Shoulder pain exercises can assist in a variety of areas such as rotator cuff problems, shoulder impingements, shoulder instability and SLAP tears
The shoulder is an incredibly complex joint. It has a large degree of
freedom at the expense of reduced stability. For this reason it is
subject to a wider range of injuries, most of which involve damage to
the rotator cuff.
The following shoulder pain exercises are designed to rehabilitate the rotator cuff muscles. They will be particularly useful for injuries such as shoulder impingement, tears in the rotator cuff, shoulder instability and SLAP lesions. The information has been adapted from the book, The Shoulder Made Simple (Version 6.0), by Dale J Buchberger.
Due to the volume of information surrounding this rehabilitation program, this article is only a summary of the shoulder pain exercises. It is strongly recommended that before attempting these exercises that you consult a physical therapist for a proper diagnosis of your shoulder condition, and any other information pertinent to the rehabilitation of your particular shoulder injury.
Rotator cuff & scapular strengthening – Day 1
1. Side lying abduction
Keep the humerus (upper arm) in the scapular plane.
Lift the humerus in the scapular plane. This is a linear movement.
Only raise the arm to the height of the knee. Approximately 30 degree
arc.
2. Push-up Plus
Keep elbows fully extended with scapulae retracted. Ensure your torso, spine and back muscles are all firmly activated.
Protract the scapulae (do not flex thoracic spine) whilst keeping the
elbows extended. Progress from using a Dyna-Disc to doing the exercise
with your feet on a physio ball and vary the lever length (start with
the physio ball under your knees first and progress to using it under
your feet).
3. Field goal
Place the Dyna-Disc under your chest while your arms hang relaxed off
the bench. The first progression is to retract the scapulae (pinch the
shoulder blades together).
While maintaining scapular retraction, extend the shoulders to 90 degrees. Keep the elbows flexed at 90 degrees.
Maintain 90 degrees of shoulder extension and scapular retraction.
From this position, externally rotate the shoulder with the thumbs
pointed up as pictured. Be sure to reverse each motion, but do so
SLOWLY!
4. Concentric/Eccentric
Side lying external rotation, pointing the thumb backwards. Elbow tucked into the front of your hip (the part part).
From the externally rotated position, press up to the ceiling, extending
the elbow. In the next photo, keep the elbow fully extended while you
perform horizontal adduction with internal rotation (turning the thumb
to the floor while crossing the chest). If there is anterior shoulder
pain, lower the arm to a comfortable level of adduction.
5. Modified empty can
Start in the thumbs down or “empty can” position. Retract the scapulae.
In the next photo, elevate the humerus with the thumbs pointed downward
in the scapular plane. At approximately 45 degrees of scapular plane
elevation, start externally rotating the arm whilst continuing to
elevate the humerus. You must maintain the scapular plane throughout the
motion.
Ensure you continue to elevate the humerus whilst externally
rotating. Notice the position of the elbow (100 degrees of abduction).
The scapula should be reset before each repetition.
6. Elbow flexion with pronation and supination
It is difficult to see in this photo, but the subject has anchored a
length of resistance tubing (with handle) at a distance from his right
side. The right arm would have initially been fully straightened at 90
degrees from the body. We see in this photo, the subject has flexed the
elbow (as in a bicep curl) whilst simultaneously supinating the forearm
(he has turned the forearm/wrist so that the palm of the hand faces the
ground at the end of the exercise)
Again, in this photo the right arm would have initially been fully
straightened at 90 degrees from the body. We see in this photo, the
subject has flexed the elbow (as in a bicep curl) whilst simultaneously
pronating the forearm (he has turned the forearm/wrist so that the palm
of the hand faces the ceiling at the end of the exercise). In both DO
NOT drop the elbow! Maintain the elbow position during elbow flexion.
This will also work the serratus anterior muscle.
Rotator cuff & scapular strengthening – Day 2
7. Subscapularis pull
Start with the elbow fully extended and the thumb up. Pull the tube
behind the back (internal rotation) and touch the bottom tip of the
opposite scapula with your thumb.
8. External rotation with scapular retraction
Keep the elbow tucked into your side as you externally rotate the
humerus. As external rotation is completed retract the scapulae
together.
