12 Expert-Led Exercises for Shoulder Pain & Subacromial Bursitis Relief | UK Physio Guide

Description: Suffering shoulder pain from subacromial bursitis? Discover 12 gentle, effective exercises guided by doctor & physio principles to ease pain, restore movement & strengthen your shoulder. Start your UK-focused recovery journey.

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Shoulder Pain Be Gone: Your Expert Guide to 12 Exercises for Subacromial Bursitis

Ah, shoulder pain. If you're reading this, chances are you know it all too well. That nagging ache, the sharp twinge when you reach for something on the top shelf, the disrupted sleep... it’s more than just a physical discomfort; it chips away at your daily life, your independence, and sometimes, your good mood. You might have heard the term "subacromial bursitis" or "shoulder impingement" bandied about by your GP or perhaps Dr. Google. It sounds rather clinical, doesn't it? But behind the jargon is a common condition that, whilst frustrating, can often be managed effectively, especially with the right approach.

We understand. We've seen countless individuals walk into clinics – doctors' surgeries and physiotherapy practices across the UK – shoulders slumped, faces etched with worry and discomfort, asking, "What can I do about this pain?" The good news? There's often quite a lot you can do, and carefully selected exercise is usually a cornerstone of recovery.

This comprehensive guide is designed with you in mind. It's penned with insights drawn from both medical understanding (the 'doctor' perspective on diagnosis and underlying issues) and hands-on rehabilitation expertise (the 'physio' perspective on movement, muscle function, and practical recovery). We’ll delve into what subacromial bursitis actually is, why it happens, and most importantly, guide you through 12 specific exercises designed to help you manage the pain, improve your shoulder’s function, and get you back to doing the things you love, whether that's gardening, playing with the grandkids, swimming, or simply reaching for that teacup without wincing.

This isn't just a list of exercises; it's a journey towards understanding your shoulder and empowering yourself with the tools for recovery. We'll talk about doing things correctly, listening to your body, and knowing when to seek further help. So, grab a comfy seat (one that encourages good posture, naturally!), perhaps a soothing cuppa, and let's explore how gentle, targeted movement can be your ally against shoulder pain.

Untangling the Knots: What Exactly Is Subacromial Bursitis?

Before we dive into the exercises, let's demystify the condition itself. Understanding what's happening inside your shoulder can make the recovery process feel less daunting and more logical.

Your Shoulder: A Marvel of Engineering (and Sometimes, a Bit Sensitive)

Think of your shoulder joint. It’s not just one simple hinge like your knee. It's an incredibly mobile and complex structure, designed to allow your arm a huge range of motion – up, down, across, around. This freedom comes at a price: stability. To achieve this movement, it relies on a delicate interplay of bones, muscles, tendons, ligaments, and other soft tissues.

Key players in this scenario include:

1.    The Bones:

o    Humerus: Your upper arm bone, topped with a ball-like head.

o    Scapula: Your shoulder blade, which has a shallow socket (the glenoid) where the humerus head sits. It also has a bony prominence arching over the top, called the Acromion. This is a crucial landmark for bursitis.

o    Clavicle: Your collarbone, connecting the shoulder blade to your breastbone.

2.    The Rotator Cuff: This isn't one thing, but a group of four muscles and their tendons (supraspinatus, infraspinatus, teres minor, subscapularis). They originate from the shoulder blade and attach to the head of the humerus. Their job is vital: they help rotate the arm (hence the name) but, more importantly, they act like dynamic ligaments, actively stabilising the ball (humerus head) in the socket (glenoid) and controlling its movement during activities. The supraspinatus tendon runs directly underneath the acromion.

3.    The Subacromial Bursa: Now we get to the heart of the matter. A bursa is essentially a small, thin, fluid-filled sac. Think of it like a tiny cushion or a biological ball bearing. Its purpose is to reduce friction between tissues that move against each other. Your body has many bursae near joints. The subacromial bursa sits in the space under (sub) the acromion (that bony arch) and above the rotator cuff tendons (particularly the supraspinatus) and the head of the humerus. It allows the rotator cuff tendons to glide smoothly beneath the acromion as you lift your arm.

So, What is Bursitis?

"Itis" in medical terms simply means inflammation. Therefore, bursitis is the inflammation of a bursa. When the subacromial bursa becomes inflamed, we call it subacromial bursitis.

Why Does it Get Inflamed? The Concept of Impingement

The space between the acromion and the rotator cuff tendons/humerus head (the subacromial space) is naturally quite narrow. If this space becomes even narrower, or if the structures within it become thickened or irritated, things can get "pinched" or "impinged" when you move your arm, especially when lifting it overhead or outwards.

