AC Joint Arthritis: Recommended Exercises, Movements to Avoid, and Important Precautions

What exercises are good for AC joint arthritis?

For individuals managing Acromioclavicular (AC) joint arthritis, the right exercise approach focuses on pain reduction, restoring range of motion, improving scapular stability, and strengthening supportive musculature without aggravating the joint.

Understanding AC Joint Arthritis

The acromioclavicular (AC) joint is located at the top of the shoulder, where the collarbone (clavicle) meets the highest part of the shoulder blade (acromion). AC joint arthritis, often a result of wear-and-tear (osteoarthritis) or previous injury, involves the degeneration of the cartilage within this joint, leading to pain, stiffness, and reduced shoulder function. Symptoms commonly include localized pain at the top of the shoulder, tenderness to touch, clicking or grinding sensations, and discomfort with overhead movements, cross-body reaching, or sleeping on the affected side.

Principles of Exercise for AC Joint Arthritis

The primary goals of an exercise program for AC joint arthritis are to:

• Reduce Pain and Inflammation: Through controlled, gentle movements that do not irritate the joint.
• Restore and Maintain Range of Motion: To prevent stiffness and improve functional mobility.
• Improve Scapular Stability: Strengthening the muscles that control the shoulder blade (scapula) is crucial, as a stable scapula provides a better foundation for arm movements and reduces stress on the AC joint.
• Strengthen Surrounding Musculature: Including the rotator cuff, deltoids, and upper back muscles, to support the shoulder complex.
• Enhance Posture: Good posture optimizes shoulder mechanics and can alleviate strain.

Key considerations for exercise selection include low impact, controlled movements, avoiding positions that cause impingement or direct compression on the AC joint, and gradual progression.

Recommended Exercise Categories

A well-rounded program will incorporate exercises from the following categories, performed with proper form and within a pain-free range.

Range of Motion (ROM) & Mobility

These exercises aim to gently move the shoulder without putting excessive stress on the AC joint.

• Pendulum Swings:
  • Lean forward, supporting your non-affected arm on a table or chair.
  • Let the affected arm hang freely.
  • Gently swing the arm forward and backward, side to side, and in small circles. Keep movements passive and relaxed.
• Wall Slides/Finger Walks:
  • Stand facing a wall, placing the fingers of the affected hand on the wall.
  • Slowly "walk" your fingers up the wall, allowing your arm to rise as high as comfortable without pain.
  • Slowly walk your fingers back down.
• Gentle Arm Circles:
  • Stand or sit with arms relaxed at your sides.
  • Perform small, controlled circles with your arms, gradually increasing the size as tolerated. Focus on smooth, pain-free movement.

Scapular Stability

Strengthening the muscles that control the scapula helps provide a stable base for the arm and reduces stress on the AC joint during movement.

• Scapular Retractions (e.g., "W" Raises, Prone Scapular Squeezes):
  • Seated/Standing: Sit or stand tall. Squeeze your shoulder blades together and down, as if trying to hold a pencil between them. Hold for 3-5 seconds, then release. Avoid shrugging your shoulders up.
  • Prone "W" Raises: Lie face down with arms bent at 90 degrees, forming a "W" shape. Lift your arms slightly off the floor by squeezing your shoulder blades together and down.
• Band Pull-Aparts:
  • Hold a light resistance band with both hands, arms extended straight out in front of you at shoulder height.
  • Keeping your arms straight, pull the band apart by squeezing your shoulder blades together. Control the return.
• Wall Angels:
  • Stand with your back against a wall, feet shoulder-width apart.
  • Press your head, upper back, and glutes against the wall. Try to get your elbows and the back of your hands against the wall, forming a "W" shape.
  • Slowly slide your arms up the wall, keeping contact if possible, as if making a snow angel. Slide back down.

Rotator Cuff Strengthening (Sub-maximal, Controlled)

Strengthening these muscles helps support the shoulder joint. Focus on light resistance and perfect form.

