Shoulder Therapy - The Ultimate at Home Guide

THE RULES - Read Before You Get Started

Rule #1. If it hurts, don't do it! If any of the ideas shared here increase the pain AT ALL, ditch it immediately.

Rule #2. Don't get creative. Stick to the instructions, but always default to Rule #1.

Rule #3. Pain management is meant to be used whenever you are in pain. That part is obvious. Here's what's not so obvious: Pain limits function, so trying to regain function while in pain can be self-limiting. A rehab "trick of the trade" is to calm down the pain first, do some functional exercise, keep the pain to a dull roar, do some more exercise, and at the end of an exercise session, continue to keep the pain to a dull roar.

Think about it this way - some of what you can do is passive (i.e. using heat or ice) and some is active (i.e. moving, aka exercise). Both, when used properly, can reduce pain and stimulate tussue healing. All you can hope for is to provide the optimal stimuli and have healing happen as fast as your body is capable.

SO...have a look at some of the choices I've written about, try some or all of the, and use the tactics that give you the best results(see THE STUFF below). Try using them both before and after (and even during breaks) doing the rehab exercises described later in this lens.

Rule #4. Be wise. If you need to seek medical help, do it. Now. What are you waiting for.

THE STUFF - Okay, Let's Get Going!

HEAT - Specifically, use moist heat (a moist heat pack - 13" x 10" should be adequate - versus dry heat, from a traditional heating pad, for example).

If the injury is less than 48 hours old, don't use heat. If your shoulder has an opened wound, don't use heat (and quit reading this and go seek medical care right away as warranted). If it's either chronic (not caused by a recent trauma) or older than 48 hours, here's what you do...

Use moist heat by taking a towel, soak it in warm water, squeeze out 80-90% of the water, and apply the warm moist towel to the painful area for 2 minutes. Yes, I said 2 minutes. Not 20. No, I didn't forget the zero. 2 minutes. That's it.

Once the area returns to pre-warming temperature, you can re-apply. If the pain is reduced, moist heat should be put in your "toolbox".

COLD - Use a cold pack (or a bag of frozen veggies), apply to the area for 2 minutes. (there's that 2 minutes again!) Once the area returns to pre-cooling temperature, you can re-apply. If the pain is reduced, ice should be put in your "toolbox".

MASSAGE - This includes any and all work on the soft tissue (generally muscles). If you are doing this yourself, or do not have the benefit of an expert (i.e. a therapist), be gentle. Use the LIGHTEST amount of effective pressure. Remember Rule #1 (see above). The best technique is the one that relieves your pain. Period. It may take some trial and error, but usually what works once will work again for any given individual.

Here's an interesting article on one soft tissue technique called Trigger Point Massage. FYI, I used it regularly in my practice as a go-to technique.

Key areas to work on are, in the order listed: (1) subscapularis, (2) upper trapezius and levator scapulae, (3) infraspinatus, (4) latissimus dorsi, (5) triceps, (6) biceps, and (7) pectoralis.

LIFESTYLE MANAGEMENT - This is really just a fancy way of saying that you should stick with Rule #1 for all things in your life during healing. So, this includes stuff at home (in the world of Physical Therapy, we call this ADLs - Activities of Daily Living), recreational activities, etc. The biggest mistake many of my patients made during rehab was ignoring this rule. It WILL set you back by 2 weeks (or more) if you break this rule. So DON'T BREAK THIS RULE (sorry for yelling, but I feel strongly about this).

Avoid doing too much during the time your shoulder is healing. Healing does not equal healed. You may feel like "testing it", but don't. You know better. Listen to your body. Heal first, then get back to your "normal" life. Be patient. 'Nuff said. (sorry again for yelling)

Another component of lifestyle management is managing your eating to support anti-inflammation. A really good place to start is to read this article by Dr. Andrew Weil.

The other side of knowing what to eat is knowing what NOT to eat... You should avoid foods that promote inflammation (called pro-inflammatory) and can read more about that in this article.

NATURAL SUPPLEMENTS - Let's keep this simple. First, they aren't miracle pills. They help your body do its job and support healing. They require consistent use. They aren't immediate pain killers. Try them and see if they work for you. The two I have found to be useful (personally and professionally) are (1) fish oil - capsule form, pharmaceutical grade, 2-4 grams per day in divided doses. I use this supplement daily, and (2) Glucosamine Sulfate - you've probably heard about this one. I use this supplement.

EXERCISE - not for strengthening (read below for that) but for pain management. Simple movements, either active (no help) or assisted (with help from a device, your other hand, or another person) can help to reduce your pain. The general idea is to provide your body with a way to know which tissues (i.e. tendons) to heal - and movement is very important in this regard. For some of you, arthritis (chronic inflammation of a joint) may be the reason for your shoulder pain. This article explains how exercise can help. See the section below for more info.

These shoulder exercises fall into two overlapping categories: reducing pain and restoring function. The key here is that as your pain is reduced, you should gradually increase functional components like range of motion, speed, repetitions (for endurance), and resistance (for coordination and initiation of return of strength).

Most of the ideas discussed earlier in this article were forms of passive pain management. Exercise can be a form of active pain management (active in this sense means that you do some physical work).

