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Injury Prevention | Physical Therapy Exercises For Shoulder Pain

Updated: Feb 25, 2023

Shoulder injuries are one of the more common areas we see in the clinic. It is likely due to the fact that your shoulder has a very large range of motion and you are constantly using your shoulders every day. The more range of motion a joint has, the more movements you will need to strengthen.

Take the knee for example, it really only flexes and extends. This makes it a simple joint to strengthen. The shoulder on the other hand can move it all 3 cardinal planes of motion and then every movement between. This creates a lot of areas of vulnerability if you aren't training the shoulder correctly.

Here is a list of the most common injuries that we see in the clinic.

The great thing about all these injuries is that we can decreased the likelihood of injury in the same way.

  1. Rotator Cuff Tears: A tear in the rotator cuff can cause pain and weakness in the shoulder joint.

  2. SLAP tears: Superior labral anterior/posterior (SLAP) tears are a common type of shoulder injury, caused by sudden movements or chronic overuse.

  3. Shoulder Impingement Syndrome: Shoulder impingement syndrome is a condition that causes inflammation and irritation to the tendons and bursae in the shoulder joint.

  4. AC Joint Sprains: An acromioclavicular (AC) joint sprain occurs when one or more of the ligaments that connect the collarbone to the shoulder bone are stretched or torn due to a trauma or overuse.

  5. Biceps Tendonitis: Biceps tendonitis is an inflammation of one or both of the long bands of tissue that connect your biceps muscle to your shoulder blade.

Over my years as a physical therapist I have a found a few keys, especially for those of us that sit a lot for our jobs, and those keys are improving posterior shoulder and rotator cuff strength along with scapular strength. The rotator cuff controls a lot of the stability of the shoulder and is highly active during all movements of the shoulder. This is also a muscle that we don't often use or work on. A lot of people think they are doing rotator cuff but in reality they are working on the larger muscles of the shoulder.

Here are some examples of rotator cuff strength exercises we do within our clinic.

Notice that with these exercises the shoulder is rotating. This will work the muscles such as infraspinatus and teres minor. It is easy to get rotator cuff mixed up with exercises that improve the strength of the posterior shoulder and scapular retractors. Not that those muscle groups aren't important, you just need both.

Here are some examples of posterior shoulder and scapular retractor strength

Notice the shoulder is staying in the same relative position as far as rotation. Here I am using my back muscles to pull my shoulder blades back as my arms move backward. This is also a very important part of shoulder stability and injury prevention.

The Golden Ratio

Have you ever heard of the golden ratio? The golden ratio, also known as the divine proportion, is a mathematical concept that expresses the relationship between two numbers. The ratio of two numbers is said to be in the golden ratio if the ratio of their sum to the larger number is equal to the ratio of the larger number to the smaller number. This concept has been used throughout history by artists and architects in creating aesthetically pleasing compositions and buildings. The golden ratio can also be found in nature, including in honeycombs, sea shells, and flowers. The ratio is approximately 1.618.

We can apply this principal to shoulder health believe it or not. The goal of pain free shoulder training is to do more pulling than pushing, especially overhead pushing. This allows the posterior body become stronger, which helps us to maintain optimal posture. Okay, so it's not exactly the golden ratio because its more like 3:1 but your get the drift.

We have our clients in our physical therapy office perform 3 times more pulling than pressing. So for ever set of bench press we try to have someone do 3 sets of rows or posterior shoulder work.

Here are some of our favorite multi-joint strength movements

Cable Bilateral Row

Cable Lift

Cable Chop

The Final Piece of the Puzzle | Shoulder Stability training

The final piece of injury prevention of the shoulder is performing shoulder stability exercises. Because of all the motion of the shoulder, it is important to train your shoulder to protect end range movements. This can be improve from doing shoulder strength activities in weight bearing, with reactive isometrics, or through reactive drills. We use all these areas to ensure our patients are ready to return to sports or activity after a shoulder injury.

These are just a few examples of some of the movements you can find inside of our physical therapy clinic.

The true goal of physical therapy and injury prevention to identify specific areas of vulnerability and opportunity. We help our clients to formulate a plan and an exercise program that helps them reduce the risk of injury and improve performance and function. As a former division 1 athlete and throughout my career as a doctor of physical therapy I have learned a couple things.

  1. Our bodies are never maintaining. They are either improving or declining.

  2. Investing in physical health is one of the most important things you can do with your money. You only get one body. Take care of it accordingly.

  3. Having a plan is the only way to move forward. Randomly choosing exercises will lead to long term frustration and lack of progression.

If you are looking for someone to help you with a plan to reduce your risk of injury, reduce a nagging pain, or even to improve your performance let us know. We would love to help you just like we have helped so many others.

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