• External Rotation (with light resistance band or dumbbell):
  • Stand or sit, holding a light resistance band or dumbbell. Keep your elbow bent at 90 degrees and tucked close to your side.
  • Rotate your forearm outwards, away from your body, using only the shoulder. Control the movement back.
• Internal Rotation (with light resistance band or dumbbell):
  • Similar setup to external rotation, but rotate your forearm inwards across your body.
• Scaption (Scapular Plane Elevation) – Modified:
  • Hold very light dumbbells (1-3 lbs) or no weight.
  • Raise your arms forward and slightly out to the sides (about 30-45 degrees from your body, in the plane of your scapula), thumbs pointing up, to shoulder height or slightly below. Avoid going overhead if it causes pain.
  • Focus on controlled movement, initiating with scapular stability.

Core & Postural Support

A strong core and good posture reduce compensatory movements and optimize overall shoulder function.

• Plank Variations:
  • Start with a modified plank on your knees or with hands elevated on a bench if a full plank is too challenging or painful for the shoulders.
  • Focus on maintaining a straight line from head to heels, engaging your core.
• Bird-Dog:
  • Start on all fours.
  • Extend one arm forward and the opposite leg backward, keeping your core stable and hips level. Avoid arching your back.
• Thoracic Mobility Exercises:
  • Thoracic Extension over Foam Roller: Lie on your back with a foam roller under your upper back. Clasp hands behind your head and gently extend your upper back over the roller.
  • Seated Thoracic Rotations: Sit tall, hands clasped behind your head or across your chest. Gently rotate your upper body from side to side.

Exercises to Approach with Caution or Avoid

Certain exercises can exacerbate AC joint pain by compressing or stressing the joint. These should generally be avoided or heavily modified.

• Overhead Pressing: Especially with heavy weights or uncontrolled movement, as it directly compresses the AC joint.
• Dips: Puts significant stress on the shoulder joint, including the AC joint.
• Push-ups: Particularly deep push-ups or those performed with poor scapular control, can aggravate the joint. Modified push-ups (on knees or against a wall) may be tolerated.
• Bench Press: Especially wide-grip or deep bench presses, which can place undue stress on the AC joint. Consider neutral grip or floor presses with limited range of motion.
• Upright Rows: This exercise often puts the shoulder in an internally rotated and abducted position, which can impinge the AC joint and rotator cuff.
• Any exercise that causes sharp or increasing pain: Pain is your body's signal; do not push through it.

Important Considerations and Precautions

• Consult a Professional: Always consult with a physician, physical therapist, or qualified exercise professional before starting any new exercise program, especially if you have an existing medical condition. They can provide a proper diagnosis and tailored recommendations.
• Pain is Your Guide: Never push through pain. Mild discomfort is acceptable, but sharp, increasing, or radiating pain indicates you should stop the exercise.
• Start Slowly, Progress Gradually: Begin with low repetitions, light or no resistance, and limited range of motion. Gradually increase intensity, duration, or resistance as your pain allows and strength improves.
• Focus on Form Over Weight: Correct technique is paramount to protect the joint and effectively target the intended muscles. Poor form can worsen the condition.
• Warm-up and Cool-down: Always begin with a gentle warm-up (e.g., light cardio, gentle arm swings) and end with a cool-down (e.g., static stretches for the shoulder and chest).
• Consistency is Key: Regular, consistent exercise yields the best results for managing chronic conditions like arthritis.
• Listen to Your Body: Your body will tell you what it can tolerate on any given day. Some days may be better than others; adjust your activity accordingly.

When to Seek Professional Guidance

If you experience persistent pain, worsening symptoms, or a significant decrease in your ability to perform daily activities despite following an exercise program, it's crucial to seek further medical evaluation. A physical therapist can also provide manual therapy, advanced exercises, and modalities to complement your home exercise routine.