Subacromial Impingement Syndrome (SAIS) is the broader term often used, where the bursa and/or the rotator cuff tendons (usually the supraspinatus) get compressed in this space. Subacromial bursitis is frequently a major component, and often the primary pain generator, in SAIS.

Imagine repeatedly pinching a tiny cushion between two hard surfaces – eventually, it's going to get sore, swollen, and inflamed. That's essentially what can happen to your subacromial bursa.

Common Culprits: Why Does Subacromial Bursitis Happen?

It's rarely down to one single event. More often, it's a combination of factors:

1.    Repetitive Overhead Activities: Think painters, decorators, swimmers, tennis players, shelf stackers, or even just enthusiastic DIYers. Repeatedly working with your arms above shoulder height can gradually irritate the bursa and tendons.

2.    Sudden Increase in Activity: Decided to paint the whole house in a weekend after months of inactivity? Or started a new, vigorous exercise regime without gradual build-up? This can overload the shoulder structures.

3.    Direct Injury: A fall onto the shoulder or a direct blow can cause acute inflammation of the bursa.

4.    Poor Posture: Slouching, rounded shoulders, and a forward head posture can alter the mechanics of your shoulder blade. This can effectively narrow the subacromial space, making impingement more likely even during everyday movements. This is a huge factor often overlooked!

5.    Muscle Imbalances: Weakness in the rotator cuff muscles or the muscles that control the shoulder blade (scapular stabilisers) can lead to poor control of the humerus head. It might ride up too high in the socket during movement, contributing to impingement. Conversely, tightness in other muscles (like the chest muscles or muscles around the neck) can pull the shoulder into a poor position.

6.    Anatomical Factors: Some people might naturally have a slightly differently shaped acromion (e.g., hooked or spurred) that predisposes them to impingement. Degenerative changes like bone spurs (osteophytes) associated with arthritis can also narrow the space.

7.    Rotator Cuff Tendinopathy/Tears: Problems with the underlying tendons (inflammation, degeneration, or small tears) can cause them to swell slightly, reducing space and potentially leading to secondary bursitis. Often, tendinopathy and bursitis coexist.

8.    Age-Related Changes: Like many tissues, bursae and tendons can become less resilient with age, making them more susceptible to irritation.

Recognising the Symptoms: Is This You?

Subacromial bursitis typically presents with a distinct pattern of symptoms:

• Pain Location: Usually felt on the outer aspect of the shoulder, sometimes radiating down the side of the upper arm, often stopping before the elbow. It’s often described as a dull ache at rest, becoming sharper with certain movements.
• Painful Arc: A classic sign is pain experienced when lifting the arm out to the side (abduction), typically between 60 and 120 degrees of elevation. Moving below or above this range might be less painful or even pain-free.
• Pain with Overhead Activities: Reaching up high (e.g., into cupboards, washing hair) is often provocative.
• Pain Reaching Behind: Movements like fastening a bra, tucking in a shirt, or reaching into the back seat of the car can be painful.
• Night Pain: Lying on the affected shoulder is often very uncomfortable and can significantly disturb sleep. Even lying on the other side can sometimes be painful if the affected arm falls across the body.
• Weakness: Often secondary to pain (pain inhibition), but sometimes due to an associated rotator cuff issue. Lifting objects, especially away from the body, might feel weak.
• Clicking or Popping: Some individuals might experience mechanical sounds, although this is not specific to bursitis.
• Tenderness: The area just below the bony tip of the shoulder (acromion) might be tender to touch.

It's important to note that these symptoms can overlap with other shoulder conditions, like rotator cuff tears, tendinopathy, frozen shoulder (adhesive capsulitis), or even referred pain from the neck. That's why a proper assessment by a healthcare professional (GP or Physiotherapist) is crucial for an accurate diagnosis.

Why Exercise? The Healing Power of Movement (Done Right!)

It might seem counterintuitive to move something that hurts, especially when rest is often the first thing we think of. Whilst a short period of relative rest (avoiding aggravating activities) can be helpful initially to calm things down, prolonged immobilisation is generally not the answer for subacromial bursitis. In fact, specific, carefully chosen exercises are fundamental to recovery. Here’s why:

1.    Improving Biomechanics: The core issue in many bursitis cases is faulty movement patterns leading to impingement. Exercises can help retrain how your shoulder blade (scapula) and upper arm bone (humerus) move together (this is called scapulohumeral rhythm). By strengthening the muscles that control the scapula and the rotator cuff, we can improve the positioning of the humerus head and effectively increase the subacromial space during movement, reducing the pinching.

2.    Reducing Pain and Inflammation: Gentle movement can help improve blood flow to the area, which aids in flushing out inflammatory by-products. Certain exercises, like pendulums, can also provide a gentle traction effect, potentially decompressing the subacromial space temporarily and offering pain relief through neural mechanisms (gate control theory of pain).

