Shoulder strength is often neglected and not always adequately restored after an injury. Consequently, shoulder injuries commonly recur. In fact, 40-50% of people with an episode of shoulder pain will report a recurrence within 12 months. Why? The main reason is that we just aren’t strong enough. So when we are strengthening, how can we do this well and look after our shoulders?
Here are some basic guidelines for returning to the gym after a shoulder injury. However, it is important you see your physiotherapist for an assessment and more specific advice on strength training.
- Initially use light weights and work within a smaller range of movement. Ideally you should also work below shoulder height and not behind the mid line of the body.
- Early exercises for a graduated return to the gym might include (this is a general guide and will depend on your injury, so check with your physio first):
- Rotator cuff activation exercises.
- Dumbbell row, triceps pull down, seated row.
- Then biceps curl, lat pull down in front, bench pull, reverse fly.
- Later: shoulder press, bench press and others.
- Keep a balance between the front and back shoulder muscles. Most people work more on the front muscles (the mirror muscles!) and neglect the muscles at the back, which are just as important. You also need a good balance between the deep, stabilising muscles (these are often neglected) and those on the surface (like the pectoral muscles).
- You can be very strong and manage to lift heavy weights, but if you do not have good activation of your deep muscles, like the rotator cuff and scapular stabilisers (trapezius and serratus anterior) they cannot do their job of supporting the shoulder. They need to keep up with the huge mover muscles and will often need a reminder to work. You can benefit from an active warm up specifically targeting these muscle groups.
- If you have rotator cuff related shoulder pain, or have had a surgical repair, avoid long lever loading (such as straight arms with lifts to the side or in front). Try a dumbbell fly with elbows slightly bent, in front of the side mid-line and below shoulder height. Keep the chest gently lifted.
- Initially avoid end of range work. This includes bench press, pec deck and dumbbell row. Keep the elbow from moving behind the side mid-line of the body and shorten the range.
- Hand spacing on bar exercises can be approximately shoulder width or slightly wider (avoid going wider than 1.5 x chest width). Discuss this with your physio. Sometimes it is better to use dumbbells to allow a change in grip.
- Maintain good form and technique throughout your exercises. If you find yourself over shrugging, arching the back or using momentum to complete the movement, it is often a sign of fatigue and you need recovery time. A little pain on return to exercise is normal, but it should settle quickly. Be guided by your physio.
- Dips, upright rows, behind the neck movements (eg. with squat bar, shoulder press and lat pull down) should generally be avoided, particularly if you have shoulder pain. If unsure ask your physio.
- Do not be afraid to load your exercises, but increase weight gradually to give your shoulder time to adapt. If unsure ask your physio. Your shoulders will love it when you load optimally!
Any of our physiotherapists at Physiotas can assess your shoulder injury and give you specific advice on how to strengthen safely. To make an appointment at any of our clinics call 03 6424 7511.
About the Author:
Sally is an APA Sports Physiotherapist with a special interest in sports injuries and the shoulder. After studying and working in Melbourne, Sally moved to Tasmania and then achieved the Sports Physiotherapy title in Perth, W.A. She is a member of Sports Medicine Australia and Shoulder & Elbow Physiotherapists of Australasia.
Sally is currently a PhD candidate at the University of Tasmania where she is investigating shoulder strength and pain in young swimmers. Working at the Sydney 2000 Olympics, Melbourne 2006 Commonwealth Games and with several sports teams has been among her career highlights.
Sally also has a passion for running and has completed (and enjoyed!) a marathon in every Australian state!