Early management of shoulder complaints is similar to other issues that patients present with: create as much shoulder movement as possible while avoiding pain generation when you are able to. As noted in the first posting, the shoulder is a highly mobile joint that is built to create a lot of movement — so maintaining as much of this movement as your body allows in the early phases of recovery is a priority.
The catch, of course, is that pain often impairs the ability of the muscles surrounding a joint to effectively control it. So in order to keep these activities safe and effective, what we need is a foundation point to build from so you can create as much movement as possible without any painful irritation.
Getting the shoulder moving again
A fundamental step in refining movement is to achieve an appropriate position to start from. For the shoulder, this means finding a ‘neutral’ position — where the arm sits in the middle of the shoulder joint. In this position the entire shoulder has the most support possible from the muscles surrounding it. The better you can establish this “centrated” position of the shoulder, the better the movement quality is likely to be (and the less likely irritation or impingement will occur).
2A – “Centrating” the shoulder
To get the shoulder in the best position possible before movement, follow these steps to find this position easier:
- Sit tall through the upper back, shoulders, and head — keep your arms at your sides.
- Turn your palms up (thumbs pointed to the sides) to begin.
- Pinch the shoulders blades together, and hold.
- Keeping what you’ve achieved so far, let you hands relax so the palms face inward (thumbs pointing forward, or up).
Establishing these steps achieve a few objectives. Sitting tall makes sure you are in a more natural position to start. Turning the palms/thumbs acts as a proxy to arm rotation at the shoulder joint, and helps to counteract the tendency to roll the shoulders forward and in towards the chest with everyday activities. And pinching the shoulder blades together sets the shoulder socket in a functional position that will make movement easier, while also creating more stability around the region as a whole — which will be important as the movements we cover become more dynamic.
2B – Getting Started With Movement – Active Ranges of Motion
In the early stages, especially when pain is involved, we sometimes need support to facilitate movement at the shoulder. This can involve using a non-moving surface (like a wall), an object you can control (like a broom handle, hockey stick, or golf club), or your own personal support (like the opposite hand/arm). The idea is to start by completing as much movement as you can without help, and use the assistance only to finish the movement — still following the rules about working around discomfort, but not through pain.
To begin addressing shoulder pain, simple activities like this can be very helpful. Remember to do as much as you can without support, and use the assistance only when required. Try these Active-Assisted Range of Motion (AAROM) activities in the early stages at 2 sets of 10 repetitions, each direction.
If you can do these without too much difficulty, try progressing the activity by removing the assistance. These are now just Active Range of Motion activities. Also complete 2 sets of 10 repetitions, each direction.
2C – Combined Active Range of Motion Activities
If these are completed comfortably, move into a more “flowing” pattern (2C) — this way the overlap of simple movements you just completed is re-created into a more functional quality similar to the day-to-day activities that the shoulder demands. These combined range of motion exercises should be done without assistive devices.
Do this in both directions — forwards and backwards. Progress, smoothly, between each step:
- Begin in the “centrated” position, thumb pointing forwards.
- Reach forwards into flexion, thumb up, until you reach the top (arm straight up).
- As you pass the top, rotate the palm away from the body (thumb points forwards) and continue backwards.
- Continue into extension, no active change with the hand (thumb now points down).
- Return to starting position, thumb facing forwards again.
Repeat this in the opposite direction as well for an additional challenge.
2D – Active Resisted Ranges of Motion
Finally, bands and other devices that provide slight resistance to movement can be extremely helpful in restoring movement in a painful shoulder. If you are using bands, ropes, or pulleys to create resistance, make sure they are anchored securely before beginning (door handles are excellent).
Keep the resistance level light, but so that you generate moderate tension during movement. The goal is not to build muscle, like most resistance exercise! Just a low-grade tension is adequate here.
You can use resistance for all the ranges of motion achieved above in 2B. However, in the early stages it is most important to maintain rotation of the shoulder — assuming no additional pain is created — so absolutely do not skip the internal and external rotation activities.
This gives a strong foundation for re-establishing movement of the shoulder when dealing with early stages of painful dysfunction. Please keep in mind, as mentioned in the first post, that shoulders are complicated structures with a lot of potential for individual differences between people — which means that there is a higher chance with the shoulder that a “routine” suggestion like that outlines above will have at least one segment that creates pain for some people. This is okay — work around your discomfort and not through pain — but I strongly advise getting assessed by a health professional if you are having continued difficulty.
In the next post, we will advance to more stability and resiliency based exercises for long-term shoulder health and prevention of future discomfort.