3.    Restoring Range of Motion: Pain and inflammation often lead to stiffness. Gentle stretching and range-of-motion exercises help prevent the shoulder from "freezing up" and gradually restore normal movement.

4.    Strengthening Supporting Muscles: Weakness in the rotator cuff and scapular stabilisers is both a potential cause and consequence of bursitis. Strengthening these muscles provides dynamic stability to the joint, improves control, and makes the shoulder more resilient to future stress.

5.    Improving Posture: As mentioned, poor posture is a major contributor. Exercises that target postural muscles (upper back, neck) help create a better foundation for healthy shoulder function.

6.    Preventing Recurrence: By addressing the underlying mechanical issues and strengthening the supporting structures, a good exercise programme significantly reduces the likelihood of the bursitis coming back.

The Keyword is Appropriate Exercise: Simply grabbing heavy weights or doing random shoulder exercises found online can easily make things worse. The exercises need to be:

• Targeted: Addressing the specific muscle imbalances and movement dysfunctions associated with bursitis.
• Gentle (Initially): Starting with movements that don't provoke significant pain.
• Progressive: Gradually increasing the challenge (range, repetitions, resistance) as pain allows and strength improves.
• Focused on Form: Quality of movement is paramount over quantity.

Before You Begin: Essential Ground Rules for Safe Exercising

Your safety and well-being are top priorities. Before starting any new exercise programme, especially when dealing with pain, please keep these crucial points in mind:

1.    Disclaimer: This guide provides general information and exercise suggestions commonly used for subacromial bursitis. It is NOT a substitute for professional medical advice. Always consult your GP or a qualified Physiotherapist before starting these or any other exercises. They can provide an accurate diagnosis, rule out other conditions, and tailor a programme specific to your individual needs, severity, and stage of recovery. This is particularly important if you experienced a traumatic injury, have severe or worsening pain, significant weakness, or other concerning symptoms (like numbness, tingling, or fever).

2.    Listen to Your Body – The Traffic Light System: Pain is your body's signal. Learn to interpret it:

o    Green Light (0-3/10 pain): Mild discomfort is sometimes acceptable, especially a stretching sensation or muscle fatigue. Generally, exercises should be performed in a pain-free range or with only very mild awareness.

o    Amber Light (4-5/10 pain): Moderate pain during the exercise that settles quickly afterwards. Proceed with caution. You might need to reduce the range of motion, number of repetitions, or the difficulty of the exercise. If the pain lingers significantly after stopping, you've likely done too much.

o    Red Light (6+/10 pain): Sharp, significant pain during the exercise, or pain that increases and persists long after you've finished. STOP the exercise immediately. This movement is likely aggravating your condition at this stage. Do not push through significant pain.

3.    Start Gently and Progress Gradually: Don't try to do everything at once or push too hard too soon. Begin with fewer repetitions and sets, focusing on mastering the correct form. As exercises become easier and your pain reduces, you can slowly increase the repetitions, sets, range of motion, or add light resistance (like a therapy band) where appropriate. Progression should be slow and steady – think weeks and months, not days.

4.    Consistency is Key: Aim to perform your exercises regularly as advised (often daily or several times a week for shorter sessions, depending on the physio's plan). Sporadic efforts are far less effective. Little and often is usually better than one long, intense session.

5.    Warm-Up and Cool-Down (Gentle): Before starting the main exercises, do some gentle movements to prepare the tissues, like shoulder rolls or arm swings (within a comfortable range). A brief cool-down with gentle stretches can also be beneficial.

6.    Focus on Form: Performing the exercise correctly is far more important than how many you do or how much weight you lift. Use a mirror if possible to check your technique. Poor form can be ineffective at best and harmful at worst.

7.    Breathe: Don't hold your breath during exercises. Breathe naturally and rhythmically. Exhaling during the exertion phase can often help.

8.    Patience and Persistence: Recovery from bursitis takes time. There will likely be good days and bad days. Don't get discouraged if progress feels slow. Stick with your programme (adjusting as needed based on pain), celebrate small improvements, and remember you're investing in your long-term shoulder health.

The 12 Physio-Approved Exercises for Subacromial Bursitis

Here are 12 exercises commonly recommended by physiotherapists to help manage subacromial bursitis. They are generally progressed from gentle range-of-motion and activation exercises to more focused strengthening. Remember to apply the "Traffic Light System" and prioritise pain-free movement, especially in the early stages.

Phase 1: Gentle Movement and Pain Relief (Focus: Reduce irritation, maintain range)

These are often the starting point when the shoulder is quite irritable.

1. Pendulum Swings (Codman's Pendulums)

• Purpose: This classic exercise uses gravity to gently distract the shoulder joint, potentially opening up the subacromial space slightly. It promotes fluid movement within the joint, encourages relaxation of surrounding muscles, and can provide significant pain relief for many. It's about passive movement – letting the arm hang and swing like a pendulum, not actively lifting it.
• Starting Position: Stand sideways next to a sturdy table or worktop. Lean forward, placing your non-painful hand on the table for support. Bend at your hips and let your painful arm hang straight down towards the floor, completely relaxed like a dead weight. Ensure your shoulder muscles are loose – give it a little jiggle to check. Maintain a straight back; don't round excessively.
• Instructions:

1.    Keeping the arm relaxed, gently sway your body slightly to initiate the swinging motion.

2.    Allow the arm to swing forwards and backwards in a small, controlled arc. Keep the movement small initially.

3.    Then, allow the arm to swing side-to-side (across your body).

4.    Finally, allow the arm to swing in small circles, both clockwise and anti-clockwise.

5.    The key is that the movement comes from your body's gentle sway, not from actively using your shoulder muscles to lift or force the arm. Imagine the arm is a heavy rope hanging from your shoulder socket.

• Repetitions & Sets: Start with 10-15 swings in each direction (forward/back, side-to-side, clockwise circle, anti-clockwise circle). Perform 1-2 sets. You can do this several times a day if it provides relief.
• Important Tips:

• RELAX the arm completely. This is the most crucial part. If you feel your shoulder muscles tensing up, stop, reset, and try again.
• Keep the movements small and within a pain-free range. Don't force it.
• Maintain good support with your other arm and keep your back comfortable.
• If leaning over is difficult due to back pain, you can try a modified version sitting on a chair and leaning forward slightly.

2. Table Slides / Hand Slides

• Purpose: This exercise encourages gentle forward elevation (flexion) of the shoulder in a supported manner, reducing the load on the joint and minimising the chance of impingement compared to lifting the arm freely in the air. It helps maintain or gently regain forward movement.
• Starting Position: Sit at a table with a smooth surface. Place a small towel or duster under the hand of your affected arm to allow it to slide easily. Rest your forearm and hand on the table, palm facing down. Sit tall with good posture.
• Instructions:

1.    Keeping your arm relaxed, slowly slide your hand forwards across the table, allowing your shoulder to flex.

2.    Only go as far as you comfortably can without significant pain (aim for Green or light Amber zone). You might feel a gentle stretch.

3.    Your torso can lean forward slightly with the movement, but try to initiate the movement from the shoulder.

4.    Hold briefly at the end range (if comfortable).

5.    Slowly slide your hand back to the starting position.

• Repetitions & Sets: Start with 10-15 repetitions. Perform 1-2 sets. Can be done 1-2 times daily.
• Important Tips:

• Keep your shoulder blade down and relaxed; avoid hunching your shoulder up towards your ear as you slide forward.
• The movement should be smooth and controlled.
• If you don't have a suitable table, you can perform a similar movement standing facing a wall, placing your hand on the wall (perhaps on a towel) and sliding it upwards, using your legs to step closer to the wall as your arm goes higher. This is often called a "Wall Slide."

3. Passive/Active-Assisted Range of Motion (Flexion & Abduction)

• Purpose: To maintain or gently restore shoulder movement (forward elevation/flexion and sideways elevation/abduction) without overloading the painful structures. Your non-painful arm provides the support and does most (passive) or some (active-assisted) of the work.
• Starting Position: Lie on your back with your knees bent and feet flat on the floor or bed. This position helps relax the shoulder muscles and stabilises your trunk. Hold a light stick (like a broom handle, cane, or umbrella) with both hands, palms facing upwards or inwards, depending on comfort. Your hands should be shoulder-width apart or slightly wider.
• Instructions (Flexion - Forward Movement):

1.    Using your non-painful arm, gently push the stick upwards towards the ceiling and then overhead, allowing the painful arm to be moved passively or with minimal effort.

2.    Keep the elbow of the painful arm relatively straight but not locked.

3.    Only go as far as you comfortably can within the Green/light Amber pain zone. Aim for a gentle stretch, not sharp pain.

4.    Hold for a second or two at the top (if comfortable).

5.    Slowly lower the stick back down, again controlled mainly by the non-painful arm.

• Instructions (Abduction - Sideways Movement):

1.    Start with the stick resting across your hips/lower abdomen.

2.    Using your non-painful arm, push the stick sideways, moving both arms out away from your body in an arc, like opening wings (keeping elbows fairly straight).

3.    Again, only move within a comfortable, relatively pain-free range.

4.    Slowly return to the start.

• Repetitions & Sets: Start with 8-12 repetitions for each direction (flexion and abduction). Perform 1-2 sets. Can be done once or twice daily.
• Important Tips:

• Focus on letting the non-painful arm do the work, especially initially (passive ROM). As you improve, you can contribute a little more effort with the painful arm (active-assisted).
• Keep the movements slow and controlled. Avoid jerky motions.
• Ensure your lower back stays comfortable on the floor/bed; don't arch excessively.
• If lying down is difficult, some variations can be done seated, but lying often provides better relaxation and control initially.

