Rehab Exercises for Shoulder Pain

Man performing shoulder exercises with a physical therapist
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Shoulder exercises can be useful in the treatment of many of the common causes of shoulder pain. These exercises are also part of the usual rehabilitation from most any shoulder surgery. Shoulder exercises should be performed under the direction of a physician to ensure the proper muscles are being targeted for your condition. It is also important if surgery has been done to only perform exercises that will not overly stress any surgical repair in the shoulder.

When to Rehab

Shoulder rehabilitation focuses on two important aspects of shoulder motion: flexibility and strength. Without adequate range of motion, many common tasks cannot be performed. Patients commonly experience shoulder stiffness when they have difficulty reaching behind their back, buckling a seatbelt, or combing their hair.

The second important aspect of shoulder exercises is to strengthen the muscles around the shoulder. It is important to not stress the rotator cuff muscles of the shoulder. These muscles may be susceptible to injury and inflammation if improper exercises and activities are done.

Stretching a Stiff Shoulder

Stretching is not only an important part of preparing for an exercise program but in many cases of shoulder pain, stretches are the most important part of treatment. Shoulder conditions often involve shoulder stiffness. Stretching exercises can help loosen these muscles that surround the shoulder joint.

The most common cause of a stiff shoulder is adhesive capsulitis, also called a frozen shoulder. This condition can arise independently, or as the result of immobilization after a shoulder injury or shoulder surgery. Shoulder stretches are important for treatment and prevention of a frozen shoulder. I often see patients and therapists focusing too much on strength when the mobility of the shoulder is severely restricted. As a general rule, strengthening should follow mobility, and moving forward with strengthening should wait until mobility has recovered.

Simple Shoulder Exercises

With many shoulder injuries, as well as post-surgical patients, exercises involving the rotator cuff may be avoided to prevent stress on these shoulder muscles. Therefore, it is important to understand a few ways to safely work the upper extremity, without stressing the rotator cuff.

The simplest shoulder exercises are called pendulum exercises. These are performed by bending forward to allow your arm to hang down towards the ground. Small circles are made with the hand, allowing momentum to carry the arm around effortlessly.

Strengthening the Rotator Cuff

The rotator cuff is the group of four muscles and tendons that surround the shoulder joint. Injuries to the rotator cuff are the most common cause of shoulder pain. It is important to know from your doctor if it is safe to exercise the rotator cuff, especially after surgical procedures. In these situations, the rotator cuff may need rest until healing has progressed sufficiently.

The rotator cuff muscles are not the large lifting muscles of the upper back and arms. The rotator cuff muscles can be exercised with little or no weights. If more weight is being used, the exercises are probably being done improperly.

Upper Back and Neck Stretches

Many shoulder problems can be traced back to poor posture and straining of the muscles of the upper back and neck. Any good shoulder exercise program should also incorporate some simple stretches and exercises for the cervical spine and upper back muscles.

Improving Mechanics of the Joint

Some people who question the effectiveness of therapy and rehab activities to relieve their shoulder pain symptoms. The shoulder is a complex joint. Not only is the shoulder a ball and socket joint, but the socket is part of the shoulder blade—a bone that moves on the back of the rib cage. The movement of the shoulder blade and the movement of the ball and socket must be coordinated in order for the mechanics of the joint to be normal. Many people with shoulder pain symptoms have abnormal shoulder mechanics.

A helpful analogy is to think of the alignment of your car. It does not matter how well-tuned or how many horsepower the engine is, if the alignment of the vehicle is off, it is just not going to drive well. In order to get the vehicle driving well, you need a mechanic who can focus on getting the alignment straightened out. Similarly with the shoulder, if the mechanics and the alignment are not functioning normally, it does not matter how strong the muscles are, the function of the shoulder simply is not going to be normal.

A good physical therapist is trained to evaluate and correct abnormal shoulder mechanics. Seldom is this a result of weakness of the large muscles of the shoulder that you may strengthen at the gym, but rather this is a result of abnormal function and mobility of the small muscles that span the shoulder region. Being fit or active means very little about how well your shoulder mechanics function. So if you think that working with physical therapy is only about getting stronger, give it a try. You may be surprised how giving your shoulder a proper tune-up may resolve your symptoms of shoulder pain more effectively and more permanently than a pill or a shot!

A Word From Verywell

The shoulder is a complex joint, and in order for the shoulder to feel normal, the complex function needs to be working normally. It is not uncommon after an injury or after surgery for the mechanics of the shoulder to become abnormal. Working with a knowledgeable therapist can help improve the mechanics of this complex joint. Having a strong shoulder does not mean the mechanics of the shoulder are necessarily going to function normally, and a good therapist can help people regardless of their shoulder strength or athletic ability.

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Article Sources

  • "Shoulder Surgery Exercise Guide" American Academy of Orthopaedic Surgeons. 2007.