Shoulder Exercises for Strength and Mobility

Physiotherapy plays a crucial role in the comprehensive management of shoulder problems, both in conservative treatment and in the post-operative recovery process. It is instrumental in reducing pain, restoring mobility, and improving strength and function in the affected shoulder.

Prior to surgery, physiotherapy helps in maintaining joint flexibility and muscle strength which can significantly contribute to better surgical outcomes. This preparatory phase, often referred to as prehabilitation, can enhance recovery speed and reduce complications. After shoulder surgery, physiotherapy becomes vital for restoring function and preventing complications such as joint stiffness, muscle atrophy, or scar tissue formation. A structured rehabilitation program, customized to the individual’s condition and surgical procedure, ensures a safe and effective return to daily activities or sports.

It includes performing specific exercises, using assistive tools, and other methods such as therapeutic ultrasound, massage therapy and electrotherapy.

The most common shoulder conditions that show significant improvement with physiotherapy are: tendonitis, impingement syndrome and rotator cuff tears. At the same time, physiotherapy is essential to optimize the outcome of a surgical procedure. Even though physiotherapists offer invaluable help in treating patients, there are some exercises that are safe and simple enough to be performed at home without their supervision. However, it is crucial for patients to follow guidelines regarding frequency, technique, and progression to avoid injury or setbacks.

Shoulder exercises are essential for recovering from injury, surgery, or managing chronic conditions. They typically fall into three main categories, each with a distinct goal in the rehabilitation or conditioning process:

• Protection
• Mobility
• Strengthening

Protection: the main goal is to prevent further injury or allow healing to occur. It is mainly achieved through immobilization using tools like Upper Limb Sling and the avoidance of harmful movements.

Mobility: the main goal is to restore or maintain range of motion (ROM) in the shoulder joint. It may need to be maintained, restored or improved. Mobility exercises often begin passively (with assistance) and progress to active movement (using your own muscles).

Strengthening: the main goal is to rebuild muscle strength around the shoulder, to support joint function and to prevent reinjury. It is appropriate once mobility has been restored.

Obviously, shoulder physiotherapy is more complex and includes specialized exercises when performed by a trained and experienced physiotherapist.

Specialist orthopedic surgeons use specific terms to describe Upper Limb movement in space:

• Flexion– Raising the arm forward (like pointing straight ahead).
• Abduction– Raising the arm to the side (like doing a jumping jack).
• External rotation– Turning the arm outward, away from the body (e.g., reaching back to throw a ball).
• Internal rotation– Turning the arm inward, toward the body (e.g., reaching to scratch your back).

These motions can be active, passive, or assisted, depending on the stage of rehab.

Understanding how movement is performed is crucial in rehab settings:

• Active movements– The patient uses their own muscles to move the joint.
• Passive movements– A therapist or helper moves the joint for the patient; the patient does not exert effort.
• Assisted active mobilization– A hybrid where the patient uses some effort (e.g., 50%) and a helper supports the movement. This is useful during the transition from passive to fully active rehab.

The home equipment that someone needs for shoulder exercises is relatively simple:

• Resistance bands: they provide progressive resistance for strengthening muscles, improve flexibility and maintain joint stability.
• Rod or stick (e.g., broomstick, umbrella): they are used in passive range of motion (ROM) exercises, especially in the early stages post-surgery or injury.
• Rope: It is often used for pulley systemsthat allow the shoulder to move passively. It helps increase shoulder range of motion without engaging the shoulder muscles directly.

Exercises that require lying down can be performed on a bed or couch as it helps stabilize the body and isolate shoulder movement.

For those exercises where the elbow needs support, towels or sheets are more practical than pillows. Towels and sheets are firmer, more adjustable, and offer better alignment than soft, uneven pillows.

Small dumbbells are used only in specific strengthening phases, typically when range of motion has improved and there’s medical clearance for resistance training.

In early rehab (especially after surgery), movement of the shoulder is often not initiated by the patient but instead done passively by another person (like a family member).

Home-based exercises are critical in maintaining gains between physiotherapy sessions, and having simple, accessible equipment increases adherence and recovery success.

Exercises should be prescribed by a physiotherapist or surgeon to match the stage of recovery. Improper use of equipment can lead to setbacks.

Frozen shoulder is a condition characterized by pain, stiffness, and limited range of motion in the shoulder joint. It typically develops gradually and can last for months or even years.

Rehabilitation is often broken down into different exercise phases based on the stage of recovery.

They are performed at the early stages of healing, after trauma, surgery (e.g., rotator cuff repair or joint replacement), or significant pain. They help to prevent joint stiffness and maintain mobility without stressing healing tissues. Passive exercises involve no active muscle use from the patient. Another person (therapist or assistant) moves the patient’s arm through its range of motion.

In passive mobilization, the patient does not exert any force. The helper moves the arm in all directions:

• Flexion– raising the arm forward.
• Abduction– moving the arm away from the body.
• Internal rotation– turning the arm inward.
• External rotation– turning the arm outward.

These exercises are performed at the second stage of recovery, when:

• Healing has progressed.
• Full strength hasn’t returned yet.
• Some pain or risk of re-injury still exists.

In this case, the patient actively moves the shoulder, but with assistance to reduce strain. This assistance may come from the opposite (healthy) arm or some tools like a stick, pulley, or towel.

These exercises encourage muscle activation, help rebuild mobility, provide controlled movement to minimize strain and prevent further injury.

Always consult an orthopedic specialist before beginning any exercise regimen for frozen shoulder. The stage of the condition and individual medical history will determine which exercises are safe and effective.

Stretching exercises are commonly prescribed for conditions such as frozen shoulder (adhesive capsulitis) or post-surgical stiffness. These conditions cause limited movement in the shoulder joint due to inflammation, scar tissue, or muscle tightness.

The main goal is to gently stretch the shoulder joint through its full range of motion (ROM) — meaning moving the arm through all the directions it can normally go (up, down, backward, forward, and rotational movements).

The exercises should be performed slowly and carefully to prevent injury. Sudden or forced movements can worsen inflammation or cause damage, so a gradual increase in flexibility is important.

Isometric Strengthening Exercises

“Isometric” refers to muscle contractions where the muscle tenses up but does not change length, and the joint stays still. For example, pressing your hand against a wall without moving your arm.

These exercises are often recommended in the early stages of shoulder rehabilitation because:

• They strengthen muscles without stressing or moving the healing joint, which is safer right after injury or surgery.
• They help maintain muscle tone and prevent muscle wasting during periods when joint movement might be limited.

After injury or surgery, the shoulder joint can become stiff and weak. Stretching helps restore motion, while strengthening (starting with isometric exercises) rebuilds muscle support without risking re-injury.

Treatment often progresses from gentle isometric strengthening to more active and dynamic exercises as healing progresses.

Strengthening Exercises with Elastic Resistance Bands or Weights

Elastic resistance bands are widely used in physical therapy and fitness to improve muscle strength, particularly in delicate areas like the shoulder. These bands provide elastic resistance, meaning the harder you stretch the band, the more resistance it provides. This variable resistance is great because it matches the strength curve of your muscles — the resistance increases as your muscles get stronger through the movement. Since the resistance is gradual and controlled, bands are safer than free weights for many rehabilitation purposes, especially for people recovering from injuries or surgery.

Weights (like dumbbells or ankle weights) provide constant resistance, which can be beneficial for muscle strengthening once your shoulder is ready for more loads. After surgery or injury, weights should be used cautiously. Too much load too soon can cause injury or slow recovery. It’s important to have guidance from a physical therapist before adding weights to your routine. When cleared to use weights, start with low weights and increase slowly to avoid overstressing the healing tissues.

Always consult a physical therapist or medical professional before beginning any strengthening program, especially post-surgery.

Scapular Exercises

Scapular exercises focus on the muscles that control and stabilize the scapula, or shoulder blade. The scapula plays a crucial role in shoulder movement and stability. If these muscles are weak or not working properly, it can lead to shoulder pain, dysfunction, or injury.

Scapular stabilization exercises target the muscles around the scapula and they are a key part of shoulder rehabilitation and injury prevention.

A simple way to perform them is to imagine your scapula as a clock and try to move your shoulder blades as follows, with the spine in the center:

• Upward movement: Move your shoulder blades toward 12 o’clock (lifting them up).
• Downward movement: Move them toward 6 o’clock (pulling them down).
• Sideways movements: Move shoulder blades out toward 3 o’clock (right) and 9 o’clock (left).

These directional movements help you engage and strengthen different scapular muscles and improve their coordination.

Recommendation

The exercises mentioned above are representative examples. This means the exercises listed earlier serve as typical or common examples, but they are not the only ones.

For each shoulder condition, the appropriate set of exercises must be individually selected. So, the treatment or rehabilitation for shoulder issues should be personalized rather than generalized.

Remember:

A proper physiotherapy program is a cornerstone in treating shoulder pathology.

The contribution of physiotherapists is invaluable and cannot be replaced by a home exercise program alone.

• While home exercises are helpful, they cannot substitute for professional evaluation and intervention.
• Physiotherapists adjust treatments based on progress and symptoms, provide manual therapy, and ensure correct exercise technique.
• Home programs should complement—not replace—professional care.