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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 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

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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.


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