Category Archives for "Shoulder Pain"

Rotator Cuff Injury Rehab – Bear Walk

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees. As you place one hand forward, bring your opposite foot forward as well.

 Do this while you also keep the shoulder blade muscles and the core stability muscles in your low back engaged. Repeat this for 25 seconds 3 sets daily.

This type of closed chain exercise is great to retrain the rotator cuff in a body weight functional movement pattern for all sports and activities that require strenuous physical activity strength of the upper limb. 

Rock Climbing warm up Shoulder and Hip Openers

Start with weight shifted to a right side step and right arm behind and hand up the back. Then step right foot back to centre with the arm and hand back in front in neutral.

Then back flag the right foot to the left side and reach the right arm straight up to the ceiling and return to the start with the right side step and arm behind and hand up the back again. Repeat this for 10 reps on each side for a couple sets. 

This is a great way to open up the mobility of the shoulder and hips and to get the movement patterns of those muscles working while mimicking important climbing movements.

If you have any pain or difficult doing this exercise, consult your local physiotherapist before continuing. 

Rock Climbing Warm Up Shoulder Cross Overs to Prevent Shoulder Rotator Cuff Injuries

With one foot forward and one foot back, engage your lower quadrant core and bend through your hips while you cross both arms over the midline of your body over and under for 30 seconds. Do a total of 3 sets as a warm up.

This will get the the blood flow and circulation running into the shoulder muscles, tendons, ligaments and joints to prepare your shoulders before you take on a load like rock climbing. You can also utilize this exercise as a warm up before doing other sports or physical manual labour involving the shoulders.

If you have any pain or difficult doing this exercise, consult your local physiotherapist before continuing.

Rotator Cuff Injury Rehab Shoulder Press Kettle Bell Perturbations

Tie a heavy duty resistance band to a 5 pound kettle bell. Secure it onto the middle of the handle. Stand with your feet in a square stance and engage your core stability muscles of your lower core to prevent your spine from moving and compensating.

Lift the kettle bell straight up by punching the fist to the ceiling. Make sure to reach a little higher with your fist without changing the alignment of your posture. With the shoulder blade fully engaged, bring the hand out to the outside a little more and keep your fist reaching towards the ceiling.

Then move the fist forward and backwards into an internal and external rotation motion. Repeat this for 30 seconds doing 3 to 5 sets on each side.

This kind of perturbation training is aimed towards a more progressive shoulder rehab strengthening for excelling in return to sports and play that require dynamic overhead shoulder rotator cuff strength and stability.

If you have any pain or difficult doing this exercise, consult your local physiotherapist before continuing. 

Rock Climbing Warm Up – Shoulder Circles to Prevent Shoulder Rotator Cuff Injuries

Standing with your arms out wide to the left and right, create circles in the forward direction for 30 seconds. Then do circles in the back direction for thirty seconds. Perform this for 60 seconds in total doing 3 sets as a warm up.

This will get the the blood flow and circulation running into the shoulder muscles, tendons, ligaments and joints to prepare your shoulders before you take on a load like rock climbing. You also utilize this exercise as a warm up before doing other sports or physical manual labour involving the shoulders.

If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing. 

Shoulder Rotator Cuff Injury Planking Ball Crosses

Place a ball underneath you between your hands. This will be the centre position for the ball as you will be moving it out to one of four positions each time and back to centre again.

Begin in a plank position and engage your lower core by trying to make yourself skinnier below your belly button at your waist line. Supporting yourself in a plank with your right side, move the ball from centre to up above, then back to centre, then from centre out to the left and then back to centre, and then from centre to below and then back to centre again.

Finally from centre out to the far right and back to centre again. Switch and plank on the left side now and move the ball with your right hand. Do 10 reps on each side daily.

You can utilize this exercise for rock climbing and many other different throwing sports such as baseball, volley ball or ultimate frisbee that require core stability and shoulder strength. 

AC Joint Shoulder Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. Multi time award-winning physiotherapy clinic. Wil's the owner, the big cheese and he's booked out all the time. It's really hard to get into because he's so good at what he does. Today we're going to talk about AC joint shoulder injuries. How are you doing Wil? 

Wil: Good. I'm good. Thanks Mark. Hey Mark, I was just wondering, you know, I know that you always love pumping up my tires, that's great., I thank you for that. But we also have a great team of other physios that actually, you know that, since we're talking about shoulder injuries that actually have a special interest in shoulders too.So I just thought I'd mention that. 

Mark: Of course, I having been to your clinic many times. I know that that's the case. You're the guy here that's the face of the business right now today though. So that's why I did that. All the team, you hold everyone to a really high standard. I know that's how you operate. That's just your nature. And so that's how the team is at Insync Physio. How does someone actually injure the AC joint? And what is it? 

Wil: Yeah, so let's start off with what it is first. So when we think of like the shoulder joint and shoulder injuries, we quite commonly think of like a part of the shoulder. That's the ball and socket. It gives us this 360 degrees range of motion. Well, we also have another part that's part of the shoulder complex, which is where the collarbone connects to your shoulder blade, which is basically called the AC joint or short for acromioclavicular joint. And it's not injured as common or the injuries that happen in the AC joint are not as common as the ball and socket joint area, but we are still seeing this in the clinic. 

