Shoulder Injuires
Immediate, Subsequent Care, & Return to Athletics
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The shoulder complex consists of two primary structural groups:
The Shoulder Joint (Glenohumeral or GH joint)
The Shoulder Girdle, which includes the Sternoclavicular (SC), Acromioclavicular (AC), and Scapulothoracic articulations.
Athletes are at risk for a variety of injuries, including sprains, strains, dislocations, subluxations, separations, impingement, and instability.
Early management and structured rehabilitation are essential to minimize reinjury and restore full function.
Overview
Overview
Proper management during the first 24–48 hours is critical for a safe and efficient return to sport. We follow the PEACE & LOVE approach for acute injury care — prioritizing protection, gentle movement, and long-term healing over outdated ice-heavy methods.
If you notice a visible deformity, seek care at an Urgent Care center or Emergency Department immediately. See our “Where Should You Go?” page for guidance.
Always follow up with your Athletic Trainer as soon as possible after an injury.
Immediate Care
Immediate Care
Key PEACE & LOVE Takeaways for the shoulder
No ice — Ice can interfere with inflammation, angiogenesis, and tissue repair, potentially delaying recovery.
Pain relief only with acetaminophen (Tylenol) as needed during the first 24–48 hours.
Avoid Ice & NSAIDs (Advil, Motrin, Ibuprofen, Aleve, Naproxen) for at least 48 hours
They may slow healing
Swelling is part of healing
Limit use — Use sling, if needed.
Hourly Range-of-Motion Exercises
Hourly Range-of-Motion Exercises
Complete every hour and move only within a pain-free range.
Pendulum swings (front-to-back, side-to-side, circular)
Assisted forward flexion using the uninjured arm.
Scapular pinches: 2×15 reps.
Depending on the clinical diagnosis, you may want to avoid these exercises.
Subsequent Care
Subsequent Care
After 24–48 Hours Post-Injury
After 24–48 Hours Post-Injury
Depending on the clinical diagnosis of the injury, please complete the rehabilitation protocol. Continue only if pain-free or working at a tolerable level of discomfort. If swelling/bruising persists, continue to add the Immediate Care hourly range-of-motion exercises at each stage.
Shoulder Muscle Strains & Overuse Injuries
Shoulder Muscle Strains & Overuse Injuries
These include overuse of the deltoid, rotator cuff, or scapular stabilizers due to repetitive throwing, lifting, or contact.
Stage 1: Pain Management & Isometrics
Stage 1: Pain Management & Isometrics
Pendulum Swings – 3×30 sec each direction (Video)
Isometric Shoulder Series (Video)
Flexion, Extension, Internal & External Rotation – 5–10 sec × 10 reps each
Scapular Squeezes – 3×15
Stage 2: Active ROM & Light Strength
Stage 2: Active ROM & Light Strength
Wall Slides (Flexion/Scaption) – 2×15 (Video to be posted)
Side-Lying External Rotation (no weight) – 2×15 (Video to be posted)
Prone I, T, Y – 2×10 each position
Serratus Wall Punches – 2×15
Stage 3: Functional Strength & Stability
Stage 3: Functional Strength & Stability
Resistance Band Rows – 3×15 (Video)
Standing External Rotation with Band – 3×15 (Video)
Band Internal Rotation – 3×15
Plank Shoulder Taps – 3×10 each
Stage 4: Sport-Specific Return
Stage 4: Sport-Specific Return
Medicine Ball Chest Pass – 3×10
Overhead Band Press – 3×12
Controlled Throwing Drills or Sport Skills – as tolerated
Stage 5: Maintenance
Stage 5: Maintenance
Continue strengthening 2–3×/week
Focus on posture, scapular control, and balanced training between pushing/pulling exercises
Acromioclavicular (AC) Joint Sprains
Acromioclavicular (AC) Joint Sprains
The AC joint connects the clavicle and scapula. “Shoulder separations” vary by severity:
Type I – Mild sprain, no deformity – Sling 3–7 days, early motion
Type II – Partial tear, mild deformity – Sling 1–2 weeks
Type III – Complete tear, possible deformity – Sling up to 3–4 weeks, or surgical referral if needed
Type IV–VI – Displacement or severe injury – Surgical repair recommended
Stage 1: Pain Management & Isometrics
Stage 1: Pain Management & Isometrics
Sling for comfort (wean as tolerated)
Pendulum Swings – 2×15 each direction (Video to be posted)
Isometrics (Flexion, Extension, IR, ER) – 5–10 sec × 10 reps
Scapular Squeezes – 3×15
Stage 2: ROM & Light Strength
Stage 2: ROM & Light Strength
Wall Slides (Pain-Free) – 2×15
Posterior Shoulder Stretch – 4×/day, 30 sec (Video to be posted)
Pectoral Stretch – 4×/day, 30 sec (Video to be posted)
Band Rows – 3×15
Stage 3: Functional Strength
Stage 3: Functional Strength
Standing External Rotation with Band – 3×15
Scaption with Light Weight – 2×15 (Video to be posted)
Prone “T” and “Y” – 3×10
Push-up Plus (Modified if needed) – 3×10
Stage 4: Sport-Specific & Contact Prep
Stage 4: Sport-Specific & Contact Prep
Medicine Ball Wall Throws – 3×10
Reactive Band Drills
Resume sport-specific drills (gradual contact introduction for collision sports)
Stage 5: Maintenance
Stage 5: Maintenance
Continue scapular and cuff strengthening 2–3×/week
Optional protective padding (e.g., Sully Shoulder Stabilizer, Battle Padded Top)
Glenohumeral Dislocation & Subluxation
Glenohumeral Dislocation & Subluxation
After reduction and rest, structured rehab restores stability, control, and confidence.
