Shoulder Therapy Made Easy

Shoulder Therapy Made Easy

If you are experiencing general shoulder pain and want to work out the kinks and reduce your shoulder soreness, this article is for you. Rather than address any one specific injury or diagnosis, I’m excited to share my general philosophy for shoulder treatment along with exercises that may save you thousands of dollars in medical bills.

With that said, it’s important to stress that I believe you’re always better off turning to your healthcare providers before implementing any therapy plan, and I encourage you to do so.  More specifically, I want to enlighten you with tips and knowledge to help you ask better questions to help strengthen these meetings with your wonderful sports medicine specialists as you, quite literally, place your shoulder in their hands.

Now, back to your treatment…So you have a sore, stiff, cranky, catching, aching and/or unhappy shoulder? And you want to learn what to do and what to avoid as you work to get your shoulders, upper back and chest stronger, more flexible and symptom free—right?

A smart starting point is to first understand your anatomy:

Your shoulder girdle involves three main bones, four articulations or joints, 20+ muscles and plenty of miscellaneous “stuff.”  The humerus is better known as the upper arm bone, the clavicle the collar bone, and the scapula the shoulder blade.

The shoulder, or glenohumeral, joint is located where the upper arm bone connects to the scapula.  Structurally, this is a mechanically weak area and a common source of stability issues and sequential shoulder pain.  Most shoulder joint therapy is focused on increasing range of motion (ROM) and improving muscle strength.

The acromioclavicular (AC) joint is where the clavicle and scapula come together.  This is located at the side or “tip” of the shoulder and rests directly above the shoulder joint. AC joint injuries, common when someone lands on the side of his/her shoulder, are sometimes more painfully debilitating than seen with a sprain or “shoulder separation” (addressed in this article) [Insert link to article].

Lastly, the sternoclavicular, or SC, joint is located in the upper and inner chest region where the clavicle and sternum merge. An SC sprain is not common and rarely requires surgery. However, when this injury does occur, it is not quick to heal. Limited motion typically persists due to this impairment.

Shoulder Exercise Dos & Don’ts

One of my goals as a physical therapist is to ensure an athlete returns to the field or court safely.  Those I train of course have the same goal. The following tips are the same rules I use with my professional athletes and can help you, too, get back in the game quickly and safely.

Shoulder Therapy Dos:

  • DO perform a 5-to-10 minute warmup of the four joints and countless shoulder girdle muscles prior to any exercise or shoulder treatment.
  • DO focus on strengthening the rotator cuff, especially if the injured shoulder is not as strong as its partner.
  • DO listen to your shoulder and follow its lead.  If your shoulder exercises tell you that a specific exercise worsens your symptoms, discontinue or adjust the plan.   This may sound too simple, but trust your instincts and your insight.  I always tell both my athletes and myself: “Work with your body, not against it!”
  • DO work hard to increase the pain-free range of motion for your shoulder joint and shoulder girdle.

Shoulder Therapy Don’ts:

  • DON’T sleep on the injured shoulder.
  • DON’T engage in shoulder exercises with the thumb pointed downward, which has a tendency to create rotator cuff impingement syndrome.
  • DON’T perform high-intensity shoulder exercises above the shoulders unless it’s a functional position your sport.  Comfortable stretching of this area is great, but aggressive strengthening is usually too risky.

Ask the Right Questions Like a Pro

Prior to exercising your shoulder, mirror what professional athletes with shoulder pain do to ensure a safe return to sport: ask their sports medicine specialist the following questions:

1. Is my rotator cuff damaged, and if torn, is it partial or full thickness?

2. What specific shoulder exercises or motions should I avoid in my shoulder therapy?

3. What can I expect with this injury over the next 2-6 weeks?

4. When testing the external rotation (ER) strength for both shoulders, what would you grade the percentage strength on my injured side versus my healthy one?

5. Do you think I presently have or am at risk for impingement syndrome?

Sports Medicine Tips for the Best Results

  • Know Your Priorities – Ask yourself: “What do I really need from this shoulder?”  If the answer is “less stiffness,” focus on stretching.  If it’s “better function,” focus on strength. “Less aching and pain?” Prioritize pain-free motion and icing.
  • Seek Stability – Your shoulder is not a stable joint, so avoid any position that risks furthering the injury in an unstable manner.
  • Ice is Your Friend – Ligaments, bursas, and muscles…oh my! With so much “stuff” around the shoulder joint and shoulder girdle, ice is a high priority.  Its chill may sting, but ice is exactly what the doctor orders for almost every shoulder injury.  The pros will tell you that ice is their best teammate, so stop complaining and do what you know you need….ICE and lots of it.
  • Hands on the Ground – Add a new wrinkle to your shoulder treatment that will open a new door for your stretches, stability exercises and strengthening.  Put your hands on the ground and use your body weight to engage the muscles that surround the shoulder girdle.  It’s very safe for most shoulder injuries as well as a fun change.  I know it sounds kind of yoga-ish, so channel your inner yogi and give it a try.
  • Long in the Front & Short in the Back – Improving the resting position of the shoulder girdle is a key part of almost every shoulder therapy program.  In today’s busy lifestyle that sometimes includes staring at a computer all day, rounded shoulders are a common problem. Thereby, it is important to lengthen the front of the shoulders (stretching the chest and internal rotators) while shortening the back of the shoulders (strengthening the upper and middle back and external rotators).

AC Joint Separation Management

AC Joint Separation Management

Acromioclavicular (AC) joints are easily injured and susceptible to secondary issues such as arthritis, laxity, and shoulder pain.  Often referred to as a “separated shoulder,” an AC separation occurs when the ligaments that stabilize the collar bone (clavicle) and the shoulder blade (scapula) are damaged.

