shoulder-injury

Shoulder Injuries require comprehensive rehabilitation exercise programs to be successful to restore your function and give you pain relief. It is vital that you participate in your recovery. Your Nose Creek Sport Physical Therapist will prescribe you a level to work on, once you find it easy, ask him or her for the next level.  Depending on your goals for your own return to play or work, will dictate how far we go with your rehabilitation exercise program. The key to shoulder muscles is to first build up the endurance before the power. That is why we say your goal is 3 sets of 10 reps in the first week, then increase to 3 sets of 15 reps in the second week, then 3 sets of 20 reps in the third week.  Once 3 sets of 20 reps is easy, we need to advance you to the next level of your rehabilitation.  Please ask if you have any questions. This online exercise resource is for your convenience to review any exercises you may have forgotten how to do.

Exercises for Shoulder Injury

  • Passive Range of Motion Stretches

    Shoulder Pendulum:

    • Stand and bend at the waist, holding a table with the unaffected arm, leaving the affected arm hanging.
    • Initiate the movement with the body and slowly rotate your arm in a circular motion, progressively getting bigger as comfort allows.
    • Repeat in the other direction.
    • Do 20 circles in each direction

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    Shoulder Pulleys:

    • Sit under a pulley. Hold each end of the pulley cord with each hand.Palm facing up on the affected arm.
    • Pull down on the cord with your good arm to lift the affected arm forward as high as possible within your pain free range of motion. Keep your arm straight.
    • Maintain the position, return to the initial position and repeat.
    • The affected arm should be relaxed, and not be doing any of the movement.

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    Assisted ROM External Rotation:

    • Lie on your back with knees bent and place each hand at either ends of the stick.
    • Keeping the affected elbow against the body at all times, move your hand away from the body and increase the mobility by pushing the hand with the stick.
    • Maintain the position, return to initial position and repeat 10 – 20 times.

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    Inferior Shoulder & Triceps:

    • Bend your elbow and position your arm overhead.
    • Grab your elbow with your opposite hand and pull back until you feel a strong pain free stretch in the back of your upper arm.
    • Hold for 20 to 30 seconds, repeat a second time if tight.

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    Posterior Shoulder & Rotator cuff:

    • Stand and place your upper arm across your chest and your hand over the opposite shoulder.
    • Squeeze your shoulder blades together and use your other hand to push your arm in towards you, until you feel a stretch in the back of your shoulder.
    • Let your forearm slowly rotate down to increase the tension in the back of the shoulder.

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    Front of Shoulder & Pectoralis Muscles:

    • Stand in a doorway with your elbow and hand against the edge of the doorway.
    • Lean your chest and hips through the doorway until you feel a stretch in your chest.
    • Hold for 20 – 30 seconds, repeat twice if tight.

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  • Level 1: Resisted Isometric Shoulder Exercises

    Internal Rotation:

    • On the corner of the wall, stand facing the wall with your elbow bent at side and the palm of your hand against the opening.
    • Push into the wall by slowly picking up intensity over a 2 second interval, then maintain the pain free intensity for 8 seconds, then slowly reduce the contraction over a 2 second interval. This technique applies to all resisted isometric exercises to avoid any quick jerky contractions which will increase pain and swelling in your shoulder.
    • Keep the wrist firm and do not allow it to bend throughout the exercise.

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    External Rotation:

    • On the corner of the wall, stand with your elbow bent at side and the back of your hand against the wall.
    • Push into the wall by slowly picking up intensity over a 2 second interval, then maintain the pain free intensity for 8 seconds, then slowly reduce the contraction over a 2 second interval. This technique applies to all resisted isometric exercises to avoid any quick jerky contractions which will increase pain and swelling in your shoulder.
    • Keep the wrist firm and do not allow it to bend throughout the exercise.

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    Extension:

    • Against a wall, stand with your elbows bent and held out from your body about 20 – 30 degrees.
    • Press your elbow back against the wall. Push into the wall by slowly picking up intensity over a 2 second interval, then maintain the pain free intensity for 8 seconds, then slowly reduce the contraction over a 2 second interval.
    • This technique applies to all resisted isometric exercises to avoid any quick jerky contractions which will increase pain and swelling in your shoulder.

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    Shoulder Abduction:

    • Stand 6 inches off the wall, then raise your forearm up against the wall.
    • Press out with your elbow and feel the outside of your shoulder contract.
    • Push into the wall by slowly picking up intensity over a 2 second interval, then maintain the pain free intensity for 8 seconds, then slowly reduce the contraction over a 2 second interval. This technique applies to all resisted isometric exercises to avoid any quick jerky contractions which will increase pain and swelling in your shoulder.

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    Shoulder Blade Retraction:

    • Sit or stand straight, with your arms by your sides.
    • Squeeze your shoulder blades together “down and in”.
    • Hold for 10 seconds, then relax for 10 seconds.
    • Repeat 5 times, 6 times per day.

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  • Level 2: Tubing Exercises

    External Rotation at 0 Degrees:

    • Anchor a resistance band at elbow height and place a rolled towel between your arm and body.
    • Keeping your elbow on the towel roll, rotate your arm out against the resistance of the band.
    • Make sure your elbow does not come away from your body.
    • Return and repeat, 3 sets of 10 – 20 repetitions.

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    Shoulder Flexion (pushing):

    • Anchor a band behind you at elbow height.
    • Push the tubing by extending your elbow and shoulder in front of you in a controlled movement (sawing wood motion). Do not let your elbow go behind you; only do the front half of the motion.
    • Return to the starting position and repeat, 3 sets of 10 – 20 repetitions.

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    Shoulder Internal Rotation at 0 Degrees:

    • Stand and tie an elastic on the side of the injured arm at elbow level.
    • Hold the end of the elastic and bend your elbow to 90 degrees.
    • Tuck your chin in and pull your shoulder blades down and in while you pull the elastic towards your belly.
    • Keep your chin in and your elbow bent against your body at all times.
    • Slowly return to the starting position and repeat, 3 sets of 10 – 20 repetitions.

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    Extension (pulling):

    • Stand in a good upright posture, knees slightly bent, lower core engaged, chest up and shoulder blades down and in, chin tucked to neutral and hold this posture throughout the exercise. Do not let the chin poke.
    • Hold the ends of the elastic with your elbows straight and thumbs pointing out.
    • Initiate the motion with the shoulder blades, drawing the blades backward with the arms. Do not shrug.
    • Pause at the end of the movement, then slowly return to the starting position.
    • Concentrate on the pattern of the movement, controlling your head and neck posture before increasing the resistance.

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  • Level 3: Closed Kinetic Chain, Recoil and PNF Diagonal Exercises

    Closed Kinetic Exercises – standing on the wall:

    • In standing position, put your hand on a ball placed against a wall, face the wall with shoulders and then turn trunk slightly (30 degrees) to the side with the arm not on the wall.
    • Push your body weight through your shoulder into the ball.

    Variations:
    • Static loading (push and hold for 10 seconds)
    • Protraction and retraction (move shoulder blade forward and backwards)
    • Elevation and depression (move shoulder blade up and down)
    • Clockwise and counterclockwise circles

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    Closed Kinetic Exercises – on the floor:

    • On the floor, in a push-up position with the ball, keep the trunk stiff by tightening your abdominals and buttock muscles. Retract the shoulder blades down and in. Now move the body on the ball, while the hands remain fixed on the floor.

    Variations:
    • Forwards and backwards
    • Side to side
    • Circles left and right
    • Protraction and retraction (Push shoulder blade forwards and backwards)
    • Elevation and depression (Push shoulder blades up and down)

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    Recoil Exercise:

    • Stand with the end of the tube under your opposite foot.
    • Grip the tube and position your elbow straight ahead just below shoulder height, with your elbow bent to 90 degrees.
    • Start with the arm in a horizontal position and pull up into external rotation to a vertical position
    • Once you can do 3 sets of 10 – 20 repetitions easily, progress by moving your upper arm out to the side 45 degrees, then straight out to the side in a 90/90 position.

