Exercises and Videos

Exercises


The Painful Shoulder or what happened to my swing?

Finally Summer seems to be here – time for gardening, a game of tennis or swinging the clubs on the local fairways. But what should have been a season of gentle leisure activities, fine tuning that killer serve or aiming for total ball control around the greens have come to an abrupt halt because of a tooth-ache-like pain – with maybe the occasional very painful stab – over the shoulder.

What happened? Where did I go wrong? I am not that old – am I?

You probably did nothing wrong. The pain appeared when you reached behind you in the car, trimmed the hedge for a bit too long, reached that little bit further out to return a volley or just threw a ball when playing with the dog. And after that movement, everyday activities such as tucking in your shirt, reaching for your rear pocket or your bra strap, combing your hair or drying your back becomes a real challenge. And putting your arm through a coat sleeve can be a killer!

The over-head serve may be a thing of the past that you can only dream of; that is if you can dream – for when the shoulder is upset nights are often even more uncomfortable than days

So what is wrong?

You are very likely suffering from the most common cause of shoulder pain in “The Ageing Athlete” (sorry, but age often plays a part!). The condition is known as “Subacromial Impingement Syndrome”. This condition occurs when the Rotator Cuff muscles become irritated underneath a prominence from the shoulder blade. The prominence – called the Acromion – can be felt at the point of the shoulder. As the Cuff muscles rub against the under surface of the Acromion they become swollen and inflamed.

The pain is felt in the fleshy part of the shoulder – often going much further down into the arm – occasionally as far as to the thumb.

Any movement associated with rotating the arm inwards (such as reaching behind your body), outwards and upwards and in particular quick movements may be associated with a very sharp stabbing pain. As the inflammation progresses the pain becomes more permanent, and the inflammation may result in build-up of scar tissue which eventually may irritate the bone. And there is a possibility that permanent muscle damage may occur in the form of rupture of the muscles.

But in most people it is a reversible process – mainly seen above the age of 40, although young athletes doing repetitive overhead activities may develop similar symptoms.


But what should I do? Do I need surgery?

First of all stop doing what brings on the pain – pain is Nature’s way of saying DON’T!! Rest the arm, place a cold compress over the shoulder rounding, take anti-inflammatory tablets (if you tolerate these). You may have promised to finish painting the ceiling, clear the gutters or play a match – DON’T DO IT!

Avoid overhead activities. If you have to reach up stand on a stool, or a step. Use your arm as comfortable below shoulder level. Do not allow your arm to stiffen up. Chances are that your symptoms will subside allowing you to return to activities (gently!). But if they do not you may benefit from further treatment.

If a course of anti-inflammatory tablets and rest have not cured the symptoms the next port of call may be physiotherapy. The aim of this is to maintain shoulder movements whilst strengthening the painful rotator cuff muscles (in particular the muscles responsible for rotating the arm away from the body).

If physiotherapy should prove unsuccessful a steroid injection close to the inflamed muscles may give relief. But if the symptoms persist surgery may be an option. At surgery the under surface of the Acromion (the bone irritating the Rotator Cuff muscles) is trimmed and any excess scar tissue removed. This is normally done as a keyhole procedure in a general anaesthetic as a day-case admission or if preferred one overnight stay. Surgery is followed by another course of physiotherapy. The majority of patients will experience relief of symptoms within 3-6 months. Time of return to work depends on how strenuous work is – and if the shoulder pain was brought on by awkward movements at or above shoulder height this may need addressing.

If surgery involves repair of a muscle rupture recovery may take much longer.

So goodbye sports?

By far the majority of patients will return to most previous activities – possibly with slight modifications to techniques – or lack of! For most the tennis racket and the golf clubs will be waiting and they should be used again. And there may still be time to practise the shot that you read about in the Golf Magazine or work on a serve that will leave your opponent shell-shocked
Remember that it applies to surgery as well as sports – you have to work on the inner game. And hopefully your inner game will not require surgery!!

Videos

Exercise 1

STRETCHING EXERCISE TO THE SHOULDER

This exercise is very useful for stiff shoulders (frozen shoulders or shoulders stiffened up following trauma or surgery).

Make sure that your orthopaedic surgeon or therapist allows you to elevate the arm fully before doing this exercise.

EXERCISE

Stand or sit next to a work top or a table.

Place the palm of your hand on the table.

Slide your arm forwards by bending at your waist i.e. by leaning forwards.

Keep your back and arm straight and reach as far forwards as you can.

Repeat this exercise 10 times 3 - 4 times per day.

Try to reach a little bit further every time you exercise.

At the maximum stretch your shoulder may feel pain. Only reach as far forwards as pain allows.

