Pain Management
Helpful Exercises

He Kori Tinana Āwhina

Helpful Exercises

 

Exercise and physical activity form the core of recovery and rehabilitation following shoulder injury or for people with shoulder pain. Rehabilitation exercises should be undertaken alongside all other treatments, such as activity modification, load management, manual therapy (and massage), pain medication, and surgery.

You should consider exercise specifically for the shoulder (starting examples are below), as well as general physical activity, such as walking regularly, jogging, cycling, or endurance exercise that you enjoy. You may also want to consider holistic exercise, such as yoga, fitness or gym training. Physical activity includes the sports that you may already be undertaking. 

There are many benefits and very few harms, if any, for exercising, particularly if you undertake exercise regularly, and within accepted guidelines. 

Exercise is important to maintain movement and to allow variability of movement. Here are just some benefits of exercise:

  • Improves your confidence in your shoulder.
  • Increases muscle strength and endurance in terms of how much you can lift and how often.
  • Improves communication between cells and within the nervous system, thereby can decrease pain pain (pain relief)..
  • Regulates the hormone system, which is required for general well-being, to manage stress, improve your ability to relax, and to improve sleep.
  • Improves strength of the tissues, including connective tissue and fascia, bones, cartilage, tendons and muscles.
  • Improves blood supply to the structures of the shoulder girdle, which is important to transport nutrients, oxygen and biochemicals and to remove waste products.
  • Improves body systems, such as digestion, immunity, and processes of the heart, lungs and kidney, amongst many others.

 

Should shoulder exercises be painful?

During the first few days following an injury it is advisable not to undertake exercises that increases pain. Once the acute pain settles, it can be acceptable to feel some pain or discomfort while doing the exercises, as long as the pain settles down immediately after the exercise session. Some tolerable soreness is acceptable after the exercise session, as long it settles down within 24 hours.

How much exercise is enough?

We need to consider how hard you are working (intensity), how many repetitions are needed, and how often you undertake the exercise (e.g. a couple of times per day, once per day, or every second day). In the examples below, we suggest doing 10 repetitions each time. As the exercises are gentle, they can be done three times or more per day. Monitor your pain and discomfort following the exercises. If the pain gets worse, decrease the number of repetitions, or do a smaller and slower movement, or choose another exercise.

Get help from a physiotherapist to work with you to decide what exercises are best for you, and what type of exercises you prefer. 32

The physiotherapist will also guide you to progress exercises as you get stronger and as the pain becomes more manageable.

The exercises below can be useful as a start-up.  

We thank Rosey Acker (physiotherapist) for demonstrating these exercises. 

 

Exercise 1: Shoulder Rolls

  • This is a useful starting exercise, connecting with breathing and relaxation.
  • It is done at very low effort and slowly.
  • It has very low loading at the shoulder joint.
  • It is possible that you feel some clicking in your shoulder while starting with exercises - that is quite normal.
  • Use it as part of a warm-up and cool-down for an exercise session, to slow down or reconnecting with the shoulder during the day.
  • Also suitable for days when the shoulder is painful or early after surgery.

 

Exercise 2: Shoulder statics

  • This exercise is suitable when you still have shoulder pain, within the first few days after an injury, and after most types of surgeries. It is also useful for days when your shoulder pain may have flared up.
  • It is done at very low effort and there is very low loading at the shoulder joint.
  • You will use your 'other' hand (painfree arm) to give counter-resistance for the sore arm. There is no movement of the sore arm, but you are asked to tighten muscles of the sore side against the 'other' hand.
  • You will be asked to slowly push against your 'other' hand placed against the outer side your elbow or at the wrist, and hold those contractions for a count of about 5 to 10 seconds. You will then slowly relax.
  • This exercise can also be used as a warm-up for other exercises.

 

Exercise 3: Accordion twists

  • This exercises focusses on the part of the rotator cuff that you use when twisting the arm outwards.
  • The exercise has low loading on the shoulder joint, and you will perform it gently and slowly. You can vary how far you twist the arm outwards.
  • If you do not have an exercise elastic, any sewing elastic can be helpful.

 

Exercise 4: Elbow rolls

  • This exercise is similar to Exercise 3, but places the arm away from your body on a table.
  • In the video, the physiotherapist uses a filled water bottle as a weight. You can also use a food can or other weight.
  • This exercise is slightly advanced from Exercise 3, but still has relatively low loading at the shoulder.
  • Continue to focus on the breathing, keep your shoulder blade pulled gently away from your ears, and do the exercise slowly, controlled,  and in a arc of movement that keeps your shoulder comfortable.
  • Feeling some painfree clicking in the shoulder may be perfectly normal.

 

Exercise 5: Wall glides

  • This exercises advances movement to the level of the shoulder.
  • The movement is slow, controlled, and in an arc of movement that is comfortable.
  • Continue to focus on the breathing, keep your shoulder blade pulled gently away from your ears.

 

Exercise 6: Wall presses

  • This exercise advances the loading on the shoulder joint, but is still a low level exercise.
  • The movement is slow, controlled, and in an arc of movement that is comfortable.
  • Continue to focus on the breathing, keep your shoulder blade pulled gently away from your ears.
  • We suggest that you try this exercise only once you know that the above exercises do not stir up the pain or discomfort.
  • As your pain improves, you may focus mainly on Exercise 4, 5 and 6.
  • Seek guidance from a physiotherapist if you have any concerns about the exercises, and also if these exercises become easy. It may be time to progress them, and to add more interesting exercises!