Shoulder impingement is a common cause of shoulder pain (1). It is characterized by a ‘pinching’ sensation while moving the hand(s) in certain directions. Dr. Jerome G. Enad, MD and board-certified orthopedic surgeon, says “Shoulder impingement occurs when one part of the shoulder is rubbing and grinding on another part, causing pain.”
Anti-inflammatory medications and physical therapy work best to counteract shoulder impingement and improve hand movement. In this post, experts talk about shoulder impingement, its causes and diagnosis, and 10 exercises that can help. Scroll down!
What Is Shoulder Impingement?
Shoulder impingement is a painful condition of the shoulder joint. It results in the physical and mechanical ‘pinching’ of a structure within the shoulder joint. Stephanie Carter Kelley, Ph.D. and a board-certified specialist in Orthopedic PT, says, “Pain typically occurs in the front aspect or deep within the shoulder as someone reaches overhead or across the body.” She explains that the main soft tissue structures pinched are:
- Rotator cuff tendons.
- Biceps tendon located at the front of the joint.
- Less often, a bursa (protective fluid-filled sac) gets swollen after an injury.
To understand shoulder impingement and treat it, knowing what causes it is important. Scroll down for a list of factors that can cause shoulder impingement.
What Causes Shoulder Impingement?
- Spatial Issue: Mechanical narrowing of the space above the ball-and-socket joint is a common cause of shoulder impingement (1).
- Poor Posture: Rounded upper back, shoulder blades positioned forward and tipped downward, and upper arm rotated inward.
- Stiffness: Loss of motion at any of the joints along the chain of the shoulders. Dr. Jordan Duncan, DC, says, “Decreased mobility of the thoracic spine can also cause shoulder impingement.”
- Shoulder Instability: Injury typically causes abnormal motion of the shoulder.
- Muscle Weakness: Weakness in muscles that support and move the shoulder blade and rotator cuff muscles (group of four muscles that enable shoulder and hand movements).
- Overactive Muscles: The upper trapezius muscles can become overactive when a person is triggered into “fight or flight” by stress or fear. These muscles run along the sides of the neck out to the top of the shoulders. According to Stephanie Carter Kelley, Ph.D., “Tension you feel all day along the sides of your neck and chronic low-level stress causes shoulders to creep up to your ears by way of upper trapezius activity. When the upper traps are overactive, they ‘take over’ the movement of reaching overhead and don’t allow the supportive muscles to properly coordinate the complex movements.”
Your doctor will run a few tests to confirm shoulder impingement. Find out which tests are required in the section below.
How To Diagnose Shoulder Impingement
Dr. Jerome G. Enad, MD, says, “An evaluation by a shoulder specialist, sports medicine specialist, or a physical therapist is usually needed to accurately diagnose the occurrence and type of impingement. The diagnosis can typically be made with a hands-on evaluation and X-rays. Sometimes, an MRI is needed, but not always.”
Dr. Robert W. Berghorn, Jr., DPT, ATC, USAW, explains the diagnosis process. He says, “I take my patients through a detailed question and answer portion first. From there, we find out what activities or movements bother the shoulder. Next, we go into a very detailed physical exam that includes motion testing, strength testing, and special tests.”
The two tests that doctors perform are (2):
- HK Test: Using a table to stabilize the elbow, passively (i.e., using the other arm to move the symptomatic side) twist your forearm down to touch the table. Does this cause pain? How far can you let your forearm drop from the table before you have pain?
- Neer’s Impingement Sign: Have a friend gently press down on your symptomatic shoulder. Reach your arm straight in front of you, turning your thumb down like you are dumping out the contents from a soda can. Keeping that orientation of your hand, try lifting your arm over your head. If you experience pain in the shoulder, you may have shoulder impingement.
Depending on the severity of the pain and the condition, doctors may recommend anti-inflammatory medications and exercise therapy (under the supervision of a licensed physical therapist). The following section lists out 10 exercises to rehabilitate the shoulder impingement syndrome. Take a look!
10 Shoulder Impingement Exercises To Reduce Pain
Apply a hot water bag to prep the muscles before starting the exercises. Start with fewer reps and increase them gradually. You can even add weights. Apply an ice pack after you complete the exercises.
Dr. Jerome G. Enad, MD, advises “one should not ‘push through’ any fatigue or pain in the shoulder.” Let your physical therapist know if you experience pain and discomfort while exercising. With these points in mind, let’s begin with the shoulder impingement exercises.