Over last couple of weeks, we've had a few people that have come in with it. And so I thought we talked about it. And usually it's from a blunt force or trauma. So in the athletic population, you know, impact sports, when you have like a shoulder to shoulder contact. Really good example is we've had some of our therapists who've worked with hockey teams and they see one of their players get checked into the boards, kind of face first and the shoulder impacts the boards and that's a very common way of injuring the AC joint.

 And another one, it doesn't have to be from athletics or from sports, but it could be like a car accident. Like you got the seatbelt on and it's an impact force with the seatbelt over the collarbone area. And then it's just a sudden jarring motion. 

Another one is also where you could be just maybe moving. I know a client of ours, one of the physios, they were helping someone move and then they're kind of holding something heavy in this position. And then they ended up just having a shoulder to shoulder sort of contact by accident. And then it caused a mild sprain in the AC joint. 

Mark: And I guess falling, that would be another cause, like with your arm out. Could that also do injury to that joint? 

Wil: Yeah, it can actually cause some impact loading forces onto that joint as well, causing some strain. And actually not what we're talking about. Sort of, other types that's non traumatic. It can actually be non traumatic. It can be something that presented as more wear and tear. And so there's special tests that we do in the clinic that kind of determine if your AC joint is affected. We don't just have one test. We have a few different ones that we do, and we cluster them and it actually provides good reliability and accuracy.

Mark: So once you've diagnosed it, which I'm sure is pretty complicated because it could feel like it's referring from the ball and socket joint into the AC, or is it specific to the AC, like someone's going to feel it there in the clavicle, in their collarbone, kind of where it inserts into the scapula. What's the symptoms that someone might notice?

Wil: Yeah, you definitely get like swelling. So there's the more obvious ones is you see it and be red hot and swollen. There's definitely pain and loss of this function. So even with an acute injury, that's something that you want to actually immobilize right away because it's going to be painful and you want to just let things settle down.

So if it's like an acute sprain into that AC joint and you see swelling in there and the pain and dysfunction is obvious. You want to just put it in a sling, for at least a few days you know, to let it settle down. But you do want to get it moving a little bit after that obviously. But you want to give it a chance to really settle down and heal. But the other symptoms too, that if you look at the AC joint, you have a lot of ligaments in there. And so we actually can test for it. But sometimes it can get to a degree where it's so severe where you can see not only a step deformity, so it's very obvious, but then you also get a lot of pain with that too.

Quite often too, if it is fully torn. And there's a step deformity, there can be no pain. Which is almost contradicting. And the reason why, and we've seen this a lot before, is because when there is a step deformity, but there's no pain is because the ligaments have been totally ruptured and the nerve supply is basically not there anymore. And so you can't feel it. But like there's a loss of range of motion. I mean, they feel the initial pain and swelling, but once that goes down and the step deformity is still there. They still have the dysfunction, but it just doesn't hurt. But they had the loss in strength and the loss and stability in that area.

Mark: So how would it present? Is it going to present similar to a broken collarbone? If that was up in that nearer to that area? 

Wil: No, that's a really good question, Mark, thank you. So when you're looking at the sprain of the AC joint, it's kind of more on the outside, closer to that ball and socket, and you can see the swelling in that joint area. And so in that area that you'll have the swelling. And whereas like with a fracture, you can feel along the line of the bone. And if it's a hairline fracture, it's gonna be a little bit tougher because you'll feel maybe sensitivity. It could be muscular is kind of hard to tell.

But if it's like something that's more obvious, then you're going to see a little more of a step deformity in there too. And that's obviously not good. But the presentation is different. And if there's any question, you know, especially if it's trauma related, then we probably want to go get that checked out more medically too. And that's important as a next step. 

Mark: So you've diagnosed it. If there need to be x-rays done. Medical consultation. Their course of treatment is underway, but now they come back. Okay. Now I want to get my range of motion and strengthening and proper function again. How does that course of treatment usually run?

Wil: Yeah. So stability is the key thing, because stability is the number one thing that we want to try and achieve in that joint, above strength and making sure that we progress that stability throughout the whole range and full mobility. And so we don't want to start doing things to strengthen it right away until we achieve that stability strength.

So what I'm talking about is like, you don't want to be doing like pushups and presses and stuff like that. Sort of an old school thinking of like, you know, if we can just strengthen it, which in other areas like your ankle, that's really good. You want to strengthen, you sprained the ligaments. In the AC joint, you got to really work on stabilizing strength. Specific things to actually really stabilize that joint, to make sure that then we can progress through the stages of healing properly.

And so depending on the severity of the injury, there's going to be different stages that you move through in terms of progressing back to like sport, especially, or to work if that's a big thing where you need to use your shoulder for. 

Mark: So what's the difference between them? What kind of exercises is that that are the stability, what you would classify as the stability exercises or steps that someone would need to take that you would guide them through?

Wil: Yeah so, a lot of it is like functional core starting off with basic core and progressing the functional core stuff. The rotator cuff strengthening is really essential. It will help and then working on a lot of stuff around that area to target certain muscles in addition to the rotator cuff, like into the shoulder blade. So there's all these stabilizing muscles.

