Shoulders are one of the most used joints for everyday movements. The lifetime prevalence of shoulder pain or injury in the general population is up to 70%.[i]
It’s a complex joint that connects the bones of your arm, your collar bone from the front and your shoulder blades from the back.
Many muscles and ligaments support it but still – the range of movement we get here is at the cost of stability. This results in injuries when your shoulders are not strong enough to handle the load.
As Physical Therapists, we see all kinds of shoulder injuries in our patients.
In this article, we’ll discuss some of the exercises that we use in rehab programs for such injuries. These can help you injury-proof your shoulders and prevent painful syndromes.
Common Shoulder Injuries in Athletes
Athletes tend to suffer a lot of shoulder injuries and most of them have to do with overuse syndromes or lack of proper training. Overhead activities, explosive movements and powerful throws are a few common culprits for this.
Here are the common shoulder injuries in athletes:
- Rotator Cuff tears and tendinitis: The rotator cuff is made of four muscles and the tears can happen anywhere but mostly occur at the point of insertion (this is where the muscles attach to the bone). Tendinitis is an inflammatory condition that can result from excessive repetitive motions. It’s commonly seen in basketball and baseball players, although most athletes that perform overhead activities in sports are at risk for rotator cuff tears. [ii]
- Labral and SLAP Tears: Labrum is a type of cartilage around the socket of the shoulder joint. It’s tear is also most common with overhead activities. So swimmers, tennis players and volleyball players are most prone to SLAP tears.
- Bursitis: The shoulder joint has six bursae (these are small bags of fluid in joint spaces). These lubricate the joint and can get inflamed with repeated overhead motion, overload and trauma. It’s common in sports that require throwing such as football.
Some other conditions that are commonly seen in athletes include torn biceps tendon, fractures, impingement and muscle imbalances in the front and the back of the shoulders.
Common Shoulder Injuries/Pathologies in Non-Athletes
Weekend warriors, the elderly and people battling underlying diseases or recovering from surgery are prone to getting shoulder injuries along with other injuries. Some of the common shoulder injuries in the non-athletic population include:
- Shoulder Sprain or Strain: There are many ligaments and muscles around the shoulder joint and a stretching injury of any of them can be painful. It can result from direct trauma or fall with outstretched hands.[iii]
- Frozen Shoulder: This involves a problem with the shoulder capsule and connective tissues around the shoulder complex. Patients suffer from a limited range of motion, pain and weakness in the muscles. This is common in middle and older aged people and those suffering from diabetes.[iv]
- Shoulder Dislocations and Instability: Anterior shoulder dislocation is the most common but your shoulder dislocates posteriorly as well. It happens when the muscles and the labrum supporting the humeral head in place become insufficient due to injury or genetics. Some people have recurrent dislocations and that can be dangerous as there is a risk of muscle or ligament tearing and nerve compression or blood supply compromise.
Arthritis, torn cartilage and impingements are some more pathologies that can happen in the shoulder joint. Although not all kinds of pain can be relieved with exercises, these can significantly help you improve your range of motion and quality of life.
Research-Backed Physical Therapy Exercises to Injury Proof Your Shoulders
Here are the best physical therapy exercises that can significantly improve your shoulder stability and flexibility. The best thing about these exercises is that you can use them either while recovering from a shoulder injury or to prevent an injury in the first place:
1. Multi-Directional Strengthening for Rotator Cuff
The dynamic stabilizers of the shoulder are those muscles and structures that resist an external pull to keep your joint secure from dislocation. These primarily include the rotator cuff, deltoids and the long head of the biceps.
Image source: Teach me anatomy
Rotator cuff strengthening exercises include:
- External and internal rotation of the shoulder with the arm abducted: Stand with your arm out while palms are facing forward. Bend the elbow at 90 degrees and drop the hand down then move it up towards the ceiling while keeping the elbow in place. [v]
- Side-lying external rotation with free weights: Lie on the side and put a folded towel under your elbow. Start by holding free weights in your hand close to the floor. Move your arm by bringing the weight closer to the ceiling. Make sure your elbow does not move away from the body during this.
