We all know someone who frequently mentions popping, clicking, or shoulder pain during certain movements. In fact, I probably get asked at least five times a day whether these sensations are normal and why they occur. If you or someone you know experiences these issues, especially if they’re accompanied by pain, weakness, or even loss of movement, it could be a sign of a common condition known as shoulder impingement. In this blog, we’ll dive into what this condition is and then explore some of the best exercises for shoulder impingement rehab & if this term is still relevant.
Anatomy of the Shoulder
Before diving into the specifics of how this condition occurs, it’s important to have a general understanding of the structures surrounding the shoulder and how they function so we have a common language to work from. The shoulder joint is classified as a “ball and socket joint,” much like the hip, with the ability to move in three different planes of motion. The joint is often compared to a golf ball on a tee to represent the fact that there is minimal contact between the two surfaces that make up the joint. All this to say that the shoulder joint is very mobile in nature.
With all that mobility, we next need to look at how the shoulder is stabilized. The shoulder joint is surrounded primarily by four muscles that make up the rotator cuff. The rotator cuff is composed of one muscle on the front of the shoulder (subscapularis), two muscles on the back of the shoulder (infraspinatus and teres minor), and one muscle on top of the shoulder (supraspinatus).
Collectively, these muscles offer a lot of support and the ability to carry out a variety of movements and functions. Along with the rotator cuff, the bicep tendon runs along the front of the shoulder. Finally, there is also a fluid-filled sac, or bursae, that offers additional support for the rotator cuff.
LISTEN: ROTATOR CUFF DISCUSSION PART 1
The Subacromial Space and Impingement
Now that we understand some of the structures around the shoulder joint, let’s dive into what actually happens during shoulder impingement. Impingement occurs when the structures that sit in the subacromial space become irritated for a variety of reasons. The subacromial space is essentially a narrow passageway between the bone on the top of the shoulder blade on the front-facing side (known as the acromion) and the supraspinatus tendon, biceps tendon, and a bursa share space in this area. It’s designed to let these structures glide smoothly as the arm moves overhead.
When these structures press or rub against the soft tissue in the space—for a variety of reasons we’ll cover later on —it can irritate the tissue resulting in pain or discomfort. Most of these factors in one way or another, relate to either postural mechanics or the movement at the scapula (shoulder blade). When the scapula is not moving as intended, this can lead to pain, restricted movement, and, over time, can even weaken the shoulder if left untreated. However, it’s important to note that just because you may have a more narrow subacromial space does not mean that you are going to develop pain in this space (5). Based on what more recent research is telling us, some healthcare providers are switching to referring to Shoulder Impingement as Subacromial Pain Syndrome due to our lack of supporting research that a narrow space is leading to structures being impinged. More research is certainly needed on this topic but some interesting food for thought.
Learn more about the phenomenon of scapular dyskinesis here!
READ: SCAPULAR DYSKINESIA
Types of Impingement
There are a few different types of shoulder impingement to be aware of:
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- Primary External Impingement: This type occurs due to structural changes that narrow the subacromial space. This could be due to boney changes following a fracture or the development of bony growths, known as osteophytes.
- Secondary External Impingement: This type happens when the shoulder joint doesn’t move properly, often due to muscle imbalances around the shoulder. This commonly occurs in younger individuals who have rotator cuff weakness paired with a joint capsule and ligaments that are loose. (for more information about muscle imbalances, check out this article below:
READ: EVIDENCE-BASED SHOULDER EXERCISES
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- Internal Impingement: This type of impingement is most common in repetitive overhead athletes. Following repeated throwing or overhead movements, the position of the shoulder joint can become pathologic and those changes can lead to impingement (2).
How do I know if it’s truly impingement or something else?
By now it should be starting to become clear that there are many different forms of what we are terming as impingement, which may lead you to wonder whether or not this is truly the issue you are dealing with. If you were to see a physical therapist for a full evaluation, they would perform several tests and examinations to confirm this diagnosis. However, there are several tests you can do in the comfort of your home,
Neer Test: (“elbow to ear test”) For this test, simply raise your hand out front overhead, so that your elbow is level with your ear, and see if this reproduces your pain.
Painful Arc Test: For this test, start with your hand at your side and your thumb pointed up. Next, you will raise your arm up and overhead in the same motion you would if you were performing a jumping jack. If you have no pain at the bottom of the movement or top of the movement and pain in the middle of the movement, it increases the likelihood you might be having impingement at the shoulder (2).
On top of these two tests, some of the most common complaints from individuals with shoulder impingement include:
- Pain when reaching overhead
- Decreased range of motion
- Sensations of popping, clicking, or scraping in the shoulder
- Weakness in the arms
LEARN MORE ABOUT OUR ROTATOR CUFF REHAB PROGRAM PROGRAM
Looking to tackle that rotator cuff related shoulder pain once and for all? Look no further than our Rotator Cuff Rehab program! Designed to improve your mobility and get your rotator cuff working appropriately, you’ll wonder why you waited so long to start it!
Exercises for impingement:
When it comes to exercises for shoulder impingement, the best exercises are the ones that are going to address your specific deficits (pain, limited motion, etc.) These deficits will undoubtedly vary depending on the cause of your subacromial pain. However, there are still some principles that will be important regardless of the cause including: regaining full range of motion, building strength and control around the rotator cuff, and lastly, working on scapular stability and kinematics (how the shoulder moves).
As we spoke about earlier, shoulder flexion, or reaching out front, is usually one of the primary causes of pain in individuals with shoulder impingements. A great exercise to begin to focus on regaining some of that motion is through towel slides in the seated position.
Additionally, when it comes to addressing motion deficits and muscle tension, performing the crossover arm stretch can help stretch the deltoid and minimize issues with the rotation of the shoulder joint that may progress toward impingement if left untreated (3).
Strength and control of the rotator cuff muscles and muscles surrounding the scapula are also very important, especially if you are demonstrating any weakness. To begin working on activating those muscles, you can try shoulder retractions to help focus on pulling the shoulder blades further back if they tend to be in a forward position. This is common, especially if you are an overhead athlete. When the muscles that attach to the shoulder, such as the rhomboids, trapezius, and serratus anterior, are weak, it may lead to instability and altered movement patterns. This lack of control and stability can cause excessive strain on the rotator cuff muscles and lead to impingement symptoms, particularly during repetitive overhead motions (1). By reinforcing these scapular stabilizers, you create a stronger foundation for shoulder movement, reducing the likelihood of impingement and allowing for improved overall shoulder mechanics.
It is also important to focus on the strength of the rotator cuff itself, as these muscles play a major role in the stability of the shoulder. If there are imbalances in the rotator cuff, compression can occur and possibly lead to impingement-like symptoms. Two of the best ways to begin to focus on the majority of the rotator cuff muscles include performing internal and external rotation of the shoulder, as these two movements strengthen 75% of the rotator cuff muscles that support the shoulder (4).
Once you have improved the range of motion of the shoulder and built stability throughout the surrounding muscles, it is important to build strength through those new ranges. A simple way to begin to work on this final step is to add resistance to key motions of the shoulder, including scaption. Scaption is the position between bringing your arms directly out to the side and directly out front. This angle is often easier on the shoulder joint and allows you to activate key stabilizers like the rotator cuff and deltoid muscles more effectively. Start with light resistance, such as 1-5 pound dumbbells, and focus on controlled, steady movements to maintain proper form. Gradually increase the weight as you build strength, aiming to keep your shoulder stable and pain-free throughout the motion.
Closing Thoughts
Impingement is an extremely common condition in the shoulder that presents for a variety of reasons and can make everyday tasks more frustrating. However, this condition is often one that can and will improve. With specifically targeted exercises focused on improving the mobility of the joint, stability of the surrounding muscles, and the movement patterns of the shoulder, you are likely to see significant improvement in both your pain and function.
LEARN MORE ABOUT OUR ROTATOR CUFF REHAB PROGRAM PROGRAM
Resources:
About the Author
John Schaefer
PT, DPT, OCS, CSCS
[P]rehab Writer & Content Creator
John is a native of Rochester, MN and a double graduate of Saint Louis University, where he studied marketing and exercise science before earning his DPT.
Always up for an adventure, John traveled to Boston following graduation to intern at Champion PT and Performance. There he was able to work with high-level high school, college, and professional athletes. Following this experience, he headed south to pursue orthopedic residency training in Houston, TX at Harris Health System, working with a largely underserved and non-English speaking population.
John’s treatment philosophy hinges on empowering movement through extensive education and easy-to-replicate exercises, as well as meeting patients where they are. This perspective is shaped by his personal experiences, including five broken bones and two surgeries, during a multi-sport childhood filled with lots of activity and adventure.
Outside of work, you can find John cycling, attending concerts/festivals, hiking, and traveling!
Follow along on instagram @johnschaefer.dpt
About the author : John Schaefer PT, DPT, OCS, CSCS
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