Anterior stabilisation of the shoulder: exercises

It is useful to use pain relief or icepacks to reduce pain before you exercise. It is normal for you to feel aching, mild discomfort or stretching sensations when you do these exercises. Intense or long-lasting pain of more than half an hour should not occur and if reducing the level of your exercise does not improve these symptoms, please discuss the problem with your physiotherapist. 

Do short and frequent sessions, for example five to ten minutes, four times a day, rather than one long session.

Gradually increase the number of repetitions you do under the guidance of your physiotherapist. 

Phase 1 – exercise from operation to three weeks afterwards

1. Neck exercises

In a standing or sitting position, turn your head to one side. Repeat five times. 

  1. Turn your head to the one side and repeat five times.
  2. Turn your head to the other side and repeat five times.
  3. Tilt your head to the right, right ear to the right shoulder. Repeat five times.
  4. Tilt your head to the left, left ear to the left shoulder. Repeat five times.

2. Elbow exercises.  These can be performed in a standing or lying position.

Straighten and then bend your elbow. Repeat five times.

Try and work towards achieving full flexion and extension of your elbow joint.

3. Scapular setting exercises

Posture:

  • Gently flatten your shoulder blade on your rib cage, as if moving your shoulder blade towards your back pocket.
  • Maintain a neutral spinal posture.
  • Avoid slumping.

Optimal posture

Avoid poor posture
 

Assisted flexion in lying, to shoulder height only:

  1. Elbow supported on a pillow
  2. Thumb up grip on walking stick
  3. Use unaffected arm to push involved arm into flexion just to shoulder level(about 90 degrees)
  4. Do not hitch the shoulder

External rotation:

  1. Elbow supported on a pillow
  2. Thumb up grip on walking stick
  3. Elbows bent to 90° and held at side of body
  4. Push involved arm outward using the stick just until it is in alignment with the shoulder. Do not over push this movement in the first four weeks or it could place strain over the shoulder repair.

Phase 2 – exercises from three weeks to eight weeks after your operation

1. Shoulder flexion in standing

Assisted elevation through flexion in lying on your back or standing.

  • Grip walking stick handle with the arm to be exercised
  • Use the opposite arm to push the involved arm into elevation moving at 90° to the plane of the body. By  four to six weeks you should be able to reach shoulder level and you can gradually increase your range as pain allows.

2. Shoulder external rotation in standing

  • Grip walking stick handle with the arm to be exercised
  • Upwardly rotate shoulder blade
  • Elbow bent to 90° and held comfortably at your side
  • Push involved arm outward using the stick
  • Keep shoulder blade still

Remember: avoid excessive hitching of the shoulder.

3. Static medial rotation muscle contraction

Using a wall:

  • upwardly rotate shoulder blade
  • elbow bent to 90 and held comfortably by side, palm placed against wall
  • gently push into the wall
  • work at 30% maximal voluntary contraction or at 3/10 effort

You can perform the same exercise using a stick

  • Upwardly rotate shoulder blade
  • Thumb-up grip on walking stick
  • Elbow bent to 90° and held comfortably by side
  • Gently push involved arm in while resisting with unaffected arm. There should be no arm movement
  • Work at 30% maximal voluntary contraction or at 3/10 effort

Repeat each exercise ten times and hold for ten seconds, building up to 30 repetitions.

4. Static external rotation muscle contraction 

  • Upwardly rotate shoulder blade
  • Elbow bent to 90° and held comfortably by side, back of hand placed against wall
  • Gently push out into the wall
  • Work at 30% maximal voluntary contraction or at 3/10 effort

Repeat each exercise ten times and hold for ten seconds, building up to 30 repetitions. 

Using a wall

You can perform the same exercise using a stick

Phase 3 – exercises: ten weeks to three months

1. External rotation in 30 to 60° flexion

  • Upwardly rotate shoulder blade
  • Thumb-up grip on walking stick
  • Keep elbows bent to 90° and elevate shoulders to 30 to 60° forward flexion
  • Gently pull out involved arm in while resisting with unaffected arm. There should be no arm movement
  • Work at 30% maximal voluntary contraction or at 3/10 effort
  • This exercise can also be repeated using a light resistance yellow tubing or band

2. The above exercise can be repeated at 90° flexion and above

3. Kneeling on all fours

Gently rock forwards taking the weight of your body through your arms, trying to keep the shoulder blades flat against the chest wall.  Repeat ten to 15 times.  

4. Press-ups 

Start by doing these against a wall. Keep your back straight. Progress to doing press-ups in the kneeling position and finally in the standard position. 

Further information

If you are unsure of who to contact or you have an appointment query, contact Mr Hand’s secretary on 023 8120 5212 between 9am and 4pm. 

If your wound changes in appearance, weeps fluid or pus or looks infected or you feel unwell with a high temperature, contact your GP urgently and ask your GP to inform the shoulder unit.

If you have a query about your exercises or movements, please contact the University Hospital Southampton physiotherapy department on 023 8120 6459.   

If you have a query about your outpatient appointment please contact 023 8120 6218.