So there's tests that we can do to look at which muscles are definitely weaker. And usually someone that has an injury, they'll show these patterns right away. And if you have a preexisting injury, like I'm thinking about a client who came in to see one of our physios, that had a pre-existing rotator cuff injury, didn't actually have trauma in the AC joint, but had some pain there as well, you know, they're presenting with other stuff.

So this is where we need to tailor and personalize the things that we need to do with you on a hands-on, you know, one-on-one sort of, okay, we gotta get this moving this way and realign the shoulder blade in this way, and then retrain the specific movement pattern for you. 

Mark: And movement pattern is really important for the shoulder joint. Is that a useful assumption?

Wil: Absolutely 100% because especially when I talked about earlier, that in the shoulder socket where it's ball and socket, it's 360 degrees of movement. And then you have your shoulder blade, which is basically a floating, it's like it's got all these other muscle attachments. And it's sort of floating around in there and it's only real attachment to like, your arm bone, and then your collar bone. So then you have all these other muscles that control and dictate how your shoulder moves. And so having that movement pattern and optimizing the best way to get it working again, especially after you know, like a sport injury, you want to get back to playing sports or work, you know, to be able to do, doing the repetitive motion, or whatever it is that you need your arm to be able to be in that position, is super important.

Mark: In other words, it takes an expert really diagnose it and help you through the process because you might think it's okay because you're free of pain and then you actually are using other muscles and other functioning is happening to take over something that didn't heal properly or hasn't been activated properly. Is that right? 

Wil: Yep. Pretty much. And then you made an interesting point about feeling like it's okay. And a lot of people, they get up to like maybe 85% and then, or they get back to being able to play their sport and they feel like they're 85% and we can get by. You know, and this is also where I talked about the getting intervention in terms of maybe on a medical aspect because like there's a lot of ligaments in there and the classification is quite complex, but you know, it may warrant a referral to see a specialist about what's another route to take. If the rehab approach is just not successful.

Mark: That whole knife thing. Perhaps. 

Wil: Possibly. So that's why we want to work with a team of sports medicine doctors as well and other doctors to kind of get that process going for that. Possibly. 

Mark: If you want a team that's going to really help you diagnose exactly what's going on, whether you have pre-existing injuries, whether it was a blunt force trauma, whether it's arthritic or some kind of thing like that. Insync Physio are the guys to get in touch with. You can reach them at their website You can book for either office in Vancouver or in North Burnaby. And of course, if you want to book and see Wil, you can reach him at 604-566-9716. Or any of the team, they're all top notch. He wouldn't have them there if they weren't. Thanks Wil. 

Thanks, Mark.

Shoulder Rotator Cuff Injury – Progressive Planks

To begin, each plank will be done with wide arms in 3 different hand positions putting the rotator cuff muscles at 3 different angles and then progressing each of them by flagging one foot out to the side. Engage your lower core by trying to make yourself skinnier below your belly button at your waist line.
The first plank position is with your fingers facing straight ahead. Hold it for 10 seconds. The second is with the fingers facing 45 degrees. Hold this for 10 seconds. The third position is at 90 degrees facing outside. Once again, hold it for 10 seconds. Hold each wide arm plank positions for 10 seconds. Then when doing all three wide arm planking positions with your foot flagged hold these for 10 seconds as well. Do one set of 10 reps for each of these on both sides after a training session or workout.
Being a rock climber, I came up with these exercises to progress the functional core, rotator cuff and entire shoulder strength to become stronger for rock climbing after recovering from a shoulder injury. You can also utilize this exercise for many different sports requiring similar static core and shoulder strength.

If you have any abnormal pain or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Shoulder Injury Rehab – Advanced Bird Dog

Start on the hands and knees with your spine in neutral alignment. Engage the inner core stability muscles of your lower spine by pulling the muscles below your belly button inward without changing your neutral spine posture.

Then, bring your hands forward on the mat and straighten the knees one at a time so that you’re on your toes. kick back and extend with one heel while keeping the hip square and lined up with the other hip and reach the opposite hand and arm forward. Hold this for 10 seconds doing 10reps on each side for 2-3 sets.

This is a great core stability strength exercise to help progressively strengthen your shoulder and upper quadrant core strength after you have injured it. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Shoulder Injury Recovery – Rotator Cuff Ball Release

Do you have a chronically sore or stiff shoulder? Do you use your shoulder repetitively or exert it intensely in sports like throwing, hitting, lifting or rock climbing? If yes, then this recovery exercise might just be one of the right exercises for you.

Start with a release ball, either a very soft one to start or a stiffer one like a lacrosse type of density) and place it under the back part of your shoulder blade lying down on top of it.

Take a big breath in then slowly exhale as you relax your body and the back of your shoulder into the ball. Then using the ball as a pressure point release gently and slowly roll over the ball while trying to keep the body relaxed. Do this for a few minutes and find 2 to 3 other areas in the muscle to repeat this on.

If you have any abnormal pain or discomfort or are unsure about what you are doing consult a local physiotherapist before continuing.

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