Exercises for shoulder pain, Impingement, Bursitis, Rotator Cuff Disease by Dr Furlan MD PhD

70% of chronic shoulder pain that I see is caused by a disease that has many names. You probably heard of impingement syndrome, subacromial bursitis, rotator cuff disease. Well, these are basically the same problem. I will explain what they are and what you can do to avoid shoulder pain and stiffness. I will demonstrate 15 exercises that you can do at home. So, let's talk about chronic shoulder pain. If you know someone who has chronic shoulder pain, hit the share button below and send this video to them. The person usually has pain that interferes with sleep, especially when they roll on the involved shoulder. They have pain with overhead activities like pushing and pulling objects. It's hard for them to lift loads and this problem interferes with work, dressing, especially putting a shirt over their heads. Well, the shoulder is an amazing structure in the shape of a ball and socket. Look at the range of motion, power and speed that the shoulder can perform. To maintain the ball in the socket, there are many tendons, ligaments and muscles that attach to them and keep them in place. A very important structure that keeps the humerus in place is called the rotator cuff. Look at these muscles. They cover the humerus like a sleeve cuff. A bursa is a small sack of fluid that sits between these bones to act like a cushion and reduce the bone-on-bone impact. So, when the muscle supraspinatus tendon is pinched during the movement of arm elevation, this is called impingement syndrome. The bursa can get swollen or inflamed, which is called bursitis. The tendon can get irritated or damaged and can also have a partial or complete tear called rotator cuff disease, injury or rotator cuff tear. Rotator cuff disease is generally a chronic disease, degenerative disease that affects people older than 40 years of age. However, younger people may also be affected, especially if they practice sports like swimming, tennis or baseball. The main symptom will be pain when the arm is in the elevated position or at night when there is pressure on this tendon and bursa. So, to reduce the pain and swelling from shoulder impingement, it's necessary to do a few things. And to remember these things, you can remember BE-MA-MEMORS. BE is for bed positioning. MA is for manual therapy. MI is for medications and inflammatories. MO for modalities to reduce pain. R for range of motion exercises to avoid frozen shoulder. The first S is for stretching of tight muscles and the last S is for straightening of the weak muscles. We spend one third of our lives sleeping. If we pinch the tendons and bursa when we sleep, this can cause or perpetuate the shoulder problem. If you are a back sleeper, don't raise your arms above your head like this. Keep your arms on the side of your body and make sure that the pillow is filling the space below your neck, but the pillow is not under your shoulder. If you are a side sleeper, it is better not to sleep on the painful side. But some people have shoulder pain on both sides and then it's really hard to find a position. You may need to get a second pillow to support your back, so you're not putting too much pressure on the shoulder underneath your body. And get a third pillow to put in front of you, so the upper shoulder will not be dropping in front of your body. Now, a stomach sleeper is the worst thing, not only for the shoulders, but also for the neck, because you have to turn your head to the side to breathe. Make sure you keep your arms on the side of your body. Not only sleep position is important, but also the position that you have when you are in the computer, watching TV or doing crafts. This slouched position can cause rounded shoulders and lead to shoulder pain. As the shoulders get rounded, there is a limitation of space for the cuff tendons to impinge and it could lead them to tear and rupture. The exercises I'll show you today are excellent to correct this slouching posture. In the early stages of impingement syndrome, it's important to reduce the inflammation and control the pain. Massage. The first thing is to try to find a tender point and massage with friction. You may apply a topical cream that contains some analgesics in them. This can also be done on the muscles around the shoulder, like the trapezius, latissimus, pectoralis and deltoid. What about medication? Over-the-counter anti-inflammatory medications, NSAIDs, especially in the early stages or beginning of the disease. 