Exercises and Stretches for Subscapularis Tendon Pain

This blog post contains: The best exercises and stretches for Subscapularis tendon pain.

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The Subscapularis is a muscle that is part of the rotator cuff and plays an important role in stabilizing the shoulder.

Injury to the Subscapularis tendon include:

• Tendinitis
• Tendinosis
• Tears (Partial/Full thickness)
• Strains

(The exercises shown on this blog post can be beneficial for all types of injury to the Subscapularis tendon.)

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Test for Subscapularis Tendon tear

Not sure if you have an injury to the Subscapularis? Try out the following tests to help you determine this.

a) Pain Location

If you have an injury to the Subscapularis tendon, the pain will be located at the inner/front portion of the shoulder.

b) Muscle Activation Test

This test is used to determine if there is pain and/or weakness in the shoulder associated with activation of the Subscapularis.

Instructions:

• Lie down on your back.
• Place your palm on top of your belly button.
• Lift your elbow upwards.
  • (Keep this elbow position throughout this test.)
• Push your palm firmly into the belly as hard as you can.
• Hold this contraction for 5 seconds.
• Compare to the unaffected side.

Results: If you have pain at the front of the shoulder (or weakness as compared to the other side) whilst performing this test, this suggests that you may have an injury to the Subscapularis tendon.

c) Lift Off Test

Instructions:

• Stand up.
• Place your hand behind your lower back.
• Keep your elbow bent at 90 degrees throughout this test.
• Without allowing the shoulder to round forwards, lift your hand off your back.

Results: Inability to lift the hand off the lower back suggests that there may be an injury to the Subscapularis.

d) Imaging

Get a MRI and/or Ultrasound scan to determine if there is a structural issue with the Subscapularis tendon.

(To get a scan – You will need to obtain a referral from your Primary Care Provider.)

How To Fix Subscapularis Tendon Pain

STEP 1: Reduce Aggravation
STEP 2: Reduce Inflammation
STEP 3: Releases
STEP 4: Stretches
STEP 5: Isometric Exercises
STEP 6: Strengthening Exercises
STEP 7: Co-Activation
STEP 8: Surgery
Common Questions

STEP 1: Reduce Exposure to aggravating activities

Reduce Exposure to, Modify or Completely stop any activity/movement/position that aggravates the pain in the Subscapularis tendon.

… Why?

It will be more difficult to perform the exercises outlined in this blog post if the shoulder is constantly being irritated.

Example of activities that may aggravate your symptoms include: Reaching over head, Driving, Throwing, Lifting/Carrying, Pulling/Pushing

Note: Do not completely stop using your shoulder! This can result in more stiffness and weakness in the long term. Use your shoulder as much as you comfortably can without significantly aggravating the pain.

STEP 2: Reduce Inflammation

A significant amount of inflammation can make the shoulder more sensitive and painful.

Here are some simple ways to reduce inflammation:

a) Anti-Inflammatory Gel

Apply an anti-inflammatory gel to the front of the shoulder.

Do this 3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths/types of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the inflammation.

Note: Please consult your Primary Care Provider before taking any medication.

c) Cold Therapy

Apply an ice pack to the front of your shoulder for at least 10-15 minutes.

Do this 3-5 times per day.

Note: Do not apply the ice pack directly to the skin as you may develop an irritation on the skin.

d) Try Natural Products

It is suggested that taking turmeric, ginger, chia seeds and/or fish oil capsules are natural ways to help reduce the inflammation.

(To be honest – I am not 100% how effective this is! … But it might be worth a shot.)

e) Cortisone Injection

The cortisone injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to reduce the inflammation and reduce the pain by numbing the area.

Talk to your Primary Care Provider to see if the cortisone injection is appropriate for your shoulder injury.

STEP 3: Releases

The following releases are designed to improve blood flow to the injured region, reduce tension and decrease sensitivity.

a) Tendon Release

Instructions:

• Sit down on a chair.
• Rest the entire weight of the arm on your lap
• Keep the arm completely relaxed throughout this exercise.
• Use the finger tips of your other arm to firmly press into the Subscapularis tendon. (See Target Area)
• Perform circular motions in this region.
• Continue for 1 minute.

Note: Releasing the Subscapularis Tendon can be very painful! You may need to skip this step if you have a significant amount of inflammation surrounding this region.

b) Muscle Release

Instructions:

• Sit down on a chair.
• Rest the entire weight of the arm on your lap.
• Completely relax your arm.
• Use the finger tips of the other arm to push into the front surface of the shoulder blade. (This is in the arm pit region.)
• Focus on areas of increased tightness.
• Continue for 30 seconds.

Note: Make sure that you are not causing numbness or tingling down the arm as you apply pressure into the arm pit region. (This means you may be squashing a nerve!)

STEP 4: Subscapularis Stretches

It is a little bit challenging to stretch the Subscapularis. Try these 3 different variations.

a) Subscapularis Stretch #1

(You will need a stick to perform the following stretch.)

Instructions:

• Lie down on your back.
• Hold onto a stick between your hands.
• Keep your elbow close to the side of your torso.
• Shift the stick towards the side you are stretching.
• Hold for 30 seconds.

b) Subscapularis Stretch #2

(You will need a stick to perform the following stretch.)

Instructions:

• Hold onto a stick as shown as above.
• Make sure that the stick is in contact with the outside of the elbow.
• Lift your arm so that your elbow is at shoulder height.
• Use your other hand to pull the stick.
• Hold for 30 seconds.

Note: Make sure that you do not stretch into any pain!

c) Subscapularis Stretch #3

Instructions:

• Sit on a chair.
• Place both hands on side the of the chair.
• Pull your shoulders BACK and tip them BACKWARDS.
  • (Lock this position in throughout the stretch!)
• Keep your elbows pointing backwards.
• Slowly sink your body backwards. Your elbows should start to bend.
  • (Do NOT let those shoulders tip forwards!)
• Aim to feel a stretch at the front of the shoulders.
• Hold for 30 seconds.

