We are moving to part 2 of the shoulder pain series.
Treatment and Management of Shoulder Pain
Shoulder pain may not be a life-threatening medical condition, but without the right approach, the pain may limit your arm movement and affect the quality of your life.
Your shoulder pain may affect your activities of daily living, such as:
- brushing your teeth
- combing your hair
- putting a book on a shelf
- sleeping on that shoulder
- opening doors
- reaching to the side to grab something
- holding your cellular phone
- carrying your purse or laptop bag
The above tasks may require much effort and irritate your shoulder pain. It is essential to keep in mind that all types of shoulder pain should never be overlooked. Shoulder pain can be progressive and lead to other problems. Whether the pain is mild or severe, the best option is to consult your physician to determine the cause and obtain the proper treatment regimen for you.
Non-invasive or conservative approaches are used to initially treat shoulder pain. During the early stages or uncomplicated cases of shoulder pain, the treatment goals are relief of pain and restoration of the normal function of the shoulder. These goals can be achieved through rest, ice and heat application, compression, and pain medications and exercises.
#1 – Active Rest for Shoulder Pain
Prevent performing activities that aggravate your shoulder pain. If your shoulder is injured or in pain, the most immediate and essential action is to reduce or stopping using the injured arm for about 48 hours. Avoid heavy lifting and overhead activities until your shoulder feels better, which may take 4 to 7 days after shoulder pain occurs. Resting the affected shoulder can reduce the swelling and the pain. It is important to emphasize that complications may arise when the shoulder area is immobile for a lengthened period. Pain-free shoulder movements are essential to keep moving. It is suggested to perform simple isometric exercises during shoulder pain to activate the shoulder muscles. This is discussed in the next section.
#2 – Ice and Heat for Shoulder Pain
The application of ice reduces the pain and inflammation during the first 24 to 48 hours following your shoulder injury. You may put an ice pack, a bag of frozen vegetables, or a towel filled with ice on the affected shoulder for 15 to 20 minutes at a time, 4 to 8 times a day. Apply ice for about 20 minutes. Never apply ice directly to the skin as it may cause a burn. Use a protective barrier, such as a towel, between the ice and the skin. You can also apply ice after activities to control inflammation and pain. Everyone responds to ice differently. Try it out and see how your shoulder responds. It should help decrease inflammation, pain, and recovery from activities or exercise.
Heat can cause vasodilation and may cause more swelling and pain. The use of heat should be avoided for the first 72 hours. After 72 hours, when the pain and inflammation have improved, you may start heat applications to relax tightened muscle tightness. Heat should be limited to 20 minutes per application.
#3 – Pain medications for Shoulder Pain
Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, or naproxen, may help reduce mild to moderate shoulder pain. It is essential to talk with your doctor to see what pain medication is most suited to you.
#4 – Compression of the Shoulder
Compressing the injured area with elastic wrap may be helpful as well. This could help with controlling inflammation, keeping the shoulder out of painful movements, and your body in a more comfortable posture.
Exercises for Shoulder Pain
Exercises are an essential part of preventing and overcoming shoulder pain and injury. Above we talked about what you can do to manage your shoulder pain, but it is necessary to move and exercise the shoulder to overcome and recover from your shoulder injury.
The most valuable exercises when resolving shoulder injuries and pain are a range of motion, stretching, and strengthening exercises.
Exercises You Can Do Soon After Your Shoulder Injury
Prolonged immobilization of the shoulder can result in a wide range of complications, including increased joint stiffness or tightness, which worsens shoulder pain. During the recovery phase, you should perform these exercises to maintain shoulder muscle strength without risking joint damage while limiting your activities and resting during periods of pain. The following two practices contract the shoulder muscles without moving the joint.
#1 – Grip Strength Exercise.
- Using the hand of the involved arm, squeeze a small ball, either a stress ball or a racquetball, with gentle and consistent pressure as many times as you can throughout the day.
#2 – Isometric Triceps Exercise
- Position the involved arm on a tabletop with your elbow at 90 degrees.
- Make a fist and push the tabletop, using the force coming from the fist to the elbow, and hold for 5 to 10 seconds.
- You should feel the muscle on the back of your upper arm contracting without moving your arm.
- Gradually release the contraction.