Stage 1: Pain Management & Isometrics
Stage 1: Pain Management & Isometrics
Pendulum Exercises – 2×15
Isometric Shoulder Series – 5–10 sec × 10 each direction
Scapular Retractions – 3×15
Stage 2: Active ROM & Early Strength
Stage 2: Active ROM & Early Strength
Assisted Flexion with Wand – 2×10
Side-Lying External Rotation (no weight) – 2×15
Prone “T” & “Y” – 3×10
Band Rows – 3×15
Stage 3: Stability & Control
Stage 3: Stability & Control
Standing External/Internal Rotation with Band – 3×15
Wall Clocks (band around wrists) – 3×10 sec each direction
Rhythmic Stabilization (manual or with ball on wall) – 3×30 sec
Stage 4: Return-to-Play
Stage 4: Return-to-Play
Controlled overhead lifting, push-up progression, plank shoulder taps
Sport-specific movements (throwing, tackling, blocking)
Must pass strength, ROM, and functional stability testing before full return
Stage 5: Maintenance
Stage 5: Maintenance
Continue scapular control, rotator cuff, and posterior chain strengthening
Use Sully Shoulder Stabilizer or similar brace for at-risk athletes
Rotator Cuff Tendinopathy / Impingement
Rotator Cuff Tendinopathy / Impingement
The rotator cuff is a group of four muscles and their tendons that surround and stabilize the shoulder joint. These muscles are: supraspinatus, infraspinatus, teres minor, and subscapularis.
The rotator cuff plays a crucial role in shoulder movements, such as abduction (raising the arm to the side), external rotation (turning the arm outward), and internal rotation (turning the arm inward). It helps maintain the stability of the shoulder joint and prevents the humerus (upper arm bone) from dislocating.
Stage 1: Pain Management & Isometrics
Stage 1: Pain Management & Isometrics
Isometric Internal Rotation – 3×15
Isometric External Rotation – 3×15
Scapular Squeezes – 3×15
Thoracic Extension Stretch over foam roller – 3×30 sec
Stage 2: ROM & Light Strength
Stage 2: ROM & Light Strength
Side-Lying External Rotation (no weight → light resistance) – 2×15
Prone “T” & “Y” – 3×10
Wall Angels – 2×10
Band Rows – 3×15
Stage 3: Functional Strength
Stage 3: Functional Strength
Standing Band ER/IR – 3×15
Serratus Wall Slides – 3×10
Prone 90/90 ER Lift – 3×10
Push-Up Plus – 3×10
Stage 4: Sport-Specific
Stage 4: Sport-Specific
Overhead Band Press – 3×10
Medicine Ball Rebound Throws – 3×10
Thrower’s 10 Program (light resistance) – 2–3×/week
Stage 5: Maintenance
Stage 5: Maintenance
Regular shoulder prehab 2×/week
Focus on external rotation endurance and scapular rhythm
Labrum Injuries — Labral Tears / SLAP-Type Strain / Biceps Tendon Irritation
Labrum Injuries — Labral Tears / SLAP-Type Strain / Biceps Tendon Irritation
Labral tears, including SLAP (Superior Labrum Anterior to Posterior) tears, and biceps tendon irritation occur in the shoulder joint's cartilage, causing pain, clicking, and instability. SLAP tears specifically involve the top of the labrum, where the biceps tendon attaches, and are often caused by trauma or repetitive overhead motions. Biceps tendon irritation can also arise from this tear, as the tendon can become inflamed or move excessively within the shoulder. Symptoms include deep shoulder pain, popping or grinding, limited range of motion, and a feeling of instability.
Stage 1: Pain Management
Stage 1: Pain Management
Avoid resisted elbow flexion and overhead activity
Ice massage 1×/day
Isometric Flexion/Extension – 5–10 sec × 10 reps
Stage 2: ROM & Light Strength
Stage 2: ROM & Light Strength
Cross-Body Stretch – 30 sec × 4/day
Scapular Retractions – 3×15
Supination/Pronation with Light Weight – 3×15
Band Rows – 3×15
Stage 3: Functional Strength
Stage 3: Functional Strength
Eccentric Biceps Curl – 3×10 (Video to be posted)
Standing Band External Rotation / Internal Rotation – 3×15
Shoulder Flexion to 90° with Light Weight – 3×10
Push-Up Plus – 3×10
Stage 4: Sport-Specific
Stage 4: Sport-Specific
Overhead Medicine Ball Catch/Throw – 3×10
Controlled Return to Lifting and Throwing
Clearance by Athletic Trainer or Physician
Stage 5: Maintenance
Stage 5: Maintenance
Regular posterior capsule stretching
Continue eccentric and scapular stabilization work
General Shoulder Strengthening Plan
General Shoulder Strengthening Plan
This plan maintains balanced shoulder strength, improves posture, and reduces risk of overuse injuries across all sports.
Maintenance / Injury Prevention
Maintenance / Injury Prevention
Perform 2–3×/week:
Band / Cable External Rotation – 3×15
Band / Cable Internal Rotation – 3×15
Band / Cable Rows – 3×15
Scaption with Light Dumbbells (<5 lbs.) – 3×10
Prone “T” & “Y” – 3×10
Serratus Wall Slides – 3×10
Plank Shoulder Taps – 3×10 each
Return to Athletics
Return to Athletics
Coming soon!
Resources planned: Return to sport recommendations, Return to throwing program, and more!
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