1. Wall Slides
- Stand facing a wall. Hold the edges (top) of a towel with each hand.
- Place a foot closer to the wall so that you are in a staggered position.
- Place your hands on the wall while you are still holding the towel.
- Slide your hands up as far as you can.
- Pause for a moment and return to the starting position.
- Do this 10 times twice or thrice a day.
2. Shoulder Scaption
- Stand straight in front of a mirror. Hold a 1-pound dumbbell in each hand.
- Raise your hands in front of you in a ‘V’. This is the starting position.
- Lower your arms slowly.
- Raise your arms again.
- Do this 10-12 times twice a day.
3. Posterior Capsular Stretch
- Sit on a chair and extend your affected arm in front of you.
- Bring the arm across your body.
- With the other hand, push the affected arm’s elbow further over.
- Count to 5 and relax.
- Do this 5-10 times twice a day.
4. Side-Lying External Rotation
- Lie down on the unaffected side.
- Hold a 1-pound dumbbell with the other arm. Keep your elbow close to your body, and the upper arm perpendicular to the forearm.
- Move your arm up while keeping your elbow against your body.
- Pause for a moment and bring your arm back to the original position.
- Do this 10 times, two to three times a day.
Note: If holding a 1-pound weight causes discomfort, do this exercise without weights for a while. Instead of a dumbbell, you can also use low-resistance therapy bands.
5. Internal Rotation
- Secure a resistance therapy band on a door handlebar.
- Sit on a chair.
- Hold the end of the band with your affected arm. Keep your elbow close to the body and place a rolled towel in between. Your upper arm and forearm should be perpendicular to each other. This is the starting position.
- Now, pull the resistance band towards your chest.
- Pause for a moment and relax.
- Do this 10-15 times twice a day.
6. Levator Scapulae Stretch
- Sit on a chair and place your hand behind your shoulders.
- Turn your head towards the opposite direction at about 45 degrees.
- Place the other hand behind your head and lower your head.
- Pause for 5 seconds, feel the stretch, and release.
- Do this five times on each side two or three times a day.
7. Open Books
- Lie down on your side with your knees at 90 degrees and both arms in front of you.
- Lift the top arm and rotate on to the opposite side without moving your lower torso.
- Keep looking at your hand and feel the stretch.
- Pause for three seconds and come back to the original position.
- Do this 5 times on each side twice a day.
8. Standing Rows
- Secure a therapy band on a door handle.
- Hold the ends with your hands, keep your elbows bent and close to the body, and forearms at 90 degrees.
- Pull the bands backwards, squeezing your shoulder blades together.
- Count to 3 and relax.
- Do this 10 times twice a day.
9. Pectoral Stretch
- Find a doorway and place the affected arm’s elbow against it. Your upper arms should be in line with your shoulders.
- Turn to the opposite side and feel the stretch on your upper and mid-chest, starting from the shoulder region.
- Count to 5 and relax.
- Do this 10 times twice a day.
Note: Don’t do this stretch if it hurts.
10. Shoulder W
- Lie down on your belly. Position your arms such that the upper arm is in line with your shoulders and forearms are perpendicular to the upper arms.
- Lift both your arms off the floor.
- Pause for a second and relax.
- Do this 10-15 times.
These are the 10 exercises you can do to relieve shoulder pain due to impingement syndrome. However, it is best to do them after consulting an orthopedic doctor and under the supervision of a licensed physical therapist.
What Kind Of Physical Therapist Can Help?
Board-certified orthopedic surgeon Dr. Jerome G. Enad, MD, advises that contacting a physical therapist experienced in shoulder and joint mobilizations can help treat shoulder impingement. Stephanie Carter Kelley, Ph.D. and a board-certified specialist in orthopedic physical therapy, recommends a physical therapist certified in orthopedics or sports. Upon examining the pain history and movements, they will provide therapeutic exercises you can perform in the clinic or at home.
Shoulder impingement is a common issue that can be treated with medications and physical rehabilitation. Talk to a doctor to know the reason behind the pain. Take the prescribed medication and start physiotherapy when your doctor gives you a go-ahead. Do these 10 impingement exercises under the guidance of a physical therapist and see positive results in 4-6 weeks.
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- Impingement Syndrome of the Shoulder
- Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial