PHYSIOTHERAPY EXERCISE FOR SHOULDER PAIN

13 Physiotherapy Exercise For Shoulder Pain

The most commonly occurring shoulder condition is rotator cuff-related shoulder pain (RCRSP) for which the main non-surgical intervention is exercise therapy. As reported in a study done by Marc-Olivier Dubé et al. in 2020, the lifetime prevalence of shoulder pain is 70%, and approximately 50% of people with shoulder pain will experience pain for more than a year.

 

In the current generation, most of the painful conditions occur due to a lack of tissue resilience or capacity to tolerate the load. If the tissue’s load tolerance capacity is low and we overload the structure, it will produce pain. This occurs due to a lack of strength (stability) and adequate range of motion needed for that activity (mobility).

 

The exercises below help you improve your load tolerance, strength, and mobility.

Overhead mobility exercises:

1. Lat stretch in babysitting

Purpose:
  • Tight latissimus muscle can restrict overhead shoulder mobility. So, stretching the latissimus dorsi muscle is essential to easing shoulder movements.
  • It also aids in improving thoracic spine mobility, reducing tension, and relieving pain.
How to perform:

Step 1: Start in the crawling (quadruped) position, and sit back on your heel.

Step 2: Extend your arms forward and move your hands towards one side while keeping your hips fixed on heels.

Step 3: Turn your upper body towards the opposite side to feel the stretch in the latissimus dorsi muscle

Step 4: Hold it for a few seconds and repeat the stretch on the opposite side.

2. Lat eccentric with band

Purpose:
  • Eccentric work of lats improves strength and neuromuscular control.
  • It improves shoulder stability and overhead mobility as well.
How to perform:

Step 1: Attach the resistance band to a firm anchor point above your head level.

Step 2: Stand apart from the anchor point, hinge your hips, and tighten your core.

Step 3: Start with your arms overhead and elbows extended, hold the band under tension.

Step 4: Pull the band with both hands and hold it down with a single arm.

Step 5: Now, using the single-arm, release the band slowly with control and feel the tension in your latissimus dorsi muscle.

3. T-spine extension

1. Side-lying External rotation
Purpose:
  • Strengthens rotator cuff muscles, especially infraspinatus, and teres minor.
  • Improves shoulder stability.  
  • Reduces pain and risk of impingement syndrome.
How to perform:

Step 1: Lie on your side with the targeted side facing upward.

Step 2: Keep your spine straight and your working arm resting against your side.

Step 3: Take a lightweight dumbbell, keeping your elbows 90 degrees bent and your forearm parallel to the ground.

Step 4: Take your forearm downwards towards your tummy.

Step 5: Start rotating your forearm upwards until your forearm is perpendicular to the body.

Step 6: Slowly drop to the starting position and repeat.

2. Standing ER eccentric
Purpose:
  • Improves eccentric control of external rotators of the shoulder, thereby improving strength and stability
  • Standing position is much more effective as it provides a lot more resistance than in other positions.
How to perform:

Step 1: Stand straight with your arms 90º abducted, elbows 90º flexed.

Step 2: Hold a lightweight dumbbell in your hand.

Step 3: Slowly lower the dumbbell downwards with control.

3. Overhead External Rotation

Purpose:
  • Strengthens the rotator cuff muscles, especially the infraspinatus and teres minor.
  • Aids in improving shoulder stability
  • Reduces pain and risk of injury to shoulder
How to perform:

Step 1: Anchor a resistance band to a stable surface at your face level.

Step 2: Stand front-facing to the anchor point.

Step 3: Pull the band, keeping your shoulder abducted sideways and your elbows bent to 90 degrees.

Step 4: Now, slowly rotate your forearm upwards against the resistance band as far as possible.

4. Kneeling ER eccentrics

Purpose:
  • Improves neuromuscular control of external rotators
  • Easy to perform with the elbow supported on the knees
How to perform:

Step 1: Sit on the floor with your elbow supported on your knee with your forearm pointing towards the ceiling.

Step 2: Hold a lightweight dumbbell in your hand.

Step 3: Slowly lower the dumbbell towards the floor with control.

Repeat as required.

5. Banded ER eccentrics

How to perform:

Step 1: Anchor a resistance band to a stable surface at your waist level.

Step 2: Stand sidewards to the anchor point, with the working side away from the anchor point.

Step 3: Hold the band, with elbows bend to 90 degrees.

Step 4: Keep your elbow fixed to the body. Start pulling the band, rotating your forearm out and away from the body (concentric external rotation)

Step 5: Slowly release the band in a controlled manner and return to the starting position.

6. Windmill

Purpose:
  • Improves shoulder stability, core strength, hip mobility, and hamstring flexibility
  • Enhances movement patterns and overall coordination.
How to perform:

Step 1: Stand with your feet slightly wider and your toes pointing slightly outward.

Step 2: Hold a kettlebell, dumbbell, or no weight depending on your fitness level.

Step 3: Press the weight overhead with one hand, keeping your arm straight and stable while the other arm hangs freely by your side.

Step 4: Rotate your torso to the side as you lower yourself, keeping your gaze on the weight overhead.

Shoulder strength training:

1. Push up (explain modified)

Purpose:
  • It targets multiple muscle groups, primarily, the pectoralis major (chest), triceps brachii, and anterior deltoids. and secondarily, it targets the serratus anterior as well.  
  • Improves core stability and shoulder stability
How to perform:

Step 1: Place your hands slightly wider than shoulder-width apart on the floor.

