can be performed on the posterior shoulder capsule)



  • posture - this relates to flexibility, as well as the movement relationship between the scapula and humerus, known as the scapulohumeral rhythm, that is a key component in rotator cuff impingement. Also, musculature imbalance is related to posture, which is especially prominent in climbers! In some instances, it may be necessary to retrain the scapula and perform scapula setting exercises.

I hope these exercises and advice can prevent an injury. These exercises need to be performed often, and with low weight, high reps, as they are stabilizing muscles.

Any feedback or queries, give me a shout!

Further Reading

Roseborrough A, Lebec M 2007 Differences in Static Scapular Position Between Rock Climbers and a Non-Rock Climber Population. North American Journal of Sports Physical Therapy 2(1): 44-50


JE Budoff 2005 The Etiology of Rotator Cuff Disease and Treatment of Partial-Thickness Pathology. Journal of the American Society for Surgery of the Hand 5(3): 139-152

McCall C Presentation on shoulder conditions in rock climbing. BMC Climbing Injuries Symposium 2012