Shoulder Pain: Exercise to Build Resiliency

Shoulder exercise should be used when you are able to complete the movements required sufficiently without significant discomfort or pain production. These activities involve more complicated shoulder mechanics and recruit a greater proportion of muscles surrounding the area than isolated exercises for specific muscles. The more you are able to complete exercise like this, the more efficient and resilient shoulder activity becomes!

(General movement and continued freedom of motion in the shoulder is still important in order to maintain the overall health of joint tissues. This is the next step in recovery.)

A number of these shoulder exercises are focused on recruiting muscles that stabilize the shoulder blade. This type of focus is important to provide a more supportive foundation from which the shoulder joint itself can move without as much potential for injury. This is a built-in mechanism to “centrate” the shoulder before and during movement.

Dos and Dont’s

Do… Take these slowly. Focus on making the appropriate movement. Prioritize quality of movement over quantity. Stick with it — these exercises are challenging for people without shoulder discomfort, and even more so if you’re on the road to recovery.

Don’t… (1) Push through truly painful movements… return to an activity later, or avoid it altogether and keep focused on the range of motion activities from last post if pain is persistent. (2) Get hung up on the number of times or total resistance you can use! Focus on quality. (3) Give up! These are difficult, and achieving resiliency means you have to stick with it.

The Shoulder Exercises

The exercises below have been selected because they effectively recruit muscles that help control the shoulder joint and shoulder girdle at the same time, rather than having each exercise focus on a selected muscle specifically. This means fewer total exercises required as you can hit several targets simultaneously — which offers a more time-efficient routine, but without sacrificing effectiveness to help build total activity resiliency.

3A> Scaption with External Rotation

“Scaption” is a term that indicates the movement you want is in the “scapular plane”. The shoulder blade sits at a slight angle behind your ribs (because the ribs are rounded) so that it points slightly forwards about 30° forward.

This means if you take arms and raise them up at your sides specifically, this is anatomical ABduction. If you do this again at about 30° forward from that line, you are now in the “scapular plane”. This is a more efficient movement plane for the shoulder blade and it’s surrounding muscles.

Shoulder Exercise Scaption

Use a small weight (1-3 lbs, soup can, water bottle, etc.) or light resistance band for this to provide slight resistance. Begin in a ‘centrated’ position. Raise your arms up in the scapular plane keeping the elbows straight and thumbs pointed up. Go as high as is comfortable, and then return to start.

Complete 2-3 sets of 10-15 repetitions.

3B> Scapular Wall Slide

This variation of a wall slide helps groove better scapular motion when you are raising your arms and shoulder. Maintaining forearm contact with the wall during movement changes how the shoulder girdle functions slightly — in this case, it helps generate better synergy between movement of the shoulder joint and movement of the shoulder blade. Consider placing a towel between your forearm and the wall if you are having difficulty with the sliding movement (ie. getting stuck to the wall).

Scapular Wall Slide

Start by facing the wall, with your dominant foot touching its base, and the other foot placed at shoulder width apart and behind the dominant foot. Place your forearms against the wall with the shoulders and elbows forming a 90° angle, keeping the thumbs pointed away from the wall.

Raise your arms by sliding your forearms up the wall, moving into a “Y” shape, and allow the shoulder blades to slide “out and around” at the same time. Continue until the elbows are straight, or you cannot go any further. You can shift your weight into your dominant foot as needed while sliding your arms up the wall, too.

Return to the start and repeat for 2-3 sets of 10 repetitions.

3C> Sidelying External Rotation

Many of the muscles that help support shoulder function, and some of the most common to fatigue, are at the back of the shoulder as part of the rotator cuff. This simple rotation exercise for the shoulder helps to build more activity tolerance into these muscles.

Side-lying External Rotation

Begin lying on your side, either propped up on the opposite elbow or flat on the floor — your choice. Place a small object (pillow, towel, tennis ball, etc.) between the up-side elbow and your torso. Use a small weight (1-3 lbs, soup can, water bottle, etc.) or light resistance band to provide a little resistance.

Squeezing the object between your up-side elbow and torso lightly so it doesn’t move, rotate your arm outwards towards the ceiling and turn the palm “up” so it points towards your face (or thumb “out”, to achieve the same thing). Hold for 1-2 seconds, and return to the start.

Repeat for 2-3 sets of 10-15 repetitions.

