Shoulder Pain: An Exercise to Help Recover

Shoulder pain is most often associated not with a "dislocated" joint, but with problems with the soft tissues around it. The most common type in adults is so-called rotator cuff pain and subacromial pain syndrome, which affects the supraspinatus tendons and other muscles that run under the bony "arch" above the shoulder joint. The trigger can be a sudden movement, prolonged overhead arm work, or accumulated strain due to weakness in the scapular stabilizers. [1]

Some patients experience inflammation or degenerative changes in the rotator cuff tendons, episodes of tissue "pinching" when raising the arm, and sometimes partial tendon ruptures. Research shows that this type of pain is not always characterized by a single structure, and the problem is considered to be a complex of changes in the muscles, tendons, capsule, and neuromuscular control. Therefore, current guidelines refer not to "local inflammation" but to rotator cuff pain or subacromial pain syndrome. [2]

Long-term, complete rest of the shoulder rarely helps. On the contrary, without movement, the tissues lose elasticity, the joint capsule can become tighter, and the muscles weaken. For some people, this results in so-called "frozen shoulder," when the pain subsides but mobility is severely limited. Clinical guidelines emphasize that moderate, well-measured activity is safe and beneficial in most cases, unless there is a recent injury or serious underlying pathology. [3]

Posture and scapular position both play a role in chronic shoulder pain. If the shoulders are constantly "slumped" forward and the scapula is high and elevated, the tendons under the acromion experience increased friction when raising the arm. Systematic reviews of scapular stabilization show that people with subacromial pain often have scapular motion abnormalities and weakness of its stabilizers. [4]

Finally, pain is also influenced by general factors: sleep deprivation, stress, comorbidities, and low overall activity levels. Research on long-term subacromial pain syndrome shows that comprehensive programs that include exercise, education, and gradual normalization of activity are more effective than attempts to "turn off" the pain with pills or injections alone. [5]

Table 1. Common causes of shoulder pain and their characteristics

Cause	What's happening	Characteristic features of pain
Rotator cuff pain	Overload, microdamage to tendons	Pain when raising the arm to the side or forward, at night when lying on the shoulder
Subacromial pain syndrome	"Pinching" of tissues under the bony arch	Pain in the arc of motion from approximately 60 to 120 degrees of arm elevation
Tendinopathy of the tendons	Changes in tendon structure under chronic load	Aching pain after exercise, morning stiffness
Adhesive capsulitis (frozen shoulder)	Thickening and shortening of the joint capsule	Severe restriction of movement in all directions
Post-traumatic conditions	Sprains, partial tears, consequences of dislocation	Acute pain after injury, sometimes swelling, bruising, instability

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How Exercises Help Reduce Shoulder Pain

Current clinical guidelines for rotator cuff pain clearly state that active rehabilitation and exercise are key elements of treatment and should be prescribed to most patients unless there are serious contraindications. Updated reviews note that exercise therapy programs are comparable in effectiveness to multi-component physical therapy and, in many cases, are as effective as surgical interventions in terms of long-term outcomes. [7]

With proper exercise, muscle activity improves blood flow to the area and promotes metabolism in the tendons and joint capsule. Moderate, measured exercise stimulates collagen regeneration and helps tissues adapt to daily stress. Randomized trials of subacromial pain syndrome show that regular exercise reduces pain and improves function compared to minimal intervention or no training. [8]

Exercises also affect neuromuscular control. In chronic pain, the shoulder and scapular muscles are often activated in the wrong sequence, with some overloaded and others "lazy." Specific programs aimed at scapular stabilization and improved motor control have been shown to reduce pain and disability in patients with subacromial syndrome. This is particularly true for exercises targeting the lower trapezius, serratus anterior, and rotator cuff. [9]

Dosage data suggest that for long-term pain, more intensive programs, with more exercises, more frequent, and supervised sessions, may produce better pain reduction and functional improvement than shorter, less frequent workouts. It is important that exercises be individually tailored and supported by feedback from a specialist. [10]

How a person perceives pain during exercise is also important. Patient brochures and guidelines recommend focusing on a "tolerable" level of pain: mild discomfort during movement that subsides within a few hours after exercise is acceptable. However, if pain increases sharply after exercise and persists for more than a few hours, the load is considered excessive and should be reduced. [11]

Table 2. Main goals of exercises for shoulder pain

Target	How Exercises Help
Pain relief	They improve blood flow, reduce the sensitivity of pain receptors, and teach tissues to tolerate stress.
Restoring mobility	Gently stretches the capsule and muscles, restoring range of motion
Strengthening muscles	Increases rotator cuff and scapular stabilizer strength
Improving coordination	Restore the correct sequence of muscle activation
Relapse prevention	Prepares the shoulder for everyday and sports activities

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Basic exercise: soft "pendulum" shoulder mobilization

One of the most well-known basic exercises for shoulder pain is pendulum movements with a relaxed arm under the influence of gravity. The idea is to gently mobilize and stretch the shoulder without actively tensing the injured muscles. This exercise is often used in the first weeks after injuries and surgeries, as well as in the early stages of treating subacromial pain. [13]

