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Which exercises can give relief from shoulder pain?

Thursday, 28 January 2010
Answered by: Dr Sakina Balsara
Physiotherapy & Pain Rehabilitation Clinic, Pune
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Q. I am a 38 years old man having pain in my right shoulder for the last 2 months. The x-ray showed a problem with my tendon due to which I am unable to lift my right hand upwards. I am taking painkillers to get relief from the pain. I am not sure if it is the cold weather, which affects me. What medication can I take? Will exercise help me? Please advise.

A.  A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder). You might experience soreness after activities such as painting, lifting or playing a sport, which require you to lift your arms. Or you may remember a specific injury.

If your Doctor has said that there is some problem with your shoulder tendon then you definitely need shoulder strengthening and stability exercises.

Also remember that cold climate seems to worsen the pain. So avoid direct exposure to cold to your shoulder.

Treatment should help relieve the pain and help you restore your shoulder to normal function. Pain relief strategies include active rest (you can and should move your shoulder, but you shouldn't do strenuous activities like lifting heavy objects or playing tennis). Application of ice, taking non-steroidal anti-inflammatory medicine and, occasionally, an injection of anti-inflammatory steroids can also help.

Special exercises may also help. The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. These range-of-motion exercises are followed by resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.

The following exercises may help you. Ask your doctor if you should do other exercises, too.
  • Range of motion. Stand up and lean over so you're facing the floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles, and then draw bigger ones. Repeat these exercises 5 to 10 times during the day. If you have pain, stop. You can try again later.
  • Rotator cuff strengthening. Use a piece of rubber tubing for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With your hand that is closest to the door, bend your arm at a 90° angle and grab the loop of the tubing. Pull the band across your tummy. At first, do 1 set of 10 exercises. Try to increase the number of sets as your shoulder pain lessens. These exercises should be done every day.
  • Upper extremity strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your left arm at your side. With a weight in your left hand and your forearm across your tummy, raise your forearm. Keep your elbow near your side.
Apart from the above strengthening exercises you should also do the below mentioned range of motion exercises.
  • Climbing the wall
    Put your hand flat on a wall in front of you. Use your fingers to "climb" up the wall (like a "spider"). As you move your fingers up little by little, stop and hold your hand in place for 30 seconds every few inches. Move your fingers up the wall as high as you can reach. Keep trying to go higher.
  • Codman exercise
    Sit sideways in a straight chair. Rest your armpit on the back of the chair. Now swing your arm slowly in circles. Make little circles at first and then make bigger circles. Make the circles in both directions.
  • Reaching
    Put things you use every day (shoes, coffee cup, toothbrush) on a high shelf. This way you have to reach up for things more often. The reaching is a good stretch for your shoulder.

A.  A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder). You might experience soreness after activities such as painting, lifting or playing a sport, which require you to lift your arms. Or you may remember a specific injury.

If your Doctor has said that there is some problem with your shoulder tendon then you definitely need shoulder strengthening and stability exercises.

Also remember that cold climate seems to worsen the pain. So avoid direct exposure to cold to your shoulder.

Treatment should help relieve the pain and help you restore your shoulder to normal function. Pain relief strategies include active rest (you can and should move your shoulder, but you shouldn't do strenuous activities like lifting heavy objects or playing tennis). Application of ice, taking non-steroidal anti-inflammatory medicine and, occasionally, an injection of anti-inflammatory steroids can also help.

Special exercises may also help. The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. These range-of-motion exercises are followed by resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.

The following exercises may help you. Ask your doctor if you should do other exercises, too.
  • Range of motion. Stand up and lean over so you're facing the floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles, and then draw bigger ones. Repeat these exercises 5 to 10 times during the day. If you have pain, stop. You can try again later.
  • Rotator cuff strengthening. Use a piece of rubber tubing for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With your hand that is closest to the door, bend your arm at a 90° angle and grab the loop of the tubing. Pull the band across your tummy. At first, do 1 set of 10 exercises. Try to increase the number of sets as your shoulder pain lessens. These exercises should be done every day.
  • Upper extremity strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your left arm at your side. With a weight in your left hand and your forearm across your tummy, raise your forearm. Keep your elbow near your side.
Apart from the above strengthening exercises you should also do the below mentioned range of motion exercises.
  • Climbing the wall
    Put your hand flat on a wall in front of you. Use your fingers to "climb" up the wall (like a "spider"). As you move your fingers up little by little, stop and hold your hand in place for 30 seconds every few inches. Move your fingers up the wall as high as you can reach. Keep trying to go higher.
  • Codman exercise
    Sit sideways in a straight chair. Rest your armpit on the back of the chair. Now swing your arm slowly in circles. Make little circles at first and then make bigger circles. Make the circles in both directions.
  • Reaching
    Put things you use every day (shoes, coffee cup, toothbrush) on a high shelf. This way you have to reach up for things more often. The reaching is a good stretch for your shoulder.

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Read Comments
Posted by : John Zenian, on Friday, April 30, 2010
Typically, Xrays cannot detect damage to the tendons. Assuming there is no gross injury the following steps might help you: Avoid any kind of exercise that involves your shoulder. Exercises are designed to strengthen and develop body parts, not to treat pain. Exercises can only make your condition worse because often they contain maneuvers that are not compatible with the normal functionong of the body. Avoid sleeping on the painful shoulder since sleeping on the shoulder for a long time can cause or exacebate shoulder pain. Sleeping on the back is the most beneficial position for your pain assuming that you are otherwise healthy. You can achieve that by sleeping in a recliner or a hospital type bed. Sleeping in a position with the back elevated will discourage turning over during sleep. The idea is to create the conditions necessary for the painful shoulder to recover by avoiding further aggravation.
 
Posted by : Amol Sangekar, on Sunday, January 31, 2010
Hope your feeling better by now! In the unfortunate scenario where in you are still suffering , m advice to you will be to see an Orthopedic surgeon specialising in Shoulder or upper-extremity. You mention in your querry that your tendon problem was detected on X-ray, is rather unusal, as xrays will only reveal bony problems( unless u mean there are boby signs indicating a tendon problem). You also mention an interesting fact that you are unable to raise your arm. If this is so , then just following a website therapy protocol may cause more damage than good. Please see a Shoulder specialist at your earliest
 
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