Many of us will experience shoulder pain at some point in our lives, and it is a
very common problem. It is vital to accurately diagnose the pain so the shoulder
can be rehabilitated and treated as soon as possible. Here are some of the more
common causes of shoulder pain, with a brief explanation of each cause.
The following conditions are treatable using my book:
Shoulder impingement syndrome – this is where the supraspinatus tendon
(one of the rotator cuff muscles) gets trapped underneath the acromioclavicular
joint (ACJ). Other names for shoulder impingement syndrome are clinical
impingement syndrome and painful arc syndrome.
Bursitis – inflammation of the bursa (fluid filled sac) that sits underneath one of
the shoulder joints, known as the acromioclavicular joint.
Supraspinatus tendonitis – this is tendonitis of the supraspinatus muscle, one
of the rotator cuff muscles. Most often caused by abrasion underneath the ACJ.
Rotator Cuff Tear – this is where one of the rotator cuff muscles tears. You may
suffer a full thickness tear, or a partial thickness tear. The rotator cuff attach all
around the shoulder and help to stabilise it.
Calcific tendonitis – this is where the rotator cuff tendon becomes calcified due
to a prolonged period of abrasion.
Shoulder Arthritis (of the acromioclavicular joint) – wear and tear changes
under the acromion of the shoulder leading to shoulder impingement syndrome.
This includes bone spurs.
Frozen shoulder – also known as adhesive capsulitis, this is where the shoulder
joint capsule hardens usually in response to trauma or surgery. This results in a
widespread stiffening of the shoulder. Commonly over-diagnosed.
Shoulder Dislocation – the arm bone (humerus) is forced out of the shoulder
joint, usually by trauma.
Shoulder instability – a loose shoulder joint which usually results after dislocation.
Acromioclavicular (AC) Dislocation – the clavicle (collar bone) is forced out of
joint. Usually results from a fall on an outstretched hand.
Labral tear – the rim of the shoulder joint is torn during trauma. Most common in
contact sports such as rugby.
Shoulder Arthritis (of the glenohumeral joint) – degeneration of the head of the
humerus.
Biceps Tendon rupture – the biceps (upper arm muscle with two heads) tendon
pulls off the bone as a result of trauma.
Exercises
I have categorised these exercises in levels 1 – 4. You should perform the levels
in order, and only progress to the next level when you have achieved the
previous level.
In the photographs, Jon has a painful RIGHT shoulder.
You may use the periodisation table in the appendix as a guide to likely time frames
of shoulder exercise progression, but don’t be tempted to rush ahead. Go
at your own pace, and perform the exercises gently and as described.
Level 1 Exercises – Passive Mobilisation:
Level 1 is designed to improve the range of mobility in your stiff shoulder.
Perhaps you want to read that again! Yes, these exercises will finally allow you to
move your arm in a comfortable range of mobility. Great for any stiff shoulder.
The exercises start assisted, so the muscles of the painful shoulder can remain
relaxed while the shoulder is mobilised. We call these passive range of mobility
exercises. Alternatively at this point, if you have a good osteopath or
physiotherapist, they can assist by lifting your arm for you.
When you do these exercises, move the joint slowly, and gently. Avoid the ranges
of movement that give you sharp pain, although feeling minor discomfort should
be expected in certain ranges.
Take the shoulder to the point of mobility which feels comfortable, and then take
it just a fraction further to increase the range of motion. At this point, return the
arm to its resting position.
You will find that every couple of days you will notice some improvement in the
range of mobility of that shoulder and arm. You can compare the movement to
that of the good shoulder to give you an indication of how far you have to go with
the mobility.
1. The Pendulum
• Keep the shoulder completely relaxed
• Let momentum and gravity move it in circles
• Go anti-clockwise and clockwise
• Keep the circles within your comfort zone
• Perform for 2 minutes, 3x per day
2. Rock the baby
• Keep the bad arm relaxed…
• The good arm holds the bad arm
• Keep the movement within your comfort zone
• Rock 15x each side, 3x per day
3. Passive flexion
• The affected shoulder should be relaxed during the movement
• The left arm lifts the right arm
• Keep the movement within your comfort zone
• Perform 15 repetitions, 3x per day.
4. Passive extension
• The right arm stays relaxed during the movement
• The left arm pushes the right arm backwards
• Keep the movement within your comfort zone
• Perform 15 repetitions, 3x per day.