Starting position: lean forward slightly, resting your healthy arm on a table or the back of a chair, while your affected arm hangs freely. Your knees are slightly bent, your back is straight, and your shoulders are relaxed. Your body then begins to gently sway, and the movement of your body causes your arm to make small circles, back and forth, or side-to-side movements. It's important that your body leads the movement, and that the muscles in your affected arm remain as relaxed as possible. [14]

Modern research on pendulum movements has shown that the primary range of motion is created by the body swing, while movement within the shoulder joint itself is relatively limited at smaller ranges. Nevertheless, such exercises help maintain minimal mobility, reduce anxiety, and can be a convenient starting point for individuals with significant pain. Wider and more active pendulum movements increase rotator cuff tendon involvement, but this may not always be desirable in early rehabilitation. [15]

It's recommended to start with small amplitudes and short series: for example, 10 circles in each direction, 2-3 times a day. If these movements are well tolerated, the amplitude can be gradually increased. Pain during the exercise should be within the range of mild discomfort, which quickly subsides after completion. If sharp or stabbing sensations occur, the amplitude should be reduced or the exercise should be temporarily discontinued and the situation discussed with a doctor or physical therapist. [16]

It's important to understand that pendulum movements aren't a "magic pill," but a gentle start. Reviews show that for lasting improvement, other types of exercises are also needed: strengthening the rotator cuff, scapular stabilizers, and core muscles. The pendulum exercise is convenient because it can be performed even when pain is already quite severe, without fear of "breaking something," unless there's a recent serious injury, fracture, or recent postoperative period, where a doctor should prescribe a movement regimen. [17]

Table 3. Algorithm for performing the pendulum exercise

Step	Action	Comment
1	Stand near the support, lean forward, and support yourself with your healthy hand	Back straight, shoulders relaxed
2	Let the sore arm hang freely down	Do not strain your shoulder and neck muscles
3	Start gently swinging your body forward, backward and to the sides	The hand moves due to the movement of the body
4	Perform small circular movements with your hand	The amplitude is small, without sharp pain
5	Repeat 10-20 times in each direction, 2-3 times a day	The pain should subside quickly after the exercise.

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A complementary mini-complex of three simple exercises

A pendulum alone won't solve the problem completely, so it's convenient to add a few simple movements that can be performed at home. Clinical guidelines and patient materials on rotational cuff pain often recommend combining gentle mobility exercises with gradual muscle strengthening. Below is a mini-sequence that is often used as the first step in active rehabilitation. [19]

The first exercise involves sliding your hand along a table or wall. You sit or stand facing the table, place your sore hand on a towel or cloth, and, using your body, gently "roll" your hand forward, trying to slightly increase the range of motion, then return it back. In the wall version, your fingers "walk" up the wall until moderate discomfort occurs, then lower your hand back down. These exercises gently stretch the capsule and muscles without requiring much force. [20]

The second exercise is isometric shoulder abduction. The affected side is pressed against a wall, the elbow bent at approximately a right angle and held close to the body. The person gently presses the elbow against the wall, as if trying to move the arm to the side, but no actual movement occurs. The tension is held for about 5-10 seconds, then rested. Research shows that isometric exercises with moderate force can reduce pain and gradually strengthen muscles without overloading the tendons. [21]

The third exercise is gentle external shoulder rotation with a resistance band. The elbow is bent and held close to the body, and the band is secured so that gentle resistance is created as the forearm rotates externally. Perform 10-15 smooth repetitions, ensuring that the movement is controlled and does not cause sharp pain. Systematic reviews emphasize that rotator cuff and scapular stabilization exercises are an important part of programs for subacromial pain. [22]

This mini-complex is typically performed almost daily, sometimes several times, within the "tolerable" pain range. Regularity and gradual progression are more important than a large effort at one time. In later stages, exercises with greater resistance, push-ups, pull-ups, and more complex movements are added, but the basic set often remains the foundation of maintenance exercises. [23]

Table 4. Mini-set of exercises for shoulder pain

Exercise	Target	Dosage example
Pendulum movements	Gentle mobilization of the joint, reducing fear of movement	10-20 circles, 2-3 times a day
Sliding your hand along a table or wall	Restoring arm lift, stretching the capsule	10-15 forward and upward movements, 1-2 times a day
Isometric wall abduction	Gentle strengthening of the deltoid muscle and cuff	5-10 seconds of tension, 5-10 repetitions
External rotation with band	Rotator cuff strengthening	10-15 smooth repetitions, 1-2 sets
Scapular control (lowering and retracting the shoulder blades)	Improving the position of the scapula	10-12 repetitions, every day

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Safety rules and how to understand that the exercise is suitable

The main rule is that exercises should not cause sharp, shooting pain or worsen symptoms for many hours afterward. Patient guidelines for rotational cuff pain suggest following a simple rule: moderate pain during movement that quickly subsides after completing the exercise is considered acceptable; increased pain that persists for more than a few hours or significantly impairs sleep requires a reduction in intensity. [25]