Phase 2: Gentle Activation and Scapular Control (Focus: Waking up support muscles, improving mechanics)

Once the initial irritability starts to settle, we can begin gently activating key stabilising muscles without causing impingement.

4. Scapular Squeezes (Shoulder Blade Squeezes)

• Purpose: This exercise targets the muscles between your shoulder blades (rhomboids and middle trapezius). These muscles are crucial for good posture and controlling the position of the shoulder blade, which directly influences the subacromial space. Strengthening them helps pull the shoulders back and down, counteracting slouching.
• Starting Position: Sit or stand tall with your arms relaxed by your sides. Imagine a string pulling the top of your head towards the ceiling. Your chin should be slightly tucked, and your shoulders relaxed away from your ears.
• Instructions:

1.    Gently squeeze your shoulder blades together as if you were trying to pinch a small object between them.

2.    Think about moving the blades backwards and slightly downwards, not shrugging your shoulders up towards your ears.

3.    Hold the squeeze for 3-5 seconds, feeling a gentle tension between the blades.

4.    Slowly relax back to the starting position.

• Repetitions & Sets: Start with 10-15 repetitions. Perform 1-2 sets. Can be done multiple times throughout the day, especially as a break from prolonged sitting.
• Important Tips:

• Keep the movement small and controlled. It's a subtle squeeze, not a forceful retraction.
• Avoid arching your lower back; keep your core gently engaged.
• Ensure your shoulders stay down; don't let them creep up. Imagine sliding the shoulder blades down your back pockets as you squeeze them together.
• Breathe normally throughout.

5. Isometric External Rotation (Against Wall)

• Purpose: To gently activate the external rotator muscles of the rotator cuff (infraspinatus and teres minor) without actually moving the shoulder joint through a range of motion. Isometrics are great in early rehab as they cause muscle contraction with minimal joint stress or irritation. These muscles help stabilise the humerus head and control rotation.
• Starting Position: Stand sideways next to a wall, with your painful shoulder closest to the wall. Bend your elbow to 90 degrees, keeping your elbow tucked close to your side. Place the back of your hand/wrist against the wall. Your forearm should be parallel to the floor.
• Instructions:

1.    Gently press the back of your hand outwards into the wall, as if you were trying to rotate your forearm away from your body.

2.    The wall will prevent any movement (hence "isometric").

3.    You should feel a gentle contraction in the muscles at the back/side of your shoulder.

4.    Hold the gentle press for 5-10 seconds. Do NOT push maximally – aim for about 30-50% of your maximal effort.

5.    Relax.

• Repetitions & Sets: Start with 8-12 repetitions. Perform 1-2 sets. Can be done daily.
• Important Tips:

• Keep your elbow tucked into your side throughout the exercise. Don't let it drift away from your body.
• Maintain good posture; stand tall, shoulders back and down (as much as comfortable).
• Avoid leaning your body into the wall; the effort should come from the shoulder muscles.
• Focus on a gentle, sustained contraction. It shouldn't cause sharp pain.

6. Isometric Internal Rotation (Against Wall/Door Frame)

• Purpose: To gently activate the internal rotator muscle of the rotator cuff (subscapularis) isometrically. This muscle also plays a role in shoulder stability and control.
• Starting Position: Stand facing a wall corner or the edge of a door frame. Stand close enough so that when you bend your affected arm's elbow to 90 degrees (elbow tucked into your side), the palm-side of your hand/wrist rests against the wall/frame. Your forearm should be parallel to the floor.
• Instructions:

1.    Gently press your palm/wrist inwards into the wall/frame, as if you were trying to rotate your forearm across your body.

2.    The wall/frame prevents movement.

3.    You should feel a gentle contraction in the muscles at the front of your shoulder/armpit area.

4.    Hold the gentle press for 5-10 seconds (again, 30-50% effort).

5.    Relax.

• Repetitions & Sets: Start with 8-12 repetitions. Perform 1-2 sets. Can be done daily.
• Important Tips:

• Keep that elbow tucked in!
• Maintain good posture.
• Don't lean your body.
• Gentle pressure is key. Avoid pain.

Phase 3: Gentle Strengthening and Control (Focus: Building endurance and control in key muscles)

As pain subsides further and basic activation is comfortable, you can start adding gentle resistance or performing movements against gravity, always prioritising form and pain-free range.

