Best Exercises for Shoulder Impingement

Best Exercises for Shoulder Impingement

Best Exercises for Shoulder Impingement and Rotator Cuff 

Have you been experiencing significant aching in your shoulder? Or sharp, pinching shoulder pain when attempting to lift even the most basic household objects? Maybe, your shoulder pain has already gotten so bad that you have stopped using that arm altogether? 

Let me show you the best exercises for shoulder impingement and rotator cuff symptoms! Shoulder pain can be caused by something called “impingement”, which occurs when the head of the upper arm bone, known as the humerus, literally rubs up against the top, or ceiling, of the shoulder joint…and that constant rubbing can sometimes cause irritation and pain, specifically to the rotator cuff muscles. At worst, it can cause constant, sharp pain in the top or front of the shoulder every time you attempt to lift even the lightest object. What can be extremely frustrating with shoulder impingement pain is that it typically worsens with most strength training exercises, so attempting to simply stay active and strengthen your upper body unfortunately ends up exacerbating the very shoulder symptoms you are looking to prevent! While there can be many causes of shoulder pain, we are going to focus our efforts here on managing and treating mechanical causes of shoulder pain. This refers to your shoulder symptoms that you may have been told are a result of impingement, rotator cuff, or “wear and tear” but can ALL be effectively managed using the following strategies. Now before getting into the more active exercise principles, let me show you a couple methods to quickly reduce your shoulder symptoms: 

1. Shoulder Extension Stretch

  • From standing, reach the affected arm straight backward, taking care to keep your thumb turned down towards the floor as you execute the stretch
  • Additionally, this stretch can be performed passively, where you place your arm into a fully extended position, resting your hand on a surface behind you…then you will squat and lower your body, while keeping your hand on the surface, thus stretching the shoulder into the extended position

2. Shoulder Adduction and Internal Rotation Stretch

  • From standing, slightly extend your arm backwards, then reach across your low back towards your other arm To increase the intensity of this stretch, you can use your unaffected hand to grab a hold of the affected wrist and “pull” that arm across the low back even further
  • Furthermore, once you have reached totally across the low back, you can then reach the affected hand up towards the middle of your back
  • To increase the intensity of this stretch, you can throw a towel over the unaffected shoulder and grasp it with the affected hand; now use the unaffected arm to “pull” the affected arm further up the middle of the back The general recommendation would be to perform 1 set of 10-15 reps, three to four times throughout your day, beginning with the basic reach backwards and progressing through the rest of these stretches if your symptoms plateau…the more significant and constant your symptoms are, the more frequent you should attempt the stretches. Also, it is normal to experience slight pinching and/or obstruction of movement when initiating these stretches, but these should improve with increased repetition, and, at minimum, should not worsen after the stretching has ceased. 
  • Now that you have significantly reduced your shoulder impingement and rotator cuff symptoms, let’s discuss a few key exercise principles that will allow you to train and strengthen your shoulder in safer, more effective ways. 
  • While the anatomical structures of your shoulder, like the rotator cuff muscles and joint cartilage, can become damaged or inflamed from impingement, the underlying cause of the injury or overload of the tissues is typically a result of dysfunctional postures, combined with faulty movement patterns of the ENTIRE upper quarter, which includes not only your shoulder, but also your entire upper extremity, middle/upper back, head, and neck.
 

So, the best way to treat the true cause of your shoulder impingement and rotator cuff pain is to effectively train and load the entire upper quarter, paying attention to the quality of both your support and posture, as well as factors like speed and power. Basically, you need to alter your exercise perspective where “shoulder” exercises are transformed into “whole body” movements that focus on the upper quarter, and not on isolating or training specific shoulder muscles. Since most shoulder problems are a result of ineffective stabilization and control, rather than weakness of particular muscles, most of your “whole body” exercises require at least one aspect of your affected upper extremity to be supported on a surface, whether that be the ground, a bench, or even against the wall. Therefore, you will focus on exercises where you are stabilizing the entire upper quarter, where either your hand, forearm, or elbow is on the ground (or against the wall) the entire time. Finally, there are some characteristics of upper quarter posture that you need to be aware of that will help to prevent overload, pain, and injury, and these principles are the same whether you are using your arm to support yourself or move something:

  • When supporting yourself through your hand, take care to ensure that your weight is evenly spread out over your ENTIRE hand…do not shift weight totally to either the inside or outside of your hand
  • When viewed from the back, just prior to performing an exercise, your shoulders ought to be relatively broad and wide, and even slightly depressed (or lowered) towards the ground, while your head, neck, and spine ought to be elongated, or said in another way, “make yourself tall” without sticking your chin out…while some attention may be required to achieve this posture, it should not require any significant straining or effort
  • When viewed from the side, similar to the description above, your focus should be on maintaining a “tall, elongated” spine, where no spinal curves are accentuated, and your shoulders are neither rounded too far forward, nor squeezed backwards…you do NOT want to squeeze your shoulders down and back!
  • Upon moving your arm, as your upper extremity reaches above the plane of your shoulder (above 90°), it is acceptable for the shoulders to begin to elevate, but take care to always attempt to “control” that elevation by maintaining as “broad and wide” a shoulder position as possible throughout the movement

Ok, now that you understand the principles that you can use to guide your upper quarter shoulder training, let’s discuss how to apply them to some specific exercises: 

3. Prone Head Raise

  • Begin by lying face down on a mat, legs and feet resting shoulder width apart
  • Position both arms above your head so that your hands rest in the same plane as your shoulders, with your elbows bent, resting in the same plane as your ears
  • Resting face down, focus on normal breathing into your belly, followed by a small, slight abdominal wall muscle bracing activity by pushing your belly muscles “out” against the floor…this action should slightly tilt your pelvis backward, straightening your spine, bringing the front of your pelvis into contact with the mat
  • Continuing to focus on your breathing and bracing into your belly, lift your head/neck/chest from the floor (approximately 6-8 inches), above the level of your shoulders, making sure to keep your neck relatively straight so that you will be continually looking down towards the floor and not in front of you, while also moving into the broadened, wide, depressed shoulder position we had discussed previously…maintain this upright position while breathing and bracing

While in the upright position, the majority of your weight should be borne through your elbows and the front of your pelvis…you should not be resting on your rib cage While this basic stabilization exercise for the upper quarter should not be extremely difficult, it should take some focus and effort to do it with quality while breathing, and is used as the “foundation” for proper posture and activation for all other upper quarter movements. 

4. Oblique Sit 

  • Begin by resting on your side, with your downside elbow directly underneath your shoulder, and your downside hip and knee flexed and bent out (to approximately 90°) in front of you…the “top-side” upper and lower extremities are resting on the body
  • Prior to the exercise, you must prepare for the movement by “up-righting” your body against gravity—this is accomplished by pressing down through your elbow/forearm to “raise” your chest, head, and neck “up and away” from the floor so that no part of your body/spine is “sagging”
  • Next, slightly rotate your upper body/chest forward so that your “top-side” shoulder is a bit “in front of” your downside shoulder…your head and neck will be straight, but turned slightly downwards, looking to the floor
  • From this “active, upright” position, you are now ready to move…reach with your topside arm obliquely forward and in front of you, turning your hand upwards as you reach—this will cause your upper body/chest to rotate further forward, shifting weight from your downside elbow into more of your forearm—hold this new “reaching” position, while paying attention to your ability to belly breathe and maintain a quality, spinal posture with no sagging or significant curvature This is an example of an exercise that utilizes the entire body, but we choose to focus on the upper quarter. Specifically, you are simultaneously training both the stability and control function of the downside shoulder and arm, while also training the movement and strength function of the topside upper extremity. Resistance can be added to that topside arm, as well as varying the direction of the “reach”. This exercise can also be performed using support through the downside extended arm and hand, rather than the elbow, and can be made more difficult by adding in lower quarter function. 

A final piece of advice: if after attempting these shoulder exercises or stretches your symptoms actually WORSEN, then these specific stretches may not be for you, so take a break and allow your symptoms to calm down. If they persist, you can try either ice or heat for relief. If you have been experiencing significant shoulder pain from impingement or rotator cuff injury, and would like a professional evaluation and expert treatment that comes directly to your home or place of business, then schedule your house call appointment now with Dr. Bill: