Shoulder Impingement Rehab Guide

8 Strategies and Exercises to Treat it For Good

By Coach E

Shoulder Impingement Rehab Guide - exercises and strategies to treat it for good

Don’t let that nagging pinch in your shoulder continue everytime you reach for something. This shoulder impingement rehab guide will teach you effective strategies to treat it for good.

Shoulder impingement is a common problem that can lead to major issues if not nipped in the bud. It’s especially common among people who do a lot of overhead movements, including weightlifting (think shoulder presses) and even yoga (downward dog).

Impingement causes pain and discomfort when you flex your shoulder, which is reaching your arm in front and then overhead.

rotator cuff injury - shoulder impingement rehab

Image by www.creeksidechiro.com

The scapula (shoulder blade) and humerus (upper arm bone) have to work together in a proper pattern called the scapulohumeral rhythm to execute overhead movements correctly.

If the pattern gets disrupted, the head of the humerus can come into contact with the acromion (a bony process on the anterior scapula). When this happens, structures in the subacromial space between the acromion and humerus –  like your rotator cuff tendons, biceps tendon, and bursa – can be pinched.

The scapula (shoulder blade) and humerus (upper arm bone) have to work together in a proper pattern called the scapulohumeral rhythm to execute overhead movements correctly. If the pattern gets disrupted, the head of the humerus can come into contact with the acromion (a bony process on the anterior scapula). When this happens, structures in the subacromial space between the acromion and humerus -  like your rotator cuff tendons, biceps tendon, and bursa - can be pinched.If this pinching continues to happen over time, with every overhead movement, these structures become aggravated and inflamed, causing nagging pain at the front of the shoulder.

To understand how to fix shoulder impingement, we have to go through a couple of steps. First, we need to identify the root causes and reduce pain and inflammation. After that, we can start resetting your movement patterns and reprogramming with functional integration.

(If you’re not sure whether your pain is impingement or something else, check out these shoulder impingement tests to find out what’s really going on.)

Recognize Root Causes

Taking a pause to first identify the root causes and to let your shoulder rest is crucial for effective shoulder impingement rehab.

If you jump straight ahead to the restorative exercises without getting at the actual cause or allowing inflamed structures to heal, you’ll be stuck in a vicious cycle of reinjury and inflammation, never finding long-term relief.

There are two major root causes – improper movement patterns and poor posture and mobility of the thoracic spine.

We’ll discuss how to address these issues as we move forward.

Reducing Pain and Inflammation

First, avoid any aggravating movement patterns until the shoulder calms down.

You can use ice for 10-15 minutes at a time during the first 24 or 72 hours throughout the day, but at the very least employ my favourite strategy of contrast hot/cold in the shower for 30 sec of each, 3-5 times going as hot and cold as possible.

You could also opt for anti-inflammatory medication (like Advil) as a SHORT-TERM tool to help decrease the inflammation, but try to drop the pain meds when you get into the corrective exercise stage.

shoulder impingement rehab - pills

Inflammation can cause inhibition of affected shoulder muscles. In turn, other muscles will start to compensate, further contributing to unbalanced and improper movement patterns

Massage is great tool because it will help relax this surrounding musculature, which has likely tensed up from the pain. Try an easy self-massage with a tennis ball and a wall.

Just keep your arm relaxed by your side and place the ball between your shoulder and the wall.

Roll out the front to get pec minor, the side of your shoulder for your deltoid muscle, in the posterior for your scapular muscles, and you can even work into your lats and teres major down near your armpit.

shoulder impingement rehab exercise - shoulder massage

While you rest your shoulder, you can also start consciously working to maintain a good posture as often as you can. Because your scapula move and function on the platform of your thoracic spine, a poor postural base can create a lot of shoulder issues.

Reset Your Movement Patterns

Once you’ve rested and the inflammation and acute pain has decreased, you can move on to the third phase of shoulder impingement rehab: resetting your movement patterns.

For someone unknown reason, I often hear trainers online and in person cueing clients to keep their shoulder blades down and back during moves like overhead press or pull ups.

If you’ve been performing these moves this way, we’ve got to fix this pattern.

shoulder impingement - shoulders down and back

If your scapulae are pinched down and back while you try to lift your arm overhead, it’s creating the perfect impingement scenario.

