What exercises are recommended for shoulder strain?

Exercise Recommendations for Shoulder Strain

For shoulder strain, implement a progressive exercise program focused on gentle stretching and mobilization techniques that specifically increase external rotation and abduction, while gradually advancing active range of motion exercises alongside strengthening of weak shoulder girdle muscles. 1, 2

Core Exercise Protocol

Initial Phase: Gentle Mobilization

• Begin with gentle stretching and mobilization techniques targeting external rotation and abduction to prevent frozen shoulder and maintain joint mobility 1, 2
• Perform active, active-assisted, or passive range of motion exercises to prevent complex regional pain syndrome and maintain joint integrity 1, 2
• Position the arm within the patient's visual field in safe, appropriate positions during all exercises 2

Progressive Strengthening Phase

• Gradually increase active range of motion while simultaneously restoring alignment and strengthening weak muscles in the shoulder girdle 1, 2
• Therapeutic exercise demonstrates significant positive effects on both pain reduction and functional improvement across all shoulder pain conditions 3
• Exercise therapy aimed at restoring neuromuscular control mechanisms is equally effective as corticosteroid injection but less costly to administer 4

Exercise Types with Equal Efficacy

All three loading patterns show effectiveness for rotator cuff tendinopathy 5:

• Open chain resisted band exercises
• Closed chain exercises
• Minimally loaded range of motion exercises

Note: Closed chain exercises have higher dropout rates but show better outcomes in patients who complete treatment 5

Critical Exercise to AVOID

Overhead pulley exercises must be avoided as they encourage uncontrolled abduction and have the highest incidence of developing hemiplegic shoulder pain 2

Adjunctive Modalities to Enhance Exercise

• Apply local heat before exercise (higher strength of recommendation than ultrasound) 2
• Use ice, heat, and soft tissue massage as adjuncts to reduce pain/swelling and improve tissue elasticity 2
• Consider neuromuscular electrical stimulation (NMES) as an adjunct, though efficacy data remain limited 2
• Mobilization with movement (MWM) added to standard exercise improves function by 15 points on the Shoulder Pain and Disability Index and reduces pain by 2.1 points at night 6

Pain During Exercise: A Common Concern

Both painful and non-painful isometric exercises cause only moderate, short-lasting increases in shoulder pain (resolving within 45 minutes), with no significant difference between approaches 7. This means exercises can be performed at either 20% above or 20% below pain threshold with similar outcomes 7.

Positioning and Support Strategies

• Ensure proper shoulder positioning and protection from trauma to reduce shoulder-hand syndrome frequency 2
• For wheelchair users, lap trays and arm troughs may reduce shoulder pain and subluxation 2
• Consider shoulder strapping during ambulation to protect from traction injury, though evidence for pain prevention remains insufficient 2

Important Clinical Pitfalls

Aggressive passive range-of-motion exercises performed improperly can cause more harm than good 2. The complex shoulder joint requires controlled, gradual progression rather than aggressive manipulation 1.

Pharmacologic Adjuncts When Needed

• If no contraindications exist, use analgesics such as acetaminophen or ibuprofen for pain relief 1
• For spasticity-related pain, consider botulinum toxin injections into subscapularis and pectoralis muscles 1
• Subacromial corticosteroid injections can address pain related to rotator cuff or bursa inflammation 1