Optimal Function Blog:
Top Tips for Managing Shoulder Impingement
You asked, so we answered!

Thanks to Trish for her request for tips to help a client with shoulder impingement:

"I have a client with a pinching arm when lifting the arm up from hip height to chest.  Do you have any advice or tips?"

You can find functional assessments and progressive strengthening exercises in our   Restoring Optimal Function: Neck & Shoulder Distance Education Workshop.

If you have a question you would like to see answered in our blog, please email it to us at admin@activeanatomy.com

We hope you enjoy the article.

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SHOULDER IMPINGEMENT

Shoulder impingement is a condition whereby the greater tubercle of the humerus is rotated  inwards  r educing the gap underneath the acromion causing a pinch on the supraspinatus tendon and the sub deltoid bur sa.

Most people will feel the pinch in an internally rotated position of the shoulder combined 
with elevation, such as in an upright row position.   

Many people try to stretch the pectoral muscles, upper trapezius muscles, and latissimus dorsi muscles to try and improve the forward-rounding internally rotating shoulder, without firstly addressing the weakness in the rotator cuff muscles.

The rotator cuff muscles, if they are weak, will not counteract the force of the deltoid on the gleno-humeral joint, causing an upward glide of the humerus in the socket and resulting in impingement.

EXERCISES THAT MAY AGGRAVATE THE CONDITION

Any exercises that take the arm into horizontal adduction, internal rotation, and flexion such as the end position in an upright row, will cause impingement pain. 

Avoid wide-arm push ups, exercises with hitched shoulders, bench press, freestyle swimming, a lso some stretches, such as triceps stretching with arms above the head. These are the classic movements and exercises that will cause a person with shoulder impingement more pain.

MANAGING AND RECOVERING FROM SHOULDER IMPINGEMENT

From clinical experience, I have found that by addressing the postural dysfunctions of the upper body initially, through stretching and mobility exercises, combined with lateral basal breathing techniques, is the best starting platform to reduce shoulder pain.

Following this, bring in strengthening exercises for scapula stabilisers, such as serratus anterior and lower trapezius, then once you have established good connection of the posture and scapula stabilisers, add in stregthening of the rotator cuff muscles.

SUGGESTED PROGRESSION

1. Diaphragmatic breathing 

Diaphragmatic Breathing
Diaphragmatic Breathing



2. Low arm chest stretch with arms behind back 
Instead of taking the arm into abduction or above shoulder height to do a pectoralis major or minor stretch, you can stretch the chest and open the shoulders by clasping both hands behind the low back and gently lifting the arms away from the low back. The aim of this stretch is to encourage the shoulder girdle to retract slightly, putting the gleno-humeral joint into a more efficient position to move.
  
 

3. Thoracic mobility - hands across chest, sit twist

Thoracic Mobility - Sit twist exercises
Thoracic Mobility - Sit twist exercises


4. Spikey ball release of pectoralis minor
Another good way of releasing tension and muscle tightness in the pectoralis minor muscle, which can affect the position of the shoulder, is to do some trigger point therapy using a small spikey ball or massage ball. This again allows the pec muscles to be released without putting the gleno-humeral in a compromising position and exacerbating the impingement.

Pectoralis Minor Spikey Ball Release
Pectoralis Minor Spikey Ball Release

  
5. Wall push-up
The wall push-up is the first step to take towards helping your clients be able to weight bear through their arms whilst keeping their shoulder girdle stabilised. Further progressions for strengthening serratus anterior muscle are to go into a four point position on your hands and knees, or a half push-up position. These beginner levels must be achieved pain free before progression on to any planks or full length push-ups.

 

6. Activate lower trapezius
Lower Trapezius Activation in Prone
Lower Trapezius Activation in Prone


7. Strengthening rotator cuff
Rotator Cuff Strengthening
Rotator Cuff Strengthening



Hands-on massage or physiotherapy treatment whilst the client is increasing strength in the rotator cuff and scapula stabilisers is a beneficial addition to the program. 

These exercises are great to improve function in the gleno-humeral joint. As the impingement subsides you can encourage your clients to slowly take their arms further into flexion and abduction, and finally to be able to reach above the head. If there is any neck or neural symptoms or components to the injury you must refer the client to health professional for further diagnosis. 

Got a question?
Email us at admin@activeanatomy.com 
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