Before beginning exercises, it's a good idea to "wake up" the shoulder and upper back a bit: perform shoulder circles, raise and lower the shoulder blades several times, and perform light neck movements. The evidence base for the necessity of a warm-up during therapeutic exercises is limited, but clinical experience shows that it makes the exercises easier for patients to tolerate and reduces the risk of the initial movements being uncomfortable. [26]

Load progression should be gradual. Research on the dosage of therapeutic exercises for subacromial syndrome and rotational cuff pain shows that higher volumes can be more effective, but only with good technique control and tolerance. In practice, it is advisable to first master proper technique with minimal resistance, then gradually increase the range of motion, the number of repetitions, and only then the resistance. [27]

There are situations when exercises should either be postponed or performed only according to an individual program under the supervision of a physician. These include a recent fracture of the humerus or clavicle, a recent complete tear of the rotator cuff, an acute infection in the joint area, or severe instability after a dislocation. In such cases, the initial movement regimen must be established by an orthopedist or a physician specializing in physical and rehabilitation medicine. [28]

The combination of exercises with manual and other modalities deserves special mention. Systematic reviews show that adding manual therapy of the spine and shoulder girdle to an exercise program has produced additional short-term benefits in reducing pain and improving function in some studies, but active rehabilitation, i.e., regular exercise, remains the key component. [29]

Table 5. How to assess shoulder response to exercises

Situation	What does it feel like?	What to do with the load
Mild discomfort during, then quick relief	The pain subsided within a few hours.	Continue in the same volume
Moderate pain during, slight increase for 1 day	The pain is bearable and does not interfere with sleep.	You can continue, but do not increase the load.
Sharp pain during exercise	It's stabbing, sharp, and makes you stop.	Stop immediately and discuss with your doctor or physical therapist.
Severe increase in pain for 24 hours or longer	Sleep and daytime activities are disrupted	Reduce volume and intensity, revise the program
The appearance of numbness, weakness, and “jamming”	New symptom or sudden worsening	Consult a doctor to clarify the diagnosis

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Frequently asked questions about the main exercise and therapeutic exercises for the shoulder

How long does it take to see relief from exercises?
Large reviews of rotator cuff pain and professional societies report that significant improvement most often occurs within 6-12 weeks of regular therapeutic exercise. For some patients, the first positive changes appear within 2-4 weeks, but for lasting results, continuing the program for several months is usually recommended. It is important not to stop exercising immediately after the first improvements, but rather transition to a maintenance regimen. [31]

Can pendulum movements be performed with shoulder osteoarthritis?
With shoulder osteoarthritis, gentle pendulum exercises and gentle glides are often used to maintain mobility and reduce stiffness. Guidelines on osteoarthritis and joint pain emphasize that measured activity is generally safer than complete rest unless there is active inflammation and significant swelling. However, if osteoarthritis is combined with other problems (such as recent surgery or a tendon rupture), exercise regimens should be discussed individually. [32]

What should you do if an exercise temporarily increases pain?
A brief increase in discomfort after starting a new exercise is possible and does not always indicate harm. It is important to assess the nature of the pain and its duration. Guidelines offer a simple guideline: if the pain increases briefly and quickly returns to normal levels, the exercise is likely acceptable. If the pain persists for more than a few hours, interferes with sleep or daily activities, reduce the range of motion, the number of repetitions, or the resistance, and discuss the program with a specialist if necessary. [33]

Are injections or surgery necessary if exercise is used?
Randomized trials show that for many patients, exercise programs provide comparable improvement to injection methods and, in some cases, are as effective as surgical interventions in terms of long-term effectiveness. Injections and surgery may be considered options for severe pain that is not amenable to rehabilitation, or for specific types of injuries. The decision is always made in consultation with a physician, but almost all modern guidelines emphasize the need for active rehabilitation as a mandatory part of treatment, regardless of the additional interventions chosen. [34]

Is it possible to exercise independently without a physiotherapist?
Patient brochures and materials from specialized societies contain simple programs for independent practice at home and demonstrate that home exercises can be effective, especially with good motivation and adherence to safety rules. At the same time, an individually tailored program under the supervision of a physiotherapist or doctor usually produces more pronounced and rapid results, especially in cases of long-term pain, complex pathology, or a combination of problems. The optimal option is considered to be starting with an in-person consultation, training in technique, and subsequent independent practice at home with periodic adjustments. [35]

Table 6. Brief answers to frequently asked questions

Question	Short answer
When to expect the effect	Most often, within 6-12 weeks of regular training
Is it possible with arthrosis?	Yes, most often, but with a soft amplitude and after consulting a doctor
What to do if the pain intensifies	If the pain goes away quickly, reduce the load; if it persists for a long time, review the program with a doctor.
Do exercises replace injections and surgeries?	They are often available without them, but the decision is individual.
Is it possible to practice without a specialist?	You can follow proven plans, but if the pain persists, it’s better to discuss the plan with a doctor or physiotherapist at least once.

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