Robert A. Panariello MS, PT, ATC, CSCS
Professional Physical Therapy
Professional Athletic Performance Center
New York, New York
A concern that often transpires with patients that present with rotator cuff pathology and/or post-operative surgery, is the reactivation of the rotator cuff muscle group to restore the deltoid-rotator cuff force couple (figure 1) for safe arm elevation. When a poor functioning rotator cuff disrupts this force couple, there will be great difficulty raising the arm overhead. The patient will then compensate by “shrugging” or “hiking” their shoulder in an attempt to elevate their arm overhead (figure 2).
Figure 1
Deltoid – Rotator Cuff Force Couple
Figure 2
Patient “Hiking” their Shoulder during Attempted Arm Elevation
It is acknowledged that there are many circumstances and contributing factors that may lead to the inability to raise the arm overhead. The purpose of this dialog will focus on two simple methods to stimulate the rotator cuff in an attempt to “normalize” the deltoid-rotator cuff force couple when attempting to raise the arm overhead.
The first method utilized is to safely “fire” the rotator cuff in preparation for the patient’s attempt for a successful arm elevation. The patient pushes their extended arm (fist) into the treatment table for 3 sets of 5 – 10 second holds, being careful not to fatigue the rotator cuff. If the patient presents with a short arm, an appropriately sized plyoball is placed on the table for the exercise performance (Figure 3). The patient will then attempt to raise their arm overhead.
Figure 3 Stimulating the Rotator Cuff
The second exercise stimulates the rotator cuff with an emphasis placed upon the supraspinatus muscle. The supraspinatus is the most involved rotator cuff muscle with regard to pathology. One exercise that is commonly utilized to strengthen this muscle is scaption. Scaption is performed in the following manner:
- The arms are fully extended at the side of the body with the hands open and thumbs up
- The extended arms are raise to 90 degrees of elevation in the scapula plane of the body, a position of approximately 30 degrees anterior to the coronal plane (Figure 4)
- The arms return (descend) to the starting exercise position
Figure 4 Scapular Plane of the Body
A method to assist in the scaption exercise is seen in figure 5.
- The patient positions their body so their extended arm is placed in the plane of the scapula against a wall surface.
- The patient actively horizontally abducts (pushes) their arm against the wall surface (black arrow) to stimulate the rotator cuff.
- The patient elevates their arm to 90 degrees in the plane of the scapula (yellow arrow) while maintaining pressure against the wall surface.
Figure 5 Assisting the Scaption Exercise
Restoring the strength and integrity of the rotator cuff after pathology or surgery can often times be very challenging. The above methods for rotator cuff stimulation have been safely utilized with great success for many years.
To schedule an appointment with a multi-specialty, Professional Physical Therapist, visit us at https://www.professionalpt.com/physical-therapy-clinics-near-me/.
