Eric Tannenbaum, MD

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Rotator Cuff & Shoulder Impingement

Most rotator cuff problems improve with a structured strengthening program. Studies show that many people with rotator cuff tendinitis, impingement and even some rotator cuff tears do as well with exercise as with surgery. The goal is to calm the tendon first, then gradually build strength in the rotator cuff and the muscles that steady the shoulder blade.

Prepared by Dr. Eric Tannenbaum, MD · Board-certified orthopedic surgeon, Southern Indiana Orthopedics

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Use this program for

  • Rotator cuff tendinitis (tendinopathy)
  • Subacromial impingement and bursitis
  • Calcific tendinitis
  • Partial-thickness rotator cuff tears
  • Full-thickness rotator cuff tears treated without surgery

Before you start

  • Check with Dr. Tannenbaum or your physical therapist that this program fits your condition.
  • Warm up with 5 minutes of easy movement.
  • Move slowly and with control. Quality matters more than speed.
  • Use the pain guide below to decide how hard to push.
0 to 3 out of 10Safe. Keep going.
4 to 5 out of 10Acceptable if it settles by the next morning. Otherwise ease off.
Above 5, or worse the next dayToo much. Reduce the reps, range or weight.

Phase 1: Calm and move

Weeks 0 to 2

Reduce pain and keep the shoulder moving.

1Pendulum

  1. Lean forward and rest your good hand on a table or counter.
  2. Let the sore arm hang straight down and relax the shoulder completely.
  3. Gently sway your body so the arm swings in small circles, then forward and back.

30 to 60 seconds each direction, 2 to 3 times a day

Let gravity do the work. The arm should feel heavy and loose, not lifted.

2Shoulder blade squeeze

  1. Stand or sit tall with your arms relaxed or elbows bent.
  2. Gently squeeze your shoulder blades back and down, as if into your back pockets.
  3. Hold without shrugging, then relax.

10 to 15 repetitions, hold 5 seconds, 1 to 2 times a day

Think "back and down," not "up toward the ears."

3Outward press into a wall (isometric)

  1. Stand sideways next to a wall with the elbow bent to 90 degrees and tucked at your side.
  2. Press the back of your wrist gently into the wall, as if rotating your arm outward.
  3. Hold the push without moving the arm.

5 repetitions, hold 30 to 45 seconds at a moderate effort, 1 to 2 times a day

Isometrics often calm a painful tendon. Effort should feel moderate, not maximal.

4Inward press into a door frame (isometric)

  1. Stand in a doorway with the elbow bent to 90 degrees at your side.
  2. Press your palm into the door frame, as if rotating your arm inward toward your belly.
  3. Hold the push without moving the arm.

5 repetitions, hold 30 to 45 seconds, 1 to 2 times a day

Keep the shoulder relaxed and down while you push.

Phase 2: Build strength

Weeks 2 to 6

Strengthen the rotator cuff and shoulder blade muscles.

5Outward rotation with a band

  1. Anchor a band at elbow height on the side opposite the sore arm.
  2. Keep the elbow at your side, bent to 90 degrees, with a small towel roll under it.
  3. Rotate the forearm outward, away from your belly, then return slowly.

3 sets of 10 to 15, once a day or every other day

The return should take 2 to 3 seconds. Slow lowering builds the tendon.

6Inward rotation with a band

  1. Anchor a band at elbow height on the same side as the sore arm.
  2. Keep the elbow at your side, bent to 90 degrees.
  3. Pull the forearm in toward your belly, then return slowly.

3 sets of 10 to 15, once a day or every other day

Keep the wrist straight and the elbow tucked.

7Rows with a band

  1. Anchor a band in front of you at chest height.
  2. Pull your elbows straight back, squeezing the shoulder blades together.
  3. Slowly return to the start.

3 sets of 10 to 15, once a day or every other day

Stand tall and keep the shoulders down away from your ears.

8Side-lying outward rotation

  1. Lie on your good side with a small towel roll under the elbow of the top arm.
  2. Hold a light weight (1 to 3 pounds) with the elbow bent to 90 degrees.
  3. Rotate the forearm up toward the ceiling, then lower slowly.

3 sets of 10 to 15, every other day

Start with a soup can or water bottle and progress slowly.

Phase 3: Return to activity

Weeks 6 to 12

Build strength in positions you use for work and sport.

9Raise in the "Y" (scaption)

  1. Stand holding light weights with thumbs pointing up.
  2. Raise the arms forward and out at a slight angle, about 30 degrees in front of your body.
  3. Lift to shoulder height or lower if painful, then lower slowly.

3 sets of 10, every other day

Stay below shoulder height until this feels easy.

10Wall push-up with a plus

  1. Stand facing a wall with your hands at shoulder height.
  2. Do a slow push-up against the wall.
  3. At the top, push a little further so your shoulder blades spread apart.

3 sets of 10 to 15, once a day

The extra "plus" at the end trains the muscles that steady the shoulder blade.

Avoid for now

  • Repeated reaching overhead or behind you while the shoulder is irritable
  • Sleeping on the sore shoulder; try a pillow under the arm
  • Heavy lifting away from your body

When to move ahead

Move to the next phase when you can do the current exercises with pain at 3 out of 10 or less that settles by the next morning.

Stop and call our office at (812) 376-9353 if you have

  • Pain that is getting worse week to week, or severe pain at night
  • New numbness, tingling or weakness
  • Significant swelling, redness, warmth or fever
  • A joint that locks, gives way or will not move
The research behind this program
  1. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138–160.
  2. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371–1379.
  3. Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthop. 2014;85(3):314–322.

Need more help?

Work with our physical therapists

Our physical therapists at the SIO Physical Therapy & MRI building, 745 Schnier Street in Columbus, work alongside Dr. Tannenbaum and can tailor this program to you.

Request an appointmentCall (812) 376-9353

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