What is Shoulder Impingement?
Shoulder impingement is caused by an abnormal mechanical relationship between the rotator cuff and surrounding anatomy of the shoulder. There are two main types of shoulder impingement: intrinsic & extrinsic. Intrinsic type shoulder impingement is caused by rotator cuff degeneration and/or arthritis, while extrinsic type shoulder impingement is due to the specific shape of one’s bony anatomy or dysfunction of shoulder/back muscles. Either type of impingement can lead to a rotator cuff tear, so early treatment can be very beneficial.

Risk Factors:
• History: >40 years (intrinsic) or younger overhead athletes (extrinsic)
• Chronic, repetitive use

Common Symptoms:
• Anterior & upper arm pain
• Decreased range of motion and decreased strength
• Unable to sleep on affected side
• Pain with overhead activities

Treatment:
• Regain full shoulder range of motion
• Reestablish dynamic rotator cuff stability
• Implement a progression of resistive exercises to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers

Tips:
• Don’t underestimate the power of posture. Proper upright posture places your shoulder in the best functional position, and can decrease stress associated with repetitive motion and overhead activities.
• Shoulder impingement is a very common shoulder condition treated in orthopedic physical therapy. A referral is not needed for treatment in Ohio. Click here to search for a physical therapist in your area.

Exercises:
Start with 1 set of 10 repetitions, and progress to 2 sets of 15 repetitions with each exercise as they become easier.

1. External rotation with a dumbbell. Lying on your side, rotate your arm from your belly to the ceiling (see picture). This is one of the exercises to increase external rotation strength. Use a 1-3 lb dumbbell as the exercise becomes easier.

2. Prone rowing into external rotation. Lying on your stomach, rotate your arm from the floor to parallel with the floor (see picture). This is another exercise to enhance external rotation strength. Use a 1-2 lb dumbbell as the exercise becomes easier.

3. Rows Using a cable column, or elastic tubing, pull your hands from an extended position towards your body. Focus on squeezing your shoulder blades together each repetition. This exercise helps with shoulder.

4. Shoulder press downs (depressions). At a cable column, or with elastic theraband, and with your elbows straight, push your hand towards the floor. The focus should be on pressing your shoulder blade down towards the floor.

5. Dumbbell raises (scaption). Using lite dumbbells (1-3 lbs), lift your arms from your sides to parallel with the floor. Be sure to go no higher than parallel with the floor, and keep your hands in front of your shoulders. Both arms can be done at the same time if desired.

6. Wall/Table/Floor Push-up with a Plus. Perform a push-up from either a wall, table, or the floor depending on the necessary degree of difficulty. Separate your shoulder blades when your arms are fully extended.

Start with 1 set of 10 repetitions, and progress to 2 sets of 15 repetitions with each exercise as they become easier.

If you are experiencing symptoms of shoulder impingement, schedule an appointment with a physical therapist in your area. A referral is not needed for treatment in Ohio. Click here to search for a physical therapist in your area.

References:

http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/home/ovc-20126921

Escamilla, R., Hooks, T., & Wilk, K. (2014). Optimal management of shoulder impingement syndrome. Open Access Journal of Sports Medicine (OAJSM), 5, 13-24.

Reinold, M., Escamilla, R., & Wilk, K. (2009). Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 105-117.

Wilk, K. E., Meister, K., & Andrews, J. R. (2002). Current concepts in the rehabilitation of the overhead throwing athlete. The American Journal of Sports Medicine, 30(1), 136-151.

A short bio:

Jeff M. Hohl, PT, DPT, OCS, ATC, CSCS is a physical therapist at Senior Independence and a continuing education instructor for IWA and Dynamic Therapy Education. He graduated from Mayo Clinic’s Physical Therapy Program, and is board certified as an Orthopaedic Clinical Specialist (OCS). His physical therapy work experience includes practice in outpatient and home health settings where he provides comprehensive care for patients with various diagnoses, and specializes in treatment of orthopedic conditions. While away from work, Jeff enjoys participating in triathlons, marathon training with his wife Lindsay, and throwing Frisbee with their golden retriever, Luna.

Email to Communications Coordinator, Megan Cardaman, mcardaman@ohiopt.org