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Shoulder pain

Best Shoulder Bursitis Exercises: Stronger Shoulders

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Shoulder Bursitis can be frustrating and painful. BUT, with the right shoulder bursitis exercises, shown in this article, you can get your shoulder to a 100%, without the need for cortisone injections or surgery.

In this post, we will outline:

  • What shoulder Bursitis is
  • What the causes are
  • Treatment options and their effectiveness
  • The best shoulder exercises to fix it

What is Shoulder Bursitis

Shoulder anatomyShoulder bursitis is technically called subacromial bursitis and is inflammation of the bursa in the shoulder. To understand what it is, you, first, need to know some basic anatomy;

What is a Shoulder Bursa

A Bursa is a very thin (1-2mm) fluid-filled sac and they are found throughout the body. They help decrease friction and ensure different tissues move smoothly.

The subacromial bursa is, as the name suggests, under the acromion. It separates and creates smooth motion between your top rotator cuff muscle and your acromion bone.

The acromion is the uppermost aspect of your shoulder blade that forms the roof of your shoulder.

Why is it sore

When the bursa gets overloaded through one of the below causes, it becomes inflamed and puffs up. Because there isn’t much space in the subacromial space between the roof of the acromion and the shoulder joint, you can then get pain and impingement.

Where should I feel the pain

Pain from shoulder bursitis is often felt to the side of the shoulder and can refer down towards the elbow.

shoulder pain

What causes shoulder bursitis

The subacromial bursa gets inflamed typically due to repetitive or sustained load that put load on the bursa. This is normally activities with either your arm out in front of you, over your head or in slouched positions.

Activities, where your arm, is elevated put the bursa in a more compressed position and hence with repetition is more likely to get irritated.

Slouching or having a forward shoulder blade position brings the roof (acromion) down lower, meaning there is less room for error.(1)

What adds to and makes you more likely to get shoulder bursitis is the following:

  • A weak rotator cuff or Lats – The cuff help keep the ball sitting in the socket nicely, without this, impingement of the bursa can happen
  • An over-active deltoid – This tends to ball the ball up in the subacromial space more
  • A tight pec minor and forward shoulder position – this brings the “roof” down

It can also be caused by prolonged compression such as sleeping in one position on your side for a long time or abnormalities of the acromion such as osteoarthritis or a beaked acromion.

So, hopefully, you are beginning to see that bursitis is generally secondary to other issues. If we address everything around it such as muscle length and strength, the bursa has a chance to settle and get better.


Treatment options

Cortisone injections

These are done very often but with high rates of recurrence of pain. This is partly due to the fact that you are just band-aiding, covering and easing the pain.

The trouble with this is that if there is any underlying causative weakness, stiffness or poor control, the shoulder bursitis or shoulder pain is likely to come back without good rehab to address deficits.

As well as that, the available literature indicates that there is little reproducible evidence to support the efficacy of subacromial corticosteroid injection in managing rotator cuff pain.(1)

Surgery

Surgery should be the last option. There is no evidence that surgery is more effective than conservative treatment. (2)

Shoulder bursitis, often called subacromial bursitis is largely a secondary issue. That means that is caused by something else and doesn’t often just happen by itself.

That, simply, is why surgery isn’t the be all and end all and why there is a lot of studies (below) that show that surgery is no better than exercise rehab for impingement syndrome (which causes shoulder bursitis) and large rotator cuff tears.

surgery

Physiotherapy rehab shoulder bursitis exercises

In my view, no one should try a cortisone injection, let alone even think about an operation until they have done 12 weeks of effective and regular exercise rehab.

Don’t try it for two or four weeks and give up – muscles and tendons simply don’t adapt fast enough to make a significant change in that time typically.

Load the muscles and tendons and they will adapt, addressing the issue behind your bursitis (most likely) and taking the load off the bursa, allowing your shoulder pain to settle naturally.

