Training guide
An external rotation turns your upper arm outwards with your elbow bent: the job of two of your rotator cuff muscles, the infraspinatus and teres minor. You can do it with a band or cable with your elbow at your side, lying on your side with a light dumbbell, or with your arm raised. Keep it light and smooth.
The research shows no single best version, and that heavier and lighter loads both work. It's a sensible part of a shoulder routine rather than a cure or a shield: exercise helps most shoulder pain, but more physiotherapy wasn't better than good advice and a home band programme, and the injury prevention evidence is for whole warm-up programmes.
This guide covers each version on the 3D figure, how heavy, how many, shoulder pain and injury prevention, and when to see someone.
With your elbow bent to a right angle and tucked at your side, turn your forearm out away from your body against a light band or cable, pause, and return slowly. It works the infraspinatus and teres minor, two of the four rotator cuff muscles.
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NHS and sports-medicine programmes start with the elbow by your side, and add the raised-arm (90/90) versions later.
Lying on your side drew the most infraspinatus activity of seven versions in one study of 10 people, but in 30 people five versions didn't differ significantly. Pick the version you can do well.
At higher loads the deltoid takes a bigger share, but in people with rotator cuff pain, heavier and lighter 12-week programmes worked equally well. Choose a band or dumbbell you can turn smoothly 12 to 15 times.
Progressive resisted exercise beat placebo or no treatment, and exercise is the recommended first treatment; but in 708 NHS patients, up to six physiotherapy sessions of progressive exercise did no better than one advice session with a home band programme. Our shoulder pain guides have the plans.
2 to 3 sets of 12 to 15 each arm, light, two or three times a week, as our shoulder routines do; an orthopaedic programme uses 3 days a week. Keep shoulder pain to about 5 out of 10, settled by your next session.
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With your elbow bent to a right angle, you turn your forearm outwards, away from your tummy, so your upper arm rotates in the shoulder socket, then return slowly. External rotation is also called lateral rotation.
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Four small muscles run from your shoulder blade to the top of your arm bone: the supraspinatus, infraspinatus, teres minor and subscapularis. Turning the arm out is the job of the infraspinatus and teres minor, with the back of the deltoid helping, and all four help keep the ball of the joint centred. The supraspinatus works more with the arm raised.
Internal rotation turns the forearm in, across your tummy: the subscapularis, with your chest and lats. Our shoulder mobility and stability routine pairs both.
Standing with a band or cable, elbow at your side; lying on your side with a light dumbbell, on the floor or a bench; face down with your arm out at 90 degrees; standing with your arms out at 90 degrees (the 90/90, or Cuban rotation); and the Cuban press, which adds an overhead press.
Nothing for the band version with your elbow at your side ("None beyond standing comfortably", its move page says). The raised-arm versions come once the elbow-at-side versions are pain-free.
The percentages on this page come from EMG (electromyography: electrodes measuring how hard a muscle works over a few reps). Studies scale them differently, so they aren't comparable between studies, and they don't show what grows or what eases pain.
From the move page and the American Council on Exercise (ACE: the one-second pause); the pace, about 2 seconds each way, is editorial. The cable version is the same movement on a cable column at elbow height.
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The movement on the figure: Standing band external rotation
The move page's steps and cues, with NHS inform's tin of beans. The bench version (its own move page) is the same exercise, easier to get on and off.
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The movement on the figure: Side-lying external rotation
The Cuban rotation's move page steps and cues. Face down on a bench (its own move page) the forearm turns up only to level. Only once the elbow-at-side versions are pain-free, and very light.
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The movement on the figure: Cuban rotation
In 10 people, side-lying rotation drew the most infraspinatus (62% of maximum) and teres minor (67%) activity of seven versions. But in 30 people measured with fine-wire electrodes, five versions didn't differ significantly for the infraspinatus (28 to 38%), and in 13 men the band's angle made no significant difference. A review lists rotation at 0 and 90 degrees among the highest-activity rotator cuff exercises.
Standing rotation with the arm at 90 degrees drew much more supraspinatus and deltoid activity, while side-lying and standing with a towel kept the deltoid lower. A band rotation at 90 degrees worked every rotator cuff muscle above 20% of maximum.
In 32 people with rounded shoulders, side-lying rotation gave the best balance of infraspinatus to rear-deltoid activity of the common versions tested.
