Exercise physiology for shoulder impingement

Sub-acromial shoulder impingement is one of the most common upper body injuries we see at Central Performance. Sub-acromial impingement is a broad diagnosis that can include a variety of conditions including subacromial bursitis, rotator cuff tendinopathy and rotator cuff tears. Sub-acromial impingement occurs when the sub-acromial space is reduced. The acromion is the ‘hook’ the shoulder blade that sits forward and the clavicle (collarbone) attaches to. The sub-acromial space is formed by the acromion at the top and the head of the humerus (bone of the upper arm).

There are many soft tissue structures that run in the sub-acromial space including the sub-acromial bursa, the tendons of the rotator cuff muscles and the long head of biceps tendon. The sub-acromial space is approximately 1-1.5cm in diameter.

Conservative management with a focus on exercise is the frontline treatment for sub-acromial impingement. At Central Performance we focus on exercises to increase strength in the rotator cuff and improve scapular mobility and control when treating subacromial impingement. The goal is to place a load on the tendons of the rotator cuff, making them more resilient, and to maximise the available room in the subacromial space.

While many people will be familiar with theraband external rotation exercises for shoulder injuries at Central Performance we pride ourselves on delivering more comprehensive exercise prescription that progresses client further towards returning to sport and activity. Here are a couple of examples of later-stage exercises we like for our clients with sub-acromial impingement:

Foam roller wall slides

We love these as they both require external rotation strength from the rotator cuff as well as emphasising appropriate protraction (forward movement) and upward rotation of the scapular. We often find that clients have for some long focused on pulling their shoulder blades back and down that they struggle to get their shoulder blades rotating upwards as they reach forward or overhead. Foam roller wall slides are great for retraining these movements and help strengthen the serratus anterior muscle, a key scapular protractor.

Cable face pull

Another favourite exercise of ours that again strengthen external rotation and upward rotation of the scapular, this time while also retracting the scapular. The face pull is great at strengthening the lower traps in their function of upwardly rotating the scapular. When combined with foam roller wall slides they give a nice variety of scapular upward rotation exercises and by improving scapular upward rotation they can help create more space in the subacromial space and alleviate the symptoms of shoulder impingement.

Shrugs

An exercise that is commonly used by bodybuilders but under used in rehab, we find the shrug to be very effective in treating a lot of shoulder injuries. Again, we often find that our clients are so focused on pulling their shoulder blades back and down that they end up with their shoulder blades in a lowered (depressed) position. This depressed position can contribute to narrowing the subacromial space seen in shoulder impingement. Shrugs can help strengthen the upper traps, resetting the scapular in a more elevated position and helping alleviate the shoulder impingement symptoms.

There three exercises are some of our favourite end-stage rehab exercises for shoulder impingement. They help promote appropriate movement of the scapular in multiple planes of movement, particularly upward rotation and protraction. They are also more gym-like than traditional shoulder rehab exercises, making our clients feel like they are having a workout rather than doing rehab.

Check out our Instagram for some more great shoulder exercises you can incorporate into your next upper body workout!


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