So, in light of that, here are our favorite rehab exercises (and most shoulder pathologies actually!) that are easy to do from home:

1. Lat pull-down

Using a Power Band or cable machine, this is a great exercise which strengthens your Lats. Your Lats help hold the ball down so it doesn’t rise up into the subacromial space and pinch your bursa.

Do 3 sets (lots) of 10-15 but with all these exercises 1-5, it is best to take the muscle to fatigue.

lat pull downs rotator cuff - shoulder bursitis exercises

2. Rotator cuff external rotations

Lie on your side with your elbow touching your side and at a right angle as shown. rotate your fist up, keeping your elbow at 90 degrees and in your side and then lower down again.

Find the weight where your tire out at about 10 reps (often 1/2 or 1 kg is enough to start with) and do 3 sets to fatigue (10-15)

Rotator cuff rehab external rotation - shoulder bursitis exercises Rotator cuff rehab external rotation phase 2 - shoulder bursitis exercises

3. The Arnie press

*If this or any of the other exercises are sore to do. Don’t do it yet, work on the ones you can do.

Start with a weight that makes your muscles tire at about 10 reps (this could be 1kg, a drink bottle or even 5kg).

Your hand should be in front of your shoulder and knuckles forward. Press upwards, while rotation through range so that your knuckles are backwards and then go back down to the start position, rotation through the range again as shown.

To 3 sets to fatigue (3 sets of 10-15 reps usually, otherwise adjust the weight)

Overhead rotational press - shoulder bursitis exercisesOverhead rotational press extended - shoulder bursitis exercises

4. Flys

You can do this shoulder and scapula strengthening exercise in standing with a resistance band OR lying on your front on a bench with weights in your hands.

Find the resistance or weight where you fatigue at about 10 reps and do 3 sets of 10

Flys - shoulder bursitis exercises

5. One arm wall push-ups

This is a great one for getting global strength and control of the shoulder girdle and for a lot of people with shoulder bursitis, is pain-free to do.

Place your hand in front of your shoulder (you don’t want it too high)  and do a push-up, looking to keep your shoulders level and not tilting into the wall with your opposite side.

Adjust the distance your feet are out from the wall to make it challenging but do-able.

Do 3 sets of 10

One arm push-up - shoulder bursitis exercises

6. Posterior cuff stretch

A lot of people with shoulder pain and bursitis lose the ability to put their hand behind their back comfortably and this tends to pull your shoulder blade forward. address this by stretching out the back of the shoulder joint as shown. Make sure to pull shoulder arm into your chest rather than in the across your body.

Hold for one minute. It shoulder stretch the back of your shoulder/arm, if it pinches on top of in the front, you aren’t ready for it yet.

Posterior shoulder stretch  -shoulder bursitis exercises

To help get rid of shoulder bursitis, do all these exercises once a day, 5 days per week for 12 weeks and as they get easier – make them harder.


Shoulder pain

Rotator Cuff Rehab: Strengthening exercises

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Rotator cuff injuries are one of the most common injuries and one of the most feared, but they don’t need to be. With the right rotator cuff rehab exercises, your shoulder can be pain-free and strong again in no time.

There is a huge amount of research coming through that is showing that we have become far too reliant on surgery which often comes with its own risks and can lead to scar tissue and frozen shoulder. Current best practice recommends about 12 weeks of conservative rehab before looking into surgery if not improving. Recent studies have shown:

  • Subacromial impingement and bursitis: Exercise is as effective as surgery AND reduces the need for surgery in 80%
  • Rotator Cuff partial tear: Exercise is as effective as surgery
  • Full Thickness Rotator cuff tears: Exercise reduces the need for surgery by 75%

Rotator cuff rehab physio

That’s some fairly awesome stats from multiple studies and shows that with the right rehab exercises, there is a good chance your shoulder pain will resolve without the risk of surgery, so let’s get into it!

 

Following on from our stage 1 post on early Rotator Cuff Rehab, this is all you need to know to lay a strong base for your shoulder stabilizers.

