5 exercises to treat and relieve shoulder tendonitis

The shoulder is a complex, fragile joint. "The shoulder is the most mobile joint in the body. In reality, it's a set of moving joints: shoulder blades, clavicles, humerus, etc.," explains physiotherapist Thierry Gaudré.

This set of joints has three degrees of motion:

• flexion / extension (backward-and-forward movement with the arm straight); 
• abduction / adduction (up-and-down movement at the side with the arm straight); 
• internal rotation / external rotation (like a backhand and forehand stroke, with the arm bent to 90°). 

Thierry explains why we no longer call it tendonitis. "The term tendonitis is no longer appropriate. Research has shown that there are no inflammatory markers in blood samples, whereas with any other type of inflammation, there would be."

The term tendonitis has therefore been replaced by tendinopathy to refer to pain in the shoulder tendon. It can be caused by:

• changes to the internal structure of the shoulder. "Such as a tendon that's ageing and working less well over time," says Thierry. 
• an activity you're not used to doing. "For example, bringing in firewood once a year, moving house, or taking up a new physical activity at a very intensive level. The shoulder responds by sending a distress signal." 
• changing your sports equipment. "If you get a new tennis or badminton racket, a new paddle or a new golf club, your shoulder might react with pain." 
• a new training exercise. "If you try something new with your shoulder and you repeat it, your shoulder might become painful to tell you that the change was too sudden," explains Thierry. This is common in sports such as handball, where the shoulders get a lot of use.

With there being so many types of shoulder tendinopathy, it's hard to give a precise number of sessions. "It can be from a minimum of 15 sessions up to 30, but there's no exact number for every tendinopathy. It all depends on where is and how it happened," says Thierry.

The good news is that, if treated properly, it will heal fully with no long-term weakness.

"In the past, the treatment was rest, icing and taking anti-inflammatories. Nowadays, we keep the joint moving because there are no inflammatory markers. We no longer rely on rest to maintain pain-free movement," he says.
What's really important is that the movement is gentle, progressive and pain-free.

To achieve this, physiotherapists work with a wall, with broomsticks or with gym balls. Once the patient can do the exercise without pain, resistance work is added, which again is introduced gradually.

These strengthening exercises can be done either statically or eccentrically.

Here's a range of gentle exercises that you can do to rehabilitate your shoulder.

According to our expert, this movement perfectly relaxes the shoulder and stretches all of the passive structures in the joint.

• Starting position: stand with your body tilted slightly forwards so that your arm is hanging straight down in front of you. Rest the other arm on a table to support yourself and protect your back. "The hanging arm should be dangling completely loose in front of you," says Thierry. 
• Movement: make very small circular motions with your arm. The rotations should be very subtle.
• Tips: "It's important to only give your arm the slightest of nudges. It should be almost as if your body were swinging your arm all by itself, like a pendulum." Do this as many times as you like and whenever you feel the need.
  

This second movement also relaxes your joint.

• Starting position: place a gym ball on a table and stand facing it with your thighs against the table. Place both hands flat on the ball. 
• Movement: gradually roll the ball on the table so that you stretch out your body. You're going to passively perform a flexion by extending your arms in front of you.  
• Tips: keep breathing throughout the movement by relaxing your muscles as much as possible. Do three sets of about 10 reps, and rest for a few seconds between each set. "The ball should be supporting the weight of your arm, so on a muscular level, your arm isn't working. You should be aiming for a good amplitude."
  

• Starting position: lie on your back on a table or on the floor. Hold the broom handle with your hands slightly further apart than shoulder width. The broom handle should be against your chest.
• Movement: as you exhale, push the stick up towards the ceiling to straighten your arms. Your shoulder blades should be very slightly lifted off the floor. Control the movement as you return to the starting position. Repeat 10 times.
• Tips: do 3 sets of 10 repetitions, with a few seconds of rest between each set. Keep breathing throughout the movement. "It's important to listen to your body. If it hurts, stop. Respect the pain and don't try to reach that point even if, at the start, you can't go very far," says Thierry.

• Starting position: stand with your arms beside your body. Hook a resistance band onto something behind you and hold it in one hand. 
• Movement: bend your arm to push your fist forwards, as if you were punching someone (but do it slowly and with control!). Your torso shouldn't move, meaning that your shoulder blade should pull forward ever so slightly. Control the movement as you return to the starting position.
• Tips: Do the movement 10 times on each side. Do 3 sets of 10 repetitions, with a few seconds of rest between each set. Stay attentive to any pain so that you can avoid it. You can stand further away from or closer to where the resistance band is attached to increase or decrease its tension.
  

• Starting position: stand upright and hold a broom handle horizontally behind you in both hands.
• Movement: push the broom handle as far behind you as possible, without moving the rest of your body. "This exercise can be a bit painful for tendinopathies in the long head of the biceps, because it stretches the muscle. So it's not the right exercise to do for this type of tendinopathy."

• Tips: do both movements 10 times on each side. Again, you can do up to 3 sets, with a few seconds' rest between each set. Stay attentive to any pain so that you can avoid it. You can stand further away from or closer to where the resistance band is attached to increase or decrease its tension.

As we mentioned above, tendinopathies can be relieved with exercise. Although rest used to be prescribed, nowadays you're advised to get moving! 

"Over the course of the various sessions, people tend to keep feeling that sense of pain, but they also feel that they're becoming more flexible. They go further in the movement and the pain isn't as strong. That's how you get over it," says Thierry.  

What that means in practice is that physiotherapists will work the shoulder, but not necessarily the muscles whose tendons are in pain. "We work the entire shoulder to retain mobility."

As well as these exercises, physiotherapists will massage the joint to relax it. "Massaging the shoulder isn't easy, because it requires the joint to be mobilised at the same time. Again, it depends on which muscles are affected."

There's no question: cold. Definitely not heat!

"With cold, you create vasoconstriction. But the pain is caused by vasodilation. So by reducing the size of the blood vessels, you relieve the pain," explains our expert.