10 days of NSAIDs is all that is needed. If you can't take NSAIDs because of a stomach bleeding, kidney insufficiency, high blood pressure or cardiac disease, then you can use the modalities to alleviate your pain. What about modalities? Apply heat before you do your exercises. You may use a bean bag heated in a microwave or a hot water bag. If you apply an electrical heating pad when you are sleeping, be careful not to sleep with the heating pad on. It can cause skin burns. You can also apply ice, especially after you do the exercises, to reduce swelling, inflammation and pain. You can leave the ice pack for about 20 minutes. Don't forget, use a piece of fabric between the ice pack and your skin, so this will avoid skin irritation and burn. You can find a link to all these products that I mentioned in the description of this video below. So next, I'll show you 15 exercises that you can do at home. You don't need any specific equipment to do them. All you need is a kitchen table at the height of your hips, a bottle of water, approximately 500 milliliters, a wall, a corner, a doorway, a towel, a lower bench or a sturdy chair like a lounge chair, a mat or carpet. So the first exercise that we'll demonstrate are range of motion exercises. So this is exercise number one, or pendulum exercise. And all of these exercises I'm going to print in a paper and you can download this description of all the 15 exercises down below. If you go there, there will be a link to this document. So the pendulum exercise, basically you need a desk that is about the height of your hip, around here. And what you're going to do is, you're going to lean on the desk or table and the arm is just going to hang there. What you're going to start doing is, you're going to start moving your legs. So then to create a pendulum for your shoulder. Then the shoulder capsule starts relaxing and removing any adhesion, removing any stiffness of the shoulder. You see I'm moving my hips. And you can do this back and forth. And if possible, also do some movements, circular movements, opening circle and closing inwards and outwards. And you do this for about one minute. And sometimes we recommend the person to hold on some sort of weight, just to pull the capsule of the shoulder a little bit more. So then if you have a water bottle, you could be doing the pendulum with a water bottle. Just relax the shoulder and move your knees, bend the knees, back and forth. And relax. The most important thing is to relax the shoulder. Okay? So this is exercise number one. The exercise number two is fingers on the wall. There are two ways of doing this. You can do this looking to the wall and go up. But for shoulder impingement problems, I usually prefer that you stay on the side. So here's the wall on your side. And because then you will be doing this movement, which is really painful. People who have shoulder impingement, when they do this, it really hurts. So let's do this. You start walking on the wall here. And you go up. And sometimes just getting here is very painful. So if that's the case, stop and then go down. But if you can go up, if you can go higher, let's say that you can get here. What you can do is if you can ride on the wall. I'm not going to ride a pencil mark on my wall. But if you can, you can do a pencil mark there. And see when you start this exercise, what was your maximum range of motion for abduction. And so here it is. Try not to bend your body. So your body should be straight. And then you just go up. And then the more you do, you'll be gaining more range of motion. Always remember to relax the shoulder. Don't get tense. Your body is straight. And go up, all the way up. And if you can reach all the way up, that's excellent. It means that your range of motion for abduction is practically normal. And then you can go down. But as I said, most people with shoulder impingement, bursitis, they can't do this movement because it hurts. But that's okay. Just go until you start having your pain and then go down. And you can repeat this eight repetitions. Go to as far as you can. And you can rest. You can, if you're getting tired, you can rest your hand here and then keep going. The exercise number three is the wall angel. And what you have to do is find a wall behind you. Touch your hips, the shoulders, the shoulder blades, and your head on the wall. So when you're touching this, what are you going to start doing? Raising your hands and keep your palms down. And try to touch the wall and go all the way up. Again, this is similar to the fingers on the wall. We're trying to improve range of motion for abduction. And sometimes it's hard. And sometimes one shoulder you can go here, the other one you can go here, and then you start having pain. If that's your case, just do that. And then lower and try to improve your range of motion slowly, slowly. And you can measure this. If you're improving, you will see that each day you'll be able to go higher and higher. And this would be normal. This is the wall angel. And you can do this eight times. Wall angel. And lower. Try to touch the wall when you do this and keep your hips, shoulder blades, and head touching the wall behind you. The exercise number four is to gain range of motion for internal rotation and external rotation. So again, in the same position on the wall, your hips, shoulder blades, and head are touching the wall. What you're going to do is internal rotation. And you do both shoulders. And you should be able to touch your belly. So to do this, your elbows are touching your body here. Touch your chest. Don't open your elbows. Keep them here. Bend the elbows at 90 degrees and just go in. This is internal rotation. This is neutral position. And now this is external rotation. So you see a normal external rotation. You are not supposed to touch the wall. It's about here. This is normal external rotation and internal rotation. Normal is touching your belly and about 70 degrees here. Internal and external. When a person has frozen