Shoulder and Rotator Cuff Rehabilitation

Presentation

The shoulder is the most mobile joint in the human body, making it particularly vulnerable to pathologies. The rotator cuff — a group of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) and their tendons — plays a fundamental role in the dynamic stabilization of the humeral head in the glenoid. Shoulder pathologies represent a significant portion of physiotherapy practice, whether involving tendinopathies, tendon tears, instability or joint stiffness.

Shoulder rehabilitation requires a thorough understanding of the biomechanics of the scapulohumeral joint complex (glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints). Active recentering of the humeral head through coordinated work of the depressors and rotators is the central principle of all shoulder rehabilitation.

Fundamental Principles

• Dynamic humeral recentering: the rotator cuff acts as an active stabilizer maintaining the humeral head centered in the glenoid during arm elevation. The imbalance between deltoid (elevator) and cuff (depressor) causes subacromial impingement
• Scapulohumeral rhythm: for every 2° of glenohumeral elevation, the scapula performs 1° of rotation (2:1 ratio). Any scapular dyskinesia must be corrected
• Eccentric strengthening: rotator cuff tendinopathies respond particularly well to progressive eccentric work
• Global kinetic chain: the shoulder functions synergistically with the trunk and lower limbs; core stability and thoracic posture directly influence shoulder function

Main Indications

• Rotator cuff tendinopathy — subacromial impingement
• Calcific tendinopathy of the shoulder
• Partial or complete rotator cuff tear (conservative or post-surgical)
• Recurrent anterior glenohumeral instability (post-dislocation or post-Bankart)
• Adhesive capsulitis (frozen shoulder)
• Post-shoulder arthroplasty rehabilitation (total or reverse prosthesis)
• Proximal humerus fractures
• Acromioclavicular pathologies
• SLAP lesion (superior labrum)

Typical Session

Assessment (5 min): Pain evaluation, active mobility check, functional status review.

Manual preparation (10 min): Upper trapezius and levator scapulae massage, gentle glenohumeral mobilization, myofascial techniques on pectoralis minor.

Recentering and stabilization (15 min): Active humeral head recentering exercises, rhythmic stabilization, scapulohumeral dissociation, scapular fixator strengthening (serratus anterior, middle and lower trapezius).

Progressive strengthening (15 min): Internal and external rotation exercises, scapular plane elevation, eccentric cuff exercises, closed kinetic chain work.

Functional and proprioceptive work (10 min): Specific functional gestures, proprioceptive exercises on unstable surfaces, sport-specific movement patterns.

Contraindications

• Non-consolidated proximal humerus fracture
• Acute unreduced dislocation
• Active joint or periarticular infection
• Acute hyperalgesic phase of capsulitis (forced mobilization prohibited)
• Passive mobilization beyond surgeon-authorized ranges after surgery
• Resistive strengthening before post-surgical healing timelines