The Shoulder Blueprint: Mobility, Stability, Longevity

When we talk about shoulder health, there are multiple factors that come into play.  As a PT practicing for over 20 years, there is never 1 set of exercises I would give, as everyone is individualized. But, there are certainly similarities I often see with people who develop shoulder pain or limitations. Ones that tend to be more common contributors to shoulder pain are:

• Rotator Cuff strength and stability

• Scapular muscle strength and stability

• Upper back and/or neck tightness

• Chest/anterior tightness

There are definitely other injuries, as well as compensation patterns that can contribute, but when we talk about a shoulder that hasn’t had a specific injury, these are usually the big culprits.  So, let’s tease them out a little.

Rotator Cuff Stability.  The rotator cuff is made up of 4 little muscles that help to position the head of the humerus in the socket (the ball in it’s socket).  These 4 muscles have to work together, and if 1 or more of them are not as strong as they should be, or even are not contracting when they should, it changes the mechanics of the shoulder.  This often results in the ball migrating up or forward in the socket.  Unfortunately, when this happens, it can cause pinching under the archway that is formed with the collar bone and shoulder blade, which is painful, and can also lead to more serious issues such as Rotator Cuff tears. There is a bursa under the archway, your Supraspinatus Tendon of the Rotator Cuff, as well as cartilage, all of which can get inflamed or irritated. 

What can we do for this?  Everyone is unique, and should be evaluated and specific exercises prescribed, but I will say the majority of folks that have this issue, tend to have weakness through the Infraspinatus muscle.  This is one of the 4 muscles, and it promotes External Rotation of the shoulder.  The reason this muscle tends to be involved more so than the others initially (I would say the Supraspintaus is the one that is most commonly torn down the road), is because we don’t naturally perform this motion in everyday life.  That means, unless you are an overhead athlete, or have a hobby that requires this motion, you have to specifically try and strengthen it.  There are countless ways to work on it, but here is my go to progression, as well as the exercise that EMG studies have shown to have the best recruitment (although may not be tolerated as well with impingement issues).

Shoulder External Rotation means your elbow is bent to 90 degrees, and you rotate your hand out to the side against resistance, maintaining the 90 degree angle at the elbow. Starting by your side with a towel roll will be easiest, then progressing to a 45 degrees angle, followed by a 90/90 position. The key is to keep the upper arm stable throughout.

Check out my video on external rotation progression here: https://youtube.com/shorts/9-2rdIGERFk

Sidelying 90/90 External Rotation has been shown to be one of the most effective ways to recruit the correct muscles when targeting the External Rotators of the Rotator Cuff. Lay on your side, bottom arm brought out in front at shoulder height, and elbow bent so hand is just below your chin. Top arm rests on the bottom hand, elbow bent to 90 degrees on both sides. The top hand then rotates up towards the ceiling, using the bottom arm as a kickstand.

For the full video, watch here: https://youtu.be/AssLqx78O84

Scapular stability.  The scapula, or the shoulder blade has an attachment to the collar bone, which forms the archway we spoke about above.  To create more space under the archway, pulling the shoulder blade back and down is helpful.  There are lots of muscles that aid in this, but a few of the important ones that tend to be neglected are the Lower Trapezius, the Rhomboids and Middle Trapezius, as well as the Lats.  In short, anything that squeezes the shoulder blades in or down can be helpful.  My go to for beginning strengthening or retraining are prone Is and Ts.  You can perform this in standing with a band as well, but I prefer the prone position, as you are less likely to “cheat” with the feedback of the bed or floor.  

Prone T is shown here. The focus is using the shoulder blades to do the work. The hands should not lift higher than the shoulders during this. Prone "I" would look the same, but with hands by your side. The focus is to squeeze shoulder blades in and down and continue to pulse until you are fatigued.

For the full video, watch here: https://youtu.be/IInJOcYZi1U

Upper back and neck tightness.  This is almost a given with anyone who has shoulder pain or poor mechanics.  It is rare these days to find someone with a mobile upper back as we tend to spend way too much time on phones, computer, reading, writing, etc; all of which place us in a rounded, forward-flexed position.  This limits the mobility of the upper back to extend backwards and rotate.  The last 20 degrees or so of shoulder motion reaching overhead requires the upper back to extend, and even more so if you have other compensation patterns.  There are endless ways to stretch the upper back and neck, but here are a few of my go tos to start:

This is a great way to stretch the upper back. It works even better if the elbows rest on the wall and slide up the wall, but for picture purposes it is shown without

For the full video, check it out here: https://youtube.com/shorts/P7VLGDEExFk

Sidelying thoracic rotation is one of my favorites for upper back mobility. Start by laying on side, with a foam roller or pillow positioned under the top knee, with the knee pulled up towards your head as far as possible. This helps to lock out your low back. Reach your top arm forward, sliding it across the floor. Take a deep breath in and lift your arm, rotating it back as if you are opening a book. Continue as far as you can towards the floor behind you in a pain-free range and keeping the knee against the roller. Go through a couple breath cycles, or go in and out, whichever feels better. For the full video, see here: https://youtu.be/bhrxFs-ylY0

Over time, this shortens the muscles in the front of the chest such as your pecs and Bicep, as well as over-uses muscles such as your upper trapezius and Levator in the neck.  This re-enforces pulling the shoulder blade up and forward, as well as the head of the humerus forward, all creating less space and poor mechanics for the ball and socket to operate. To help this, any kind of "release" to the pec can be helpful. Use a lacross ball or tennis ball against the wall, and slowly lean into the ball against the tender spot. Try and avoid direct pressure on a bone or on the tendon of the Bicep, with the pressure aimed more on the chest, close to the shoulder. Release may take anywhere from 30 sec to 5 min. The focus should be on deep breathes and trying to "sink into the ball." You will know you have accomplished this when you actually feel yourself sink in, or it stops being as painful.

These are all wonderful exercises to add into a routine if you don’t regularly have shoulder pain.  Especially if you are someone who has noticed some "twinges" here and there. They aren't just exercises given to treat a shoulder injury, but very effective in helping to prevent it occurring in the future. If the shoulder bothers you on a regular basis, scheduling an evaluation with a PT or orthopedic provider is definitely recommended, as this doesn’t even scratch the surface of ways people’s bodies learn to compensate.  If you are looking for more advice or to run through some of these exercises, sign up for my FREE workshop scheduled for Friday, April 24th, 2026 from 12-1pm at 311 Price st.  This is a free event, but space is limited, so use this link to secure your spot: https://l.bttr.to/VNAW1

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Here's to healthier shoulders and more pain-free movement in the future!

~Alicia