Stage 2 Rotator Cuff Rehab: Building strength

This stage starts when you can lift your arm up in front of you over shoulder height at least. If you can’t do that, step back to stage 1 or consult your health professional

1. External rotations

  • Lie on your side with your elbow at 90° and holding a small weight – starting with about .5kg can be a good start
  • Then lift the weight, rotating with your shoulder as shown – making sure your elbow stays touching your side the entire time and then lower down
  • Repeat for 3 sets of 10 and increase or decrease weight as needed to fatigue the muscle without pain

Rotator cuff rehab external rotationRotator cuff rehab external rotation

 

2. Overhead rotational press

  • Always start with your knuckles forward and in front of your shoulder and then press up while rotating so that your knuckles are backwards
  • Do 3 sets of 12, starting with a weight that is pain-free (such as a can of beans) and build up from there

Overhead rotational pressOverhead rotational press

3. Lawn mowers

  • Start with your hand in front of your opposite pocket. Leading with your elbow, bring your arm across your body and up to the opposite corner as shown.
  • Start with a weight that is pain-free such as .5kg and build up from there with, performing 3 sets of 12 with an aim of the shoulder being fatigued at the end.

Disco dancer shoulder rehab exerciseDisco dancer shoulder rehab exercise

4. One arm push-up

  • Place your hand on the wall at chest/nipple height. Do a push-up to the wall, keeping back straight and shoulders level.
  • Only go as far as you can control and adjust the distance of your feet from the wall so that it is challenging but not painful.
  • Do 3 sets of 10

One arm push-up shoulder exercise

Tip: If the exercise is sore to do, try and use something lighter (or move closer to the wall for #4) and if you can’t do it without pain, don’t do that one for a couple of weeks – just start with the exercises that you can do. Remember rotator cuff rehab typically takes around 12 weeks on average so patience is key

Get into routine of doing the exercises 5 days a week, combined with other exercise such as walking or biking regularly


Shoulder pain

Rotator Cuff Tear Exercises: Heal Strong and Fast

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A Rotator cuff tear is one of the most feared injuries but shouldn’t be. Here’s what you need to know about rotator cuff tears to get them stronger, faster.

Just how common are they?

A rotator cuff tear is present in over 20% of the population, but don’t let that number fool you because not 1 in 5 of us actually have painful rotator cuffs. This is because, just like you can and probably do have joint degeneration in your knee that gives you no pain at all, you can have rotator cuff tears that are pain-free (asymptomatic).

So the real number you should be interested in is the number of symptomatic tears; 35% of rotator cuff tears on radiology are symptomatic, which is still very common!(1)

Rotator cuff tearWhat is the rotator cuff?

Put simply, it is a group of muscles which come from the front, back and top of your shoulder-blade and wraps around that ball and socket of your shoulder. Their job is to coordinate between themselves to help keep the ball positioned nicely in the socket while you move your arm.

Rotator cuff tears often happen in the tendon, close to the shoulder joint.

Does a rotator cuff tear need surgery?

Really, it is case by case but most rotator cuff injuries do not need surgery.

As a good guideline, with all rotator cuff tears, it is best to trial 12 weeks of conservative rehab and if that has not much improved the injury, then you look at seeing the surgeon.

A recent study actually showed that there was no difference between surgery and active physiotherapy at 1-year follow-up(2)

Physio Rehab exercises for a rotator cuff tear needs to cover three things:

  • Regaining range of motion and muscle activation
  • Improving strength
  • Regaining full control and function

We are going to cover these stages in three posts and here is Stage 1, which starts after 3-4 days of rest, or more if needed:

Stage 1: Regaining range and muscle activation

1. Pendular circles

YouTube player

2. Regular movement

Using a broomstick or a pulley, this is a great active-assisted exercise for regaining movement and stopping the shoulder stiffening up.

Hold onto the end of the stick with your injured side and help lift it up with the other hand.

Repeat this 20 times 5 times per day without pushing into pain.

Active assisted shoulder flexion Active assisted shoulder flexion

 

isometric rotator cuff strengthening exercise3. Rotator cuff activation

These exercises activate the rotator cuff in a safe way by doing gentle wall pushes. It is essential to load the rotator cuff in a safe way and gently to encourage strong healing and minimizes scar tissue formation.

  1. External rotation
  2. Abduction

 

Read for Stage 2 rotator cuff rehab? Follow this link to the next post in the series.


Shoulder pain, Spine

Stiff neck – Neck and Shoulder Mobility Exercise

• By

neck pain sitting at desk - fix it nowIf you experience stiff neck, regular headaches or neck pain, this mobility exercise will help improve this fast.

A stiff neck and tight shoulders are a very real problem for desk workers (plus new moms and others that do a lot of lifting) and people can put up with this for years!

Posture and Tight Neck and Shoulders

This basically happens because we assume a posture where our backs are rounded out and our shoulder roll forward. This causes the muscles running from the top of your shoulder to your neck to be put under a lot of tension and stress causing then to get knotty, weak and angry from overworking – causing you to feel pain, stiffness and headaches.

Mobility Exercise to alleviate Tight Neck and Shoulders

See the video for a simple demo if how to loosen up your stiff neck or check out this link for more info and this link for more info on headaches and how to fix them.

YouTube player

upper traps, self trigger point knots, tension headaches treatmentTry do this mobility exercise daily for two weeks and notice the difference. Your stiff neck will thank you!

You may also like:

Mobilise your-self!

5 Great exercises for neck pain

All you need to know to get rid of headaches


Health, Shoulder pain, Upper limb

Shoulder dislocations – Don’t brush it off – Prevent Re-injury Now

• By

Have you had a shoulder dislocation physioshoulder dislocation playing contact sport? If you are young and want to keep playing sport – you are at massive risk of re-injury.

There is growing evidence that if a young athlete dislocates his shoulder and plays a physically demanding contact sport – They should have surgery. This is because the shoulder becomes unstable following this and the chances of further dislocations are incredibly high.

In a study by Slaa et al, it was found that:

  • Over-all recurrence rate of 24%
  • There is a huge 64% recurrence rate in patients under 20 years of age

Also a literature review found an average recurrence rate of 67%, with much less chance of re-injury if the patient is older than 40 years of age.

The most important findings in these studies are that you have very high chance of sustaining further dislocations if you are an athlete (82% – simonet and Cofield) and/or are a young person.

 

shoulder labral tearA large part of this is because damage has occurred to the labrum – This is the tissue that helps make the shoulder socket larger and suck the ball of the shoulder joint in. If the labrum is torn (which it often is in shoulder dislocation) this causes a break in the negative pressure in the joint – it has lost the suction – meaning it is easier to “pop out” again.

 

Thedislocated shoulder, do you need surgery? shoulder joint has a tiny socket to start with!

Think of shoulder joint like a golf ball sitting on a tee – The ball of the shoulder is much larger than the socket (the tee), so to make the socket larger, the labrum comes off the socket to add more stability.

 

So if you have dislocated your shoulder, are young and/or want to continue playing a contact sport…

  • Go have your shoulder assessed by your Physio
  • Get referred to an orthopedic specialist if they deem it necessary
  • Rehab your shoulder well and get your rotator cuff as strong and stable as you can.

Do it right the first time.

 

Yours in good in health,

Shaun

 


Mobility, neck pain, Shoulder pain

Myofascial Release: Tight neck and shoulder self-treatment!

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Everyone gets tight neck and shoulders, whether you are an athlete, office worker or new-mum and this easy myofascial release will give you huge relief!

How does this Myofascial Release of the neck help?

By using gentle pressure on trigger points or using long flowing stretching strokes helps release myofascial pain. This when applied to tight neck and or shoulders helps relieve the pain and increase mobility.

