Shoulder Therapy Made Easy

"Look Maa, the Shoulder Therapy is Working!"

If you are experiencing general shoulder pain and want to return to exercising your shoulders or reduce your shoulder soreness, this article is written for you. Today I’m not going to address any one injury or diagnosis.  Instead I’m excited to share my general philosophies for shoulder treatment along with exercises that may save you thousands of dollars in medical bills.

With that being said, it’s very important to stress that I think you’re always better off when you utilize your health care providers before implementing any therapy program.  As I always point out, I do not want to replace nor do I want to discourage you from seeing your health care providers.  Quite the contrary:  I want to help you better utilize your many wonderful sports medicine specialists by enlightening you with tips and knowledge to help you ask better questions and grow your trust in their assistance with your shoulder treatment.

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

A smart starting point is to first understand your anatomy so you can get the best shoulder treatment possible.

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

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

The acromioclavicular (AC) joint is where the clavicle and the scapula come together.  This AC joint is located at the side or “tip” of the shoulder and it rests directly above the shoulder joint.  Commonly injured when someone lands on the side of his/her shoulder, the AC joint can be more painfully debilitating than 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.  The SC sprain is not common and rarely requires surgery.  However, when this injury occurs, it is not quick to heal. Plus limited motions typically remains with a little disability because of this impairment.

Do’s & Don’t for Shoulder Exercises

One of the goals of my position as a physical therapist is to make sure an athlete gets back on the field safely.  Of course the athletes I train also want to get back as quickly as possible too. The following tips are the rules I use with my professional athletes and will help you too—get back in the game quickly and safely.

The Do’s of Shoulder Therapy:

  • Perform a 5 to 10 minute warm-up of the four joints and countless muscles of the shoulder girdle before any exercise or shoulder treatment.
  • Focus on the strengthening the rotator cuff, especially if the injured side is not as strong as the other shoulder.
  • Listen to your shoulder and follow its lead.  If your shoulder exercises are telling you that a specific exercise makes your symptoms worse, discontinue or adjust the plan.   This may sound too simple but trust your instincts and your insight.  I always tell my athletes and myself: “Work with your body not against your body!”
  • Work hard to increase the pain-free range of motion of your shoulder joint and shoulder girdle.

The Don’ts of Shoulder Therapy:

  • Sleep on the injured shoulder.
  • Perform shoulder exercises with the thumb pointed downward, which have a tendency to create an impingement syndrome of the rotator cuff.
  • Perform high-intensity shoulder exercises above the shoulders unless it’s a functional position for the sports.  Comfortable stretching up there is great but aggressive strengthening up there is usually too risky.

Asking the Right Questions

Before you start exercising your shoulder, you’ll want to do like a professional athlete with shoulder pain. To ensure he can safely return to his sport, a pro athlete should ask his sports medicine specialist the following questions:

  1. Is my rotator cuff damaged and if torn, is it a partial thickness tear or a full thickness tear?
  2. With my shoulder therapy, what specific shoulder exercises or motions should I avoid?
  3. What can I expect with this injury for the next 2, 4 and 6 weeks?
  4. When you test my external rotation (ER) strength for both shoulders, what would you grade the percentage strength would you grade my external rotators on my injured side?
  5. Do you think I presently have or am I at risk of having an impingement syndrome?

Sports Medicine Tips To Get The Results You Want

  • Know Your Priorities – Ask yourself: “What do I really need from this shoulder?”  If it’s “less stiffness”, focus on stretching.  If it’s “better function”, focus on getting it stronger.  If your body tells you “less aching and pain”, prioritize the pain-free motion and icing.
  • Get Stable – Your shoulder is not a stable joint so avoid any position that risks injuring the shoulder and making the shoulder more unstable.
  • Ice is Your Friend – With the many ligament, bursas, muscles and stuff around the shoulder joint and shoulder girdle, ice is a very high priority.  Ice hurts but it’s exactly what you need for almost every shoulder injury.  The Pro’s will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.
  • Put Your Hands on the Ground – Add a new wrinkle to your shoulder treatment that will open a new door to your stretches, your stability exercises and your 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 and it’s a fun change.  I know it’s kind of yoga-ish but that’s okay with me.
  • Lengthen the Front & Shorten the Back – For almost every shoulder therapy program, improving the resting position of the shoulder girdle is needed.  With today’s busy lifestyle that includes a large part of our day sitting in front of a computer, rounded shoulders is often a result. Lengthening the front of the shoulders (stretching the chest and internal rotators of the shoulders) while shortening the back of the shoulders (strengthening the upper and middle back and external rotators of the shoulders) should be addressed.