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Shoulder Instability Exercises That are Actually Effective

by Jaydee Vykoukal, PT, DPT December 01, 2021 0 Comments

Woman dumbbell exercise

Shoulder instability is a result of laxity of connective tissues within the shoulder. This can include the shoulder joint itself (glenohumeral joint), shoulder blade (scapula), and/or collar bone (clavicle). There are various reasons that instability may be present in the shoulder, ranging from a traumatic shoulder injury like a dislocation to overuse or genetics. Having a high-quality exercise program in place can help improve shoulder stability and reduce your risk of injury and long-term issues. Keep reading to learn more about shoulder instability exercises that can help your shoulder feel as stable as possible.  

Best Exercises for Shoulder Instability

The goal of exercise for shoulder instability is to restore as much innate stability as possible in the joint. The shoulder becomes most dependent on muscle strength to protect the joint with daily activities. The two primary areas of focus for rehab for instability include the rotator cuff muscles that directly support the shoulder and supporting muscles in the mid-back and shoulder blade area. 

Rotator Cuff Exercises

There are four muscles that comprise the rotator cuff: the supraspinatus, infraspinatus, teres minor, and subscapularis. When properly coordinated and utilized, these muscles keep the ball of the joint (head of the humerus) in an optimal position as the arm moves within the socket (glenoid). This keeps it stable and prevents unnecessary joint damage and strain. 

Isometrics

An isometric exercise means that you are activating specific muscle groups without actually moving the joint itself. This makes it possible to strengthen muscles while keeping it relatively pain-free and avoiding unnecessary strain to the shoulder joint capsule.

  • There are 4 primary movements for strengthening the rotator cuff with isometrics: abduction, flexion, internal rotation, and external rotation.
  • For each movement, keep your arm at your side in a comfortable position. Don’t forget to keep your neck relaxed and in a good posture. 
  • For each position, hold for 5-10 seconds for 10 repetitions and repeat 2-3 times total. 

    Abduction
    1. Stand sideways by a wall with the elbow of your injured shoulder touching the wall (use a pillow for a cushion between if needed). 
    2. Push your elbow against the wall as if you were going to lift your arm sideways and hold (to strengthen both the supraspinatus and deltoid muscles). 
    Flexion
    1. Stand facing the wall with your arm at your side, elbow bent, and fist touching the wall (or pillow). 
    2. Push your fist forward into the wall and hold.  

    External Rotation (but you’re working the internal rotators)
    1. Keep your injured arm at your side with your elbow bent to 90 degrees.
    2. Place your opposite hand on the inside of your forearm near your wrist and apply pressure as if the forearm was going to rotate away from the body.

    Internal Rotation (but you’re working the external rotators)
    1. Keep your arm at your side and elbow bent. 
    2. Place your opposite hand on the outside of the forearm by reaching across/above and apply pressure as if you were going to rotate your forearm toward your belly button.

  • The key is to keep your muscle activation relatively pain-free and joint stable throughout.

Resistance Bands

Once you have mastered isometrics and they are getting too easy, it’s time to progress to active motion against resistance. If the resistance feels like too much to start, you can also focus on shoulder range of motion while keeping good form first instead.

  • Grab a resistance band to get started. Choose a resistance level that you can comfortably use. If you’re not sure, start lighter and progress from there.
  • For each move, focus on keeping it slow and controlled in both directions. Plus, it’s important to keep good posture and the neck relaxed throughout (if your neck feels tense, you are probably using too much resistance). 
  • Complete 10-15 repetitions for 2-3 sets for each exercise. Stay within a range of motion that is tolerable for you and doesn’t make your shoulder feel unstable.

    Abduction
    1. hold one end of the band in your injured arm with your thumb pointing up toward the ceiling and arm at your side with the elbow straight. 
    2. secure the other end of your band with your opposite hand against your hip bone (adjust resistance as needed).
    3. lift your straight arm sideways away from the body until it gets to shoulder height and hold for 1-2 seconds before returning to the starting position. 
    4. When you’re ready, you can progress to a higher range of motion.

    Flexion

    The setup is the same as abduction for this move. However, this time you are lifting your arm straight up in front of you. Once again, start with a goal of shoulder height and progress from there. Make sure your thumb is facing upward or inward (not downward to prevent pinching).

    External rotation
    1. Hold your band in both hands in front of your navel at shoulder width with the elbows bent to 90 degrees and palms facing upward. 
    2. Keep your elbows at your side as you pull your hands away from each other as far as possible and hold for 1-2 seconds. (Again, adjust resistance as needed.) 
    3. Alternatively, you can focus on one shoulder at a time by securing the band to a door or other sturdy surface and completing the same move.

    Internal rotation
    1. Secure your band at navel height to a sturdy surface like a doorknob. 
    2. Stand sideways to your secured band with the arm you want to work closest to it. 
    3. Hold the band in your hand with the elbow bent to 90 degrees and resting at your side.
    4. Keep your elbow in place as you pull that band across your body toward your belly button and hold 1-2 seconds before returning.
  • Additionally, you can add movements like bicep curls by standing on the band and tricep curls by securing the band overhead.

Scapular/Core Exercises

If you’re trying to move your arm and don’t have adequate shoulder blade strength and coordination, you are putting your shoulder at risk for re-injury and aggravation. Addressing the shoulder blades and mid-back is a part of the shoulder rehab program that is often neglected. Incorporating these few exercises will make a huge difference in your overall shoulder function. 

Shoulder Blade Squeezes

This is one of the most basic moves you can start with to strengthen the muscles between the shoulder blades, particularly the middle and lower trapezius muscles (that are often overpowered by the upper trapezius muscle along the top of the shoulder and neck). It might seem simple but can be hard to coordinate with an injured shoulder or chronic bad posture.

  • Sit or stand with good posture (shoulder back, head above the shoulders, chin slightly tucked)
  • Imagine there is a quarter between your shoulder blades as you pinch the shoulder blades together (shoulder retraction) and hold for 5-10 seconds
  • Make sure you are keeping the shoulders relaxed and do not let them lift up toward your ears. You may feel a stretch in the front of the chest if you tend to slump or have tight pec muscles
  • Repeat for 10-15 repetitions for 2-3 sets total
  • Progress to resistance exercises as tolerated. However, keep this one in mind with daily activities to build your awareness of your posture and keep these muscles strong.

Rows

    This traditional move is essential for shoulder blade coordination and is the next step in progression from the exercise above.

    • Grab a resistance band and secure it around a sturdy surface at navel height
    • Hold each end of the band in one hand with the elbows bend to 90 degrees at your side and palms facing each other
    • Stand at a distance that gives you enough resistance without tensing your neck
    • Keep good posture as you squeeze the shoulder blades together (just like the exercise above) and pull your elbows back behind your body
    • Hold for 2-5 seconds before returning to the starting position and repeating
    • Continue for 2-3 sets
    • Progress the band resistance as tolerated. Plus, you can utilize row machines at the gym to complete this move as well

       

    Prone Arm Lifts

    These final three moves can feel quite difficult with an injured and unstable shoulder. You should not attempt these until you’re in the later stages of recovery and have better control of your shoulder movements.

    • Lie on your stomach with your forehead supported by a small towel roll if needed
    • Focus on optimal posture while keeping your neck as relaxed as possible
    • Start with your arms out to the side to make a “T” shape 
    • Lift your arms up toward the ceiling as you squeeze the shoulder blades together and hold for 2-5 seconds
    • Repeat for 10-15 repetitions
    • Next, bring your arms up overhead to make a “Y” shape
    • Lift your arms up toward the ceiling again and squeeze the shoulder blades and hold
    • Repeat for another 10-15 repetitions
    • Finally, bring your arms completely overhead into an “I” shape
    • Again, lift your arms up toward the ceiling while still squeezing the shoulder blades (this will be the hardest to coordinate and is in a position of instability- so start slowly). 
    • Repeat for 10-15 repetitions
    • Continue for 2-3 sets of each exercise
    • If you’re having trouble coordinating any of these moves (they get progressively harder), go back to the other exercises and return to these later when you’re ready
    • To progress, hold small weights in your hands or hold for 5-10 seconds with each repetition

       

    The Goal of Physical Therapy

    Following a shoulder dislocation or when dealing with chronic wear and tear that has left your shoulder unstable, physical therapy is the best option for restoring shoulder function. When you work with a physical therapist, they will do a full shoulder (and body) assessment to determine your unique deficits. From there, they can work with you to design a personalized rehabilitation program for the clinic and a home program to expedite your recovery. In general, your PT will help you with the following:

    • Strengthening of the shoulder, shoulder blades, mid-back, and neck
    • Posture training with sitting, standing, sleeping, and other daily activities to maximize tissue health and coordination of the shoulder girdle muscles with movement
    • Reduce shoulder pain with modalities, such as ice, heat, electrical stimulation, ultrasound, and soft tissue massage
    • Restore capsular joint mobility. Usually when one area of the shoulder is hypermobile (most often anterior shoulder instability), other areas are immobile or stiff- targeted joint mobility with the guidance of your PT can help restore biomechanics
    • Biomechanical and proprioception training with dynamic exercises and use of feedback (visual, verbal, and the use of tools like kinesiology tape)
    • Provide extensive education regarding your shoulder health to help you feel empowered to keep your shoulder instability well managed at home and prevent chronic issues for years (even decades) to come

    Tips for Effective Exercises

    Now that you have a grasp of where to start and how to progress with exercise for shoulder instability, let’s review a few tips for maximizing your efforts.

    Mechanics are King

    As your shoulder heals, you do not want to return back to square one because of faulty mechanics that re-strain affected tissues. The primary goal is to optimize the position of the ball in the socket and of shoulder blade movement on the ribcage. From there, you can gradually progress without risking reinjury.

    Get the Feedback you Need

    When re-training your shoulder mechanics, it can be hard to self monitor your progress. Utilize tools like kinesiology tape (talk to your PT to get started) or a mirror.

    Start with the Basics and use your Symptoms as a Gauge

    It’s always best to start with the easiest exercises and give your shoulder time to adjust gradually. Then, only progress when you feel in control of your shoulder mechanics, don’t experience shoulder impingement (pinching), and your symptoms don’t get worse. Be patient!

    Manage your Symptoms with Modalities

    Use home remedies to manage any pain, stiffness, or swelling- both before and after your exercises. Once again, this might include ice, heat, and/or electrical stimulation (with a home unit).

    Use Massage Tools at Home

    Your PT will help you with stiffness, pain, and joint mobility as needed. At home, you can work on this independently with tools like a foam roller for thoracic mobility (a common cause of poor shoulder biomechanics) and a massage cane for addressing tension in the neck and mid-back. 

    Use a Brace when Returning to Higher Level Activities

    As you get back to reaching activities or even a sport, you may consider wearing a brace for additional support and biofeedback. Talk to your sports medicine doctor or PT about what type of shoulder brace is right for you.

    Building Shoulder Stability

    Shoulder instability can make it feel impossible to complete your regular activities. It will definitely take time and patience to restore stability and confidence in your shoulder. However, with the right plan and strengthening exercises in place you can gradually make progress on your way to a full recovery. If symptoms get worse, we recommend seeking medical advice from your healthcare professional.

    Resources:

    https://orthop.washington.edu/patient-care/articles/shoulder/home-exercises-for-the-unstable-shoulder.html

    https://orthoinfo.aaos.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/

    https://www.physio-pedia.com/Shoulder_Instability

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    Jaydee Vykoukal, PT, DPT
    Jaydee Vykoukal, PT, DPT

    JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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