Shoulder Impingement Stretches and Exercises

Many of us have some shoulder issues, including but not limited to tightness, weakness, and pain. I've compiled a number of resources to help you take care of your shoulders if they're giving you impingement problems.

First, we need to have a brief anatomy lesson. The shoulder joint is the articulation between the head of the humerus (upper arm) and the glenoid fossa (hollow depression on the scapula, aka shoulder blade). The shoulder blade hangs on your upper ribcage, and the muscles that stabilize the scapula include the rhomboids, trapezius, levator scapulae, pectoralis minor, and serratus anterior. These muscles need to work together to keep the scapula in place during various shoulder movements.

The rotator cuff consists of four muscles, all of which originate on the scapula and insert on the humerus. These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles work together to steer and stabilize the humerus to the glenoid fossa. When these muscles don't work well, for whatever reason, the humeral head usually jams up above the fossa in to the acromion. This jamming leads to irritation and impingement, or pinching and squeezing.

Finally, the big movers or positioners of the shoulder include the deltoids, latissimus dorsi, and the pectoralis major.

Flexibility, mobility, and recovery are crucial components of any training program, including addressing weaknesses or injuries. Therefore, proper stretching of the posterior (toward the back) and anterior (toward the front) deep tissues is important. Here's a great video by Phil Donley, ATC, PT of the Morgan Kalman Clinic in Wilmington, DE. In it he demonstrates the sleeper stretch and its modifications, designed to stretch the posterior capsule.

And here is a good explanation and description of a pectoralis minor stretch, from Eastside Therapeutic Arts in Redmond, WA.

The primary stabilizers need general strengthening in the early phases of rehabilitation. This includes scapular retraction to strengthen the rhomboids; this can be done standing with some Theraband or tubing, or prone (lying on your stomach) with a small weight. The next exercise is called a ceiling punch, or protraction, to strengthen the serratus anterior.

Strengthening of the various rotator cuff muscles is the vital next step. Perform these exercises 3 times per week, starting with 2 sets of 10 reps with only 1 pound, and progressing to 8 sets of 10 reps before increase the weight by 1 pound. Yes, you read that right, just one pound. Go back to 2x10, progressing again to 8x10, then increasing the weight again by 1 pound. You can be a little aggressive with set increases early on, but you can set yourself back a lot by over-doing these exercises. Here are the exercises from Terry Trundle, PTA, ATC, LAT of the Athletic Rehab Institute in Atlanta, GA. Prior to performing these exercises, please ask me to explain and demonstrate them in person. Performing them improperly could make your shoulder worse!

Last but not least, it's time to ice. If you've worked your shoulder, it needs some ice to calm things down and help reduce inflammation. Ice is much better than ibuprofen, in my opinion.

Please remember that this is no substitute for medical care or advice. I'm neither a doctor, nor do I play one on TV. This presentation only has to do with various impingement problems. If you have shoulder instability, serious pain, or lack of range of motion, please see your primary doc, an orthopaedist, or an osteopath who specializes in sports medicine. If you have any medical questions or concerns, please consult your health care provider.