Return to training: The aim of phase 4 is to increase the function throughout the shoulder. To increase ability to deal with external forces. Absorb and produce force rapidly.
Treatment
Can be done daily.
Massage
Deep tissue massage if available. Can be applied lightly every day.
Foam rolling
This is an excellent exercise for improving the range of motion and helping to relieve upper back pain.
This exercise massages the thoracic or upper area of the spine.
Teaching point:
- With hands behind the head, gently roll up and down from the lower ribs to the shoulders
Stretching
Can be done daily.
Pectorals
Teaching point:
- Place your arm so that it is slightly above horizontal, with your palm against the wall
- Turn your body away from the wall, keeping your hand firmly against the wall
- This will stretch your pec to the side nearest the wall
• Hold this position for 45 seconds
- Repeat on the opposite side
- 2 times a day
Posterior capsule
Teaching point:
- Bring your arm up to shoulder level and gently pull it across your body
- Use your other hand to pull the arm in until a stretch is felt in the shoulder
- Hold the stretch for 45 seconds
- 2 times a day
Trapezius stretch
Teaching point:
- Sit on a seat or bench in an upright position
- Use your hand to hold onto the side of the seat or bench which will stabilise the shoulder
- Move your ear to your shoulder
- 2 sets for 45 seconds
Neck rotation & flexion
Teaching point:
- Start in a good seated posture
- Turn the head to the left and to the right, as far as you feel comfortable
- Tilt the head to the left and right
- Hold for 1-2 seconds
- 2 sets for 45 seconds
- At least once a day
Active Range of Motion
Can be done daily.
Wall Mobility
Teaching points:
3 sets for 10 seconds for each exercise.
1) Shoulder Flexion
- Keeping your thumbs forward, Raise your arms as high as you can trying to touch your thumbs to the wall
- Maintain a good posture
2) Shoulder Abduction
- Keeping your thumbs slightly turned out, keep your arms at about 45 deg
- Bring your hands up above your head as if you were going to clap
3) Shoulder External Rotation
- Push your arms outwards (as if you are opening your hands and pulling them apart from each other)
- Maintain a good posture throughout
4) Internal Rotation
- Hands tucked in (not gripped)
- Bring your thumbs up as close to your shoulder blades as you can
5) Shoulder Extension
- With your hands flat, bring your arms back as far as you can go
- Keep your palms down
Strengthening
Can be done daily.
Shoulder flexion with resistance band
Teaching point:
- Stand on the band holding the other end in the hand of your injured shoulder
- Keeping the elbow straight, pull your hand straight up in front of you to about shoulder height
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase, you can then progress to light weights (cables and dumbbells).
Shoulder extension with band
Teaching point:
- Holds both ends of a band at hip height
- Keep the elbows straight and palms facing inwards
- Starting just in front of the body, pull the arms backwards, keeping the elbows straight and squeezing the shoulder blades together and down
- 3 sets for 8 reps
Note: Start with a light resistance band and gradually increase, you can then progress to light weights (cables and dumbbells).
Shoulder internal rotation
Teaching point:
- Start with your elbow out to the side • Keeping it next to your body, move your arm inwards towards your stomach using the band as resistance
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase, you can then progress to light weights (cables and dumbbells).
Shoulder external rotation
Teaching point:
- Take your arm out to the side as far away from you as you can
- They then slowly return to the starting position and repeat
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase, you can then progress to light weights (cables and dumbbells).
Shoulder adduction
Teaching point:
- Wrap the band around something secure
- Hold the other end and stand with your injured side closest to the attachment
- Keeping the elbow straight, pull your hand across your body as far as is comfortable
- 3 sets for 8 reps
Note: Start with a light resistance band and gradually increase, you can then progress to light weights (cables and dumbbells).
Shoulder abduction
Teaching point:
- Stand on one end of the band and hold the other end
- Keeping the elbow straight, pull your arm out to the side so that the hand ends up level with your shoulder
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase, you can then progress to light weights (cables and dumbbells).
