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Shoulder Pain Exercises
Shoulder pain exercises, at least from a physical therapy perspective are divided into three phases: acute, recovery, and rehabilitation. The first phase is the acute phase, that is, the period of time soon after injury. It could also refer to the period of time in which chronic shoulder pain becomes unusually intense. The second phase is the recovery phase. This brings the shoulder from acute injury to being a stable joint. In this phase, the initial inflammation should be passed so that the shoulder can tolerate increasingly strenuous activity. The third form of shoulder pain exercises occurs during the rehabilitation phase. These exercises are task- or sport-specific and are meant to improve function and reduce future injury.
Acute phase of shoulder physical therapy
This phase is devoted to stopping the intense shoulder pain and reducing inflammation. Unlike low back injuries, these shoulder pain exercises may involve more rest than exercise, at least initially. Shoulder pain exercises include activity modification, which in many respects is similar to relative rest. Activity modification for shoulder pain includes reducing or eliminating overhead activities, that is, activities in which the arm is lifted above the level of the shoulder (greater than 90° at the shoulder joint). The joint should not be loaded during the acute phase of shoulder pain exercises. In other words, the shoulder should not be used to lift or move anything heavier than about 10 pounds. Activities such as pushups, kayaking, and golfing should be avoided in this phase. Some shoulder exercises are actually encouraged as directed by your doctor or physical therapist.
Recovery phase - Range of motion shoulder pain exercises
The second phase of shoulder pain exercises includes three types of exercises: range of motion exercises, strength training, and dynamic joint stabilization. As you might expect, range of motion exercises involve a significant amount of stretching. Shoulder pain exercises in this phase include Codman pendulum exercises, stick exercises, towel exercises, and wall walking. The addition of ultrasound energy to these shoulder pain exercises can facilitate muscle lengthening and stretching. Range of motion exercises are not only for the shoulder joint, be include the upper arm, upper back, spine and chest as well.
Recovery phase - Strength building shoulder pain exercises
Once the shoulder joint has regained (or attained) a satisfactory range of motion, the muscles are strengthened. These shoulder pain exercises do not attempt to build significant bulk, but rather to acquire the muscle strength necessary to carry out daily, occupational, and athletic activities. Importantly, shoulder strength training should be done only within a range of motion that does not cause pain. Shoulder pain exercises in this phase begin with isometric exercises (keeping the length of the muscle constant throughout the movement) and progress to include shoulder shrugs, rowing, and pushups. Particular techniques that have been helpful to some people are plyometrics and progressive resistive exercises.
Recovery phase - Dynamic joint stabilization
Dynamic joint stabilization is a process of training the patient to keep the joint in a relatively neutral position while the surrounding muscles are actively (dynamically) performing a task. One major goal of this phase is to improve proprioception. Proprioception is joint sense or the ability to precisely determine how the shoulder joint is positioned in space. Closed kinetic chain exercises are usually the first physical therapy to be employed. Shoulder pain exercises then progress to open chain activities as the patient can tolerate.
Rehabilitation phase
By the end of the recovery phase, the shoulder pain should be gone, the muscles lengthened and strengthened, and the joint should be stable. Once this occurs, the patient can be moved into the rehabilitation phase. Rehabilitation phase shoulder pain exercises build on the proprioception part of the previous phase; the muscles are trained to be able to perform the task or tasks that the patient attempted to do previously (and perhaps led to shoulder injury). This phase is as much cognitive and psychological as it is physical. The goal of the rehabilitation phase shoulder pain exercises is to teach patient exercises in such a way that proper shoulder movements occur without conscious thought.
Shoulder pain treatment paths
Shoulder pain exercises are far more effective if the cause of the shoulder pain is clearly identified. Typically if a clinical study of shoulder pain exercises failed to show improvement of symptoms, it was because 1) patients had multiple shoulder issues and 2) a single physical therapy was tested by itself. Therefore it is always best to have a physician examine the shoulder and try to determine a root cause for the shoulder pain. Also, more than one type of shoulder pain exercise is probably needed. Physiatrists, rheumatologists, and sports medicine physicians can reach a diagnosis and offer comprehensive, conservative therapy including physical therapy.
shoulder pain exercises references
Doiron Y, Delacroix S, Denninger M, Simoneau M. Kinetic strategies of patients with shoulder impingement syndrome. J Orthop Res. Jul 7 2009. [epub ahead of print]
Janda DH, Loubert P. Basic science and clinical application in the athlete's shoulder. A preventative program focusing on the glenohumeral joint. Clin Sports Med. Oct 1991;10(4):955-71.
Wuelker N, Korell M, Thren K. Dynamic glenohumeral joint stability. J Shoulder Elbow Surg. Jan-Feb 1998;7(1):43-52.
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