5. Passive abduction 30°
• The right arm stays relaxed during the movement
• The left arm lifts the right arm
• Make sure the arm is lifted at 30°
• Perform 15 repetitions, 3x per day
6. Towel exercise for internal rotation
• The active arm is the left arm, the right arm stays completely
relaxed except to hold the towel
• Straighten the left arm, thus allowing the right arm to come up
the back
• Move up and down within your comfort zone
• Perform 15 repetitions, 3x per day
Level 2 Exercises – Stabilisation:
1. Sitting stabilisation
• Sit on a bench or chair
• Rest your hands by your side
• Gently lean from one hand to the other hand, putting gentle but
increasing weight through the shoulder
• Do not put all your weight through the right shoulder, just lean
into it
• Rock 15x onto the right shoulder, 3x per day.
2. Standing stabilisation
• Start around 1½ feet from a wall
• Lean forwards onto the wall, resting the palms flat against the
wall with the elbows bent (in a standing press-up position)
• Rock gently from side to side, applying pressure to one shoulder
and then the other.
• You can make the exercise more challenging by moving the feet
further away from the wall.
• Hold for 30 seconds, 3x per day
• Start in a 4 point kneeling position
• Rock gently from side to side, applying pressure to one shoulder
and then the other.
• Hold for 30 seconds, 3x per day
Level 3 Exercises: Active Mobilisation:
Level 2 exercises are a natural progression from level 1, because they now rely
on your shoulder muscles to move the joint.
Again, work within your comfort zone… don’t push the shoulder through the pain
barrier. Take it to its comfortable end of range, and then just a fraction further to
get the required mobility.
1. Side-Arm pendulum
• Swing the arm in a pendulum as shown
• Go clockwise and counter-clockwise
• Perform for 30 seconds, 3x per day
2. Shoulder shrugs
• Upwards: lift the shoulders towards the ceiling, and hold for a
couple of seconds, before relaxing.
• Backwards: pull the shoulders backwards by squeezing the
shoulder blades, and hold for a couple of seconds before
relaxing.
• Perform 10 repetitions, 3x per day.
3. Chicken wings
• Resting the hands on the hips, pull the shoulders backwards
and forwards
• Perform 10 repetitions, 3x per day
4. Flexion
• Raise your bad arm as far as is comfortable, then try and take it
just a fraction further
• Hold for a couple of seconds, then lower.
• Perform 10 repetitions, 3x per day
5. Internal rotation “The Brastrap Exercise”
• Reach behind your back, and take the hand as high up the back
as comfortable, then just a fraction further.
• You should feel a gentle pulling feeling at the front of the
shoulder. Hold this position for a couple of seconds
• At first you may find this exercise difficult and uncomfortable,
but persevere, and over a few days you will achieve greater
mobility
• Perform 10 repetitions, 3x per day
6. Stroke the shoulder blade
• Reach behind the opposite/good shoulder and try to stroke the
shoulder blade.
• This is another movement that is likely to be quite painful, but
again keep practising; go to your end of comfort zone, and just
a fraction further.
• Perform 10 repetitions, 3x per day
7. 30° wall crawl
• Make sure the arm is not directly to your side
• Leave it at a 30° angle, as shown in the picture
• Crawl up the wall to your end of comfortable range, then just a
fraction further, and back down the wall.
• Perform 10 repetitions, 3x per day
8. The Drawing of the Sword
• The thumb starts facing downwards, and at the end of the
movement, faces upwards
• Imagine you are drawing a sword out of its sheath
• Perform 10 repetitions, 3x per day
9. Pec Stretch
• A lovely shoulder exercise, great for posture; it will improve
mobility in the anterior capsule of the shoulder
• Rotate the torso, and lean forward, creating a stretch to the
shoulder
• Perform 10 repetitions, 3x per day
10. The Football Supporter
• One of my favourites, but the hardest in this level, so don’t do it
unless you feel comfortable with it
• Holding a towel above your head (imagine it’s a scarf of your
favourite football team), gently move the arms from side to side
• Perform 10 repetitions, 3x per day
Level 4 Exercises: Advanced Stabilisation
1. Swiss Ball Stabilisation 2 hands
• Kneel down, place the hands on a Swiss ball
• The instability of the ball will help the small stabiliser muscles of
the shoulder strengthen
• Progress the exercise by moving the knees further from the ball
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger
2. Swiss Ball Stabilisation 1 hand
• The same exercise as the previous, but one handed
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger
3. 2-point Kneeling
• Adopt a 4-point kneeling position
• Lift opposite arm and leg 2 inches from the floor, so that your
weight is put through the bad shoulder
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger
4. Prone Cobra
• This is a great exercise for scapular stability, and back extensor
strength, helping to keep those shoulders back, thus helping to put the
shoulder in a mechanically advantageous position
• Make sure the thumbs are facing upwards, with the arms turning
outwards (n.b. not inwards). You will notice that turning the arms
outwards opens the chest and shoulders (=good), inwards closes the
chest and shoulders (=bad)
• Hold for 30 seconds, 3x per day
• Increase the hold for up to 2 minutes as you get stronger
