Shoulder pain exercises
Shoulder pain exercises
Due to the large range of motion throughout the shoulder region and the reliance upon appropriate balance and strength of the supporting muscles for pain free function, rehabilitation exercises play a vital role in the rehabilitation of shoulder pain.
When planning a comprehensive shoulder pain rehabilitation strategy for our clients, our expert physiotherapists will consider several different types of exercise to restore optimal shoulder function.
Although there are many clinical diagnoses which may be the cause of shoulder pain, in the majority of cases the pain is felt when lifting the arm away from the side, above the head or when lifting load. To function pain free, the shoulder region requires appropriate joint and muscular flexibility as well as appropriate strength in muscles which rotate the scapular and shoulder joint.
Early stage postural strengthening exercises for shoulder pain may involve educating the patient regarding inappropriate movement strategies such as shoulder hitching and repeating a normal pattern of shoulder movements with feedback. Feedback may be best done visually in front of a mirror or manually using the other hand. Taping techniques may also be used around the scapular to give feedback.
Further strengthening exercises for scapular upward rotation may involve reaching exercises against resistance tubing or against weighted medicine balls or dumbells. This may be progressed to shoulder press movements as required. Press up variations in standing against a wall and progressing to single arm and to inclined surfaces to increase load may also be utilised.
To target scapular tilt more than upward rotation, physiotherapists may employ arm raises focusing on movement from the thorax and scapular. These may often be performed lying prone, sometimes over a swiss ball.
The rotator cuff muscles and tendons are placed under load with all shoulder movements and loading tasks. Exact rehabilitation exercises may vary according to the patients intensity of symptoms but will be progressed slowly under all circumstances. To obtain appropriate rotational load, the elbow will often be held at a right angle and resistance added by resistance tubing or with small handweights. The shoulder will be rotated in to rotation against these loads in a slow and controlled manner. Evidence suggests that recruitment of the rotator cuff muscles may be accentuated when the fist is clenched firmly so this may be employed as part of these rehabilitation exercises.
Stretches employed as part of a shoulder rehabilitation plan may target the pectoral and latissimus muscles at the front and underside of the chest to improve thorax and shoulder girdle posture. There are several common ways of performing these types of stretches. A doorway stretch involves placing the arm against a doorframe, gently stepping forwards and rotating the thorax away from the arm to impart the stretch. In lying, the arm may be rotated up and away from the side and the legs and thorax rotated away from the arm to impart the stretch. A third increasingly common stretch to target these muscles begins weight bearing on hands and knees. The arm/s to be stretched is then placed on to a swiss ball and the bodyweight utilised to lean away to impart the stretch.
As part of attempting to increase thorax posture and mobility, some physiotherapists may also employ mobilisation techniques to the mid spine and ribcage manually during physiotherapy sessions. These may be complemented with self mobilisation strategies using a foam roller against the mid spinal joints at home.
Aside from thorax and muscular stretches to enhance the shoulder posture, stretches aimed directly at the shoulder joint soft tissue capsule will often be employed. The back of the shoulder joint capsule is often stretched by overpressing the arm across the chest. This may be referred to as a “scarfe stretch”. Another common method for targeting the back of the shoulder capsule is an exercise termed the “sleeper stretch”. This involves placing the upper arm on the floor while side lying and rotating the fist downwards towards the floor with the elbow at a right angle.
In specific circumstances, most notably when rehabilitating from a frozen shoulder some general shoulder capsule stretches may be recommended which may involve rotating the hand away from the side using a stick or fixing the hand against a doorway and rotating the thorax away.
Once full range of motion and strength to the appropriate muscle groups have been optimised, our expert physiotherapists at Circle Health will emphasise functional movements which challenge to balance mechanisms of the shoulder. Depending on patient goals and activity levels this may involve throwing and catching movements, balancing exercise balls in the air or against the wall or introducing unstable surfaces to common exercises such as press-ups.