    Sets: 3
    Repetitions: 10 – 20

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    PNF Pattern: Ext.Rot.+ Abduction:

    • Tie tubing to the leg of a couch or bed.
    • Standing beside it with your opposite side close to the attachment.
    • Grasp the tube with your thumb, pointing to the opposite hip.
    • Pull the band up and across your trunk at a 45 degree angle, ending with your thumb pointing behind you, above the shoulder level into the 90/90 position (like drawing a sword).
    • Slowly recoil down to the starting position.

    Sets: 3
    Repetitions: 10 – 20

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    PNF Pattern: Int.Rot.+ Adduction:

    • Arm in the 90/90 position, thumb points behind you.
    • Pull the tube down and across at a 45 degree angle, ending with your thumb pointing to your opposite hip (like putting away a sword).
    • Slowly recoil to the starting position

    Sets: 3
    Repetitions: 10 – 20

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    PNF Pattern: Ext.Rot.+ Extension:

    • Grasp the tube with your thumb pointing behind you, your arm at a 45 degree angle above shoulder height.
    • Pull tube down and across chest at a 45 degree angle, ending with your thumb pointing behind you.
    • Slowly recoil to the starting position

    Sets: 3
    Repetitions: 10 – 20

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    PNF Pattern: Int.Rot.+ Adduction:

    • Grasp the tube with your thumb pointing behind you, you arm 45 degrees away from your side.
    • Pull tube up and across chest at a 45 degree angle, ending with your thumb pointing behind you above shoulder level.
    • Slowly recoil to the starting position.

    Sets: 3
    Repetitions: 10 – 20

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  • Level 4: Super 6 Dumbbell Exercises

    External Rotation:

    • Lie on your side with your elbow bent at 90 degrees and the upper arm resting on the top side of body. Place a towel under your upper arm to keep your elbow off your side.
    • Rotate your forearm from your stomach towards the ceiling and then slowly lower it over a 5 second count.

    Sets: 3
    Repetition: 10 – 20

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    Pitching Drill:

    • Lie on your side with one arm straight up and the shoulder blade tucked down and in.
    • Slowly lower the arm down towards the floor on a 45 degree angle from the trunk, leading with the thumb pointing down. Stop when you touch the bed or floor.
    • To reposition the arm to start position, bend the elbow to 90 degrees and tuck it into your side.
    • Lift your upper arm from the shoulder, pointing the elbow to the ceiling.
    • Straighten the elbow so that the arm is straight up.

    Sets: 3
    Repetition: 10 – 20

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    Beer Can Exercise:

    • In a standing position raise arms to 80 degrees elevation in the scapular plane (i.e.- 30 degrees forward from the lateral position).
    • To protect your Rotator Cuff, make sure to raise arms up with the thumb pointing up and go down slowly with the thumbs pointing down.

    Sets: 3
    Repetition: 10 – 20

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    Serratus Anterior (shoulder blade exercise):

    •Lie on your back with the affected arm pointing straight up to the ceiling.
    • Reach for the ceiling and then lower arms over a 4 second count, focusing on moving the shoulder blades apart and then slowly back together.
    • Progress:
    a.) Hold the arm with the shoulder blade protracted up, shoulder blade held forwards to the ceiling, while you move your arm in a circle. Start with small circles and then gradually make them larger.
    b.) Imagine an “X” drawn through the shoulder, then move the arm diagonally along the “X” (45 degree angle).

    Sets: 3
    Repetition: 10 – 20

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    Extension (pull back drill):

    • Set shoulder blades down and in, and maintain while pulling your arm back in line with your body.
    • Slowly return to starting position and relax shoulder girdle.

    Sets: 3
    Repetition: 10 – 20

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