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A rolled towel between elbow and ribs didn't raise infraspinatus activity in two studies, and raising the arm lowered how well the infraspinatus was isolated in 10 people, though the lower part of the muscle worked harder with the arm raised in 20 people. Use the towel to keep your elbow in place: the Chartered Society of Physiotherapy's video does.
Start with the band or side-lying version, elbow at your side; add the 90/90 versions later, if they're comfortable, as the move pages and professional progressions do. The one that you do well, regularly, is the best one (our view).
At 10 to 40% of maximum effort the infraspinatus did its biggest share of the work; at higher loads the deltoid took over, more so in people with impingement. In healthy people, though, all the rotator muscles rose together with load.
In 100 people with rotator cuff tendinopathy, 12 weeks of heavier training (down to 6-rep maximums, 4 sets) and lighter training (20 to 25-rep maximums, 3 sets) improved function equally. One good trial.
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Reviews of exercise dose in rotator cuff pain are low to very low certainty and conflicting. Motor-control exercise slightly beat general exercise for disability, at moderate certainty.
In 16 men, 8 weeks of light, slow side-lying rotation (3 sets of 10, three times a week) grew the infraspinatus by 7.3%, without a measured strength change. A moderate band drew more infraspinatus activity than a very light one in another study.
A band or dumbbell you can turn smoothly 12 to 15 times with your elbow still at your side; studies used 0.5 to 2.5 kg or light bands. If your elbow lifts off, your trunk rolls or your shoulder shrugs, it's too heavy (our editorial rule).
For subacromial (rotator cuff related) shoulder pain, exercise is the recommended first treatment. A UK pathway suggests physiotherapy usually for 6 weeks, with a further 6 if it's improving, and NHS inform says to see a professional if the pain hasn't improved within 6 weeks.
Progressive resisted exercise beat placebo or no treatment by about 15 points out of 100 (low certainty); non-progressive exercise by 4, which wasn't significant. In another review, exercise beat no exercise for pain, and specific exercises beat general ones, though the evidence was very low quality.
In 708 NHS patients, up to six physiotherapy sessions of progressive exercise, focused on resisted outward rotation and arm raises 5 days a week, did no better over 12 months than one advice session with a band and home exercises. In a smaller trial, a single self-managed exercise matched usual physiotherapy.
In 102 people with long-standing impingement on a waiting list for surgery, a specific rotator cuff and shoulder-blade programme (15 reps, 3 sets, twice a day for 8 weeks) changed how many chose surgery: 20% of the exercise group against 63% of the control group. Pain was allowed up to 5 out of 10 and had to settle before the next session.
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Across 21 trials in middle-aged and older adults with rotator cuff related pain, exercise improved pain, function and range of movement, but strength gains were small and not significant.
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Our shoulder impingement, rotator cuff tear, rotator cuff repair, frozen shoulder, calcific tendinitis and swimmer's shoulder guides have the staged plans. The NHS says to follow exercises from your GP or physiotherapist, not to make up your own strenuous exercises or use heavy gym equipment while your shoulder hurts, and to keep up shoulder exercises for 6 to 8 weeks to stop pain returning.
A shoulder warm-up programme (outward rotation strength, shoulder-blade strength, inward rotation range and upper-back mobility, 3 times a week) lowered the odds of shoulder problems in 660 elite handball players: 17% against 23% had problems (odds ratio 0.72), though substantial problems didn't differ significantly. Another, with outward rotation at 90 degrees among its five exercises, cut the shoulder injury rate by 56% in teenage players (hazard ratio 0.44). But a rubber-band programme made no difference in 579 players, and pooled across 3 trials the effect is uncertain (odds ratio 0.73, 0.45 to 1.17; low certainty).
The handball programme that worked didn't raise outward rotation strength more than usual training (+10% against +6%), and an 8-week rotation-only programme improved neither strength nor the outward-to-inward strength ratio. A youth baseball programme with no rotation strengthening also cut throwing injuries.
Weaker outward rotation went with more shoulder injuries in elite male handball players, youth players and professional pitchers, but not in a mixed-sex elite cohort of 329, and a review found only limited evidence.
Weight trainers who strengthened their outward rotators had fewer signs of impingement and instability, and those with impingement had weaker outward rotators. Snapshot studies like these can't show cause.
As part of a warm-up before throwing or pressing, and of a balanced upper-body routine with rows, face pulls and pressing, without promising they prevent injury. An expert consensus found prevention programmes cut upper-body injuries in female athletes, at very low certainty.
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The stick-assisted rotation for a stiff or very irritable shoulder (10 slow pain-free reps twice a day, or 3 to 5 holds of 20 to 30 s once less irritable: its move page's editorial starting point). Standing band rotation, 2 × 12 to 15 each arm (our shoulder workout at home) or 2 rounds of 12 to 15 (our shoulder mobility and stability routine); the cable version, the same (our editorial suggestion). Side-lying on the floor, 2 × 8 with a tin of beans or nothing (our Pilates for shoulder pain workout); on a bench, 8 to 15 reps working up to 3 sets, and face down with the arm out, 3 × 8 to 15 with a light dumbbell (both their move pages' doses, from NHS Ayrshire & Arran); the Cuban rotation, 2 × 10, 5 s each way (our swimmers' shoulder routine); the Cuban press, 2 to 3 sets of 8 to 12 (its move page's editorial starting point).
3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions
3D demoStanding band external rotationBeginner · A band + An anchor point
3D demoCable external rotationBeginner · A cable machine
3D demoSide-lying external rotationBeginner · A dumbbell
3D demoSide-lying dumbbell external rotation (on a bench)Beginner · A dumbbell + A bench or box
3D demoProne dumbbell external rotationIntermediate · A dumbbell + A bench or box
3D demoCuban rotationIntermediate · A dumbbell + A band
3D demoCuban pressIntermediate · A dumbbellNo 3D demo for these.
The standing rotation with your upper arm out at shoulder height, a band anchored in front. Teach it over the Cuban rotation and the face-down version, once the elbow-at-side versions are easy.
Press the back of your wrist into a wall or a partner's hand, elbow at your side, and hold, without moving. Useful when moving hurts (our suggestion).
A pull-apart that finishes with the forearms turned up; our band pull-apart guide covers it.
The same exercise as the figure, with a rolled towel between elbow and ribs to keep the elbow in place.
Tuck a rolled towel between elbow and ribs as a reminder.
Use a smaller range and a lighter band.
Shoulder down and back, chin level.
At high efforts the deltoid takes over. Choose a weight you can turn smoothly 12 to 15 times.
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Return slowly, about as long as the turn out.
Stop short of it: turn only as far as is comfortable.
Keep your elbows at shoulder height, as the move page's cue says.
Starting points from our routines and from NHS and orthopaedic programmes. The band, cable and floor side-lying move pages give no dose.
2 to 3 sets of 12 to 15 each arm: our shoulder workout at home uses 2 × 12 to 15, our shoulder routine 2 rounds of 12 to 15, and our impingement plan 2 to 3 × 15.
2 to 3 sets of 12 to 15, lowering over about 3 seconds, as our impingement plan does (3 × 15). NHS inform builds from 2 sets of 8 to 2 sets of 15; the bench version's move page gives 8 to 15 reps, working up to 3 sets.
2 sets of 10, 5 seconds each way, light, as our swimmers' routine does; the face-down version's move page gives 3 × 8 to 15, light.
About 60 seconds, or none in a circuit, as in our routines.
Smooth reps, stopping 2 or 3 short of failure (the last set 1 to 2 short), and never through sharp pain: our editorial rule, in line with our plans.
Two or three times a week. An orthopaedic programme uses 3 days a week, then 2 to 3 to maintain; our shoulder routine runs 3 times a week, like the handball programme it's built on. As a warm-up before throwing or pressing, 1 or 2 sets.
Add reps up to 15, then slow the return, then move to the next band or 0.5 to 1 kg more. The orthopaedic programme builds from 3 × 8 to 3 × 12.
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Light daily sets are fine, and some NHS and trial programmes are daily, but for a healthy shoulder two or three times a week is plenty.
From our shoulder mobility and stability routine: band internal rotations, 2 rounds of 12 to 15 each arm; scaption raises, 10 to 12, thumbs up, to shoulder height, lowering over 3 s; scapular push-ups, 10; Y-T-W raises, 5 of each shape; band pull-aparts, 15; and the cross-body shoulder stretch, 2 holds of 30 s each side. Face pulls, 3 sets of 12 to 20 (our face pull guide); band rows, 3 sets of 10 to 15 (the move page's dose); shoulder circles, 3 slow circles each way with each arm (the move page's dose), to warm up.
