With shoulder injuries rampant among fitness enthusiasts, it’s important to know how to strengthen your shoulders for injury prevention and recovery. Your shoulder is insanely mobile and can move in many different planes, unlike other joints (like an elbow), which you can only straighten and bend. This means there are a lot of moving parts, and taking good care of this joint to strengthen your shoulders is paramount if you want to enjoy life and exercise injury-free.

What Makes Up the Shoulder?

Because the shoulder is a complex joint with many functions and movement in several planes, it has many players, including bones, muscles, tendons, and ligaments. Your upper arm (the humerus), your collarbone (the clavicle), and your shoulder blade (your scapula) are the bony structures that make up the shoulder joint. Since these are a ball and socket type of setup, it’s crucial they have supporting structures made of muscles, ligament, and tendons. The most well-known of these muscle structures are the four rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscle wrap around and stabilize the shoulder joint.

What Are Common Shoulder Injuries?

Shoulder injuries can either be from an acute sudden movement, or they can develop over time from repetitive use or arthritis.

Bursitis & tendonitis—these conditions are due to inflammation. A bursa is a little pillow filled with fluid which provides cushioning between the parts of a joint. Bursitis is when the bursa becomes inflamed. Shoulder bursitis is often related to tenderness or inflammation in the shoulder tendons (tendonitis) as well and can be caused by shoulder impingement, which occurs when parts of the shoulder anatomy are trapped, crushed, or pinched during movement. This type of injury often occurs after repetitive misuse of the shoulder.

Impingement—this may be the issue if you have trouble reaching behind your back or extending your arm above your head without pain. Over time, it can lead to inflammation of the rotator cuff or bursitis.

Dislocation—a shoulder dislocation is rarer than the other injuries and is extremely painful and incapacitating. A partial location (called subluxation) is when the ball of the upper arm is partially out of the socket. And a complete dislocation is when it’s all of the way out of the socket. It can cause ligaments or tendons to tear or may even damage nerves and typically requires an emergency visit to the doctor to x-ray and replace the arm bone back into place in the joint socket followed by physical therapy for rehabilitation.

Tears—rotator cuff tears are the most common injuries to occur to the muscles surrounding the shoulder joint. Tears can range from full tears to more minor tears that can be repaired by abridging the area. While you may be able to “work around” such an injury, often, surgical intervention is needed for a full recovery.

Fracture—clearly, if you have a broken bone, this is going to be quite severe and needs immediate medical attention as well as significant follow up with physical therapy over several months to heal. Any one of the bones that make up the shoulder region would be considered part of a shoulder fracture.

How Do You Strengthen Shoulders for Injury Prevention?

It’s always important to warm up and stretch properly for injury prevention across the board. However, shoulders can be especially vulnerable to injury if they are not warmed up enough prior to working them out. In fact, since you use your shoulders both directly and indirectly for multiple movements, it’s not a bad idea to warm them up before every workout.

If you’d like to avoid joining the “injured shoulders club,” it’s a smart idea to think about adding some preventative exercises to your weekly workouts. Two of the best exercises you can do to both prevent injury to the shoulders, as well as recover from shoulder injury, are internal and external rotations. You’ll see people at fitness facilities doing these exercises regularly as they prepare for their routines.

It’s important to remember that shoulders have three sides: front, side, and back, and all areas should be worked equally for balance, strength, and stability, so using a variety of exercises which recruit each area is crucial.

1. Cable Internal Rotations—while using a cable machine with the cable set at waist height, grab the handle with your right hand. Turn your body so your right hand is closest to the machine and bend your arm to a 90-degree angle, keeping your elbow tucked in at your side. Step away from the machine until you have tension on the cable. Next, move your hand toward your abdomen while keeping it parallel to the floor until your forearm and hand are perpendicular to the machine. Slowly return to start and repeat for ten repetitions. Duplicate the exercise on the left side. You can also use resistance bands for this exercise.

2. Lying External Rotations—while lying on your side with your left arm under your head, keep your right arm next to your body with your elbow tucked in close to your hip and your arm bent at a 90-degree angle. With a small weight in your hand (just two to three pounds), keep your hand aligned with your forearm, and rotate your hand up toward the ceiling until it is perpendicular to the floor (if you can move it back that far). Slowly return to starting position for one repetition. Repeat ten times, and then switch sides for another ten repetitions.

3. Lying Floor Dumbbell Press—lie on your back with your knees bent and about hip width apart with your feet and shoulders firmly pressed down and into the ground and your core tight, with your spine neutral. With your arms by your sides, grasp a dumbbell in each hand, palms facing forward. With your elbows bent to 90 degrees, push them out to the sides, raising your hands until they are perpendicular to the floor. This is your starting position. Next, using your shoulder and chest muscles, push the dumbbells upward toward the ceiling until your arms are straightened and the ends of the dumbbells meet overhead. Return to start and repeat ten times.

4. Lying Dumbbell Raises—while lying face down on a raised platform (like a massage table, bed, or bench), let your right arm hang off the side of the platform, straight down. You can begin with no weight and progress to using a small dumbbell. While keeping your arm straight and your hand aligned with your arm, raise your arm straight up and out to the front, then lower and raise out directly to your side, lower and raise out, up and to the back (again, all with your arm straight). Go up as high as you comfortably can. This is one repetition. Repeat for 10 repetitions and continue with the same on the opposite side.

Note: there are many, many exercises to choose from. These are just a sample to get you started.

How Do You Recover from a Shoulder Injury?

If you’re suffering from a shoulder injury, you’re not alone! Studies show that at least 21% of adults have incurred at least one shoulder injury in their lives, and the older the population, the more likely they are to incur an injury to the shoulder region.

Depending on where you injured your shoulder, how severe it is, and whether or not you and your doctor elect surgery, your training for recovery will vary. Physical therapists will have you do strengthening exercises that involve internal and external rotations as well as exercise combinations that involve lifting your arm to the front, to the side, and over your head. Strength is built by progressively increasing the weight used for each movement.

But, besides surgery and preventative warmup exercises, here are some of the easiest and most straightforward ways to reduce pain and minimize or avoid injury:

• Avoid the offending movement that causes you pain—sometimes, all you need to do is stop doing what you’re doing. The area may just require rest and often an extended period of nonuse will fix the problem.
• Ice—this is almost always a good idea. Ice helps to reduce pain and swelling to the area. Calming down irritated muscles and tissues can help ensure these tissues don’t cause an impingement or continue to swell and cause further issues.
• Anti-inflammatories—these can be just what the doctor ordered to relieve the swelling and pressure that may be causing you pain in your shoulder region.
  Cortisone injection—this steroid injection, while not the most fun, can many times solve the problem within a few days or weeks. Again, it addresses swelling and inflammation and helps reduce pain.
• Physical Therapy—your physical therapist will work with you to strengthen and improve your muscle strength and range of motion over time. In addition to various exercises without weight, you’ll also perform exercises with small weights, cables, and balls. And they may use additional therapies like ultrasound, dry needling, massage, and more.
  Proper Use—always making sure you are using proper form may be the number one preventative and healing modality you can use.
• Proper Use—always making sure you are using proper form may be the number one preventative and healing modality you can use.

As long as you don’t have an acute injury, such as a broken bone or dislocation, let pain be your guide. If something is painful, then stop doing it. Assess the movement to ensure you are performing it correctly. After sufficient rest and once your pain has subsided, you can try the offending movement again. If pain persist, then it’s time to see a doctor to evaluate your symptoms. Then follow the directions of your doctor and physical therapist for the fastest, most complete recovery.