Shoulder Pain Relief & Recovery: How an Exercise Physiologist Can Help

Shoulder pain can result from injuries, poor posture, or overuse, affecting daily activities like lifting, reaching, and even sleeping.

Whether it's rotator cuff issues, frozen shoulder, or impingement; targeted rehabilitation exercises can reduce pain, restore mobility, and improve strength.

As an Exercise Physiologist, Nick specialises in shoulder rehabilitation programs designed to aid recovery and prevent future injuries.

Rotator Cuff Injuries

The rotator cuff is a group of 4 muscles that surround the shoulder. They work mainly as a dynamic stabiliser of the shoulder, ensuring the shoulder joint is stable when moving in all directions. A rotator cuff tear involves a disruption to the muscles and/or tendons of the rotator cuff and is a common injury of the shoulder.

It is first to determine if the orator cuff tear is acute or degenerative

Acute

Usually a sudden and sharp explosive movements of the shoulder under high load can cause a tear.

Common causes of this injury include:

Pushing, pulling or lifting objects with incorrect technique
Dogs pulling on a leash, pulling on the shoulder. Children pulling down on the arm/shoulder.
Falling onto the shoulder

Treatment:

Protect, elevate and compress the area if possible (tape or bandage)
Once intial pain seeltes down, strengthening exercises involving the muscles between the shoulder blades and the rotator cuff muscles itself, improve control of the shoulder complex.

Degenerative

Due to its lack of good blood supply, the rotator cuff is susceptible to wear and tear.

Degenerative rotator cuff tears can occur with no apparent mechanism of injury, or with sudden sharp movements such as:

Pushing, pulling or lifting objects with incorrect technique
Repeated irritating movements
Falling onto the shoulder

Treatment:

Mobility exercises: Exercises that promote a gradual improvement of shoulder range of motion, without aggravating the injury.
Strengthening exercises involving the muscles between the shoulder blades and the rotator cuff muscles itself, improve control of the shoulder complex.

Shoulder Impingement

Shoulder (or sub-acromial) impingement is the mechanical irritation of either the supraspinatus tendon or subacromial bursa, resulting in pain and inflammation.

These structures lie in the subacromial space and are sensitive to friction and compression.

What causes impingement?

There are several factors which may contribute to this condition. These include:

Tightness around the capsule which surrounds the shoulder joints
Instability and excessive movements of the shoulder joint
Weakness and/or damage to the muscles which control the shoulder blade, or the shoulder joint itself
Other changes such as acute injury or labral tears (less common).

Signs and symptoms

Slow onset of pain, over a few weeks
Pain at the front or top of the shoulder, which can refer down the muscles of the shoulder.
Pain with overhead movement/activity
Night pain can indicate inflammation of the subacromial bursa (bursitis)

Treatment Approach:

Activity modification: Identifying and modifying any activities involving the shoulder that puts it at risk of impingement. A rehabilitation program will aim to gradually get you back to these activities.

Strengthening Exercises: the KEY to rehabilitating sub-acromial impingement. Working on the strength and control of the shoulder blade muscles, and the strength of the rotator cuff will help improve the position of the shoulder girdle, increasing the subacromial space and reducing the chances of impingement.

Other interventions: some structures such as inflamed bursae or bone spurs can also reduce the subacromial space.

If your rehab program is not effective in reducing your shoulder pain after 7weeks or so, referral for imaging and/or corticosteroid injection may be considered.

Frozen Shoulder (Adhesive Capsulitis)

A frozen shoulder is a rheumatological (inflammatory) condition characterised by scarring and tightening of the connective tissue surrounding the shoulder joint, usually resulting in a large loss of shoulder movement.

Frozen shoulders most commonly occur in people over 40 years of age and typically affect women more than men.

Despite the name, it has nothing to do with winter or being cold.

What causes frozen shoulder?

The exact cause is not known, being a rheumatological condition, it can spontaneously occur following injury or damage to the shoulder joint or adjacent soft tissue. In these cases, a frozen shoulder is more likely to develop if the initial injury is not treated appropriately.

Signs and symptoms

Frozen shoulders can generally be divided into 3 phases, each of which can last a number of months:

Freezing / Pain – the shoulder typically becomes painful with most movements and may also start to stiffen. During this phase other injuries of the shoulder may be misdiagnosed, as the general “freezing pattern” is yet to occur.
Frozen – a marked loss of movement of the shoulder, coinciding with scarring of the shoulder joint capsule.
This follows a very particular pattern, which is why frozen shoulders are most commonly diagnosed in this phase. Patients typically experience difficulty when elevating the arm or taking their hand behind their back.
Pain may decrease noticeably during this phase, but stiffness increases dramatically.
Thawing – In this final phase, the shoulder spontaneously begins to 'loosen' up and movement to the shoulder is gradually restored.

Treatment

Unfortunately, there is no “fix” for frozen shoulder once it has set in, and you need to allow it to run its course.

However it is important to participate in stretching and activity to maintain as much movement and strength as possible.

Strengthening Exercises: Play an important role in maintaining as much shoulder strength and function as possible.

Mobility Exercises: Generally begin at the end of the freezing phase or beginning of the thawing phase. These aim to maximise the available range of motion of the shoulder.

Other interventions: an injection called a hydrodilation can help restore shoulder range of movement more quickly. These are normally performed under ultrasound and give decent results.

Shoulder Dislocation & Instability

Shoulder dislocation is when the humerus (upper arm bone) is separated from the glenoid fossa (shoulder socket).

It is a painful injury that can occur from a fall or direct blows to the shoulder.

Instability usually occurs following a dislocation injury, it can also occur naturally in a person with hypermobile joints. If the ligaments, tendons, labrum and capsule of the shoulder are generally looser (lax), the shoulder joint moves in a more uncontrolled manner.

This laxity can lead to other issues, such as rotator cuff impingement, labrum tears, or further risk of dislocation.

Signs and symptoms

History of dislocation or subluxation – every dislocation or subluxation further stretches the ligaments and capsule of the shoulder, leading to further joint laxity.
Apprehension – the feeling that the shoulder will dislocate and the bodies subsequent involuntary muscle contractions to keep the shoulder in place
Untreated instability can result in increased load on the ligaments and muscles of the shoulder, leading to other injuries secondary to the instability.

Treatment

Acute injury management: If an acute dislocation occurs, never try to "put it back in", go to the Emergency Department and have it relocated under medical supervision. Subsequent imaging should be completed to assess for any damage to the joint.

if you are recovering from a subluxation or dislocation, it is important to give the shoulder some rest to allow it to settle down.

Activity modification: Avoiding activities or exercises that put the shoulder at risk of causing further injury, UNTIL there is better motor control and stability of the shoulder. Rehab will aim to progress you back to completing these activities safely.

Strengthening exercises: the KEY to rehabilitating or managing shoulder instability. Specific strengthening of the shoulder blade and rotator cuff musculature improves the stability and motor control of the shoulder joint.

Other intervention: depending on the severity of the instability, and especially in light of previous dislocation, a surgical opinion may be warranted. This is especially important if you are an athlete that uses the arms in their sport (football, tennis etc)

Shoulder Arthritis

Osteoarthritis (OA) is the general wear of the articular cartilage lining of a joint.

OA can present in the gleno-humeral joint (the shoulder), however, it is less common than the knees and hips, which are weight-bearing joints.

History of shoulder injuries, shoulder surgeries (such as arthroscopes) and genetics can lead to accelerated shoulder OA.

Signs and Symptoms

Severe shoulder stiffness, particularly overhead, occasionally with “grinding” type sensations accompanying movement.
Secondary muscular referred pain can be present down the side or front of the shoulder, normally about halfway to the elbow.
Pain is generally an ache type pain, that is more intermittent than constant.
Pain is generally worse in the morning, and can be worse in cold weather

Treatment

Shoulder mobility exercises: movements that help push the shoulder into more range, especially overhead, can help reduce stiffness and improve range of motion of the arthritic shoulder.

Strengthening exercises: Exercises targeting the muscles of the shoulder blades and rotator cuff can help improve the efficiency of movement of the shoulder, and can help improve pain and function.

Surgery: An operation called a reverse shoulder replacement can help restore pain free range of motion, depending on the severity of the shoulder OA.

Book an Appointment – Start Your Recovery Today

Shoulder pain can make daily tasks challenging, but exercise therapy and rehabilitation can help you regain movement, strength, and confidence. Book a session with Nick to start your recovery today.