You can also do this exercise whilst seated on an office chair with wheels. Place your palm on the desk as described above. Keep the hand in the same position on the table while you push the chair backwards thereby increasing the stretch on the shoulder


Exercise 2

SUPINE SHOULDER STRETCHES

Performing shoulder stretches whilst lying down is a good way of concentrating the forces applied to the shoulder joint itself. If you try to push the arm upwards while you are standing upright it is easy to "cheat" by leaning backwards - this makes it appear that the shoulder is going higher than it really is.

If the exercise is done lying down(supine) your back movements are neutralised and it is only the shoulder joint which is stretched.

This exercise is useful for any stiff shoulder i.e. frozen shoulders or shoulders which have been operated on or have been injured.

Make sure that your orthopaedic surgeon or therapist allows you to elevate the arm fully before doing this exercise. If you suffer from arthritis or a reduced range of movement of the other arm you may not be able to lift the arms fully up. In that case it may be easier to support the stiff side by holding around the elbow instead of holding the wrist.

EXERCISE

Lie down on the floor or on a firm mattress.

With your good hand grab hold of the wrist on the side that needs stretching (or hold around the elbow as suggested above).

Guide / lift the stiff arm as high as possibly ultimately aiming for bringing the arms up to touch the floor / mattress above your head.

Repeat this exercise 10 times (as pain allows) several times a day.

Exercise 3

SUPINE ACTIVE DELTOID STRENGTHENING EXERCISE

Once a good range of passive movements has been obtained the next step is strengthening the Deltoid muscle. Although this can be done in the upright position it may be difficult if the muscle has not been used for a while.

By exercising the Deltoid muscle in the supine position (lying on your back) the strain on the muscle is much less.
Before doing this exercise check with your surgeon or therapist that you are ready and safe to start on strengthening exercises.
If your good arm suffers from stiffness or arthritis you can do the exercise by holding around the elbow instead of the wrist

EXERCISE

Lie down on the floor or on a firm mattress.

With your good hand grab hold of the wrist on the side that needs stretching (or hold around the elbow as suggested above).

Guide / lift the stiff arm up to the upright position, i.e. at an angle of 90° to the floor.

Slowly let go with your good hand making sure that your weak deltoid muscle is strong enough to hold the weight of the arm. You may have to practice this stage to prevent your weak arm from dropping down.

Practice holding the arm steady in the upright position.

When you can hold the arm unsupported start swaying it back and forth in line with your body. As the Deltoid muscle gets stronger you can increase the angles in either direction i.e. bring the arm further up above your head and further down towards and past your waist.

Do this exercise 10 times at a time several times every day. If the shoulder becomes painful return to Exercise 2

Exercise 4

SUPINE RESISTED DELTOID STRENGTHENING EXERCISES

This is exercise is useful once you have enough strength to sway the arm back and forth on its own (Exercise 3) with out supporting it with the other arm.

You must ensure that your surgeon or therapist allows you to strengthen the Deltoid before commencing this exercise.

I will suggest that you use a plastic bottle (with a lid!!). I do NOT advice holding on to a glass bottle or a tin or can. Hold the bottle rotated away from your face in case you should drop it.

Start off with only a small amount of water in the bottle. This will naturally depend on your muscle strength, but starting with 2-300 ml (approx. half a pint) may be sufficient.

Gradually increase the weight of the bottle.

EXERCISE

Lie down on the floor or on a firm mattress

Hold a plastic bottle with water in your hand (rotate the hand so the knuckles face you and the bottle faces away from your face)

Bring the arm with the bottle up straight in front of you (at an angle of 90° to the floor)

Commence swaying movements in the line of your  body - i.e. bring your hand above head height and lower it down towards and gradually past your waist.

Do this exercise 10 times at a time 3-4 times per day as you are able.

Once you can do this exercise with several pounds of weight in the hand you are ready for exercises in the upright position.

Exercise 5

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ASSISTED ELEVATION OF THE SHOULDER USING A THERABAND

This is a very useful exercise to strengthen a weak Deltoid muscle. By allowing the rubber band (Theraband) to assist the arm when it is raised up and to resist the arm when it is lowered down even a very weak Deltoid muscle may be able to elevate the arm to above head height.

Very often lowering the arm down from a raised position is painful. By lowering it against the resistance of the rubber band the movement becomes less painful.

Make sure that your orthopaedic surgeon or therapist allows you to elevate the arm fully and also allow you start strengthening exercises before doing this exercise.

EXERCISE

Tie a knot to the end of a yellow Theraband or a similar broad rubber band
Place the knotted end over a door and close the door

Stand or sit facing the door (Video 5) Reach up as high as possibly with the arm that needs exercise and grab hold of the rubber band.

Now place your other (good) hand above the one that needs exercise and pull down the rubber band, in order for the hand of the weak arm to be placed above the good one.

Let go with your good hand.

The rubber band will now help you lift up the weak arm and give some resistance when you lower it down.

If you need more assistance to elevate the arm, use your good hand to pull the rubber band further down before you grab hold of it with your other hand. The further up you hold on to the rubber band the more it will assist you lifting up the arm and resist you bringing it down.

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