3D> Elevation plus External Rotation

Another elevation exercise, this combined motion of elevation with external rotation of the shoulders is another exercise designed to create synergy between muscles controlling the shoulder blade and the shoulder joint itself. However, different muscles are targeted with this exercise than with 3B), so it is important to do both activities if possible.

For Elevation Plus External Rotation, having a resistance element during movement is preferred. Fortunately, there are several options available for home use: you can use a looped band if you have one (my preference), pull a resistance band between your hands to create consistent tension, or pull on both ends of a towel to create tension if nothing else is available. Since the towel has no elasticity it is the least preferable, but will work in a pinch.

Elevation plus Ext Rotation

Begin seated or standing with the shoulder “centrated” and elbows bent to 90°, thumbs up. Pinch the shoulder blades together slightly so the arms rotate outwards about 30°, creating moderate tension. Then raise the arms to shoulder height while maintaining the same tension. Hold for 1-2 seconds, and return to the starting position.

Repeat for 2-3 sets of 10-15 repetitions.

3E> “W” Exercise

This is a very similar exercise, but more specific to the muscles of the shoulder blades. It is also one of my favourite clinical exercises for people with pain while raising their arm to the front — establishing good muscle function at the back of the shoulder (like this exercise is designed to do) frequently helps with this a lot.

Once again use a looped band between your hands if you have one, or pull on a resistance band or create tension by pulling on both ends of a towel if nothing else is available, as this exercise is most effective with a resistance component.

W Shoulder Exercise

Begin seated or standing, and find a “centrated” shoulder position, and bend the elbows to 90*. Create moderate tension by pinching the shoulders together slightly and rotate the arms outwards at the same time. Try to make the shape of a “W” (viewed from the back). Hold this position 3-5 seconds, and return to the starting position.

Repeat for 2-3 sets of 10-15 repetitions.

3F1 and 3F2> D1/D2 Shoulder Pattern

These final activities have a more complicated pattern, but they are very effective movements for recruiting a number of shoulder muscles simultaneously and in a safe manner. You can do these without resistance, with low resistance, or with moderate resistance. (Start low — take it slow — do NOT push through painful barriers).

Complete these sitting to begin, and progress to standing once you get a feel for the movements. Let the movement at the hand and wrist guide the overall motion, as this helps make the movement between positions smoother overall, and easier to follow. Both of these movements are described in steps (ie. first, then, now, etc.), but if possible perform the body movements in each step simultaneously as you become more comfortable.

There are two movements to complete, termed D1 and D2:

Shoulder Pattern D1

For those with anatomy backgrounds, we are moving the shoulder from Flexion-ADDuction-External Rotation to Extension-ABduction-Internal Rotation.

For everyone else, here are the steps for D1:

1> Begin in your “centrated” shoulder position. Thumb up.
2> Flex your fingers and wrist, roll your thumb out, and raise your arm up and across your body (in front of your face). Hold 2 seconds.
3> Then, extend your fingers and wrist, roll your thumb down, and lower your arm so it extends behind you, and out away from your side slightly. Hold 2 seconds.
4> Repeat movement between step 2) and 3) for 8-10 times.

D1 Shoulder Pattern

Shoulder Pattern D2

For those with anatomy backgrounds, we are moving the shoulder from Flexion-ABduction-External Rotation to Extension-ADDuction-Internal Rotation.

For everyone else, here are the steps for D2:

1> Begin in your “centrated” shoulder position. Thumb up.
2> Extend your fingers and wrist, roll your thumb out, and raise your arm up and away your body (like holding a tray in the air with your palm). Hold 2 seconds.
3> Then, flex your fingers and wrist, roll your thumb down, and lower your arm so it reaches down and in front to the opposite hip. Hold 2 seconds.
4> Repeat movement between 2) and 3) for 8-10 times.

D2 Shoulder Pattern

For reference, completing a routine like this ensures activation of all of the following muscles important for shoulder health and function: supraspinatus, subscapularis, deltoid (anterior/middle/posterior), teres minor, infraspinatus, trapezius (middle/lower), serratus anterior, rhomboid major.

It is also important to note that there are a number of different shoulder exercises that are possible to complete, so please don’t consider this a comprehensive list. Having said that, the six exercises above were selected for their ability to selectively activate the areas most important for shoulder function, without further compounding frequent problem areas that come with shoulder pain (like the upper trapezius) — and of course doing so in an efficient manner so it doesn’t take several hours to complete.

As always, if you have concerns or further discomfort with your shoulder while trying to go through a series of activities like these, seek an assessment with a health practitioner who can offer further review specific to your present needs.

Until then, good luck!

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