- Shoulder abductions with resistance: Stand firmly and place one end of the resistance band under your foot. Hold the other end of the band in your hand and move your arm away from the body by keeping the elbow straight. You can do the same with a dumbbell.
- Weighted pendulum: stand with knees and hips slightly bent. Lean forward so that one arm hangs freely. Swing the arm back and forth like a pendulum while controlling the motion. You can add weights for progression.[vi]
Rotator cuff stretches can also improve your shoulder health and flexibility. These include a cross-body stretch and doorway stretch.
2. Wall Push-Ups and Shoulder Circles for the Elderly
Wall pushups and shoulder press-ups are ideal to work on several muscles in your back and secondary dynamic stabilizers of the shoulder. This exercise works on anterior deltoids, pectoralis muscles in the chest, biceps and triceps and the upper back muscles.[vii]
General shoulder strengthening exercises can be great for non-athletes and the elderly to build muscle tone.
These include:
- shoulder abduction (taking your arms out and away from the body sideways),
- flexion (taking your arms out and away from the body in the front)
- external and internal rotation exercises with an elastic band or two or three pounds free weights.
Shoulder circles are an ideal low-intensity exercise for maintaining flexibility and gaining tone in the shoulder muscles. You can begin with a pendulum-type motion while sitting with your arm hanging loose. Then increase the intensity by elevating the arm and adding weights as recommended.[viii]
3. Upper Back and Shoulder External Rotator Strengthening
If you have any damage to the rotator cuff, even if it’s asymptomatic, then the deltoid muscles and the trapezius muscles begin to take over the rotator cuff’s functions.
In that case, you’ll need to strengthen the middle and lower trapezius muscles and the external rotators of the shoulders. These muscles provide an additional layer of stability to your upper back and shoulders.
Middle Trapezius Strengthening: Start by lying on your stomach on a bed or a couch and leave your arms hanging on the side of the surface. Bend your elbows 90 degrees and lift them while squeezing the shoulder blades. Hold it for 3-5 sec and slowly bring the elbows back down.
You can extend the arms and add free weights as you progress (T-Raise). But remember to start slow and add resistance only when you’re ready.
Lower Trap Strengthening: Lie on your stomach on a bed and raise your arms in a Y position. Hold for 3-5 sec then lower and add weights as you progress.
You can also do chin-ups for strengthening your lower traps.[ix]
Shoulder External Rotator Strengthening: Prone external rotation with horizontal abduction (PER) is a great exercise for strengthening the Infraspinatus muscles which is a primary external rotator of the shoulder.
Here, you lie on your stomach with one arm hanging on the outside of the bed. Then you lift your arm to bring up towards the ceiling while keeping your thumb pointed outwards.
Shoulder Exercises That Reduce Risk Of Injury – In a Nutshell
Shoulder pain and injuries have a high recurrence rate so it is imperative that you injury-proof your shoulder from the get-go. 40-50% of people treated for shoulder related pain report persistent pain and recurrence at 12 months follow up.
Unresolved injuries from a long time ago can also cause pain and the flare-ups can be just as bad as the initial injury.
If you’ve suffered from an athletic injury or your shoulder aches and restricts movements, then you should consult with your health care provider to find the most suitable remedy and exercise regimen to get you back to full painless functioning.
[i] https://pubmed.ncbi.nlm.nih.gov/15163107/
[ii] https://www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-labrum-tear#:~:text=The%20labrum%20is%20a%20type,part%20of%20the%20shoulder%20blade.
[iii] https://nyulangone.org/conditions/shoulder-sprains-strains-tears/types#:~:text=Common%20causes%20of%20a%20shoulder,the%20clavicle%20and%20the%20acromion.
[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301845/
[v] https://journals.sagepub.com/doi/abs/10.1177/1758573219888829
[vi] https://orthoinfo.aaos.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/
[vii] https://journals.lww.com/nsca-scj/fulltext/2012/10000/the_biomechanics_of_the_push_up__implications_for.6.aspx
[viii] https://www.healthline.com/health/shoulder-pain-exercises#shouder-circles
[ix] https://www.healthline.com/health/fitness-exercise/lower-trap-exercises#chinup