Congratulations on taking the first step toward solving your SHOULDER PAIN! After working through our protocol, you should be able to:

Before we dive in, we want you to understand that your shoulders are designed to be worked hard and last a hundred years. Shoulder pain is not a freak accident and didn’t spontaneously occur. Movements that you’ve performed safely and without pain many times, can sometimes become sensitized and painful. It may be complicated, but the steps to solving this very annoying problem are quite manageable! Keep in mind that human beings are incredible healing machines and your ability to heal and improve the function of your body doesn’t have an expiration date.

We have organized this protocol into three sections: Desensitize, Restore, and Prevent. In the Desensitize section you will find techniques that help you get out of pain. The Restore section contains mobilizations designed to restore the soft tissue function of your shoulder. Lastly, the Prevent section goes over some techniques to keep you moving pain-free. To see the best results while working through this protocol:

  • Expect to spend 10-20 mins per day DESENSITIZING with the Breathing, Contract/Relax, and Blood Flow Restriction Techniques
  • Expect to spend 10 mins per day RESTORING MOVEMENT with the Daily Shoulder Spin-up and Rotation Primer drills in videos 11 and 12
  • Expect to spend 10 mins per day (no more than 20min) RESTORING TISSUES with the mobilizations in videos 13-16
  • Expect to PRIORITIZE MOVEMENT with 8-10K steps per day
  • Expect to work on controlling your SLEEP QUALITY and QUANTITY every day with a minimum of 8 hours sleep per night
  • Expect to work through the content in this protocol in 4 Days, and then continue by revisiting 1-2 mobilization techniques per day that you found most helpful until your symptoms feel better

1. Introduction

2. A Systems Approach

Our treatment model is organized around a few key concepts.

How can we influence the environment around the site of our pain? Are there methods with which we can DESENSITIZE the pain signaling in the shoulder in a way that doesn’t slow or limit tissue healing? Can we remove congestion and swelling in the shoulder tissues that may be slowing healing time and contributing to your symptoms when you use your arm?

Can we RESTORE the normal function and movement to your shoulder? Rarely do we see mechanical based shoulder pain that isn’t also associated with some kind of tissue restriction in the shoulder joint. Improving global functional capacity of your arm may potentially unload an aspect of your sensitized shoulder.

Are there particular shapes and positions that support better functioning of your shoulders day-to-day that might unload your painful shoulder while it normalizes and heals? How can we PREVENT future injury by changing your movement patterns and better preparing your body for the rigors of dynamic movement?

3. Better Resting Positions

Pain is you body’s way of letting you know that something needs to change. It does not necessarily mean that there is tissue trauma. Our first priority is to identify better resting positions with a simple breath assessment and a couple of quick postural shifts.

4. Mechanical Breathing and Decongestion

Breathing is a great way to get some non-threatening movement into the system and start to reset the way the scapula and shoulder relate to the trunk. This also serves to circulate the lymphatic system which is crucial in decongesting the shoulder.

Rx: 1x per day, 5-10 minutes per session while symptoms persist (or forever!)

5. Contract/Relax

Incorporating the contract/relax technique is a very simple way to get movement into the system, without motion. This is a powerful way to improve the function of the shoulder as well as improve the way the brain is perceiving threat in the structural tissues of the shoulder.

Rx: Max time 10 minutes

6. Sleep + Walking

Experiencing pain often leads to a decrease in exercise/non-exercise movement and can disrupt sleep. Making sure to get enough movement in the day will help with blood flow, tissue congestion, as well as sleep quality.

Rx: 8-10K steps per day; 8 hours per night, which may require being in bed 9 hours

7. Blood Flow Restriction

Blood Flow Restriction serves to decongest the tissues and hyper-perfuse the area with increased blood flow.

Rx: 3-5 minutes, 1x day

8. Percussion

Percussion tools can add safe mechanical input into a sensitized system. This non-threatening motion and vibration can often influence how the brain is perceiving a sensitized tissue.

Rx: 3-5 minutes, before exercise

9. NMES Therapy

The next level of decongestion might include the use of neuromuscular-electrical-stimulation or “NMES.” While this technology is advanced and may not be practical for everyone, it is a cutting edge technology that we would be remiss in not explaining.

Rx: As much as possible during downtime

As we noted in the introduction, the next phase of our protocol is designed to restore and improve the soft tissue function of your shoulder. While you won’t see traditional stretches, your Shoulder Pain Protocol contains the most clinically advanced thinking around movements and mobilizations today. These interventions are designed to restore the ideal ranges of motion of your shoulder. We’ve organized these interventions into stand-alone sessions and it is critical that you accumulate many short sessions over the course of the week, rather than only a few longer sessions.

We recommend that you do the spin-up and primer in videos 11 and 12 every day. In addition, you should spend 10 mins per day (no more than 20) working through the mobilizations in videos 13-16 in order. Once you have worked through each technique, continue working the techniques you found most helpful, 1-2 per day, until your symptoms feel better.

10. Healing times, Isometrics, and Tempo

A quick overview on healing times and using isometrics and tempo (slowing things down) to start returning your shoulder function.

11. Daily Shoulder Spin-Up

Tools: None
Time: 10 reps per side, per movement, every day

12. Rotation Primer

Tools: Band
Time: 5 mins rotation each side, every day

13. Posterior Cuff Mobilization

Tools: Lacrosse Ball
Time: 4-5 mins per side max

14. Traps/Scapula Mobilization

Tools: Lacrosse Ball
Time: 5 mins per side max

15. Lat Scrub/Chest Wall Mobilization

Tools: Roller
Time: 5 mins per side

16. Anterior Chest Wall / Pec Minor / Subscapula

Tools: Ball, Roller
Time: 5-8 mins per side

When we find our lives and activities suddenly limited by a painful condition, our gut instinct is to correctly solve that pain problem first. Unfortunately, the immediacy of our pain needs often override our long-term planning and behavior modification needs. When our athletes and patients present with a problem, we always want to try and discover “why” and if there were contributing factors like stress, changes in volume, or a new tennis racquet for example. Our shoulders are some pretty extraordinary engineering. When a problem pops up, we believe that you should know how to put out the flames, develop an understanding for potentially why those tissues became sensitized and painful in the first place, and an action plan to keep it from happening again. We will take you through what we call our “After Action Report.” This is an exercise we work through with our athletes and clients to help them discover potential behaviors that may have contributed to their dysfunction. And finally, we will briefly talk about how seemingly innocuous or unrelated issues like stress and lack of sleep can challenge the resilience of even the most solid tissues.

17. Plank Breathing

Tools: None
Time: Accumulate 2 minutes in this position

18. Turkish Get-Up

Tools: 5lb-50lb dumbbell, move up in weight as tolerated
Time: 5 minutes per side

19. After Action Report

Thank you for working through our SHOULDER PAIN PROTOCOL

We hope that you found it helpful and are on your way to recovery. Take control of your movement and mobility by subscribing to our Virtual Mobility Coach to resolve pain, prevent injury, and improve physical performance.

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