  • Ease neck and shoulder tension
  • Improve shoulder range
  • Ease headaches
  • Make you more upright
  • The best of all, it will just make you feel great!

Myofascial Release Technique

See the Video demo here or see below for an easy description.

upper traps, self trigger point knots, tension headaches treatmentThe upper trapezius (traps) knot up very regularly and cause you to feel tight, hunched over and can often cause stress and tension headaches. All you need is a firm massage ball and do the following exercise for a great myofascial release:

TP UT1

Lie on your back with your knees bent up and place the ball under your upper traps as shown.  You will be able to feel the knots and tight muscles through this area (they will feel harder, often tender and like a marble or golf ball).

Self trigger point of upper traps and stress pointsNext bring your arm up and back towards the ground and then oscillate it up and down (grind it!).

Tip: If you do not feel it much, lift your bottom off the ground and put all your weight through the ball.

This is a fantastic technique and once you have tried you will see what I mean! For the is best results and long-lasting relief, do this every evening or as a break at work.

This myofascial release is great to combine with a couple of other things that will combine to create a long-term fix! It is important to look at the muscles (which we are doing here) AND the joints, so try out this easy spinal self-mobilization or this back stretch your mobility.

Let me know how you get on!

Please share and like and if you want more self-treatment exercises, check out our great Ebook

Pro-tip: If you get headaches with your neck pain you could well have cervicogenic headaches – check out more info in this post form Headache Proof

Here is a great product on amazon that helps relax neck and shoulder pain.


Health, Mobility, Shoulder pain, Upper limb

Shoulder Stretches: Only the Best

• By

Shoulder stretching is an essential part of gaining a Pain-free, functional and strong shoulder. Whether you have had shoulder injury in the past, have tight shoulders due to poor work posture or you just want to have full range for an overhead squat – then these shoulder stretches and for you – all of you!

(Skip down the page if you want to get straight to the Shoulder Stretches!)

Following injury: regaining flexibility and range in the joints and soft tissues is an important aspect to the rehab process and if not addressed, you can develop other, secondary injuries such as sub-acromial impingement, postural dysfunction and any number of neck problems.

Poor posture: In today’s world, too many of us have sedentary jobs which require a lot of time sitting at a desk or behind the wheel. This leads tightness in muscles the pull your shoulders forward (namely your Pecs and Upper Traps) and weakness in muscles that hold your shoulder in a good, functional position (lower traps, Serratus ant etc). This is explained well by the Jandas Upper Crossed Syndrome.

Overhead squat and shoulder range: To hold a barbell overhead and squat down  we need great mobility around the shoulder and hip to do this safely. The main muscle that affects this is the Lat (along with your Glutes and Thoracic extension) as the come all the way from your pelvis to your shoulder.

Exercises:

Ideally you should do these everyday – You can water it down and do it less often but you will not get thew best result and it will take longer.

Horizontal abduction stretch for the shoulder. posterior capsule and deltoid stretch

1. Posterior capsule stretch:

Action: Pull your arm across your body.

Hold for 1 Minute.

 

 

Shoulder stretch for the triceps muscle and inferior capsule to decrease shoulder pain

2. Triceps and inferior capsule:

Action: gripping the elbow as shown, pull back and across.

Hold for 1 minute.

Tip: bend upper body away from side being stretched.

 

 

 

sleeper stretch for the shoulder - to stretch the post capsule and rotator cuff

3. Sleeper stretch:

Lye on your shoulder with your arm in front of you and your elbow bent to 90 degrees. using your free arm, grip your wrist and rotate it down towards your feet until you feel a moderate stretch.

Hold for 1 minute

shoulder stretch for the pectorals and thoracic spine. good for swimmers, cyclists etc4. Streamline stretch:

This is a great stretch as it stretches, Pecs , Lats and thoracic spine.

No balls – You do not have to use a Swiss/Physio ball – I use the back of my couch.