The head of your humerus will lift up and ram right into your acromion, pinching whatever’s in the way and causing you a lot of pain and inflammation.

Your scapulae need to be able to move, elevating and rotating (with control) while your arm goes overhead, allowing you full range and your acromion to move WITH your humerus.

This dissociation exercise will help break bad habits, reset natural scapulohumeral rhythm, and prime your neuromuscular system for proper overhead movement.

Shoulder Flexion Dissociation Technique

shoulder impingement rehab exercise - shoulder dissociation technique

  • Lift both arms overhead as high as is comfortable
  • Shrug your shoulder blades up to your ears as high as you can
  • Lower your arms back down to your sides
  • Repeat 5-10 times

Restore Strength & Mobility

Now that we’ve reset your movement pattern, we can start to restore shoulder strength and mobility.  The 3 exercises below each address specific deficits that can contribute to shoulder impingement.

T-Spine Mobilization

shoulder impingement rehab exercise - thoracic spine mobilization

If your mid-back is rounded forward, your scapula won’t ne able to properly rotate upwards, setting the stage for impingement. Restoring T-spine extension will help improve posture and create a better platform for scapular movements.

Simply lean backwards and extend your spine over a foam roller or a yoga block on the floor. Keep your arms in front of you and your scaps protracted, or wrapping toward the front of the body, to isolate your thoracic spine.

Move up or down on the block and repeat, leaning back to mobilize a different segment.

4-Point T-Spine ERE

This Thoracic Spine End Range Expansion (ERE) technique is a great tool for restoring proper posture.

Check out the link for details on how to perform this move. It’s a simple exercise, but it’s crucial to pay attention to the technique to get the most benefit.

It takes the improved passive mobility you gained in the previous exercise and helps you actively turn it into long-lasting postural improvement.

Overhead Doorway ERE Sequence

This Overhead Doorway ERE Sequence will help you start working safely in the overhead range of motion by building strength and stability in that range.

shoulder impingement rehab exercise - overhead doorway ERE sequence

As you build strength at your end range of motion, you can continually expand the range and learn to better control the movement.

Reprogram with Functional Integration

Now that we’ve restored proper movement by activating our surrounding muscles and working to rebuild mobility in the range, it’s time to focus on reprograming through functional integration.

Functional integration means we bring in compound movement patterns and closed chain techniques that mimic how you actually use your body to perform the things you like to do  – whether that’s sport or playing with the kids.

This means multiple joints are involved, there’s more complicated transitions, and your neuromuscular system becomes reprogrammed for firing properly in a more complex, real-world situation.

Overhead Wall Rollouts

The Overhead Wall Rollouts drill is great for training scapulohumeral rhythm and integrating it with core stability. Maintaining a strong, stable core while your arms are overhead is key to reducing stress on the lumbar spine and again creating a proper platform for scapular movements.

shoulder impingement rehab exercise - overhead wall rollout

  • Stand leaning against a wall with an ab-wheel in your hands
  • Protract the scapulae
  • Slowly roll the wheel up the wall and ensure you’re shrugging the shoulders to elevate your scapulae as your arms rise up
  • While doing this, keep tension in your core to avoid lumbar extension
  • Roll back down slowly and return to the initial position
  • Breathe naturally throughout the movement

DB Arnold Press

For the second functional reprogramming technique, we’ll do a twist on the basic overhead press. This move will not only build strength, it will reinforce proper scapulohumeral rhythm as you incorporate rotation into overhead movements.

shoulder impingement rehab exercise - arnold press

  • Grab dumbbells with elbows bent and palms facing your chest
  • Press your arms overhead, externally rotating as you press up, so that you end with your arms overhead and palms facing out
  • Internally rotate as you lower and return to the starting position with control
  • Repeat 5-10 reps

Beyond Shoulder Impingement Rehab

This high-level overview gives you an excellent framework for shoulder impingement rehab so you can fix the nagging pain for good and get back to doing what you love.

If you want to really take control of your shoulder health and prevent future issues, I suggest you check out my Shoulder Control course. It’s a comprehensive, detailed approach that utilizes a lot of the concepts I’ve introduced here to totally transform the performance and health of your shoulder.

I hope you’re able to use these resources to bounce back quickly from shoulder impingement pain and to protect yourself from future shoulder injuries.

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.

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