Anterior shoulder impingement is cleverly termed to describe pain in the front and sometimes top of your shoulder. That’s the basic descriptor most patient’s get when leaving a doctor's office. The breakdown of this pain is tissue under the roof of your shoulder, your acromion (top bone of your shoulder), is being entrapped or pinched (Garving et al., 2017). Oftentimes it feels like a pinch in the front of your shoulder. Pain usually occurs in our definition of a ‘painful arc’ between about 70-120 deg of motion (Garving et al., 2017). This just means you usually note pain when your arm is being raised and gets to just below to just above shoulder level.
Impingement can occur in four categories: subacromial impingement syndrome (most common), subcoricoid impingement, posterosuperior inner impingement, and anterosuperior impingement (Garving et al., 2017), (Cunningham, & Lädermann, 2018). This blog will focus on the most common occurrence of impingement and dysfunction to keep it short and sweet. The best practice is to seek evaluation from a licensed physical therapist or orthopedic to further evaluate any dysfunction you have.
The subacromial space is housed by the bony/fibrous “top” of the shoulder: acromion, coracoacromial ligament, and coracoid process (Garving et al., 2017), and the “floor” being the humerus and rotator cuff musculature. Between the roof and floor is the subacromial space which consists of a bursa and more rotator cuff musculature. Poor mechanics, muscular imbalances and structural changes to bone, bursa, calcification of ligaments/tendons can narrow the joint space (Garving et al., 2017). This ultimately leads to “abnormal contact between the rotator cuff and the roof of the shoulder (Garving et al., 2017).”
Now that we know the why, how do we go about fixing it. The body is connected to the ground via the kinematic chain (fun term for your body needs to work as a whole for the individual parts to be successful). For the shoulder to perform properly in high demand tasks: leg strength, body rotation, core strength, scapular position and motion and shoulder rotation are required (Corpus et al., 2016). This means lack of flexibility, mobility, weakness and imbalance in that chain can cause increased stress at shoulder when asked to perform in overhead and high demand/recruitment activity (Corpus et al., 2016). Another vital component to success in shoulder activity is periscapular (surrounding the shoulder blade - i.e. scapula) muscular strength, mobility, and recruitment (Corpus et al., 2016). Recruiting musculature around the shoulder blade vs. reliance on pec and upper trap dominant recruitment are crucial. Mobility of the posterior capsule/shoulder is also important to success in overhead and high demand activity.
Evidence supports the use of conservative treatment to include mobility and flexibility training combined with strengthening, proper sequencing recruitment, and endurance training of the shoulder, periscapular musculature and kinematic chain (Saltychev et al., 2015).
Below are some exercises to aid in mobility and strengthening of potential deficits and provide exercises that can be added as accessory and mobility work to your shoulder/overhead routines. Please note none of these exercises are to be done through pain or reproduce your pain. If you are experience pain with these exercises do not perform the listed exercises. These are a global list of exercises to aid in potential deficits, not to be used as diagnosis or prescribed rehab plan.
Posterior Capsule Mobility:
Posterior Delt Activation:
Periscapular Musculature Activation:
Core Work:
Thoracic Mobility:
*You can check out Ground to Overhead Physical Therapy You Tube channel, https://www.youtube.com/@groundtooverheadphysicalth2915/, for more exercise and mobility guides.
If you have struggled with shoulder pain or have recently developed pain that has limited your workouts, daily routines, or is a constant reminder of pain. Contact us for an individualized assessment and treatment protocol that addresses you as a whole person. We find the pieces to what feels like the illusive puzzle of your pain, and help bring you to the strongest version of yourself. We use a 3-step process to help athletes feel better and move better:
Fixing your pain.
Figuring out the root cause.
Providing you the necessary tools to get back to being active and not dealing with this again.
Corpus KT, Camp CL, Dines DM, Altchek DW, Dines JS. Evaluation and treatment of internal impingement of the shoulder in overhead athletes. World J Orthop. 2016 Dec 18;7(12):776-784. doi: 10.5312/wjo.v7.i12.776. PMID: 28032029; PMCID: PMC5155252.
Cunningham, G., & Lädermann, A. (2018). Redefining anterior shoulder impingement: a literature review. International orthopaedics, 42(2), 359-366.
Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017 Nov 10;114(45):765-776. doi: 10.3238/arztebl.2017.0765. PMID: 29202926; PMCID: PMC5729225
Saltychev, M., Äärimaa, V., Virolainen, P., & Laimi, K. (2015). Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disability and rehabilitation, 37(1), 1-8.
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