digest
what's going on everyone welcome back to my channel in today's video we're looking at rehab exercises for shoulder bursitis. This is typically pain that occurs up here, the subacromial bursa, which is right underneath this bone, the acromion. So if you get pain towards the top, kind of outside of your shoulder, maybe it goes down your arm when reaching overhead, this video will be for you.
So when we think about this subacromial bursitis, again that bursa is up here under the bone in that subacromial space. There are other structures that are also present there. One is a rotator cuff tendon, our muscle called supraspinatus, whose tendon runs right through here. And also the tendon for the biceps, one of the tendons of our biceps muscle, also goes right up here in the joint. So we've got a rotator cuff tendon, a biceps tendon, and a bursa right next to each other. Many people are diagnosed with bursitis and actually have tendinopathy, meaning they have an irritation of one of those tendons. Basically, it's hard to differentiate with testing what people have: do you have bursitis, do you have a tendinopathy? We can't always tell with clinical tests, but it doesn't really change what we do in rehab a lot. So the exercises I'm going to show today will help you with bursitis and will help with addressing and strengthening the tendons, just in case you also have tendinopathy.
Okay, so we're going to look at four exercises, so let's go ahead and jump into them. Early on in this process, when your pain is more acute and irritable, we're going to focus really on mobility. One of the things that happens with bursitis and tendinopathy in the subacromial space is that people will tend to have pain when they reach overhead. So you want to be careful to modify those activities. If you play racket sports or you're a swimmer, or if you're participating in activities that are flaring this up, make sure you dial those back or temporarily eliminate them to let the shoulder calm down. Then we're going to implement mobility exercises so that we don't lose mobility. Sometimes when people have irritation in their rotator cuff tendons or the bursa and they stop moving their shoulder, they're more likely to develop frozen shoulder, so we don't want to go down that route. The thing that's going to help us avoid that is our mobility exercises. Since reaching overhead is the thing that hurts most people, that's what we're going to focus on in terms of mobility. But instead of just having you start reaching, which is going to cause pain, we're going to use some other strategies to work on that mobility with less pain.
So the first one here is called a table slide. You can use a countertop at your house or a table like this. What you're going to do is take your painful arm, my right arm, and set it here on the table with the pinky side of my hand down so that my thumb is up. Then I'm going to lean forward with my trunk, which forces my arm to go overhead. By using the table, my muscles aren't having to work, so my shoulder muscles get to stay relaxed. I'm just going to bend forward and stretch my shoulder, going up and down and doing repetitions. I'm working on my shoulder flexion mobility and allowing the table to let my arm slide, so I don't have to use my muscles the way I would if I was doing it without the table. This is what would normally hurt, so using the table reduces pain. It allows me to work on what's called passive range of motion, because my arm is passively moving, forced overhead by the table as an external object. You can even get down here and just hold, but usually we have people run through two to three sets of about 10 to 15 repetitions, and you can do this throughout the day at the beginning of rehab while your shoulder is calming down. So that's our first exercise, a table slide.
Our second exercise is another mobility exercise. If the table slide gets easy, you can go through full range of motion with minimal symptoms, and then you would progress to this one, called a wall crawl. It works on overhead shoulder mobility but keeps the shoulder muscles more relaxed to limit pain and stress on those sensitive tissues. For the wall crawl, I take my painful arm, come up to the wall, and basically walk my hand up. This lets some of my body weight go into the wall, so I don't have to use my muscles and tendons as much. Then I reach up as far as I can. If you hit a point of pain, go up and down to that point. Eventually, we're looking to get all the way up and get full shoulder flexion against the wall. You may have to turn your head away to get that full mobility, but in the beginning, just like the table slide, work up and down the wall to your pain barrier. Over time this will get easier and easier, and at a certain point you won't need the wall. You'll step away from it and go through full range shoulder flexion without the wall, leading with your thumb like we did on the table slide and reaching up as far as you can. That's the end of the progression: getting back to lifting full arm weight without needing the help of the table or the wall. So those are our two primary mobility exercises. Once you can do those and your pain is not too bad, you'll go to these next two, which will help strengthen the two tendons that run up inside the subacromial space.
Our third exercise is to strengthen one of the tendons, focusing on the biceps long head tendon, which goes inside the joint in that subacromial space. We do this with a dumbbell and an uppercut-type movement. We actually use an uppercut-type test to see if the biceps tendon is what's causing a person's pain, and the exercise is very similar. Find a dumbbell that's challenging but doesn't create more than moderate symptoms. With tendinopathies it's okay to have mild to moderate pain during the exercise, as long as you're not flared up later or into the next day. Find the weight that's right for you. I start with the dumbbell down at my side, supinate my forearm to rotate so my palm is up, and then do an uppercut up to about chin height, where my hand is at chin height. Then I rotate back down. I repeat that: rotate, come up, uppercut. This works the biceps tendon. Most people think of the biceps as just doing curls, which is the elbow portion, but it also helps move our shoulder through flexion. As we come up, we work that upper part of the biceps tendon as it goes up inside the joint. With this exercise and the next one, go for three sets of 10 to 15 repetitions. Find a weight you can feel working, that's challenging, but that doesn't cause a flare-up in your shoulder pain. So that's our first strengthening exercise, the biceps uppercut.
Our last exercise is a rotator cuff strengthening exercise. This one looks at external rotation, which is a really important action of the rotator cuff, and it helps the supraspinatus muscle, the other tendon that goes through that subacromial space. For this one, I have a piece of Thera-Band here, which works really well. I'll put a link in the description if you want to know where to get one. Then take a small hand towel, roll it up, and put it between your elbow and your side. That helps focus on the rotational movement. Start with the band secured and your hand by your stomach, then go out through external rotation as far as the shoulder joint should go, about 70 degrees, with the elbow at your side. For some people, when their pain is more severe, it will be hard to do this on their own. In that case, use your other arm to grab the band and help pull it out, which takes stress off the painful shoulder. Then let go and slowly lower back in with your painful side. That lowering is an eccentric contraction, where the muscle fibers are contracting and lengthening in that direction. On the way out, the muscle is shortening, which is concentric and tends to create more pain at the beginning of rehab. That's why you use the other arm to help pull the band, set it, do a small isometric hold, and then slowly, over about three to four seconds, do a slow eccentric lowering. This will really help strengthen that tendon while creating less pain. As you get better over time, try to do the whole movement with your painful shoulder, looking at no more than three to four out of 10 pain. If you're flared up the next day, it was probably too much, and you need less resistance or fewer repetitions. As with the last exercise, aim for three sets of 10 to 15 repetitions every day or every other day.
So those are our four exercises for subacromial bursitis or tendinopathy, depending on what you might have going on. A lot of people have both. Work on calming things down first with the mobility exercises, the first two, and as things calm down, you can start implementing the strengthening exercises, which will help with pain and reduce the likelihood you get this again in the future. If you have any questions, put them in the comment section and I'll get back to you. See you next time, bye.