Got Impingement?

Shoulder Impingement is one of the, if not the most, common non-traumatic injuries to the shoulder and it can be a nagging pain in the-you-know-what.

Let’s go over the what, the how, and possible home solutions or adjuncts to other therapeutic intervention:
The what: Somehow the muscle that fits between the acromion, which is the bone you feel over the top of your shoulder, and the humerus (which is actually the arm bone) is getting smushed. That muscle is the supraspinatus. One of the ways this can happen is pure genetics: The shoulder is genetically designed one of three ways described by the picture.
The more “hooked” the acromion is (the third picture), the more likely you will end up with shoulder impingement because it creates less space for the supraspinatus (one of the rotator cuff muscles) to glide and move through when you elevate your arm. You can also have an inflamed bursa which is a fluid-filled sac between the acromion and supraspinatus tendon. When the bursa swells up, essentially the same effect takes place; less space for the muscle to move through.

Rotator Cuff Muscles

Subacromial Bursa

Note the position of the shoulder in relation to the body
Lastly, and most common, the shoulder (head of the humerus) has translated anterior in the glenoid (fossa or space for the arm bone to fit in to create a ball and socket joint). When this happens, the supraspintus is pinched when the person elevates their arm and the humerus (arm bone) rolls and glides in a suboptimal position (forward), therefore pinching the tendon. This happens because everything we do in life is in front of us. For a few examples think about typing on the computer (like I am now!), driving, cleaning, cooking, answering the phone, and sometimes the way we exercise (focusing on biceps and pecs while neglecting the muscles in the back such as the rhomboids (muscles that squeeze the shoulder blades together), mid and low trap (muscles that would draw the acromion back by moving the shoulder blade), and external rotators of the shoulder named the infraspinatus and teres minor).
The how: This is where we figure out how to fix it! Keep in mind my tips are no substitute for a thorough evaluation from a medical professional, but general things that have shown to be effective in the research.
-Posture comes first and is most important! Most people would benefit from drawing their head back, shoulder back slightly, and drawing the scapula, or shoulder blade slightly down and inward. See the posture picture here to the right:

Extension exercise
- changing a couple exercises that are frequently performed incorrectly can help too. Let’s just start with rows and extensions. The weight should be light, make sure when drawing the arms back to the sides the elbows don’t bypass the side of the body, rather think of the very top of your shoulder drawing further back. Now squeeze the shoulder blades together as tightly as you can without pulling your shoulders up into your ears. Extensions have the same principle but the arms are straight at your sides (picture to the left), engaging the triceps as well. See also the external rotators exercise sequence described below. The first three pictures are steps 1-3, the picture on the bottom is showing the incorrect method. Sometimes people arch their back when trying to actually retract, or draw shoulder blades back. If the external rotators are weak, more stress is placed on the supraspinatus (our pinched muscle) to stabilize the shoulder joint. This discrepancy between using the muscles in the front of the arm versus back of the arm draws the shoulders even further forward, causing more impingement. See how strong your external rotators and rhomboids are by trying the exercise below:

Arm external rotation:
-hold the theraband shoulder distance apart, elbows at sides
-bring both hands out, keeping the elbows in at the sides
-start to extend the arms and lift the chest
-keeps abs in/keep the back from arching
-slowly reverse the movement

- For my yogis check out the picture of the two chaturangas. To the left, the yogi is dropping her shoulders past her elbows, stressing the anterior capsule which can lead to impingement. The yogi to the right has her shoulders lined up with her elbows and demonstrates proper technique.

Poor Chaturanga Technique

Good Chaturanga Technique

Sleeper Stretch for Posterior Capsule

-Self stretches: You can self stretch the posterior capsule of the shoulder with something called the sleeper stretch. Lying on the affected shoulder position your body a little forward, create a 90 degree bend at the elbow, and use your other arm to press the affected forearm gently towards your belly. Remember this stretch should be gentle! You can also stretch the pecs by lying on a foamroll with your arms at the sides

-Last but not least keep in mind icing and resting can be your friend if your shoulder is really hurting! Please feel free to post comments and questions so we can get a discussion going!

Contributed by Dr. Katie Addis, PT, DPT


  1. Doesn't external rotation strengthening decrease subacromial space, while internal rotation strengthening increase the space?

  2. The aim for ER strengthening would be to re-active the inferior pull of the R/C mm on the head of the humerus while it is rotating superiorly, thus preventing impingement.

  3. how does internal rotation strengthening increase the space? i know overall RTC activation is important for concave-compression into the socket. but what exactly does IR alone acheive? is this what the sahrmann prone 90 degrees internal rotation is for?

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