Even though rehab & training look awfully similar (they both use strength & mobility tools), knowing the WHEN to add specific exercises is often the difference between living with pain & getting rid of it for good.
Here’s the Rehab Rundown:
1- Get full range of motion first.
You should be able to position yourself in the "stick-em up" position (90 degrees at the shoulder, 90 degrees at the elbow) without tightness or pain. The same goes for being able to raise your arms overhead (without weight) or reaching behind your back.
If your range of motion has a painful arc or is pretty limited because of pain, start your self-care by employing as many anti-inflammatory measures as possible, while focusing on regaining all of your range. Icing what hurts, taking NSAIDs (as directed, but consistently), and/or switching to an anti-inflammatory diet can do wonders for reducing inflammation & regaining motion quickly in the early stages of pain. Light stretching into flexion, abduction and external rotation can be done to speed mobility even further.
If it’s been more than a week with pain just moving your arm, it’s time to call in reinforcements. The orthopedic MD/Physical therapist team can guide you through a more specific anti-inflammatory & shoulder stretching program that might be needed to make your active motion pain free.
2- Once the pain is gone, you still have some rehab to go.
Just because the pain with everyday motion is gone, doesn't mean the cause of your injury has been eliminated. There are still strength issues that need to be addressed in order to go back to your workouts without a return of pain: Investigate rotator cuff and scapular strengthening. Cable rows, Kneeling rows, Seated rows, Reverse rows, TRX rows with a lunge, Ts, Ys, Ms, Sidelying rotation, Rotations with a band, Ball catches, Windmills, Arm bars are all examples of the exercises necessary for scapular stability and rotator cuff strength. Do a lot of them.
3- Don’t forget your core.
This is more than crunches! Planks are key and so are pushups for both the mobile AND stiff person recovering from shoulder pain. Once range is pain-free and Delt & Rotator cuff strength is progressing, I use planks & pushups as a test for whether or not a patient can progress to the 3 faves: bench, lats & overhead. If pushups are still painful, regress to planks. If planks are still painful, look to adding more strength and awareness to your core, scap muscles & rotator cuff and try again in a month or two.
4- Your upper spine contributes more than you know.
➡Stiff shoulders usually belong to stiff upper backs- if you can’t twist, bend and extend your upper back, your shoulder will do too much to compensate for the lack of motion. Upper back stretches and mobility drills are a great addition to your program if you are stiff.
➡ Unstable shoulders usually belong to overly mobile spines. If you are in this category, work on core stability and learn how to control the excessive motion you were gifted with. Know that planks, press-ups, even arm bars and other new-ish stability drills shouldn’t be performed looking for end range if you are unstable and overly mobile. Maximal contraction is a good strengthening principle, but it should be attempted in various angles of mid-range not end range, especially in this population. If staying in mid-range seems too easy, exploring quick firing and/or quick motion reversals might be a good option for you. When in doubt, a physical therapist who is experienced in the sports population could show you other challenging stability exercises or direct your focus to other areas that need more attention.
There can be several reasons why your shoulders hurt: a tendency twds yo-yo exercise, incomplete program design, or increasing stiffness or hypermobility to name a few. But knowledge is power- sometimes a small change in mindset and program design is all you need to continue training without pain through this decade. Know it’s healthier AND more efficient to train smarter, not just harder, and you will be able to stay fit for life.