When a shoulder gets sore, a lot of people stop training and start babying the arm. The NHS advises against that. It says to stay active and gently move the shoulder, and it warns that completely stopping using it can keep it from getting better (NHS, 2023).
This post covers what the research says about strengthening for shoulder pain. Then it shows how a coach sets that up at our studio in Concord, Vaughan. If it's your neck that hurts, read where strength training fits for neck pain instead.
Please read first. This post is general information and isn't medical advice. It's about shoulder pain that builds up over time and gets worse when you use the arm. If your pain started after a fall or an injury, get medical care before you train.
When to get your shoulder checked first
The NHS lists signs that need urgent care. These can be signs of something serious, like a broken or dislocated bone, or a torn ligament or tendon. Get urgent medical care if any of these fit you:
- you have sudden or very bad shoulder pain
- you cannot move your arm
- your arm or shoulder has changed shape or is badly swollen
- you have pins and needles that do not go away
- there's no feeling in your arm or shoulder
- your arm or shoulder is hot or cold to touch
- the pain started after an injury or accident, like a fall
- you develop severe pain in both shoulders
- you feel feverish or unwell
It also says to see a doctor if the pain gets worse or doesn't improve after 2 weeks, or if it's very difficult to move your arm or shoulder. The NHS tells people not to make up their own strenuous exercises or use heavy equipment on a sore shoulder (NHS, 2023). If none of the urgent signs above apply and a doctor or physio has cleared you to train, a coach can set up the strength work at the studio.
What the reviews say about exercise for shoulder pain
Most of the trials below are on subacromial pain. That's the term researchers use for what most people call shoulder impingement.
A 2020 umbrella review, which is a review of reviews, pulled together 16 systematic reviews on treatments for subacromial shoulder pain. It made a strong recommendation for exercise therapy as the first treatment to improve pain and function (Pieters et al., 2020).
A 2017 meta analysis of randomized trials on shoulder impingement found that exercise lowered pain more than control treatments without exercise. Specific exercises lowered pain more than generic ones (Steuri et al., 2017).
The trial that tracked who still wanted surgery
A Swedish trial took 102 people who'd had shoulder impingement for over six months. Earlier treatment hadn't worked, and they were recruited through orthopaedic specialists. Both groups had a steroid injection and a physio-led program. Half did strengthening for the rotator cuff and the muscles that hold the shoulder blade, with slow lowering work and manual mobilisation. The other half did general movement exercises for the neck and shoulder. Both groups had five to six guided sessions over 12 weeks and did their exercises daily between visits (Holmgren et al., 2012).
The strengthening group's Constant-Murley shoulder score went up 24 points, compared with 9 in the general exercise group. At the trial's 12 week check, 10 of 51 people in the strengthening group chose surgery, compared with 29 of 46 in the other group (Holmgren et al., 2012).
Strengthening vs general exercise for shoulder impingement
102 people with shoulder impingement for over six months, recruited through orthopaedic specialists. Both groups had a steroid injection and a physio-led program, with five to six guided sessions over 12 weeks. Source is Holmgren et al., 2012 (abstract).
Two placebo controlled surgery trials looked at a common operation for this kind of pain, called subacromial decompression. In the UK trial, decompression did no better than a placebo surgery at 6 months (Beard et al., 2018). In the Finnish trial, decompression gave no benefit over placebo surgery at 24 months (Paavola et al., 2018).
Rotator cuff tears and physical therapy
A study of 452 patients with tears that came on without an injury started everyone on a physical therapy program. Fewer than 25% chose surgery over 2 years. Most of those decisions came within 12 weeks (Kuhn et al., 2013). A tear needs a diagnosis from a doctor before you train around it.
Training compared with no training
A 2021 review of 10 trials compared supervised training with no training for subacromial pain. Compared with no training, supervised training lowered pain during movement by 1.84 points more on a 0 to 10 scale, and pain at rest by 1.68 points more (Liaghat et al., 2021).
Use the timeline below to see where the studies checked in and what the NHS says about timing.
Shoulder pain week by week
Slide to a week to see what the NHS says about timing and where the studies checked in.
Week
Sources are NHS, 2023 (page), Holmgren et al., 2012 (abstract), Kuhn et al., 2013 (abstract) and Beard et al., 2018 (abstract). This is general information and isn't medical advice.
How a coach sets it up in the studio
A coach isn't a doctor and can't diagnose your shoulder. Anyone with the signs above, or with an unexplained injury, sees a doctor or physio first. A coach can then set up strength training around your shoulder and adjust it every session.