Guidelines
Rule #1 (see above) applies here. But don't throw the baby out with the bath water. You can modify the following components of these exercises if pain increases during exercise performance:

-Change the speed - either speed up or slow down.
-Change the range of motion - move more, less, or limit motion to the pain free zone.
-Resistance - either increase or decrease the resistance.
-Repetitions or time - generally doing less is the rule (in other words, stop if pain starts to increase).
-Position - if possible, re-position your body to accommodate discomfort (i.e. perform the exercise sitting versus supine/laying down).
-Frequency - alter the number of times per day or week.

Generally, for pain management, the resistance is low (or absent). Unless otherwise indicated, the repetitions are higher (on the magnitude of 30 or more. The time to perform the exercise is in the 2-5 minute range. The rate / speed is generally 1-2 seconds per repetition. The range of motion should be the most you are capable of without incurring / inducing pain. The frequency is several times per day (3-5 or more). The frequency per week is daily.

Here are the exercises to focus on:

(1) Shoulder Pulley Exercises - Using a shoulder rope pulley allows you to "help" raise your arm, thereby moving your shoulder, when it needs help. Generally, pain limits motion. When you are in pain, you'll either avoid moving, or you might find ways to "cheat" to get the motion done. Both are not ideal for healing.

A basic way to use a shoulder rope pulley is to perform flexion (assisted raising and lowering of your injured arm to the front to) and abduction (assisted raising and lowering to the side). My patients use the deluxe overdoor pulley.

(2) Shoulder Rehab Protocol Exercises - I recommend you have a look at the following shoulder rehab protocol.

Yes, I know the page says these exercises are for shoulder surgery patients - but you should know two things. ONE, most patients are encouraged to do these exercises before surgery to prepare their joints and muscles for a more speedy recovery, and TWO, they are effective shoulder rehab exercises even if you never need surgery (which I hope you don't!).

Once the pain is either under control or absent, you can officially "graduate" from these exercises. Think of them just as you think of the other pain management tools. Use them as needed, and return to them if you either have a set-back, or if they help with pain management.

To do these exercises, you will need to get the MARV handle with resistance tube. If you are interested in a complete kit, you should buy the MARV shoulder kit.

The MARV has solid research behind it that you can read about in this article.

Once your shoulder pain is under control (either absent, or nearly so) you will likely be at the point such that:
(1) Your motion is 80-100% restored.
(2) Your strength is returning.
(3) You are in the process of using your arm during the day, with the exception of lifting the "heavy" stuff.
(4) You can sleep through the night most of the time without waking up in pain.
(5) You are eager to get back to your normal recreational activities.

Now is the time to focus on exercises that fully restore your mobility / range of motion and your strength and endurance.

PHASE I

Phase I is all about doing motions in one plane at a time. There are many motions available to work at this time, but I've listed several important starting exercises below.

First, here are some basic rules to follow:
-As always, avoid pain.

-Move through the most motion you can, trying to increase the range of motion each workout until the motion is normal (i.e. the same as your other, healthy shoulder).

-Use enough resistance so that the workout is challenging, but possible. Too easy is just as ineffective as too difficult.

-If you are sore, reduce the resistance and do your best. If you are unable to do a specific exercise, take a day off. Remember, pain is not your friend!

My patients made excellent progress by concentrating their efforts on the following exercises (consult this exercise chart for photos and descriptions):

-Depressions (see page 3 of the exercise chart)

-External Rotation (see page 4 of the exercise chart, do both versions)

-Empty Can (see page 2 of the exercise chart) - OR do this exercise in the thumb up position, also called Full Can

-Rowing (see page 5 of the exercise chart)

For definitions of the following UPPERCASE WORDS, you can refer to this fitness glossary.

Your goal is to perform 3 SETS, resting 1 minute between SETS. Each SET should consist of 25 REPETITIONS performed under full control. Use enough tension in the band to allow for completion of the target REPS, but it should be challenging.

If it's too easy, increase the tension. If it's too difficult, decrease the tension.

Do one exercise at a time, in the order listed above. The entire workout should take about 25 to 30 minutes to complete.

You should do this workout once per day, every day.

I'd highly recommend keeping a journal or some written record of what you do day to day, noting the exercise name, the number of sets and repetitions, the amount of rest between exercises and sets, and how you felt.

Once you are fully pain free and have full and normal range of motion, move to Phase II.

PHASE II

You have some options in Phase II. For those of you who are looking to move to more comprehensive strength training, you can do more exercises from the shoulder exercise chart, and you may even choose to do some elbow exercises from the following elbow exercise chart.

If so, the rules are the same as above, with the following goals: Do 4-6 sets of each exercise, performing 6-12 repetitions, and resting 90 to 120 seconds between sets. You may decide to break the workout up into 2 parts, which you perform in alternating fashion from workout to workout. Exercise every other day.

In this scheme, you may do 6 exercises as your "A" workout, and 5 different exercises as your "B" workout. You would then do workout A on Monday, workout B on Wednesday, workout A on Friday, workout B on Sunday, etc.

For those seeking a different more functional challenge, you may opt to return to your pre-injury recreational activities. Just remember to ease back into it.

For many people, it can take 12 to 16 weeks of consistent effort to get to this point. There's no rushing the healing process. You can only optimize it.