shoulder, this is one of the first movements that they lose. They are unable to do external rotation. And this means that the shoulder is starting to get frozen. Internal rotation. External rotation. And remember to keep the elbows close to your chest. And the exercise number five is shoulder circumference, which is another range of motion exercise. We're just going to do this movement. So forward, circumferences forward and backwards. Backwards. You can do eight backwards. Five, six, seven, eight. And now eight forward. One, two, three, four, five, six, seven, eight. And then what you can do when you finish is try to squish your shoulders against the wall. So try to touch the shoulders, the back of your shoulders on the wall and squish, squish, squish. So then you're contracting the rhomboids and getting the shoulder blades close to each other. So do this and squish. So now we're going to start doing the stretching exercises. And the first one we're going to do is stretching the pectoralis muscles or the pecs. And the pecs have fibers that are lower fibers, medium fibers and upper fibers. So we need a doorway. And what you're going to do is to stretch the upper fibers. You're going to keep your elbow down like this. And what you do is you move your body. You move your body backwards. So just keep the elbow here. Don't move. And just keep doing this. And you should feel stretching the pecs here. Keep doing this. And just stretch, stretch, stretch. Do a good stretch here. Come back. And you can do this eight times. Stretch and stretch. Leave your elbow touching the doorway. Don't move it. And then to stretch the mid fibers, you put your elbow at about 90 degrees here with the shoulder. So the same level at the shoulder. And do the same thing. You go backwards. And then you feel stretching. You feel all these fibers stretching here. And it should not hurt. If it's hurting, then you don't need to do it. And stretch, stretch, stretch. And move your body backwards. That's good. And then the last one is to stretch the lower fibers. You should be putting your elbow your hand and elbow all the way up. And do the same thing. Then you turn your body away from the doorway. And then you'll be stretching those muscles there. Okay. And you're stretching also the latissimus dorsi and the pectoralis muscles. For the exercise seven, which is still a stretching exercise, you need a towel. And what you're going to do is you grab the towel with one hand and the other one like this. So ideally you do this and then you raise this. And one hand you're going to go up and down eight times. Two, three, four, five, six, seven and eight. And then change to the other side. And this is important because when a person has problems with their shoulders, usually one thing that is very difficult is for them to do their bra, tie their bra, put on a shirt, wash their hair. And that's all because these movements are very hard for them. And so this is a kind of exercise. And you do within your limits. If you can't do all of this, just do your limits. If all you can do is here, that's what you do. Try to improve. Ideally all the way up and all the way down. All the way up and all the way down. This is the towel exercise. The other exercise is the cross chest stretch. You're going to go across your chest and with one hand you're going to stretch. You're stretching the posterior capsule of the shoulder, which is usually very painful, especially if the person is starting to develop frozen shoulder. If this is too painful to you, you should be doing this exercise with a physiotherapist. But if you can tolerate this, just stretch, pull some, pull the back of your shoulder here and do the same thing for the other one. Bring all the way down here, all the way across the other shoulder and then you pull and try to relax. When you do this, don't get too tense. Relax, relax and feel the fibers on the back of your shoulder stretching. This is the cross chest stretch. Now the exercise number nine is the strengthening of the shoulder against the wall. So what you're going to do is with your elbow straight, you're going to put your hand here and you're going to press the wall. Just be careful if you have dry wall and if you are too heavy you're not going to punch a hole on the dry wall. So here press against the wall, press, press, press, press, press. So you should be feeling that you are strengthening these muscles here of the anterior side of your shoulder. And you can do with the other one, press, press, press, press, press. So you're strengthening the flexors of the shoulder, which are the anterior, the front of the shoulder. You can also do on the side. So press against the side and remember your elbow should be straight. So press, press, press, press, and the same here. Press against the wall. This is an isometric exercise. It should not hurt when you do this. Now the other one that is important is now you bend your elbow, touch the elbow and your hand here. Because we're going to do here, first is you press the elbow against the wall, press, press, press, press. And now you're going to press the hand. So don't touch the elbow on the wall and press just the hand. So this is strengthening for the external rotators. So press the elbow, now press the