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Ideas to Fix Shoulder Impingement

Shoulder impingement is one of the most common causes of shoulder pain with activity. This diagnosis was initially believed to be pain caused by structures of the shoulder such as the rotator cuff tendons rubbing against the acromion when lifting the arm overhead. There have been a number of research studies that have disproved this theory and the medical community has not reached consensus on how we should be labeling this condition. Nowadays you may hear diagnoses such as subacromial pain syndrome, shoulder pain with muscle performance deficits, rotator cuff syndrome, and rotator cuff related pain. These are overarching descriptions of what is causing your shoulder pain and do little to provide guidance on how to improve symptoms! Regardless of what terminology you use to describe shoulder pain, all roads tend to lead to a targeted strengthening program for long term symptom resolution.


Nonspecific shoulder pain can be challenging due to the dynamic nature of the shoulder joint. The shoulder is the most “unstable” joint in the human body, we sacrifice anatomical stability to maximize mobility enabling us to position the hand in space during a wide variety of tasks. As a result of this inherent instability, we are reliant on multiple force coupling dynamics between different groups of muscles at the shoulder to enable appropriate mechanics. The most common force couples we need to address are the lower trapezius/serratus anterior and external rotation/internal rotation.


Lower Trapezius and Serratus Anterior: The lower trapezius (LT) and serratus anterior (SA) must work together to enable appropriate positioning of the scapula during upper extremity activity. Oftentimes we are able to improve activation of these muscles with manual facilitation techniques and immediately change shoulder pain. Here are some common exercises we will prescribe in early rehab to increase activation of LT prior to activity.


External Rotation to Internal Rotation: The rotator cuff is comprised of multiple muscles that perform external or internal rotation of the shoulder. Although these muscles perform rotation of the shoulder, their primary function is to counter the forces created by primary movers of the shoulder such as the deltoid, pectoralis major, and latissimus dorsi. There is data that shows on average we expect to see a pain-free shoulder producing external rotation force at 21-26% of bodyweight in men and 17-19% of bodyweight in women. We also know that in overhead athletes we should expect to see external rotation force production of at least 70% of internal rotation force for a healthy shoulder. When these muscles are weak compared to bodyweight or strength ratios are out of whack, we often see pain develop. Here are just a few examples of early phase exercises we prescribe to target the rotator cuff musculature.


If you are experiencing shoulder pain, these exercises are a great starting point. If you would like to perform strength testing and develop a targeted program unique to your needs, book an appointment with one of the expert clinicians at Rise today!



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