The robbery and hold-up.
The robbery and hold-up.

Do you have a twinge of shoulder pain when you roll over at night or reach overhead to put on a shirt? If you do, you’re not alone. Shoulder pain is one of the more common complaints that bring people in to see their occupational or physical therapist. The good news is that with the right mix of rest, hands-on treatment and strengthening, shoulder stiffness and pain can resolve.

The shoulder is the most mobile joint in the human body. Its motion allows us to throw a ball to our dogs in Washington Park and reach the skis from the roof rack for our trip to Stevens Pass. There are 16 major muscles that control the shoulder blade (scapula) and many of these, the trapezius for example, move the shoulder in several different directions. The often-injured rotator cuff is comprised of four individual muscles, the supraspinatus, infraspinatus, teres minor and subscapularis.

Slouching posture, repetitive strain and trauma can all lead to inflammation and weakness of the muscles and tendons of the shoulder. Conditions such as tendonitis, dislocation and rotator cuff tears are common. These injuries can occur when the arm moves beyond its normal range of motion or from simple age related wear and tear.

Occupational and physical therapists work to return an injured shoulder to a state of stability and strength. There are literally hundreds of shoulder exercises that can facilitate the return of motion and performance. With the guidance of an expert in shoulder rehabilitation an individual with a shoulder injury, even one needing surgery, can usually return to sport. Therapy focuses on specific goals and can include a pain free return to a Live Love Flow yoga class or master’s tournament play at the Seattle Tennis Club. Addressing sleep disturbances from shoulder pain is often the highest priority for those with shoulder pain.

Sleeping with a small pillow or blanket under the arm places the elbow a few inches away from the body. In this position the rotator cuff and tissue of the shoulder get better blood flow which often leads to a decrease in pain.

There are several motions that can improve the health of the muscles and tendons of the shoulder. One movement is referred to as a “lawnmower.” From a standing or sitting position the arm reaches down and across the body and then moves back to the starting position, as if you were pulling the string to start a lawn mower. Reaching down and across moves the shoulder blade to the side and moving into the pulling position strengthens the muscles that stabilize the shoulder. (See picture at top of article)

A second helpful movement is the “robbery" (see small picture at upper left). With the arms by the side, hold the elbows in a ninety-degree angle. From this starting position rotate the hands away from the body while keeping the elbows tucked-in by the side. This moves the shoulder into external rotation. The muscles of the rotator cuff are activated with this movement.

Moving the arms from the externally rotated position into an overhead position is called a “hold-up.” This movement activates the muscles that provide a base of support for the shoulder blades and enable us to reach overhead.

If moving through any of these motions causes discomfort you should discontinue the motion and contact a therapist who specializes in shoulder rehabilitation. If you spend many hours at a desk it may be helpful to perform five repetitions of each of these movements once or twice a day. With guidance for technique these exercises can be added into a general fitness routine and be performed several days a week. It is essential that these movements are pain free before adding resistance.  

If you find that your shoulder hurts when reaching overhead or is uncomfortable when sleeping you should seek medical attention. Most shoulder injuries, including rotator cuff tears, happen gradually over time. The sooner you see a shoulder specialist the sooner you can get back to a pain-free game of fetch with your pup.

Aaron Shaw is an occupational therapist, certified hand therapist, certified strength and conditioning specialist, and proprietor of MoveMend in Madison Valley. More info at movemend.info.