STEP 5: Isometric Contraction

An isometric contraction is where the muscle contracts without moving the joint.

Performing exercises which involve this type of muscular contraction is a good place to start when attempting to strengthen a painful shoulder.

a) Wall Press

Instructions:

• Stand in front of the corner of the wall.
• Bend your elbow so that your forearm is perpendicular to the wall.
• Place you palm onto the side of the wall.
• Push your palm into the wall as hard as you comfortably can.
• Hold this contraction of 45 seconds.
• Repeat 3 times.
• Try out different angles.

b) Shoulder/Belly/Hip Press

Instructions:

• Stand up right.
• Place your hand on your shoulder, belly or hip.
• Push your hand firmly into your body.
• Hold for 45 seconds.
• Repeat 3 times.

c) Prayer Position

Instructions:

• Place both hands together with fingers pointing upwards.
• Raise your arms until the elbows are at shoulder height.
• Keep your elbows bent at 90 degrees.
• Push your hands together firmly.
• Hold for 45 seconds.
• Repeat 3 times.

d) Hi 5 Position

Instructions:

• Raise your arm out to the side to shoulder height.
• Keep your elbows bent at 90 degrees.
• Push your hands firmly into a stationary object.
• Hold for 45 seconds.
• Repeat 3 times.

STEP 6: Strengthening Exercises

It is important to strengthen the Subscapularis in the full range of the shoulder… especially in the range/position that you are experiencing your pain with.

Here are a few ways to strengthen the Subscapularis:

a) Shoulder Neutral

Instructions:

• Tie a resistance band to a stationary object at elbow height.
• Hold onto the band.
• Move away from the anchor point to increase tension on the band.
• Keep shoulders back throughout the exercise.
• Bend your elbows to 90 degrees.
• Keep your elbow fixated to the side of your body.
• Pull the resistance band across the body.
• Perform 20 repetitions.

b) Shoulder Abducted

Instructions:

• Tie a resistance band to a stationary object above you.
• Support your elbow on a flat surface at shoulder height.
• Keep your elbow bent at 90 degrees.
• Whilst holding onto the resistance, slowly pull the band forwards/downwards.
• Perform 30 repetitions.

c) Diagonal Lift

Instructions:

• Anchor a resistance band onto the floor.
• Hold onto the other end of the band.
• Step away from the anchor point create tension on the band.
• Move your arm across the body.
• Aim to feel a contraction in the inside of the shoulder.
• Hold for 3-5 seconds.
• Perform 10 repetitions.

d) Prone Hand Lift

Instructions:

• Lie down on your stomach.
• Place your hand behind your hip.
• Keep your shoulder blade pulled back.
• Lift your hand off your back.
• Hold for 3-5 seconds.
• Perform 10 repetitions.

STEP 7: Co-Contraction

It is important to engage the Subscapularis whilst moving the shoulder. This will help with stability and control of the shoulder.

a) Flexion

Instructions:

• Hold onto a resistance band that is anchored towards the side at shoulder height.
• Step away from the anchor point to create a firm amount of tension in the band.
• Bend your arm to 90 degrees and have your elbow next to the side of your torso.
• Lift your arm up so that the elbow is at shoulder height.
• Perform 20 repetitions.

b) Shoulder Press

Instructions:

• Hold onto a resistance band that is anchored behind you at head height.
• Step away from the anchor point to create a firm amount of tension in the band.
• Sit down on a chair.
• Maintain the vertical position of the forearm throughout this exercise.
• Raise your arm above your head.
• Perform 20 repetitions.

c) Chest Press

Instructions:

• Hold onto a resistance band that is anchored behind you slightly above the height of a bench.
• Step away from the anchor point to create a firm amount of tension in the band.
• Lie down on a bench.
• Assume the chest press position.
• Raise your arms upwards.
• Perform 20 repetitions.

STEP 8: Surgery

If there has been nil improvement in your Subscapular tendon pain after persisting with suggested exercises for at least 3 months, you may need to consider getting a review with a shoulder surgeon.

(Generally speaking – As surgical intervention is an invasive form of treatment that carries associated risks, it should rarely be the first thing to consider when dealing with your shoulder pain.)

If there is a tear in the tendon, the surgeon can re-attach the tendon to the bone.

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Common Questions

Do you have a question for me? Please feel free to leave a comment on this blog post and I’ll get back to you.

a) How long does it take for the Subscapularis tendon to heal?

The recovery time of an injury to the Subscapular tendon really depends on multiple factors such as the severity of the injury, strength of the tendon, past injuries to the area etc.

As a (very) rough guideline:

• 2-6 weeks for a strain
• 6-12 weeks for a partial thickness tear
• 12+ weeks for a full thickness tear

b) How should I sleep with Subscapularis pain?

Avoid sleeping directly on top of the painful shoulder as this may irritate the Subscapularis tendon.

Instead – it is recommended to sleep on the back with a pillow underneath the arm for support.

Alternatively – if you prefer to sleep on your side, you can do so but have the painful shoulder on the upper side.

c) What causes a tight Subscapularis?

In my opinion – the main cause would be having Rounded Shoulders.

This can encourage the shoulder joint to be in a position internal rotation.

(When the shoulder is internally rotated, the Subscapularis is placed in a shortened position.)

Over time in this position – the Subscapularis muscle may become tight.

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Conclusion

Subscapularis tendon pain usually involves tendonitis, tendinosis, tear or a strain to the tendon.

Perform the exercises and stretches mentioned in this blog post to help address your Subscapularis tendon pain.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical Disclaimer.