How to Prevent and Treat Shoulder Injuries

What To Do the First Few Day After Injury

The body's protective response against injury is inflammation.

The signs of inflammation include pain, swelling, redness and impairment of function.

These signs inform the body (through pain signals) that the area is injured and that it should rest.

However, these natural processes slow down the recovery.

The aim of the RICE protocol is to speed up the healing process.

R.I.C.E. stands for Rest, Ice, Compression, Elevation and should be implemented as first aid treatment in the initial stage, the first 72 hours, of acute musculoskeletal injuries or in chronic injuries when inflammation is present.

Rest from any activity that increases your pain.

A couple of days rest is usually all that is needed, then it is better to start moving your limb.

Ice is preferred for the initial two or three days post-injury. 

It will decrease bleeding in the area, reduce swelling and will numb the nerve endings in the area, helping to decrease pain.

Apply ice for 15-20 minutes every 2-3 hours for the first 3 days.

Use crushed ice or an ice pack wrapped in a damp tea towel. You can also freeze a paper cup filled with water and a popsicle in it, and then remove its base, exposing the ice. Use this cone to massage over the area that is painful.

Compress the injured area with a compression bandage to minimize swelling.

If you feel a numb or tingling sensation, or the area under the bandage starts feeling cold or turns blue, it means the bandage is too tight. Remove and re-wrap it. 

Remove your compression bandage at night.


Gravity will encourage swelling to settle at the lowest point. Try to elevate and rest your arm above your heart (provided this does not cause an increase in pain) for as long as possible to minimize bleeding and swelling.


It is preferable to avoid heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early.

Once the “heat” has come out of your injury, heat packs can be used to stimulate blood flow.

We recommend 20 minute applications a few times a day to increase the blood flow and hasten your healing rate. Heat will also help your muscles relax and ease your pain.

FlaxEze Heat Patches are an excellent home solution. 

Magnesium is crucial in the healing process and is often depleted in the body. This mineral helps to reduce pain and inflammation while promoting quicker regeneration of tissues. Topical application of Magnesium Oil increases flexibility and helps avoid injuries.

A powerful blend of anti-inflammatory herbs and nutrients with a strong antioxidant properties will help reduce the swelling, bruising and pain after a shoulder injury.

Quercetin and Bromelain protect the structure of the blood capillaries and have powerful anti-inflammatory effect, and will help reduce swelling.

Massage, Acupuncture, Dry Needling and T.E.N.S. are useful modalities to provide pain relief and assist injury rehabilitation.


Range Of Motion Exercises (ROM)

Normal shoulder range-of-motion allows people to raise their arm above their head so that their arm is touching their ear.

Patients with range-of-motion limitations often cannot raise their arm as high.

Patients commonly experience shoulder stiffness when they have difficulty reaching behind their back, buckling a seatbelt, or combing their hair.

The easiest way to look for a loss of range-of-motion is to compare your injured joint to the joint on the opposite side of your body.

Pendulum circles can be started almost immediately after a shoulder injury.

Bend at your waist with your injured side hand hanging down and your other arm supporting your upper body on table/chair.

Relax your shoulder muscles.

Slowly swing your arm forward to back, then side to side, then in small circles in each direction. Only minimal pain should be felt.

Stretch the arm only (without added weight) for 3-7 days.

Increase the stretch by adding 0.5 to 1 kg per week and gradually increase the diameter of the movements (not to exceed 45 to 60 cm).


Wand Exercises

Wand Shoulder Flexion

Use a long object such as a broom stick.

Start by lying on your back holding the rod against the abdomen with both elbows straight and hands shoulder-width apart.

Keeping elbows straight, lift arms up to shoulder height while keeping shoulder blades squeezed down and back together.

Return wand to rest on abdomen. Repeat 10-15 times and do it 2-3 times during the day.


Wand Standing Abduction

 Hold it in both hands, take the affected shoulder out to the side as far as possible.

Apply pressure using the good arm and broom stick to try to push it a bit further.

Hold for 10 seconds and try to push a bit further again.

Perform 5 to 10 repetitions, lifting the wand to 90 degrees (shoulder height), then if there is no pain, move the wand through a full range of motion (over the head). Increase to two sets of 10 repetitions with a 2-3 second pause at the end of the motion.