3D demoBand internal rotationBeginner · A band + An anchor point
3D demoScaption raiseBeginner · A dumbbell
3D demoScapular push-up (push-up plus)Beginner · No equipment
3D demoProne Y-T-W raisesBeginner · No equipment
3D demoBand pull-apartIntermediate · A band
3D demoFace pullIntermediate · A band
3D demoBand rowBeginner · A band + An anchor point
3D demoCross-body shoulder stretchBeginner · No equipment
3D demoShoulder CARs (controlled articular rotations)Beginner · No equipmentThe shoulder mobility and stability routine is the band rotator cuff session, built on the parts of the handball warm-up programme; the shoulder workouts use band and Cuban rotations; the throwing, swimming, Pilates and yoga sessions are for those sports and for sore shoulders.
A 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.
25 minBeginner12 movesA wall, A bandA 30-minute home shoulder workout with dumbbells or a band: presses, lateral raises for the side of the shoulder, and rear-shoulder and rotator cuff work.
30 minBeginner8 movesA band, A dumbbellA shoulder workout for all three heads: overhead press, lateral raises, reverse flyes, face pulls and rotations.
40 minIntermediate8 movesA band, A barbellA 35-minute session for baseball and softball players: the five Shoulder Control exercises, rotator cuff and forearm work, medicine-ball throws and legs.
35 minIntermediate17 movesA dumbbell, A cable machineA 20-minute rotator cuff and shoulder-blade routine for swimmers, from a 12-week trial in competitive swimmers, plus a daily cross-body stretch.
20 minBeginner9 movesA wall, A dumbbellA 20-minute Pilates class for a sore shoulder: gentle range first, then shoulder-blade and rotator cuff strength, then light weight on the arms, in steps.
20 minBeginner15 movesA bench or box, Other / check instructionsA 20-minute yoga sequence for shoulder pain: gentle movement, standing poses with the arms low, shoulder strength, and weight on the arms built up from the wall.
20 minBeginner16 movesA bench or box, A wallThis plan's shoulder day uses Cuban rotations.
Keep your elbow by your side and stop short of any feeling of slipping. With the shoulder slipping forwards, a rehabilitation protocol says not to push into outward rotation or into moving the raised arm backwards, and after a dislocation it limits rotation with the arm raised to 90 degrees to 65 to 70 degrees for about 4 to 8 weeks. So leave the 90/90 versions until your physiotherapist clears them. Your doctor or physiotherapist will advise when you can return to sport.
After stabilisation surgery or a rotator cuff repair, follow your surgical team's protocol; our shoulder stabilisation surgery and rotator cuff repair guides explain the stages.
Follow our frozen shoulder guide, which sets its own pain rules for each stage; the stick-assisted version is the gentler start.
Pain up to about 5 out of 10 that is back to its usual level by your next session is acceptable, as our shoulder pain guides say; NHS inform uses 0 to 5 and "no worse the morning after". If it isn't, go lighter or smaller, not to nothing. Sharp, pinching pain, or pain that's worse after the session, is not acceptable.
Standing band and cable rotations suit pregnancy if you already exercise. Later in pregnancy the NHS advises avoiding lying flat on your back for more than a few minutes; side-lying is fine, but the stick-assisted version lies on your back.
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If you get chest pain or pressure, feel faint or dizzy, are unusually breathless, or your heart races or beats irregularly during exercise, as our plans advise. The American Heart Association says these need immediate medical evaluation.
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For chest pain that comes on suddenly and doesn't go away, feels tight or like squeezing, spreads to your arms, neck, jaw, stomach or back, or comes with sweating, feeling sick, light-headedness or breathlessness; arm pain that comes on suddenly with pressure, heaviness or squeezing across your chest; severe difficulty breathing, or a chest that feels tight or heavy; someone who faints while exercising; palpitations that don't go away, or come with chest pain, shortness of breath or feeling faint; or a headache that starts suddenly and is extremely painful, especially while lifting or straining. The NHS says a bleed on the brain may be more likely when lifting something heavy. Don't drive yourself to A&E.
Arm pain that comes with pressure, heaviness or squeezing across your chest is a 999 call, not a rotator cuff problem.