7. Wall Push-Ups (Wall Presses)

• Purpose: A modified push-up that strengthens the chest muscles (pectorals), front of the shoulders (anterior deltoid), and importantly, the serratus anterior muscle. Serratus anterior is vital for stabilising the shoulder blade against the rib cage and rotating it upwards correctly during elevation, helping to clear the subacromial space. Working against a wall reduces the load compared to floor push-ups.
• Starting Position: Stand facing a wall, about arm's length away. Place your hands on the wall slightly wider than shoulder-width apart, at chest height. Keep your feet flat on the floor, core gently engaged, and back straight.
• Instructions:

1.    Slowly bend your elbows, leaning your body towards the wall. Keep your body in a straight line from head to heels (don't let your hips sag or poke out).

2.    Lower yourself until your nose or forehead is close to the wall, or as far as comfortable without shoulder pain. Focus on feeling your shoulder blades glide smoothly on your back.

3.    Push back slowly to the starting position, straightening your elbows. Actively think about pushing the wall away and slightly protracting your shoulder blades (moving them forward around your ribcage) at the very end of the movement, without rounding your upper back excessively. This helps engage the serratus anterior.

• Repetitions & Sets: Start with 10-15 repetitions. Perform 1-2 sets. Can be done daily or every other day.
• Important Tips:

• Keep your elbows slightly tucked, not flaring directly out to the sides.
• Maintain a stable core and straight body line.
• Control the movement in both directions (lowering and pushing).
• To make it easier, stand closer to the wall. To make it harder, stand further away or progress to incline push-ups on a sturdy table/countertop.
• Focus on the shoulder blade movement – they should retract (come together slightly) as you lower, and protract (move apart/forward) as you push away.

8. Resistance Band Rows (Seated or Standing)

• Purpose: Excellent for strengthening the mid-back muscles (rhomboids, middle trapezius) and the back of the shoulders (posterior deltoid, rotator cuff). These muscles act as crucial counter-balances to the chest muscles, improve posture, and help control the shoulder blade. Using a resistance band allows for adjustable difficulty.
• Starting Position:
• Seated: Sit tall on a chair or the floor with legs straight (or slightly bent). Loop a resistance band securely around your feet. Hold the ends of the band in each hand, palms facing each other or downwards. Start with slight tension on the band, arms extended forward.
• Standing: Secure the band at chest height to a sturdy object (door handle, railing). Stand facing the anchor point, holding the ends of the band with slight tension, arms extended.
• Instructions:

1.    Keeping your back straight and shoulders down, pull the band towards your torso.

2.    Focus on squeezing your shoulder blades together as you pull. Imagine pulling from your shoulder blades.

3.    Your elbows should bend and travel backwards, staying relatively close to your body (don't let them flare up high).

4.    Pull until your hands are roughly level with your torso.

5.    Hold the squeeze briefly.

6.    Slowly return the band to the starting position with control; don't let it snap back.

• Repetitions & Sets: Start with 10-15 repetitions. Perform 1-2 sets. Progress to 2-3 sets as you get stronger. Perform 2-3 times per week.
• Important Tips:

• Maintain upright posture throughout. Avoid leaning back excessively.
• Initiate the movement by retracting the shoulder blades.
• Keep shoulders relaxed away from ears – no shrugging!
• Choose a band resistance that allows you to complete the reps with good form but feels challenging towards the end. Start light!
• Control the return phase (eccentric) – this is just as important as the pull.

9. Resistance Band External Rotation (Standing)

• Purpose: To strengthen the external rotator muscles (infraspinatus, teres minor) through their range of motion, now adding resistance. This builds on the isometric version.
• Starting Position: Stand holding a resistance band anchored at elbow height to your side (e.g., in a door jamb or held by your other hand if anchor points are tricky). Stand sideways to the anchor point, with your affected shoulder further away. Hold the band with your affected hand, elbow bent to 90 degrees and tucked firmly into your side. There should be slight tension on the band.
• Instructions:

1.    Keeping your elbow glued to your side, slowly rotate your forearm outwards, stretching the band.

2.    Move only as far as comfortable, focusing on the rotation coming purely from the shoulder joint.

3.    Hold briefly at the end of the rotation.

4.    Slowly return to the starting position with control, resisting the pull of the band.

• Repetitions & Sets: Start with 10-15 repetitions. Perform 1-2 sets. Progress to 2-3 sets. Perform 2-3 times per week.
• Important Tips:

• The elbow must stay tucked into your side. Placing a small rolled towel between your elbow and waist can provide feedback. If the towel drops, your elbow has moved.
• Maintain good posture; stand tall.
• Avoid rotating your torso; the movement should be isolated to the shoulder.
• Use a light resistance band initially. Form is critical.