The acromioclavicular joint connects the lateral end of the clavicle (collar bone) and the lateral end of the scapula (shoulder blade).  This bony section of the scapula is referred to as the acromion. The AC joint creates a stabilizing union between the front and back of the shoulder girdle.  It’s important to note that when healthy, this joint has ample mobility that allows for significant motion of the shoulder.  The AC joint forms an important archway that protects the rotator cuff and shoulder joint below.

Stabilized by a joint capsule, the acromioclavicular joint encompasses the ends of the clavicle and acromion along with several ligaments. Because ligaments attach bones to bones, when the AC joint ligaments (located under the clavicle) are damaged due to a separated shoulder, there is a downward pull to the clavicle and AC joint.

What Causes a Sprained AC Joint?

Falls are a main cause of separated shoulder injuries.  The AC joint is not overly stable, and its location makes it quite vulnerable to injury.

The two most common injury mechanisms are:

  • Landing on the lateral part of the shoulder, forcing the shoulder downward
  • Landing on an outstretched arm or elbow, forcing the shoulder joint upward into the undersurface of the acromioclavicular joint

Either of these situations noted above will disrupt the AC joint capsule and compromise the stabilizing ligaments.  The grade, or degree, of separation depends on the level of damage to both the ligaments and capsule.

Grades of Separation

Shoulder Separation, Grade I

Mild disruption of the AC joint capsule, resulting in minimal joint instability

Shoulder Separation, Grade II

Moderate disruption of both the AC joint capsule and stabilizing ligaments, resulting in moderate AC joint instability.  Partial tears of both the AC joint capsule and stabilizing ligaments are present.  Holding a weighted object with the injured arm at one’s side will present moderate AC joint laxity with visible elevation of the outer clavicle. The amount of elevation with a Grade II AC sprain is typically ½ to 1 inch, when compared bilaterally.

Shoulder Separation, Grade III

Significant disruption of both the AC joint capsule and stabilizing ligaments results in significant AC joint instability.  Complete tears of the AC joint capsule, and possibly complete tears of at least some of the stabilizing ligaments, are present. When the injured arm rests at the side of the body, there is visible laxity of the acromioclavicular joint and visible elevation of the outer clavicle.  When the arm reaches across the body toward the back of the other shoulder, abnormal lateral clavicle elevation increases.

AC Sprains Grade IV to VI are much more severe and based on the hyper-mobility of the acromioclavicular joint.

Signs & Symptoms of an AC Joint Sprain

  • Pain and localized swelling on the top of the shoulder at the acromioclavicular joint
  • Swelling and/or bruising on the top of the shoulder
  • An obvious bony lump on the top of the shoulder, which is the end of the displaced collarbone (the higher the grade of shoulder separation, the larger the elevation of the outer tip of the clavicle)
  • Limited range of motion (ROM) and pain when lifting the arm
  • With Grade II and Grade III AC joint sprains, a “clicking” or shifting felt in the AC joint with shoulder motion
  • Significant AC pain with active motion (personally moving the arm) or passive motion (someone else moving the arm), horizontally across the body toward the back of the other shoulder

Treating a Separated Shoulder

  • Ice the top and front of the shoulder with the elbow flexed to approximately 90 degrees and supported.
  • Use an arm sling if pain or clicking occur when walking.  This helps to support the weight of the arm while also restricting motion.
  • Once a fracture is ruled out, initiate early motion to reduce stiffness and pain.  Avoid horizontal adduction motion (horizontal movement of the arm across the midline of the body) until pain-free motion is achieved.
  • Perform easy pendulum swings to help regain motion of the shoulder.
  • Initiate a shoulder strengthening program early on with a Grade I & II sprain, if tolerable.  Start with rotational motions and progress with overhead lifts, continuing to avoid horizontal adduction as long as possible.

Ask the Right Questions Like a Pro

As always, my goal is to help you get back in the game as quickly as possible while ensuring a safe return.  Ask the following questions—the same ones smart professional athletes with a separated shoulder would ask their sports medicine specialist—so you too can recover quickly and safely:

1. What grade is my shoulder separation?

2. Do you think I can successfully rehab this AC joint sprain and avoid surgery?

3. Are special padding, taping, or sports equipment alterations needed to reduce the chance of reinjuring my acromioclavicular joint?  Which specific lifts, activities, and motions should I avoid to help my AC joint separation heal quickly?

Sports Medicine Tips For an AC Joint Separation

  • No Need for the Knife – AC joint surgeries are not overly common unless instability is severe or complex limitations are present.
  • Sleep Well? – Plan to avoid sleeping on the injured shoulder for a while.  I severely separated my right AC joint in a winter mountain bike race on a ski slalom course (I know, not the smartest thing that I’ve ever done, but it sure was fun…until I crashed!) in Vermont in 1994. I still can’t sleep on that side!
  • Prioritize Posture – Any position, movement or activity that rounds your shoulders will worsen the pain. It’s that simple.
  • Ice, Motion, Ice – Ice it, move it (in pain-free directions) and then ice it again. It’s a simple formula with fast results.
  • Exercise Efficiently – While sitting or standing tall, relax your arms while squeezing your shoulder blades (scapula) together and exhaling hard.  Hold for 2 seconds and repeat 10 times.  Do this drill as much as possible to stretch out your chest muscles, strengthen your shoulder stabilizing muscle and, most importantly, decompress your AC joint.