Ask for an urgent GP appointment or get help from NHS 111 for sudden or very bad shoulder pain, an arm you can't move, a shoulder that has changed shape or is badly swollen, pins and needles that don't go away, no feeling in your arm or shoulder, an arm or shoulder that's hot or cold to touch, pain after an injury or a fall, severe pain in both shoulders, or feeling feverish or unwell. Go to A&E if, after an injury, you can't move your arm or your shoulder looks out of place or has changed shape. See a GP if shoulder pain is getting worse or hasn't improved after 2 weeks.
Or a muscle that looks thinner: see a GP or physiotherapist, as our back of shoulder pain guide says, because a nerve can be involved.
Sudden weakness lifting or turning your arm after a fall or a wrench needs prompt checking: a UK pathway says an acute rotator cuff tear after an injury needs urgent referral. See a GP promptly rather than trying to strengthen it.
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Speak to your GP first if you haven't exercised for some time or have medical conditions or concerns, as the NHS advises. Get advice before hard, explosive or straining work if your blood pressure is uncontrolled (140/90 or higher at a clinic, or 135/85 at home), or you have heart disease or chest pain when you're active, a pacemaker or defibrillator, diabetic eye disease, glaucoma, a hernia, recent eye or tummy surgery, or you're pregnant, as our breathing guide lists.
After a recent shoulder dislocation or shoulder surgery, follow our shoulder dislocation guide or your surgical team first.
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At high efforts the deltoid takes over, and in rotator cuff pain heavier and lighter programmes did equally well. Choose a weight you can turn smoothly 12 to 15 times.
Light and heavy did equally well in the trial, and a moderate band drew more infraspinatus activity than a very light one. Light to moderate is the sensible range.
Exercise is the first treatment for rotator cuff related pain, but more supervised sessions didn't beat good advice and a home band programme. Weakness after an injury, a shoulder that has changed shape, or feeling feverish and unwell need checking first.
Whole warm-up programmes cut shoulder problems in some handball trials but not others, the pooled effect is uncertain, and the effective programme didn't change rotation strength. Nothing has tested the exercise alone.
It led in one study of 10 people; in 30 people five versions were similar.
It didn't raise infraspinatus activity in two studies. Use it to keep your elbow in place.
No trial has tested them for posture. Our rounded shoulders guide's evidence is for whole strengthening programmes, and posture isn't a reliable cause of shoulder pain.
With your elbow bent to a right angle and tucked at your side, turn your forearm out away from your body against a light band or cable, pause, and return slowly. Keep your elbow by your side and your trunk still.
Mainly the infraspinatus and teres minor, two of your four rotator cuff muscles, with the back of the shoulder helping. With your arm raised, the supraspinatus and deltoid work more.
No single version clearly wins. Lying on your side drew the most infraspinatus activity in one small study, but in a larger one five versions were similar. Start with the band or side-lying version, elbow at your side.
If it helps keep your elbow in place, yes. It didn't make the rotator cuff work harder in two studies.
Light to moderate: a band or dumbbell you can turn smoothly 12 to 15 times. At high efforts the deltoid takes over, and in a trial in shoulder pain, heavier and lighter programmes worked equally well.
2 to 3 sets of 12 to 15 each arm, two or three times a week. NHS and orthopaedic programmes use similar doses.
Light sets are fine, and some NHS and trial programmes are daily. For a healthy shoulder, though, two or three times a week is plenty.
Exercise is the first treatment for most rotator cuff related shoulder pain, and progressive programmes help. But in a large NHS trial, extra physiotherapy sessions did no better than one advice session with a home band programme. Our shoulder pain guides have the plans.
Warm-up programmes that include them cut shoulder problems in some handball trials, but not all, and the effect pooled across trials is uncertain. Nobody has tested the exercise on its own.
Often the band is too heavy, the range too big or the elbow drifting. Go lighter, turn only as far as is comfortable and keep pain to about 5 out of 10, settled by your next session. See a GP if shoulder pain is getting worse or hasn't improved after 2 weeks.
Usually yes, with your elbow by your side and stopping short of any feeling of slipping. Leave the raised-arm (90/90) versions until your physiotherapist clears them.
Both train the back of the shoulder. External rotations target the rotator cuff directly; face pulls add a high row for the upper back. Many programmes use both, and our face pull guide covers those.
Exercise education, not a personal prescription, and clinical review of these guides is pending. Check with a GP before starting hard training if you have a heart condition, chest pain, dizziness or breathlessness when active, and stop for sharp or increasing pain. Health disclaimer.