Shoulder Stretching Exercises (Day 10-14 after injury)

Stretching is not only an important part of preparing for an exercise program, but in many cases of shoulder pain, stretches are the most important part of treatment as shoulder injuries often cause joint, tendon and muscle stiffness.

Gentle stretching exercises after heat and massage treatment will help to dramatically speed up the recovery process.

As part of the rehabilitation process, stretching can help to ease the tendons and muscles and restore flexibility.

By lengthening your muscles via stretching, you promote flexibility and your ability to have a full range of motion in your joints.

You may feel some discomfort, but never push yourself to the point where you're feeling pain.

Be very careful with any activity you do. Pain is the warning sign; don't ignore it.


Sleep Stretch

Tightness in the ligaments/capsule of the shoulder can develop in people with rotator cuff injuries.

This tightness can contribute to further movement abnormalities and pain in the shoulder.

Lie directly on affected shoulder with head well supported by pillows.

Slide your arm up to 90 degrees and bend your elbow to 90 degrees.

Use your unaffected side hand to gently push the forearm and hand toward the ground alongside your body until you feel a stretch in the back of your shoulder.

Maintain the stretch for at least 30 seconds. If you start to feel a pinch, ease up on the stretch.


Supraspinatus Towel Stretch

Throw a towel over your left shoulder. You can also use a long strap or your belt.

Hold the towel in one hand and drape it over your shoulder and down your back. If you are stretching your right shoulder, the towel should be placed over your left shoulder and be held in your left hand.

Reach behind your back with your other hand and grip the towel.

Gently pull the towel up and allow your hand behind your back to move across and up your back.

A gentle stretch should be felt in the front or side of your shoulder.

Once you feel a stretch in your shoulder, hold the position for 10 seconds, and then slowly release the stretch.

Repeat 10 times, trying to pull your arm up your back a little further each time.

Be sure to move slowly and avoid sudden or jerking motions.

If you experience pain, decrease the intensity of the stretches or the number of repetitions; anyone who feels sharp or tearing pain should stop exercising immediately and consult with their healthcare provider.


Shoulder Strengthening Exercises (Week 3-6)

Isometric or static exercises are often used in the early stages of the rehabilitation process.

During isometric exercises, you contract your muscles without movement.

This maintains or builds muscle strength without risking joint damage as you heal.

Isometric arm and shoulder exercises are easy to perform and have a great benefit for easing arm and shoulder pain.

Isometric Shoulder Extension:

Stand with your back against the wall and your arms straight at your sides.

Keeping your elbows straight, push your arms back into the wall.

Hold for 5 seconds, then relax. Repeat 10 times.


Isometric Shoulder External Rotation:

Stand with the injured side of your body against a wall.

Bend your elbow 90 degrees.

Push your arm into the wall.

Hold for 5 seconds, then relax. Repeat 10 times.


Isometric Shoulder Internal Rotation:

Stand in a corner or in a door frame.

Place the injured arm against the wall around the corner, bending your elbow 90 degrees.

Push your arm into the wall. Hold for 5 seconds, then relax. Repeat 10 times. 


Resisted Strengthening Exercises 

These exercises work on your strength, and involve using different resistances to help you train the muscles gradually. 

The ideal method of doing this involves using a resistance band which is basically like a large elastic band. 

It comes in different 'strengths' according to the colour.

Thera-Band Shoulder Forward Punch in Standing

Begin with band wrapped around your mid back. Grasp the ends of the band in front of you with your elbows bent at your side.

Extend your elbows forward and push the band away from your trunk. Hold and slowly return. 

TIP: Avoid leaning back.


Thera-Band Shoulder External Rotation at 90 degrees

Begin with one end of the band securely attached in front of you at shoulder-height.

Grasp the other end of the band with tension. Pull the band away from the wall, rotating your forearm backward.

Be sure to keep your upper arm parallel to the ground, your elbow at shoulder level, and your wrist straight.

TIP: Don't let your elbow drop below shoulder level. Keep elbow bent at 90 degrees; don't extend your elbow to complete the motion.


Thera-Band Shoulder Horizontal Abduction-unilateral (sitting on ball) 

Strengthens the back of the shoulder and scapular muscles. This exercise is also good for core stability.

Securely attach one end of the band or tubing.

Grasp the other end of the band in front of you at shoulder level.

Keeping your elbow straight and arm parallel to the ground, pull the band outward and back.

Hold & slowly return. Keep your back and neck straight, and avoid leaning over.

VARIATION: perform sitting in chair or bench.


Rotator Cuff Strengthening Exercises 

Thera-Band Shoulder Extension

Begin with one end of the band securely attached. Grasp the other end of the band with slight tension.

Extend your arm backward, keeping your elbow straight. Hold and slowly return.  


Thera-Band Shoulder Flexion to 90 degrees

Begin with a slightly stretched band or tubing anchored under your foot.

Lift the band in front of our body.

Keep your thumb pointing upward and your elbow straight. 

Avoid arching your back.


Thera-Band Shoulder Abduction to 90 degrees

Begin with one end of the band or tubing stabilized under your foot.

Grasp the band with tension at your side.

Keeping your elbow straight, lift the arm upward to shoulder level. 

Hold and slowly return. Avoid arching your back.


Thera-Band Shoulder Adduction

Begin with one end of the band or tubing securely attached.

Grasp the other end with slight tension in the band or tubing, and pull toward your side.

Keep your elbow straight and avoid leaning over. Hold and slowly return.


Thera-Band Shoulder Internal Rotation at 0 degrees

Begin with one end of the band securely attached at waist-height. (You may place a towel roll under your arm as well.)

Grasp the other end of the band with tension.

Pull the band away from the wall, rotating your forearm inward. Hold and slowly return.

TIP: Be sure to keep your forearm parallel to the ground, your elbow by your side, and your wrist straight.


Thera-Band Shoulder External Rotation at 0 degrees

Begin with one end of the band securely attached at waist-height. (You may place a towel roll under your arm as well.)

Grasp the other end of the band with tension.

Pull the band away from the wall, rotating your forearm outward. Hold and slowly return.

TIP: Be sure to keep your forearm parallel to the ground, your elbow by your side, and your wrist straight.


Complete between 10 and 15 repetitions in 2 to 3 sets for all the Tera-Band Rotator Cuff Strengthening Exercises.

Perform the routine 3 days a week.


Prone External Rotation with Soft Weight

Lay on your stomach with your arm hanging by your side.

Bend your elbow to 90 degrees holding the soft ball.

Lift your elbow upward until it’s level with your body. Rotate your forearm upward. 

Hold and slowly return.

Exercises should not cause more than a mild level of pain.


Posture Corrective Exercises

You may not realise it, but most of us have poor posture.

Unfortunately, this causes long term wear and tear on the spine.

Poor posture, like a rounded shoulders posture, may prevent the shoulders from functioning properly.

What is the Correct Posture Standing? 

By learning to maintain proper posture, you can be certain that your shoulder is in the best possible position to function the way it is meant to.


How To Improve Your standing posture

  • Stand tall!
  • Hold your head up straight with your chin in. Do not tilt your head forward, backward or sideways.
  • Keep your earlobes in line with the middle of your shoulders.
  • Keep your shoulders back, your knees straight and your back straight.
  • Let arms hang naturally down the sides of the body
  • Lightly draw in your core stomach muscles. Do not tilt your pelvis forward.
  • Avoid locking the knees.
  • Ensure your feet arches are in a neutral (not flat) position.
  • Stand with weight mostly on the balls of the feet, not with weight on the heels.
  • Keep feet slightly apart, about shoulder-width
  • If standing for a long period of time, shift weight from one foot to the other, or rock from heels to toes.


How to Quickly Check Your Standing Posture

Stand against a wall with shoulders and bottom touching wall.

In this position, the back of the head should also touch the wall – if it does not, the head is carried to far forward.

Good posture can be retrained 

Posture braces can address poor control in the lower back or in the mid to upper back and shoulders during the initial phase when you have no or little postural awareness.

Swiss balls are not only good for exercise programs but they can also be effective in helping to retrain your postural muscles simply while sitting.

When used as a chair, the Swiss Exercise Ball encourages your pelvis to move while sitting.

In addition to creating better circulation in your spine, gentle bouncing and balance reactions will improve the strength of your vital postural muscles in your back

Listen To Your Body

Often people will work throughout the pain, or take an attitude that if it hurts it must be weak and therefore continue training, and train even harder.

Constant maximal work and exercise and especially overhead lifts, can severely wear on the shoulder.

Simple way to avoid to avoid unnecessary wear and tear on your shoulder if it begins to show signs of injury is to give it a rest.


Further Reading: