QUESTION: How do I strengthen and stretch a sore or injured shoulder?

Dear Beth,

I am impressed with your knowledge relating to surfing injuries. I am a 43 year-old kneeboard surfer in Adelaide, South Australia, who has been surfing since I was 16. About two years ago I came up sore in the left shoulder after a particularly long surf in windy offshore conditions. My AC joint became swollen and painful. I have had a steroid injection, prolotherapy, but the AC joint is still a problem. [I only surf occasionally now.] I know I am very tight through shoulders and upper back, and have shoulders pulled forward. I would be very grateful if you had any advice on stretches/strengthening, etc.

Thanks heaps in advance,
Dave

ANSWER:

Hey Dave,

I forwarded your email to a ripping surfer friend of mine who is the owner of a physical therapy facility in the city (he is a well known PT as well). His name is Lance Harriman at Potrero Physical Therapy and not only are you benefiting from his response, so am I! Here is his response:

"This injury is interesting. Dave could benefit from further diagnostic testing to rule out other diagnoses, such as a rotator cuff tear or tendinitis. At 43, he is in that age group where a rotator cuff tear or a labral tear from years and years of poor mechanics at his shoulder is a possibility. Dave is on the right path with seeking exercises to change the mechanics of his shoulder girdle, considering that the injection and prolotherapy have not made a difference. The fact that the symptoms are still there paints a strong picture for changing the biomechanics of the shoulder, as well as following up with symptom management techniques to get rid of the pain. An evaluation by a good physical therapist or Orthopedic MD would be very helpful to rule out other pathologies and to assess the symmetry of the shoulder girdle (i.e. muscle length and strength, joint mobility of AC, SC, Glenohumeral, Scapulothoracic, thoracic spine). A good program would incorporate exercises for the whole region:

1. Strengthening the humeral head depressors (the rotator cuff, biceps, and lattissimus)
2. Strengthening the scapula upward rotators (serratus anterior, and lower trapezius)
3. Mobilizing the sternoclavicular joint (SC), the thoracic spine, and the scapula (foam roller exercises, and yoga stretching with an emphasis on opening up the chest)
4. Symptom management (ice and NSAIDS if the MD prescribes)
5. Taping
6. Soft tissue massage/myofascial release to areas that are restricted. It might be worth it to travel and get the assessment by a specialist, then follow up with an exercise physiologist or physical therapist locally to go over the program.

Hope this helps!"

We should both thank Lance a ton for this! Best of luck!

Hasta,
Beth