Weight-Bearing Upper Extremity and Shoulder Exercises

Shoulder weight-bearing exercises may be required after a shoulder injury or surgery to help you fully recover. Your physical therapist can work with you to make sure you properly incorporate shoulder balance and weight-bearing exercises into your rehab routine.

If you have shoulder pain or have had an upper extremity injury or surgery, you may benefit from the skilled services of a physical therapist to help you fully recover. One important part of your program is exercise, specifically exercises to help improve the way your shoulder, elbow, and wrist all work together to function properly. One type of exercise is upper extremity weight-bearing, also known as closed kinetic chain shoulder exercises.

Conditions That May Require Weight Bearing Shoulder Exercises

People with certain conditions may benefit from shoulder weight-bearing and balance exercises in quadruped (the crawling position on all fours) or in the plank position. These conditions may include:

• Stroke
• Upper extremity fracture
• Rotator cuff repair
• Labrum injury or surgical repair of the labrum
• Elbow fracture

Basically, any upper extremity injury or condition may cause limited balance and proprioception in your shoulder or arm. (Proprioception is simply your body's awareness of its position in your environment.) Your PT may recommend you work to improve your overall balance through your arms during your rehab.

Why Work on Shoulder Weight Bearing and Balance?

After an upper extremity injury, you may have impaired balance and proprioception in your upper extremity. Working on specific exercises to improve upper extremity proprioception can help you regain normal use of your arm. Your physical therapist may choose to use various exercises and an exercise progression like this one to help you recover after a shoulder or arm injury or surgery.

Exercising your shoulders in a quadruped or weight-bearing position, like a plank, can activate muscles around your rotator cuff and shoulder blade. These muscles are working when you lift your arms overhead or during activities that require you to push or pull something. They may become impaired after an injury or surgery to your shoulder that requires a period of immobilization. During this immobilization time, your shoulder or arm may be healing, but it may also be losing strength, the range of motion (ROM), and proprioception.

Shoulder Exercise Progression in a Weight-Bearing Position

If your physical therapist chooses to prescribe weight-bearing shoulder and arm exercises for you, he or she will likely follow a progressive program. You should progress from simple to more advanced exercises.

Before starting with weight-bearing shoulder exercises, your therapist should ensure that your shoulder strength and stability are adequate enough for you to bear weight through your arm. He or she may have you perform rotator cuff strengthening exercises with a resistance band and supine dynamic shoulder stabilization exercises before starting these weight-bearing exercises as part of your rehab.

A typical progression of weight-bearing shoulder proprioception exercises may include:

1. Quadruped weight shifts. Simply get in a position like you are crawling. Rock slowly left and right and forward and backward for thirty to sixty seconds.
2. Quadruped weight shifts on an unsteady surface. Repeat the exercise above with a small pillow underneath the hand of your injured shoulder. Using a rubber ball under your hand can increase the challenge of this exercise.
3. Quadruped position with opposite arm motions. Start in the quadruped position, and then lift up your non-injured arm up until it is parallel to the floor. Hold this position for a few seconds, and then return to the start position. Repeat 10 to 15 times. Be sure to keep your shoulder right over your hand while performing the exercise. Remember, the non-injured hand moves, so your shoulder that needs the work is bearing your weight.
4. Quadruped position with arm motion on an unsteady surface. Perform exercise 3 above with your hand on a pillow or small ball.
5. Quadruped position on a BAPS board. Your PT may have an exercise device called a BAPS board for ankle proprioception. You can actually use it for upper extremity balance as well. Simple position your hands on the BAPS board, and keep it steady while performing weight shifts in the quadruped position. Of course, this exercise can only be done in the PT clinic and not as a part of your home exercise program (unless you happen to own a BAPS board).
6. Plank position weight shift. Once you have gained adequate strength and stability, you can move away from the quadruped position and repeat the sequence in the plank position. Simply start by getting into the plank pose, and then shift your weight from side to side and forward and backward.
7. Plank position on an unsteady surface. Repeat the plank with weight shifts in exercise 6 while keeping your hand on an unsteady surface.
8. Plank position on a BAPS board. Perform the plank position weights shifts while keeping your hands steady on a BAPS board.
9. BOSU Walkovers. If you have access to a BOSU, you can use it for shoulder balance and proprioception training. Simply get in the plank position with your hands on the BOSU, and the "step" sideways with one hand, and then the other. "Walk" side to side over the BOSU with your hands. Be sure to maintain a steady plank with your abs engaged. Perform about ten repetitions of the lateral walkovers with the BOSU.
10. Lateral upper extremity walking with resistance bands. To perform this exercise, loop a resistance band around your wrists, and get in the plank position. Walk your hands sideways, keeping tension on the band as you go. Maintain a stable core by keeping your abs engaged, and walk your hands sideways about ten steps to the left and ten to the right. Your feet are going to have to walk along sideways as you go too.

If any exercise causes pain, you must check in with your healthcare provider or PT to ensure that you are performing the exercise correctly and to be sure it is right for you.

This progression starts simply with a basic crawling position and progresses to advanced dynamic motions for your shoulders with resistance and on unsteady surfaces. Your physical therapist can help you decide when it is time to progress through each stage of the exercise progression.

You may not be able to (or need to) make it through the entire progression. Some people find that simple quadruped weight bearing is enough to improve shoulder balance and function. Other people, especially those who participate in high-level athletics, may need to progress through to the advanced upper extremity exercises to fully recover.

Before starting any exercise program, you must check in with your healthcare provider to ensure that weight-bearing shoulder exercises are safe for you to do.

A shoulder injury or surgery can prevent you from doing your normal work or recreational activities. If you have shoulder pain or weakness, a rehab program with your physical therapist can help you restore normal shoulder ROM and strength. One component of your rehab program may be upper extremity weight-bearing exercises in the quadruped or in the plank position. When done correctly and when progressed properly, the exercises can help you regain maximal function so you can return to your previous level of activity.