Shoulder elevation
Teaching point:
- Stand tall, holding a weight you feel comfortable with
- Lift your shoulders straight up, then lower them back down
- 3 sets of 8 reps
Note: you can progress to a heavier weight
Bicep curls
Teaching point:
- Raise the barbell to your shoulders, keeping your arms close to your body
- Lower the barbell slowly, until your arms are fully extended
3 sets of 8 reps
Note: You can also use a dumbbell using one arm at a time.
Tricep extensions
Teaching point:
- Attach a band to a sturdy object above your head
- Extend your elbows, making sure to lock your arms at the bottom
- Control it on the way back up
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase.
Bent over row
Teaching point:
- Put your knee on the bench, with your arm fully extended pull the dumbbell up towards your chest
- Squeezing your shoulder blades at the top
- 3 sets of 12 to 15 reps
Upright row
Teaching point:
- Stand on a resistance band and pull both hands up towards your chin
- Keep your back straight and hold for a second at the top
- Slowly relax on your way down
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase.
Pull to face
Teaching point:
- Attach a band to a sturdy object at face level
- Keep your arms in towards your chin
- Control it on the way back
- 3 sets of 8 reps
Note: Start with a light resistance band and gradually increase.
Chest press
This exercise can be done at home on the floor or on the bench at the gym.
Teaching point:
3 sets of 8 reps
Push the weights above your chest as far as you feel comfortable
Single arm dumbbell chest press
Teaching point:
- Lie on your back with the dumbbells above you with straight arms
- Lower one dumbbell to the side of your chest, and raise it back up, do the same with the other side
- 3 sets of 10 reps
Pectoral fly
Teaching point:
- Lie on your back with the dumbbells directly above your chest with your elbows slightly bent
- Lower the dumbbells towards the floor at shoulder height
- Slowly raise the dumbbells back to the starting position, keeping your elbows slightly bent
- 3 sets of 10 reps
Force absorption
Can be done daily.
High plank shoulder taps
Teaching point:
- Start in a plank with your abdomen balancing on the ball and your hands on the floor, maintain your balance!
- Keep your core nice and tight, move your body weight on to one side, reach up and touch the shoulder, and come back down
- Repeat this on the opposite side
- 3 sets of 8 reps on each side
Plyometric press up
Teaching point:
- Start in a press-up position on your knees, and keep your core tight
- Lower your body as if you’re going to do a pushup until your chest is almost touching the floor
- Push up with force so your hands leave the ground
- Land lightly on the ground, moving into your next rep immediately
- 3 sets for 5 reps
Note: Once this exercise becomes easier you can make it more challenging by going into a full press-up position.
Throw and catch
Teaching point:
- Throw the ball towards the ceiling
- Catch it before it hits your chest
- 3 sets of 5 reps
Note: Start supine with a Swiss ball catch and press, then progress to a heavier ball. Progress to plyometric wall press up, progress to incline plyometric press up, and then progress to prone plyometric press.
External contact
If you are involved in contact sports then begin to very gently introduce your body to contact training. Use a Gym ball or Rugby tackle pads under the supervision of your coaches.
Functional
Can be done daily.
Running mechanics (Wall drills)
Teaching point:
- Go into a high knee while leaning into the wall
- Take the hip up to 90 degrees and pull your toes up towards the ceiling
- Once you feel more comfortable, pick up the speed and do sets of 3
- 2 sets of 5 on each side
Depth drop stick landing and hold
Teaching point:
- Start on the step, then hop off
- Hold on the landing for a couple of seconds and repeat
- 2 sets of 5 reps on each side
Note: You can make this more difficult by increasing the height of the box which is more challenging.
Running
Can be done daily.
Running
Gradually increase to a normal week’s training load of running in a progressive manner to ensure no acute overload occurs.
Move on to phase 5?
Check if you are ready to move on:
Exit criteria
- Pain-free through full range
- Pain-free resisted shoulder
exercises - No apprehension with force absorption.
- No pain with sport-specific actions that require overhead activities.
- No pain during running
- Strength 95%+ uninjured side