9. Bilateral Blackburn 3 [BB3] – position 1 & 2
Use a Dyna-Disc under your chest, with your arms externally rotated. Retract the scapulae with elbows fully extended.
Lift thumbs to the ceiling with the elbows fully extended. Do not
hyperextend the shoulders. Hyperextension of the shoulders will cause
excess stress on the anterior shoulder capsule leading to shoulder
instability.
10. Standing 3-way
Start with the arms lowered by the side of your body, with elbows
extended. Retract the scapulae, and raise the arms forward keeping the
thumbs up, elbows still extended. Perform this motion slowly.
As above, start with the arms lowered by the side of your body, with
elbows extended. Retract the scapulae, and raise the arms in the
scapular plane. Keeping the thumbs up and elbows fully extended.
11. Dynamic Blackburn
Merely place the hands on the buttocks, and retract the scapulae.
Depress the scapulae by reaching for your feet. Keep the hands together.
While keeping the hands together lift them off of your buttocks.
Slowly release hands. Begin to externally rotate the humerus while continuously abducting the humerus.
Continue externally rotating whilst abducting, thumbs should point upwards now, and the arm is at 90 degrees of abduction.
Continue externally rotating whilst abducting, thumbs should point
upwards now, and the arm is at 100 degrees of abduction. This is the end
range of motion for this exercise. Do not go higher! Reverse the motion
slowly. Begin the next repetition from position 1.
12. Scapular retraction – End range
Lie face down with a dyna-disc under the chest. Shoulders and elbows are
at 90 degrees. The first movement is to retract the scapulae. The
forearms should not come off the floor.
Whilst maintaining scapular retraction, lift the elbows and thumbs to the ceiling. Maintain 90/90 degree position.
How many should I do?
These twelve shoulder pain exercises have been split into two days. There is no need to perform more than one day’s worth of exercises each day. You should perform two to three sets of each exercise. The advice Dale Buchberger suggests is to start each exercise with no weight and perform 10-15 repetitions. If this seems too easy, you can increase the number of repetitions by five until you can perform 30 repetitions pain free (eg. 15, 20, 25, 30). Before you can increase or add weight to an individual exercise, you must be able to perform 30 repetitions of that exercise. Some of the exercises will seem harder than others so expect to be using different weights across the twelve exercises.
Furthermore, you cannot increase repetitions until you have spent at least two weeks on the starting amount. For example, you must perform two to three sets of 15 repetitions of each of the twelve Buchberger shoulder pain exercises for two weeks. Only then, in the following two weeks may you increase to 20 repetitions of each exercise. Aim to do the Day 1 and Day 2 exercises four times each in the two week period.
If you do the maths, you’ll start to realise how long this
rehabilitation program can take. Understand however, that it may well
have taken longer than you realise to have damaged your rotator cuff in
the first place. Whilst it might be a slow process to recover from your
injury, know that Dale Buchberger has developed these exercises over a
period of longer than 15 years and has assisted numerous professional
baseballers (mostly pitchers) return to activity. The rotator cuff is a
small muscle group and so you need only work up to a weight of four to
five kilograms maximum. Overloading these small muscles is a frequent
cause of rotator cuff damage.
The level of discomfort you may or may not
feel after each exercise should help determine whether you can manage
more, or whether you should reduce the repetitions. You should not feel
pain during these exercises. If you do feel pain you may well be
performing them incorrectly. It is acceptable to experience a degree of
discomfort while performing some of the exercises. Your challenge is to
determine the difference between damaging pain and rehabilitative
discomfort. The emphasis must be on quality of performance, not quantity
of weight.
You can access more information on tips to save your shoulders here. Ensure you have run through these exercises with a practitioner, and that you understand their purpose.
*DISCLAIMER: This discussion does not provide medical advice. The
information, including but not limited to, text, graphics, images and
other material contained in this discussion are for informational
purposes only. The purpose of this discussion is to promote broad
consumer understanding and knowledge of various health topics. It is not
intended to be a substitute for professional medical advice, diagnosis
or treatment. Always seek the advice of your physician or other
qualified health care provider with any questions you may have regarding
a medical condition or treatment and before undertaking a new health
care regimen, and never disregard professional medical advice or delay
in seeking it because of something you have read in this blog.
