Eccentric external rotation loads the rotator cuff muscles behind the shoulder (infraspinatus and teres minor) while they lengthen, as they brake the forearm on its way down. You sit with the upper arm resting out to the side at shoulder height and the elbow bent to a right angle. A stick held in both hands turns the forearm up until it points at the ceiling, then you take the stick away and lower the forearm slowly by itself.

How to do the eccentric external rotation

Sit upright beside a table or other firm surface that lets your upper arm rest out to the side at shoulder height. In the video a step block on a treatment bench gives the height. A folded towel under the elbow can make it more comfortable.
Rest the upper arm on the surface, straight out from your side, and bend the elbow to a right angle so the forearm lies flat and points forward.
Hold a stick in both hands. Use your other arm to push the stick so the working forearm turns up until it points at the ceiling. The elbow stays on the surface at a right angle.
Take away the stick's help, then lower the forearm slowly back down to the surface on its own, taking a few seconds.
Keep your back straight and the shoulder blade gently back and down throughout. Use the stick to raise the arm again for every repetition.

What you should feel

Work at the back of the shoulder and around the shoulder blade while the forearm lowers. The way up should feel easy, because the stick does it.

Common mistakes

Lifting the forearm with the working arm's own muscles. The voice guide says to use the stick for every lift.
Letting the forearm drop once the stick lets go.
Letting the elbow slide, sink below shoulder height or open out of its right angle.
Slumping, or hitching the shoulder toward your ear.

How often

Many programs use 2 to 3 sets of 8 to 12 slow lowerings, each over about 3 to 5 seconds, once a day or a few days a week. Your physio will adjust this.

Stop and check with your physio if

A sharp pain or catch in the shoulder, or a feeling that it is slipping or giving way as the forearm turns up.
Pain, pins and needles or numbness spreading down your arm or into your hand.
Pins and needles in your arm or hand that do not go away after you stop, or part of your arm or hand goes numb. Get medical advice the same day. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
A sudden pop or tearing feeling in the shoulder that brings sharp pain, new weakness or trouble lifting the arm. Stop and contact your surgical team the same day, or get medical advice the same day if you have not had surgery.
The shoulder feels as if it has slipped out of place, looks a different shape or suddenly locks so you cannot move the arm, or your hand turns cold, pale or blue. Go to an emergency department straight away, without driving yourself, and do not try to put the shoulder back in yourself.

From the clinic

Eccentric means the muscle is working while it gets longer. The stick does all the lifting here, so the shoulder only has to control the way down. Count slowly as you lower, and keep the elbow planted so the turn comes from the shoulder. If you have high blood pressure, breathe steadily through every repetition and never hold your breath.

The arm out to the side and turned up, with the hand beside your head, is the position in which a shoulder that has come out at the front is most likely to feel unstable. If yours has ever dislocated or feels loose, ask your physio before you try this, and stop well short of upright if it feels insecure.

After shoulder surgery, including a rotator cuff repair, or after a shoulder fracture or dislocation, follow your surgeon's or physio's plan, and do only the movements and range they have cleared. Many plans allow only passive movement at first, where the arm is moved for you and its muscles stay relaxed. Many surgeons hold back both the arm-out position and outward turning under load for several weeks after cuff repairs, stabilization surgery and shoulder replacements, so ask whether this is on your plan yet.

With the elbow at your side, side-lying external rotation is a common earlier step. The 90/90 external rotation with band works the same arm position against a band, through both the lift and the lowering.

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.

This page is general education, not a diagnosis or a personal treatment plan. If you have pain, an injury or a health condition, see a physiotherapist or doctor before starting new exercises.

Eccentric external rotation