Recovering from a shoulder injury isn’t simply about reducing pain or increasing range of motion. The goal should be to rebuild strength, confidence and the ability to use your shoulder in everyday life.
Shoulder injuries can have a surprisingly large impact on everyday life.
Getting dressed, washing your hair, carrying shopping, exercising or playing with your children can suddenly become difficult. And when movement hurts, the natural response is often to start avoiding it.
Over time, your world can become smaller.
At NG Health & Fitness in Weybridge, we regularly work with people who have completed physiotherapy or reached a point in their rehabilitation where they need to start rebuilding strength and confidence.
One of our newer clients, Emilie, is a great example of why rehabilitation isn’t always as straightforward as simply following a protocol.
From a broken collarbone to a “frozen shoulder”
In March, Emilie quite spectacularly broke her collarbone whilst away for a weekend in Dublin.
The injury occurred during an unsuccessful attempt to recreate the Dirty Dancing lift with an intoxicated Irishman.
We can neither confirm nor deny whether alcohol contributed to this decision.
Unfortunately for Emilie, the entire incident was also caught on camera.
By the time she came to NG Health & Fitness in July, the initial fracture had been given time to heal, but her shoulder had become extremely restricted.
It had unofficially been described as a “frozen shoulder.”
She had been receiving physiotherapy, but despite everyone’s best efforts, progress had been limited.
Her shoulder wasn’t just affecting exercise anymore.
Getting changed was difficult.
Washing her hair was difficult.
And Emilie has a young daughter, which meant the consequences extended well beyond the gym.
That’s an important point when we talk about injury rehabilitation.
We aren’t rehabilitating shoulders, knees or backs in isolation. We’re helping people get their lives back.
Why simply stretching an injured shoulder isn’t always enough
Stretching and mobility work can absolutely have a place within shoulder rehabilitation.
But increasing range of motion isn’t necessarily the same thing as increasing someone’s capacity to use that range.
A shoulder may need to tolerate force.
Muscles need to produce force.
Movements need to become progressively stronger.
And perhaps most importantly, the person needs to become confident using the affected area again.
When something has hurt for months, it’s completely understandable to protect it.
You stop reaching into certain positions.
You use the other arm.
You avoid exercises.
Eventually, you may become apprehensive about movements that previously wouldn’t have required a second thought.
Hence the old expression:
If you don’t use it, you lose it.
Our first goal with Emilie therefore wasn’t to force her shoulder into greater and greater ranges.
It was to answer a much simpler question:
What can she currently do comfortably?
Finding movements that work
During Emilie’s first session, we experimented with different movements, positions and resistance.
We quickly found ways of moving her shoulder that she could tolerate considerably better.
Her pain reduced and her available movement increased.
But arguably the most important improvement wasn’t something we could measure.
She became more confident using her arm.
Instead of seeing her shoulder as something fragile that needed constant protection, she could begin to see a route towards using it normally again.
That’s a hugely important part of returning to exercise after an injury.
However, rehabilitation rarely progresses in a perfectly straight line.
Recovery isn’t linear
Before Emilie’s next session, she had been prescribed steroids for an unrelated allergic reaction.
During this period her collarbone became particularly painful again.
So we adapted.
Rather than continuing to chase greater ranges of movement, we experimented with ways of contracting the muscles surrounding the shoulder without aggravating her symptoms.
Once she’d completed the course of steroids, things settled again and we were able to progress.
This is where individual rehabilitation differs from simply following a predetermined programme.
The plan has to respond to the person.
Sometimes you progress.
Sometimes you regress.
Sometimes you simply maintain what you have while something else settles down.
And sometimes the body gives you information that makes you reconsider the entire situation.
When an “easier” exercise becomes harder
As Emilie’s movement improved, we experimented with variations of a lateral raise — lifting the arm out towards the side.
Mechanically, bending the elbow should generally make this movement easier.
Think about holding a heavy bag.
You wouldn’t voluntarily hold it at arm’s length. You’d keep it close to your body because the further the load moves away from you, the greater the mechanical demand.