Step 2: Align your wrists directly under your shoulders and elbows extended straight.

Step 3: Extend your legs straight back, keeping your toes on the ground.

Step 4: Modified push-up: If bearing weight on your toes is difficult, we can modify it by taking weight on your knees (as shown in the picture).

Step 5: Maintain your body in a straight line from your head to your heels by engaging your core and glutes.

Step 6: Slowly lower your body to the floor by bending your elbows, keeping them approximately at 45º to your body. Reach as low as possible. 

Step 7: Push through your palms and extend your elbows, returning to the starting position.  

2. Australian pull-ups (explain modified with a towel)

Purpose:
  • Improves the strength of your biceps, core, and lats muscles
  • Serves as a regression of traditional pull-ups.
How to perform:

Step 1: Set a barbell at waist height or lower, depending on your strength level.

Step 2: Lie underneath the bar with your body straight and grab the bar with palms facing away from you, hands shoulder-width apart.

Step 3: Extend your arms, keeping your body straight like a plank.

Step 4: Rest on your heels on the ground, with your legs straight and core engaged.

Step 5: Pull your chest toward the bar by bending your elbows and retracting your shoulder blades.

Step 6: Keep your body in a straight line throughout the movement. Pull until your chest nearly touches the bar.

Step 7: Now slowly straighten your arms, lowering your body back to the starting position with control.

Step 8: Avoid letting your hips sag or arching your back.

2. Standing ER eccentric

Purpose:
  • Improves eccentric control of external rotators of the shoulder, thereby improving strength and stability
  • Standing position is much more effective as it provides a lot more resistance than in other positions.
How to perform:

Step 1: Stand straight with your arms 90º abducted, elbows 90º flexed.

Step 2: Hold a lightweight dumbbell in your hand.

Step 3: Slowly lower the dumbbell downwards with control.

3. Face pull

Purpose:
  • Enhances rotator cuff strength and shoulder joint stability.
  • Reduces the risk of shoulder injuries.
  • Promotes healthy shoulder mechanics by working on the small stabilizing muscles often neglected in other exercises.
  • Useful for athletes needing upper-body strength and stability, especially in sports requiring throwing or overhead movements.
How to perform:

Step 1: Anchor a resistance band to a firm surface at eye level.

Step 2: Stand facing the anchor point and hold the band with arms extended in front, elbows straight, and thumbs pointing toward each other.

Step 3: Keep your feet hip-width apart and engage your core keeping the band taut. 

Step 4: Pull the band toward your face by driving your elbows outward and backward.

Step 5: Keep your wrists neutral and hands at eye or upper-chest level.

Step 6: Squeeze your shoulder blades together at the end of the motion.

Step 7: Hold it for a few seconds and then slowly extend your arms & elbows back to the starting position with control.

4. Dumbbell bench press

Purpose:
  • Strengthens chest muscles (pectoralis major, serratus anterior), shoulder muscles (triceps, rotator cuff, anterior deltoid), and core muscles as well.
  • Helps in improving both mobility and stability of the shoulder joint and reduces risk of injury.
How to perform:

Step 1: Lie flat on a bench with a dumbbell of adequate weight in each hand.

Step 2: Keep your back flat on the bench, and plant your feet firmly on the floor.

Step 3: Keep the dumbbells at chest level, palms facing forward, and elbows slightly below your shoulders.

Step 4: Now, extend your elbows fully to press the weights straight up, then slowly lower them back down to the starting position.

Step 5: Perform this with control throughout the movement.

5. Standing shoulder press

Purpose:

This strengthens the shoulders, upper back, and arms while also engaging the core for stability.

How to perform:

Step 1: Stand upright with your feet shoulder-width apart.

Step 2: Hold dumbbells in your hands forward at shoulder height with your palm facing forward.

Step 3: Keeping your spine straight and core engaged, press the weights straight overhead.

Step 4: Slowly lower the weights back to the starting position.

Step 5: Repeat this 8-12 reps.

6. Lateral raise D/B

Purpose:

This strengthens your shoulder abductors, especially the middle deltoid.

How to perform:

Step 1: Stand straight with your feet shoulder-width apart.

Step 2: Hold dumbbells on each hand with palms facing your body, arms hanging freely by your sides.

Step 3: Engage your core and keep your spine neutral.

Step 4: Now start lifting your arms outward and upward towards the ceiling with your elbows slightly bent.     

Step 5: Raise your arms to shoulder height and hold this for a few seconds.

Step 6: Slowly lower the weights with control back to the starting position.

Step 7: Repeat this for 8-12 reps.

NOTES:

But the Majority of the time, shoulder pain occurs just because of weakness in the neck, midback, and elbow muscles, loading the joint and muscle beyond your tolerance. So, it is necessary to strengthen these areas also. To see the strengthening exercises for neck, exercise for midback, and exercise for elbow muscles Visit our Article

DISCLAIMER:

The exercises mentioned above are to be performed with a specific progression and regression. To know more about it, click here to watch this video.

Always keep in mind that this exercise plan helps to improve general shoulder health, flexibility, ROM, and strength. Considering that every individual has differences in anatomical structure, pain perception, lifestyle, needs, and goals.

So, it is better to consult with a physician or a physiotherapist. Click here to book an appointment for a consultation to get a better understanding of your problem, and to obtain a tailor-made rehab plan, specific to your needs and goals.