- Repeat the exercise 5 times
Range of motion exercises
Gentle and early active, active-assisted, or passive range of motion exercises is the most recommended after controlling and managing shoulder pain. These exercises are helpful in gradually restoring the affected shoulders’ range of motion. Codman or pendulum exercises are commonly included in the earliest stage of treatment to improve muscular relaxation and a pain-free range of motion and prepare the shoulder for more complex activities.
#3 – Circular Pendulum Exercises (Arm Circles)
- Use your good arm to hold onto a sturdy chair or tabletop. Bend at the waist and then at the knees. Let the involved arm relax, hanging in a resting position. Remove all tension from the shoulder blade.
- Using the involved arm, create small circular patterns in the air.
- Make five circles in a clockwise direction and five more in counterclockwise order.
- You can gradually draw bigger and more circles as your shoulder improves.
- Repeat the exercise 5 times a day.
#4 – Flexion-Extension Pendulum (Arm Forward and Back)
- Use your good arm to hold onto a sturdy chair or tabletop. Bend at the waist and then at the knees. Let the involved arm relax in a resting position. Remove all tension from the shoulder blade.
- Swing the involved arm forward and back 5 to 10 times.
- Repeat the exercise 5 times a day.
#5 – Shoulder Flexion (Lifting Arm Up)
- Stand tall with both arms on your sides.
- Raise the involved arm, reaching the ceiling as the elbow is kept straight. As you get the highest point, hold for 10 seconds.
- Release, and return to your standing position. Repeat five times.
Shoulder Stretching Exercises
Stretching exercises regain and maintain the flexibility and mobility of the soft tissues, such as the muscles, tendons, and fascia in the injured arm. These exercises improve the range of motion, prevent muscle stiffness and reduce the risk for shoulder injuries. All of which encourage long-term pain relief.
#6 – Posterior Stretch
- Stand tall, and grasp the elbow of the involved arm using the hand of the good arm.
- Gently pull the involved arm across the chest with the good arm at the shoulder level or at whatever level you can lift, which is pain-free. Hold the position for at least 10 seconds. You should feel a slight stretch in the back of your shoulder.
- Release the stretch. Repeat the exercise 3 times.
#7 – Chest Stretch
- Stand tall in the doorway, and extend both arms at a right angle—Bend elbows at 90 degrees.
- Position the forearms against the door jamb and lean forward. Hold the stretch for at least 10 seconds. To stretch the upper chest area, position the elbows below the shoulders. Stretching the middle fiber requires the elbow to be placed at shoulder level. To stretch the lower fibers, elbows are positioned above the shoulder.
- Release and repeat the exercise 3 times.
Rotator Cuff Strengthening Exercises
Using dumbbells, tubing, and your body weight, you can combine other types of strengthening exercises to enhance your shoulder strength. Isometric exercises, a form of strengthening exercises, contract and build muscles without moving a joint or bone. Strengthening exercises are only introduced or included in the exercise regimen if the involved shoulder is strong enough to tolerate the pressure and can complete the activities in a pain-free range.
#8 – Shoulder Extension
- Stand tall with your back against the wall. Move the involved arm behind the back. The hand’s pinkie (ulnar) side should be resting against the wall.
- Push the involved arm against the wall. Keep the elbow extended. Hold the position for 5 to 10 seconds.
- Release. Repeat the exercise 5 times.
#9 – Shoulder Abduction with Tubing
- Stand tall with your straight arms at your side.
- Lift the tubing away from your body until the arm holding the tubing reaches the shoulder height, or to the point that you can do it pain-free.
- Gradually return to the starting position. Repeat up to 10 times.
Key Points to Remember
- If any exercises cause or aggravate pain, stop doing the training and ensure you are doing them correctly. You may have to limit the shoulder range of motion as you exercise.
- Do not overdo things. Later in the day and the next day, you should feel like you have done something, but your shoulder pain should not increase.
- Start off slow and gradually build up the intensity of your exercises. If you are using weights, you may need to lower or eliminate the consequences until your shoulder is well enough to tolerate the exercises.
- After the exercises, you may have to use some of the pain management strategies discussed above.
- If you have any concerns about these exercises, contact your doctor to see if they are appropriate for you.
I hope this program gets you started on the road to recovering from your shoulder pain.
If you would like to read the first part of this series, click the below link:
What Causes Shoulder Pain?
Rick Kaselj, MS
