Top 5 Exercises for Shoulder Impingement

Shoulder impingement syndrome is a common injury in the general population. It is a result of a reduction in space between the top of the arm (humeral head) and the acromion. It is also known as external or subacromial impingement and is a condition where the structures of the shoulder can become inflamed, irritated and involves a cluster of symptoms and anatomical characteristics.

The shoulder joint is made up of three bones: the shoulder blade (scapula), the upper arm bone (humerus), the collarbone (clavicle) and acromion (bone attached to the clavicle and shoulder blade). Theses bones are all held together by muscles, tendons and ligaments called the rotator cuff. Upon lifting the arm, the rotator cuff muscles and tendons slide underneath the acromion. If the space between the tendons, bursa and acromion is reduced it causes restriction resulting in compression causing impingement.

Shoulder impingement can be caused by a variety of factors, including the shape of the acromion, repetitive compression (E.g., overhead sports/activities), aging of the tendon, fraying of the rotator cuff tendons and inflammation of the bursa (small fluid sacs) can contribute. Whereas secondary shoulder impingement is characterised by onset of impingement during shoulder motion. Mostly related to the weakness of the shoulder blade muscles (rotator cuff) and potential weakness of the trapezius and serratus anterior muscles which all affect the movement of the arm and shoulder blade.

Most commonly shoulder impingement syndrome is seen in individuals who engage in sports or work activities that involve repetitive overhead movements such as swimming, carpentry, hairdressing, painting and decorating, amongst others. Other environmental risk factors that may contribute to impingement syndrome includes lifting heavy loads, infection, smoking and previous shoulder injuries. The prevalence of shoulder impingement rises with age with most experiencing this condition in their 6th decade of life.

Research favours physical therapy to treat shoulder impingement initially, however in some cases surgery may be necessary to relieve shoulder impingement. This may involve removing a small part of the acromion to create more space for the rotator cuff tendons and bursa.

Often the patients we treat as Surrey Physio present with pain in the front or side of the shoulder particularly upon lifting the arm or when lying on the affected side. The pain may also radiate down the arm and you may also feel weakness or stiffness in the shoulder. If you suspect that you have shoulder impingement, it is important that you visit us in clinic. We will ask you about your symptoms and perform a thorough physical examination.

At Surrey Physio we provide personalised rehabilitation program to ensure a good recovery. We use a combination of hand on rehab, education, and advice on affected daily activities, guidance on exercises to strengthen the rotator cuff muscles and improve your range of movement. With proper treatment, most people with shoulder impingement can recover fully and return to their normal activities. It is important to seek treatment early, as untreated shoulder impingement can lead to further damage and chronic pain.

In the meantime, here are 5 exercises that could help if you suspect shoulder impingement.

1. Supported rotator cuff external rotation with dumbbell

Sit to the side of a table. Keep your elbow bent at 90 degrees. Take your arm away from your body at a 30-degree angle. The table will provide support to your arm and elbow. Hold a 0.5kg dumbbell. Turn your first outwards. After you can perform this exercise pain-free, increase the weight in 0.5kg increments. Turn your first outwards then bring your arm back down to the table. This is a supported rotator cuff exercise. Try 12 -20 reps 3-5 times daily.

2. Supported Mobilisation - Table Slide

Sit down next to a table. Turn your arms outward slightly to rest on the outside of your fists. Use your body to initiate the movement which will push your arms away. This will forward flex your arms at the shoulder joint. This exercise will help unload the shoulder to re-engage the muscular system at the shoulder. Try 12 -20 reps 3-5 times daily.

3. Shoulder Extension with Band

Loop an exercise band around a door or other stable object at about chest level. Ensure your palm is facing backward. Pull your arm backwards into extension, against the resistance of the exercise band. This is a shoulder strengthening exercise. Try 12 -20 reps 3-5 times daily.

4. Serratus anterior dumbbell punch

Lying on your back, holding a dumbbell in each hand, push the dumbbell upwards towards the ceiling. Make sure you keep your elbows straight, and as you push them upwards, your shoulder blades will lift off the bench. Strengthening the serratus anterior muscle will help to stabilise your shoulder blade when you elevate your arm. Try 12 -20 reps 3-5 times daily.

5. Supported Mobilisation - Wall Slide

Stand facing a wall. Turn your arms outward slightly to rest the outside of your fists on the wall. Transfer weight on to the opposite leg to your painful shoulder as you elevate your shoulders. Transfer weight into the back leg as you bring your arms back down. This exercise helps to facilitate movement while unloading pressure on the shoulder. Try 12 -20 reps 3-5 times daily.

(Therapists reading this page, these videos are provided by Rehab My Patient – the best exercise prescription software for therapists to prescribe exercises www.rehabmypatient.com. If you are a patient needing advice, call Surrey Physio to book a telephone/video consultation with one of our expert physios or osteopaths, or book in face-to-face for an appointment. You can call us on 0208 685 6930 or book online by clicking the link at the top of the page).