- Tell your coach what hurts. Say which movements set it off and how long it's been going on. If a doctor or physio has seen it, bring what they told you.
- Start where it's calm. Your coach picks loads and angles you can handle without sharp pain. If pressing overhead bothers you, the press moves to an angle that feels fine.
- Train the rotator cuff and shoulder blade muscles. A coach often starts with rows and rotation work with light dumbbells, done with a slow lowering phase.
- Add load as it settles. Your coach adds weight in small steps as the shoulder stays calm.
- Keep training the rest of you. Your legs and trunk don't need a break because one shoulder is sore.
- Know the difference between sore and sharp. In the training review, more people reported mild pain after training that passed (Liaghat et al., 2021). If something hurts sharply during an exercise, stop and get medical care if it doesn't settle.
- Stay with it. The Swedish trial ran 12 weeks, and the NHS suggests shoulder exercises for 6 to 8 weeks to stop pain coming back (Holmgren et al., 2012; NHS, 2023).
Pick the lift that bugs your shoulder below to see where a coach might start.
Pick the lift that bothers your shoulder
Pick one to see where a coach might start you in the studio.
These are common coaching starting points. They aren't a diagnosis or a treatment plan. If a movement gives you sharp pain, stop and get medical care. See the class schedule.
Train your shoulder back at our studio in Concord, Vaughan
Our small group classes are capped at 16, so a coach can watch how your shoulder moves and swap exercises on the spot. We're open weekdays 5:45 AM to 8 PM and weekends 8:30 AM to 4 PM at 11-411 Confederation Pkwy, 2nd floor, with parking on site.
If you want a plan designed only for your shoulder, look at personal training in Vaughan. We also offer one on one training focused on balance and strength. Our posts on exercises for lower back pain and knee pain exercises cover other sore spots.
Try the $30 seven day trial (+ HST). Join by day 5 and your $30 is credited toward your membership. Call (289) 536-8066 or email g-squad@innerg.ca. Book your first class for next week and tell the coach at the door which shoulder it is.
References
- Beard, D. J., Rees, J. L., Cook, J. A., Rombach, I., Cooper, C., Merritt, N., Shirkey, B. A., Donovan, J. L., Gwilym, S., Savulescu, J., Moser, J., Gray, A., Jepson, M., Tracey, I., Judge, A., Wartolowska, K., Carr, A. J., & CSAW Study Group. (2018). Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 391(10118), 329-338. https://doi.org/10.1016/S0140-6736(17)32457-1 | PubMed
- Holmgren, T., Björnsson Hallgren, H., Öberg, B., Adolfsson, L., & Johansson, K. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ, 344, e787. https://doi.org/10.1136/bmj.e787 | PubMed
- Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., Brophy, R. H., Carey, J. L., Holloway, B. G., Jones, G. L., Ma, C. B., Marx, R. G., McCarty, E. C., Poddar, S. K., Smith, M. V., Spencer, E. E., Vidal, A. F., Wolf, B. R., Wright, R. W., & MOON Shoulder Group. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery, 22(10), 1371-1379. https://doi.org/10.1016/j.jse.2013.01.026 | PubMed
- Liaghat, B., Ussing, A., Petersen, B. H., Andersen, H. K., Barfod, K. W., Jensen, M. B., Hoegh, M., Tarp, S., Juul-Kristensen, B., & Brorson, S. (2021). Supervised training compared with no training or self-training in patients with subacromial pain syndrome: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 102(12), 2428-2441.e10. https://doi.org/10.1016/j.apmr.2021.03.027 | PubMed
- NHS. (2023, May 22). Shoulder pain. https://www.nhs.uk/conditions/shoulder-pain/
- Paavola, M., Malmivaara, A., Taimela, S., Kanto, K., Inkinen, J., Kalske, J., Sinisaari, I., Savolainen, V., Ranstam, J., Järvinen, T. L. N., & FIMPACT Investigators. (2018). Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ, 362, k2860. https://doi.org/10.1136/bmj.k2860 | PubMed
- Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 131-141. https://doi.org/10.2519/jospt.2020.8498 | PubMed
- Steuri, R., Sattelmayer, M., Elsig, S., Kolly, C., Tal, A., Taeymans, J., & Hilfiker, R. (2017). Effectiveness of conservative interventions including exercise, manual therapy and medical management in shoulder impingement: a systematic review and meta-analysis of RCTs (official title shortened). British Journal of Sports Medicine, 51(18), 1340-1347. https://doi.org/10.1136/bjsports-2016-096515 | PubMed