So we might reasonably expect a bent-arm lateral raise to be easier than performing the movement with a straight arm.
For Emilie, the opposite happened.
The theoretically “easier” version was considerably more painful and restricted.
Something didn’t add up.
Rather than assuming she simply needed to push harder, this was useful information.
Emilie returned for further medical investigation.
The subsequent scans revealed something that hadn’t previously been identified:
A hairline fracture halfway down her humerus.
There was, unfortunately, nothing humorous about it.
The original collarbone fracture had understandably been the obvious injury following her accident.
But watching the video of her fall again showed that Emilie had landed directly onto her upper arm as well.
The new diagnosis changed our approach.
Sometimes rehabilitation means doing less
No exercise we could give Emilie was going to magically accelerate the healing of a fractured bone.
Sometimes Mother Nature simply needs time to do her thing.
Once we knew about the humeral fracture, our job was to continue building movement and strength where appropriate while being mindful of how we loaded the injured area, particularly during movements involving rotation.
And that illustrates an important principle of exercise rehabilitation:
More doesn’t always mean better.
More stretching isn’t automatically better.
More range isn’t automatically better.
More weight isn’t automatically better.
More exercises aren’t automatically better.
Successful rehabilitation is about applying an appropriate amount of stress, to the appropriate tissues, at an appropriate time — and adapting that process as new information becomes available.
Pain-free shouldn’t necessarily be the finish line
Reducing pain is obviously important.
But imagine Emilie’s shoulder eventually became completely pain-free while remaining weak enough that she was still apprehensive about carrying something, exercising or playing with her daughter.
Would we really consider the rehabilitation complete?
Our aim is to move beyond simply reducing symptoms.
We want to progressively rebuild:
- Movement
- Strength
- Physical capacity
- Confidence
- Tolerance to everyday activities
- Tolerance to exercise
The goal isn’t a “perfect” shoulder.
It’s a shoulder that allows Emilie to live her life without constantly thinking about it.
Bridging the gap between physiotherapy and strength training
There’s often an awkward period after an injury.
You may no longer require regular medical treatment or physiotherapy, but you don’t yet feel ready to walk into a gym and start training normally.
This is where appropriately programmed strength training can be incredibly valuable.
At NG Health & Fitness in Weybridge, our approach starts with understanding the individual rather than immediately prescribing exercises.
We look at your injury and medical history, current symptoms, available movement, strength, goals and — importantly — what you actually need your body to be capable of doing.
From there, we find exercises and positions you can currently tolerate and progressively build upon them.
The process is essentially:
Assess → Understand → Adapt → Progress.
Sometimes that means increasing resistance.
Sometimes it means changing an exercise.
Sometimes it means increasing range.
And occasionally, as Emilie’s case demonstrates, it means recognising that something doesn’t quite make sense and recommending further medical investigation before progressing.
Making your world bigger again
Emilie’s rehabilitation is still ongoing.
We’re certainly not claiming to have discovered a magical treatment for frozen shoulder, nor does every painful shoulder have an undiagnosed fracture hiding inside it.
But we’ve already been able to make a meaningful difference.
She’s moving more.
She’s more confident using her shoulder.
Everyday activities are becoming easier.
And as the fracture heals, we can continue progressively rebuilding the strength and capacity of her arm and shoulder.
Hopefully, eventually, the whole episode becomes nothing more than a funny story about an ill-advised Dirty Dancing recreation in Dublin.
Because good rehabilitation shouldn’t just make a painful body part feel better.
It should help make your world bigger again.
Returning to exercise after an injury?
If you’ve finished physiotherapy, are dealing with a longstanding injury or simply don’t feel confident returning to the gym, we’re opening a small number of new coaching places at NG Health & Fitness in Weybridge over the coming weeks.
Our one-to-one coaching is designed around the individual — particularly people who need more guidance than simply being handed a generic exercise programme.
Keep an eye on our website and newsletter for details of our next intake.
