First off, I want to say that if you have pain in the shoulder you should come and see a physical therapists. Why? Because we are experts in treatment of shoulder injuries and this is literally what we do all day every day.
In this article I am going to give you an idea of where to start your rehab and some of the things I would hope your physical therapy would include.
So let's break this down.
Here are the 4 most common shoulder injuries and their cause
Below are the 4 most common shoulder injuries we see in clinic. The 2nd one, shoulder impingement, is actually a complex injury which may not be what the name suggests but this is the most common name for it so we will go with it.
Rotator Cuff Tears: The rotator cuff is a group of four muscles that stabilize the shoulder, and their tendons can tear from either acute injury or chronic overuse. This is commonly found in athletes who regularly use their arms for overhead activities, like baseball or tennis players, as well as in individuals with jobs that require repetitive arm motions.
Shoulder Impingement: Shoulder impingement occurs when the top of the shoulder blade puts pressure on the underlying soft tissues when the arm is lifted away from the body. Over time, this can lead to bursitis or tendinitis. It's usually caused by repetitive overhead arm movements, poor posture, or naturally narrow space between the acromion (part of the shoulder blade) and rotator cuff.
Frozen Shoulder (Adhesive Capsulitis): This condition involves stiffness and pain in your shoulder joint, which typically gets worse over time and then resolves, usually over the course of a year or more. The exact causes of frozen shoulder are not fully understood, but it can often follow a period of forced immobility due to surgery, fracture, or other injury.
Shoulder Dislocation: A dislocation happens when the ball at the top of the upper arm bone (the humerus) is forced out of its socket. This is typically the result of a strong force or extreme rotation, such as during a sports collision or a fall. Once a shoulder has been dislocated, it's at higher risk for future dislocations.
All of these injuries require physical therapy and in order to get the most out of your rehab you need to be doing the right exercises.
Where to start with shoulder rehab
I am going to skip a couple steps here because I don't want to bore you and I want to get to the more exciting stuff.
I will say that in the very early stages of rehab our focus is on techniques to reduce pain and regain range of motion. These can be tedious and boring but I promise this phase is important. I am going to skip examples but that doesn't mean they aren't important.
Early phase rehab of the shoulder
The early phase should be focused on single plane range of motion and strength movements of the shoulder. We start with some common few that I will drop down below. The name of the game here is to slowly improve strength and range of motion of the shoulder without causing increased pain or further injury.
Below is a shoulder horizontal abduction, which will work the back side of the shoulder. A very important structure to work after injury.
You can also work the posterior shoulder with something like the one below. This will work more on the external rotators versus the abductors in this case. Both are important movements.
Once these ones feel good you may move the elbow away from the body and do a variety of different shoulder rotational movements in these patterns.
We typically progress from no weight up to 5 or even 10 lb dumbbells depending on the movement.
As you gain strength with these we can start to incorporate some shoulder stability movements. I like to do exercises called reactive isometrics. Most exercises will be progress from neutral shoulder up to elevated positions.
It's important to work the shoulder in different directions with the arm by the side and overhead.
Scapular strengthening exercises
The next phase is also to incorporate strength of the scapular retractors and back muscles. Here are a variety of exercises you may see inside of one of our physical therapy clinics.
Mid stage shoulder rehab
This is the phase where we start to add in some progress exercises for the shoulder. We may add some ball drops to get used to eccentric loading on the posterior shoulder.
Or something that will utilize strength and stability of the shoulder like a bottoms up kettlebell press.
You can even add a little iso hold and walk to spice this one up a bit.
We can even do some stability training on a ball.
In the mid stage rehab programs we also like to add upper body pulling patterns.
Later Stage Shoulder Rehab
As we move through our progressions the exercises become more multi planar and more functional. This is also where we would start working on more sports specific movements for athletes like overhead lifters or throwing athletes.
Here is also where we want to work on more stability with weight bearing and difficult activities that engage the shoulder.
As you can see there are hundreds of exercises you can do for your shoulders. The important part is dosage of exercise and the selection of the exercise based on the injury or impairments.
The shoulder is probably the most complex joint in the body and requires a customized program to get back to 100%.
If you want it done right, reach out to an expert who knows how to evaluate and rehab your specific injury.