Shoulder Impingement: Stretching and Strengthening Exercises

Shoulder impingement involves compression of the rotator cuff tendons between the top of the shoulder blade (acromion process) and upper aspect of the arm bone (humerus).  Other structures involved include the biceps tendon and bursa (a fluid-filled sac between 2 bones).  Shoulder impingement accounts for approximately 1/3 of all shoulder pain.  Pain is usually worst when reaching with an outstretched arm or lifting overhead.

Impingement Syndrome

During normal activities of daily living, your rotator cuff becomes compressed and stretched.  This typically does not result in any pain.  However, several factors can contribute to excessive compression of your rotator cuff and pain.  Thankfully, the majority of these factors are modifiable through exercise.  In fact, research shows exercise is at least equally effective or better than medications, injections, and surgery for most painful shoulder problems.

Exercise addresses many of the modifiable risk factors that contribute to shoulder impingement.  Stretching exercises increase the available space between the shoulder blade and humerus. This can alleviate compression of the rotator cuff, bursa, and biceps tendon.  Strengthening exercises  that target the rotator cuff and shoulder blade muscles also increase the available space.  Exercising with an appropriate load strengthens the tendons which further reduces pain.  There is no one-size-fits-all exercise approach for shoulder impingement.  The following exercises are only examples which may be included in an individualized rehabilitation program.

Stretching Exercises for Shoulder Impingement

Stretching the shoulder is an important part of any shoulder rehabilitation program.  In particular, exercises targeting mobility of your pectoralis minor muscle, thoracic spine, and posterior shoulder are important.  Increasing the length of your pectoralis minor pulls the shoulder blade back, improves posture, and increases the available space for your rotator cuff.  Improving extension of your thoracic spine improves posture and overhead shoulder mobility. Stretching the back of your shoulder helps reposition your upper arm bone allowing greater space for any compressed soft tissues.  For the best results perform stretching exercises daily.

Rotator Cuff Exercises for Shoulder Impingement

The primary job of your rotator cuff is to center the ball of your arm bone (humerus) in the socket of your shoulder blade.  Any weakness of your rotator cuff causes the ball to migrate upwards into the bone above it leading to impingement.  Once your  shoulder becomes painful, your rotator cuff muscles shut down leading to a vicious cycle of pain and weakness. It is imperative that your rotator cuff is strengthened in order to restore proper shoulder function. There are 4 muscles of the rotator cuff.  They are the supraspinatus, infraspinatus, teres minor, and subscapularis.  These muscles function together and are all strengthened during rehabilitation.

Performing the following 3 exercises will improve the strength of your entire rotator cuff.  Strengthening exercises are performed 3-4 times per week.  Start with a weight that allows you to perform 12 to 15 repetitions for 3 sets.  Over the course of several weeks, progress the weight so you are performing closer to 8 to 10 repetitions for each set.  A sense of fatigue and some pain is acceptable and in most cases beneficial for recovery.  On a 0 to 10 scale, keep the pain levels at a 5/10 or less.

Shoulder Blade Exercises for Impingement

Your trapezius and serratus anterior muscles function together to rotate your shoulder blade upwards.  They also tilt your shoulder blade backward as your arm is raised.  This is essential for overhead function.  If your shoulder blade does not appropriately tilt backwards or rotate upwards,  aryourm bone will jam into your acromion.  This results in impingement of your rotator cuff.   Follow the same guidelines described above for rotator cuff strengthening exercises (i.e., sets, repetitions, etc).

Closing Thoughts

Shoulder impingement is a common disorder in athletes, weekend warriors, and sedentary adults.   Exercise is the first line of treatment and in most cases, very successful.  Your shoulder complex is composed of several joints and many small but intricate muscles.  Therefore, recovery is often slow at first.  However, if you stick to your exercise program expect a full recovery in 3 to 4 months.  For faster results, it is best to work with your physical therapist so your exercise program is targeted to your individual needs.  Give us a call if you would like some help.

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