Action: when on your knee place both arms on the surface and relax your shoulder and upper back down. you can adjust the force that goes through your shoulders by moving your knees further away or closer.

Hold for 1 minute.

TIP: to get more of a tricep stretch place your hands behind your neck with elbows on the ball/couch!

5: Lat Band Stretch: 

The best way I have found for stretching Lats is using a band (a technique picked up from Crossfit) – now you can use a proper exercise band or a simple belt (yes one of the ones that holds your pants up) at home. Below is a nice simple video on how to do it:

Overhead distraction with Band

Hold for 1 minute.

Tip: you can also do this by holding on to a pole.

streamlined

And THAT my fiends is ten minutes well spent!

For Best results combine the above stretches with a good Shoulder stabilisation regime and you will really reap the rewards.

 

Note if you feel any pain (other than stretching pain) or have range of motion limitations post surgery then consult a trained health professional.

 

Please LIKE, SHARE and COMMENT!


neck pain, Shoulder pain, Upper limb

Scapula stabilising exercises – Beat shoulder pain for good.

• By

winging scapula shoulder bladeWhy does your shoulder pain not get better or keep coming back??  Scapula stability and control is often overlooked yet it is absolutely necessary for good shoulder function. Here we will increase shoulder girdle strength, stability and control to get rid of and minimise the chances of:

  • Rotator cuff impingement
  • Shoulder tendinopathy
  • Subacromial Bursitis
  • Neck pain and Headaches
  • And much more

Scapula Dyskinesia is a very very common response to shoulder pain and leads to ongoing, prolonged and frustrating shoulder pain. This is basically abnormal movement of your shoulder-blade. For more detail: Skapula dyskineia

Normal shoulder movement, strength, control and performance is fully dependent on the scapula – and not just movement but it’s stability as well. The scapula is the base that your arm works off and if you don’t have a stable base, you will be much more likely to have shoulder and neck pain – It would be like trying to walk in an earthquake!

Normally when you lift your arm, your shoulder blade rotates upwards as seen in the picture below. If your shoulder-blade doesn’t rotate – your shoulder gets jammed against it, leading to pain and tightness.

So given that Scapula Dyskinesia occurs in 68-100% of shoulder injuries, this is something that needs to be addressed in EVERY PERSON WITH SHOULDER PAIN. So below is your exercise regime to address this yourself at home or the gym.

1. Push-up Plus: skapual, serratus anterior strengthening exercises, physiotherapy, shoulder pain

keeping your body and arms straight, push your shoulders forward(body upwards and then control your shoulders back to the starting position).

Too easy? do a push up and add the press at the top of each push-up (this is the plus!)

2×12 reps (to start with!)and start on your knees if you need to.

 

2. Shoulder external rotation: shoulder ER

Remember to always keep your elbow into your side and at 90degress.

You can also do theses in side lying with a 1-2kg dumbell in your upper hand.

2 x 12reps, increase the stretch to progress.

 

 

3. Chariot Pull: chdariot pull

Keeping your arms straight and shoulder back and down, take your arms back untill they are level with your body.

2 x 12reps, increase the stretch to progress.

 

 

 

 

4. Thoracic Mobility: I have included this as if you have a stiff spine, your shoulder chariot pull, shoulder strengtheningblades are always going to be in a bad position, so it is important to address this so that you don’t get stuck at 95%!

Using either a full or preferably 1.2 foam roller (high density!) lie on it, placed below your shoulder blades as shown, bridge up and extend your arms overhead and then elbows down to your sides.

Tip: Keep your head up and chin tucked in.

spend 1-2minutes working on your spine.

Do these exercises two times daily (Ideally!) for 6 weeks for awesome shoulder stability and a pain-free shoulder.

http://bjsm.bmj.com/content/47/14/877.long

http://www.ncbi.nlm.nih.gov/pubmed/12670140

Also see:

Mobilise yourself

Beating neck pain and headaches

Please share and let me know how you get on.

 


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