Mid-Stage Shoulder Pain Rehab: Practical Pearls

The mid-stage is arguably the trickiest time in shoulder rehabilitation.

By this stage you’ve already helped the patient navigate the acute irritability, restore some basic movement, and build a foundation of strength. But the challenge lies with bridging the gap between early recovery and return to full, functional performance. How do you progress and challenge the patient without overloading them, all the while keeping them engaged in rehab? That’s the art (and major challenge!) of mid-stage shoulder rehab.

In her Practical, expert consultant shoulder physio Anju Jaggi provides in-depth insights into her approach to managing shoulder pain. This blog provides some great takeaways for the mid-stage of rehab.

If you’d like to see exactly how expert physio Anju Jaggi manages shoulder pain, watch her full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more here.

Mid-stage exercise prescription

Mid-stage management is all about transitioning from isolated control to integrated, functional strength. For the shoulder, that means progressing beyond early isometrics and simple range-of-motion exercises into exercises that replicate the demands of real-life activities.

Rotator cuff exercises

At this stage, the rotator cuff remains a priority, but the way it’s loaded changes. Instead of purely isolated movements, think about adding dynamic stability demands, varying angles, and controlling both concentric and eccentric phases. Elastic resistance, cable systems, and light dumbbells are all useful tools here. The goal isn’t just strength, it’s building the cuff’s ability to react to sudden changes in load or position, and work as both a shoulder mover and stabiliser.

Functional exercises

The shoulder rarely works in isolation in the real world. That’s why Anju emphasises exercises that integrate the cuff with the scapular stabilisers, trunk, and lower limb. Examples include multi-plane pulling and pushing, diagonal patterns, and closed kinetic chain activities that mimic sport- or work-specific movements.

Incorporating weight-bearing

Mid-stage is also the right time to start loading the shoulder in partial and full weight-bearing positions. Think quadruped progressions, wall-supported positions, and eventually floor-based variations. These stimulate co-contraction patterns and enhance joint position sense, as well as increasing the patient’s confidence in their shoulder. Watch Anju demonstrate some great weight-bearing exercises in the below video from her Practical:

Proprioception

Anju highlights the importance of proprioceptive exercises, whether it’s perturbation training in weight-bearing, stabilisation with manual resistance, or unstable surface work, proprioceptive exercises help the patient’s neuromuscular system adapt to unpredictable forces, preparing them for daily challenges.

Dosage

Anju draws on her years of clinical experience and takes a refreshingly practical approach to dosing for shoulder management. Watch her explain in the below clip from her Practical:

Progression considerations

Progression is one of the most difficult things to master in this period – hitting the sweet spot between challenging the patient without overloading them is a real skill. One of the most common questions patients ask at this stage is: “should I push through pain?”

Anju’s answer is nuanced. Pain during exercise isn’t a bad thing during the subacute and chronic stages, but it’s not something to ignore blindly, either. Factors to weigh include:

• Pain quality: Is it sharp and localised, or a dull, diffuse ache?
• Post-exercise response: Does the pain settle within 24 hours or does it linger and/or worsen?
• Patient history: Chronic pain and central sensitisation may alter pain thresholds and require a different approach.

See Anju explain her approach in this video from her Practical:

Progression should also consider factors like load complexity, not just load magnitude. For example, moving from stable, single-plane movements to multi-directional or unstable environments can be just as challenging, and beneficial, as adding kilograms to the bar.

Last but not least, Anju highlights a key part of her shoulder pain management – considering the psychosocial factors; it’s going to be important to take into account the patient’s beliefs about their pain, their confidence in their shoulder, their self-efficacy in management, and other life circumstances which might affect their engagement, and/or response to progression in rehabilitation. And as always, progression decisions should be made with the patient, keeping their end-goals and individual circumstances in mind!

Wrapping up

Mid-stage management of shoulder pain is where rehab gets interesting (and can get difficult!).
You’re no longer just restoring movement and reducing acute pain, you’re supporting the balancing act of preparing the patient for the demands of life, while also reducing the risk of flare ups.

By blending targeted rotator cuff work with realistic, functional exercises, incorporating weight-bearing and proprioceptive challenges, progressing thoughtfully, and taking into account the psychosocial aspects of management, you can set your patients up for lasting success.

If you want world-class shoulder tips distilled from years of clinical expertise, watch Anju Jaggi’s full Practical HERE. This is a session you won’t want to miss!