hand. And do the same thing for the other side. Bend the elbow, press the elbow and now press the hand. Press the elbow and now press the hand. So this is exercise number 12. In exercise number 12 you need a corner. And for this corner what you're going to do is you go a little bit, maybe two steps away from the corner, raise your elbows to the level of your shoulders. And what you're going to do is you're going to go all the way down and so all the way, touch all the way the corners and then come up. And again, be careful if you have dry wall and you are too heavy not to punch holes on your dry wall. And go all the way. Make sure that your hips are not bending, so you're not doing this. Your whole body is like a plank and all you're doing is using your shoulders. The idea here is to strengthen the muscles of your shoulder. So you're going to do this eight times. Make sure that they are at the level of the elbows and shoulders here. And you do this. And when this becomes easy for you, you're going to start doing 12 repetitions, 15 repetitions and if you can do 20 repetitions. You're going to feel that your muscles on the shoulder are getting stronger. And of course if you're not used to do these exercises, the next day they're going to hurt. The muscles are going to hurt, but that's normal. It's the muscle pain that is the good muscle pain. Just because you're exercising those muscles, they're going to hurt for maybe 24 or 48 hours. That's called delayed onset muscle soreness or DOMS. This is exercise number 13, which is the shoulder press down. You need a bench, a lower bench about the height of your knee. And this could also be a lounge chair, but something that is sturdy. You're going to put both of your hands in the edge here and go forward. And what you're going to do is you go down and up. And when you go up, go all the way up. So then you're putting strength on your shoulder here and go down and do this eight times. Three, four, five, don't forget to breathe, six, seven and eight. So this is shoulder press down. So this is exercise number 14 for the shoulders, which is a kind of advanced exercise because you need to be very fit to do a front plank. And you can start doing 10 seconds, 15, 20, 30 seconds, or one minute if you can. But it's important that you do right. So the right plank is, if you get a mat, what you're going to do is your elbows need to be below your shoulders here. So don't put too much up or down here. They should be here. And then you're going to don't look ahead. You're going to look down. Don't arch your back too much and don't lower the hips. If you do this, you're going to do a right plank. So when you're ready, just go up and start counting. You can start counting the seconds. And if you can tolerate, you can do 10, 15, 20, 30 seconds and look down. Don't look up. Stay in this position and go up. Feel the strength on your shoulders and stay there. This is an excellent strengthening exercise for the muscles around the shoulder. So the exercise number 15 is the side plank. And there is an easy way that you can do the side plank, which is if you raise your body on the knees. And the hardest one is if you raise your body on the ankles like this. And it's important that when you do the side plank, again, the elbow is under your shoulder at the same level here. And you are like a plank. You are like a straight line. So don't go, don't put your legs in front. They should be like straight, like a straight line like this. And you can do the hardest one or the easiest one. And you can hold up for 10 seconds, 15, 20, 30, or one minute if you can. Okay, so let's get started. One, two, three, up. And you feel your shoulders getting, you're doing some movement there. And go down. Don't forget to apply ice after you finish this routine. You can do this 15 exercise four times a week and progress by doing more repetition. Let's say you can increase to 12, 15, and 20 repetitions of each exercise. I have some patients who use tight bras with narrow straps. And this compresses the muscles, tendons, veins, and nerves that go from the neck to the arm. I usually examine the shoulder for any mark of skin compression. And I recommend them to wear bras with wider straps. The same for people who carry bags or backpacks on their shoulders. It is good if they can distribute the weight of their backpack on both shoulders with a wide strap. In some rare cases, the shoulder impingement syndrome may lead to frozen shoulder, which is a condition where the shoulder gets stiff and unable to perform all movements. If this is your case, you may need a different type of exercise. Also, in some people, the rotator cuff will have a partial or complete tear, and the person may need to see an orthopedic surgeon to fix the problem with surgery. It's important that you have a proper diagnosis of impingement syndrome by a doctor or a physiotherapist. Please remember that this video is intended for educational purposes only. If your shoulder pain is not getting better, then talk to your doctor or your physiotherapist. They should be able to help you to get individualized exercises that are specific to your problem. If you like this video, don't forget to like it below. 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