10. Resistance Band Internal Rotation (Standing)

• Purpose: To strengthen the internal rotator muscle (subscapularis) through range with resistance.
• Starting Position: Stand holding a resistance band anchored at elbow height to your side. Stand sideways to the anchor point, this time with your affected shoulder closer to the anchor. Hold the band with your affected hand, elbow bent to 90 degrees and tucked into your side. Start with your forearm rotated slightly outwards, with gentle tension on the band.
• Instructions:

1.    Keeping your elbow tucked into your side, slowly rotate your forearm inwards across your body, pulling the band.

2.    Focus on the rotation coming from the shoulder joint.

3.    Hold briefly when your hand is near your stomach.

4.    Slowly return to the starting position with control.

• Repetitions & Sets: Start with 10-15 repetitions. Perform 1-2 sets. Progress to 2-3 sets. Perform 2-3 times per week.
• Important Tips:

• Keep the elbow tucked! Use the towel trick if needed.
• Maintain good posture.
• Isolate the movement to the shoulder; don't twist your body.
• Start with light resistance.

11. Prone 'T' Exercise (or Bent-Over 'T')

• Purpose: Targets the middle trapezius and rhomboids (scapular retractors) as well as the posterior deltoids, encouraging good scapular positioning and strengthening the upper back against gravity.
• Starting Position:
• Prone (Ideal if comfortable): Lie face down on a bed or bench, with your affected arm hanging straight down towards the floor. You may need a pillow under your forehead for comfort.
• Bent-Over (Alternative): Stand with feet shoulder-width apart, knees slightly bent. Hinge forward at your hips, keeping your back straight (like a deadlift position), until your torso is close to parallel with the floor. Let your arms hang straight down. You may want to support your non-affected hand on a chair or table for balance.
• Instructions:

1.    Keeping your elbow straight (or with a very slight bend), lift your arm straight out to the side, level with your shoulder, forming a 'T' shape with your body.

2.    As you lift, focus on squeezing your shoulder blade towards your spine.

3.    Keep your neck relaxed and avoid shrugging your shoulder towards your ear.

4.    Hold the top position briefly.

5.    Slowly lower the arm back down with control.

• Repetitions & Sets: Start with 8-12 repetitions. Perform 1-2 sets. Progress to 2-3 sets. Perform 2-3 times per week. Start with no weight, then consider adding very light dumbbells (e.g., 0.5kg - 1kg, or even a tin of beans) only when the bodyweight version is easy and pain-free.
• Important Tips:

• The movement should be controlled, not jerky or swinging.
• Lead with the shoulder blade squeeze.
• Keep your thumb pointing upwards towards the ceiling – this helps bias external rotation and can be more comfortable for the shoulder.
• If prone or bent-over positions are difficult, similar muscles can be targeted with band exercises (like rows or band pull-aparts).

12. Standing Scaption (Empty Can / Full Can)

• Purpose: To strengthen the supraspinatus muscle (a key rotator cuff muscle often involved in impingement) and the deltoid muscle in a plane of movement that is often less likely to cause impingement than straight forward flexion or side abduction. Scaption is elevation in the plane of the scapula – about 30-45 degrees forward of pure sideways abduction.
• Starting Position: Stand tall with good posture, arms by your sides, core gently engaged.
• Instructions:

1.    Turn your thumbs so they are pointing slightly upwards or forwards (the "Full Can" position - generally considered more comfortable and potentially less impinging than the traditional "Empty Can" / thumbs down position, which should usually be avoided initially).

2.    Keeping your elbow straight, slowly lift your affected arm forwards and slightly out to the side (about 30-45 degrees angle from the front of your body). Imagine following a diagonal line.

3.    Lift the arm only up to shoulder height (90 degrees) or slightly below, or only as high as you can go without pain or shoulder shrugging. Do NOT force it higher if it hurts.

4.    Focus on keeping your shoulder blade stable and down – don't let your shoulder hunch up towards your ear.

5.    Hold briefly at the top.

6.    Slowly lower the arm back down with control.

• Repetitions & Sets: Start with 8-12 repetitions. Perform 1-2 sets. Progress to 2-3 sets. Perform 2-3 times per week. Start with no weight, then progress to very light dumbbells (0.5kg - 2kg) only when comfortable and pain-free.
• Important Tips:

• Prioritise the "Full Can" (thumbs up/forward) position initially. Avoid thumbs down ("Empty Can") unless specifically advised by your physio, as it can increase impingement risk for some.
• Do NOT lift above shoulder height if it causes pain. Quality and pain-free range are key.
• Keep the shoulder blade set back and down. Use a mirror to watch for shrugging.
• Control the lowering phase.

Beyond the Exercises: A Holistic Approach to Shoulder Health

Whilst these exercises are crucial, managing subacromial bursitis effectively often involves looking at the bigger picture:

1.    Posture, Posture, Posture! We can't stress this enough. Slouching rounds the shoulders and encourages impingement.

o    Sitting: Sit back in your chair, use lumbar support if needed, keep feet flat, shoulders relaxed back and down, head balanced over shoulders (avoid forward head poke). Take regular breaks.

o    Standing: Stand tall, gentle core engagement, shoulders back and down, weight balanced.

o    Sleeping: Avoid sleeping directly on the painful shoulder. Try sleeping on your back (perhaps with a pillow under the affected arm for support) or on the non-painful side with a pillow hugged in front to support the affected arm and prevent it falling across your body.

2.    Activity Modification: Identify activities that consistently aggravate your pain and try to modify or temporarily avoid them. This might mean:

o    Avoiding heavy lifting or carrying bags on the affected side.

o    Breaking down overhead tasks into smaller chunks.

o    Using a step stool to avoid over-reaching.

o    Adjusting your technique in sports or hobbies.

o    This doesn't mean stopping everything, but being smarter about how you move.

3.    Ergonomics: Assess your workspace. Is your monitor at eye level? Is your keyboard positioned so your elbows are bent at roughly 90 degrees and shoulders relaxed? Are frequently used items within easy reach? Small adjustments can make a big difference if you spend hours at a desk.

4.    Pain Relief Modalities (Use Wisely):

o    Ice: Applying an ice pack (wrapped in a thin towel) to the painful area for 15-20 minutes, several times a day, can help reduce inflammation and numb the pain, especially after activity or in the acute phase.

o    Heat: Some people find heat (heat pack, warm shower) more soothing, particularly for stiffness, once the acute inflammation has settled. It can help relax muscles. Experiment to see what works best for you.

o    Over-the-Counter Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (gel or tablets) can help reduce pain and inflammation. Paracetamol can help with pain. Always use as directed, be aware of potential side effects and contraindications, and check with your pharmacist or GP if you have other health conditions or are taking other medications.

5.    The Role of Professionals:

o    GP (General Practitioner): Your first port of call for diagnosis, ruling out other serious issues, prescribing medication if appropriate, and referring you to physiotherapy or specialist care if needed.

o    Physiotherapist: Experts in musculoskeletal assessment and rehabilitation. They can provide a definitive diagnosis, perform hands-on treatments (like massage, joint mobilisations), guide you through a tailored exercise programme (progressing beyond this list), advise on activity modification and posture, and use modalities like taping or acupuncture if appropriate. This is often the most crucial professional input for bursitis recovery.

o    Specialist (Orthopaedic Surgeon / Sports Medicine Doctor): If conservative measures (physio, medication) fail after a significant period (e.g., 3-6 months), or if there's suspicion of a significant structural issue (like a large rotator cuff tear), your GP or physio might refer you to a specialist. They may consider investigations like ultrasound or MRI scans and discuss options like corticosteroid injections (which can provide temporary relief from inflammation and pain, allowing a better window for rehab) or, in rare, persistent cases, surgical options (like subacromial decompression).

Moving Forward: Progression, Patience, and Prevention

Recovery is a process, not an event.

• Progression: As your pain settles and exercises become easier, discuss progression with your physio. This might involve:
• Increasing repetitions and sets.
• Increasing the range of motion (carefully).
• Adding resistance (bands, light weights).
• Moving to more challenging exercises.
• Gradually reintroducing previously provocative activities with good technique.
• Patience: Don't expect overnight results. It can take weeks or even months to fully resolve symptoms and restore full function. Consistency and adherence to your programme are vital. Listen to your body and don't push through flare-ups – ease back temporarily if needed, then gradually resume.
• Prevention: Once your pain has resolved, don't just stop! Continue with some maintenance exercises (especially strengthening and postural work) 2-3 times a week. Stay mindful of your posture, warm up properly before strenuous activity, avoid sudden massive increases in workload, and continue using good lifting/reaching techniques. Addressing the root causes is key to stopping bursitis from becoming a recurring visitor.

Taking the First Step Towards a Pain-Free Shoulder

Dealing with subacromial bursitis can be disheartening, but hopefully, this guide has shown you that there are concrete steps you can take to manage your pain and reclaim your shoulder function. These 12 exercises, rooted in physiotherapy principles, offer a starting point for gentle movement, muscle activation, and strengthening – key components of effective rehabilitation.

Remember, the journey starts with understanding your condition, respecting your body's signals (especially pain!), and committing to consistent, correct exercise. While this guide provides valuable information, it's always best complemented by personalised advice from your GP or physiotherapist. They can ensure the exercises are right for you and guide your progression safely.

You don't have to simply put up with shoulder pain. By taking an active role in your recovery, embracing gentle movement, and addressing underlying factors like posture, you can significantly improve your symptoms and work towards a future with less pain and more freedom of movement. Start slowly, be patient, stay consistent, and don't hesitate to seek professional help when you need it. Your shoulders will thank you for it.

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