Shoulder Impingement: The 7 steps to fix it!

shoulder impingement
Image courtesy of stockimages at FreeDigitalPhotos.net


Here’s what to expect in this post:


// What is Shoulder Impingement?

Shoulder Impingement is a condition where certain structures in the shoulder (… namely the Subacromial bursa and Supraspinatus tendon) get squashed by the surrounding bones.

As a result, shoulder pain can arise from 2 main issues:

  • a) Subacromial bursitis
  • b) Supraspinatus tendonopathy.

a) Subacromial bursitis:

subacromial-bursitis

What does this mean?… Let’s break it down into simpler terms:

  • Subacromial = “underneath the acromion”. (The acromion is a bony part of your shoulder blade.)
  • Bursitis “inflammation of the bursa”. (A bursa is a fluid-filled sac within the shoulder complex.)

Translation: It is the inflammation of the fluid-filled sac structure in the area of your shoulder that is underneath the acromion.

… Still confused?… You see that red thing in the above picture? … It’s getting squashed …and it’s causing your pain!

b) Supraspinatus tendonopathy:

supraspinatusimpingement

The Supraspinatus muscle is part of a group of shoulder muscles which has the important role of stabilising the shoulder joint.

As the tendon of the Supraspinatus is subject to getting squashed in Shoulder impingement, it can lead to inflammation, strains and tears.

 

// Area of pain

supraspinatus-2

With Shoulder impingement, the area of pain is usually felt deep within the shoulder joint.

In many cases, pain can also refer down the side of your upper arm. (see above)

// What are the causes?


Video from Smart PT Pro.

Since the area where your Subacromial bursa and Suprasinatus tendon is located is already very narrow, it is subject to being squashed and irritated. (see video)

There is further narrowing of the area when you move your shoulder (eg. lifting/throwing/pulling/pushing/carrying). And even more so if the shoulder is not moving properly.

… But here’s the real issue:

Your posture.

If you have bad posture… your shoulder will be in a position which will amplify the impingement of the bursa and tendon!

By fixing your posture, you will be addressing the root cause of your Shoulder impingement issue.

 

// The posture of someone with Shoulder Impingement

kyphosis

This type of posture is very common in people with Shoulder Impingement. (.. although I must admit I may be exaggerating it just a tad bit).

It places the shoulder in a very ineffective position which predisposes the bursa and tendon to being impinged.

… How does your posture compare?

// Do you have Shoulder Impingement?

Here are 3 quick tests that you can do to find out!

a) Painful arc

painful-arc

Instructions:

  • Raise your arm out to the side and over your head.
    • (Also known as Shoulder abduction)
  • You may have Shoulder Impingement… if you have pain between ~60-120 degrees of abduction, but nil/reduced pain at early and late movements.

b) Hawkins Kennedy test

crank-test

Instructions:

  • Bring your bent arm bent to 90 degrees of shoulder flexion in front of you. (see above)
  • Crank your hand down with the help of your other hand. (Internal rotation)
  • You may have Shoulder Impingement if this movement reproduces your symptoms.

c) Neer’s test

neer-test

Instructions:

  • Raise your arm in front of you with your thumb pointing downwards.
  • You may have Shoulder Impingement if this movement reproduces your symptoms.

Note: These tests for Shoulder Impingement give a general guide line in diagnosing your shoulder problem. Many other structures in your shoulder can also make these tests reproduce pain as well.

 

 


The 7 steps to fix your Shoulder Impingement

shoulder-hurts
Image courtesy of stockimages at FreeDigitalPhotos.net

  1. Stop all activities that cause pain
  2. Reduce inflammation
  3. Reduce pressure on squashed structures 
  4. Release tight muscles
  5. Start with these exercises
  6. Scapula position
  7. Strengthening exercises

Note: Each exercise must be comfortable and performed gently. Listen to  your body!


Step 1: Stop all activities that cause pain

How can you expect your shoulder to get better if you keep exposing it the activities that make it worse?

stop

It may sound really straightforward, but I’ve seen so many people get this first simple step wrong.

… STOP aggravating your pain!

The body can not (…and will not) heal itself if you don’t allow enough time for it to do so.

“… If it hurts, don’t do it!”

Avoid over head movements, lifting and sleeping on the painful shoulder!

reachingover-head-liftingside-sleeping-no

Step 2: Reduce inflammation

If there is excessive inflammation in the area, everything will be painful! Once the inflammation levels have subsided, we can then start to do some exercises without aggravating the shoulder again.

a) Anti-inflammatory gel

voltaren

Apply the anti-inflammatory gel to the whole shoulder.

Do this 2-3/day.

I prefer products with natural active ingredients like arnica, calendula or hypericum.

 

b) Non-steroidal anti-inflammatory drugs (NSAIDs)

It is recommended that you take the anti-inflammatory medication for at least 7-10 days.

(**  Please consult your general practitioner before taking any new medication)

 

c) Ice/Cold therapy

coldpack

Apply an ice pack to your shoulder for at least 10-15 minutes.

Do this 4-5/day.

 

d) Shoulder sling

shoulder-sling

If all else fails, you can temporarily immobilise your shoulder for a short period of time. (… but I wouldn’t go past 2 days!)

Step 3: Reduce pressure on painful structures

a) Shoulder traction (with a resistance band)

traction-shoulder

Instructions:

  • Anchor a strong resistance band underneath your foot.
  • Whilst holding onto the end of the resistance band, start to lean away from the band.
  • Aim to feel a downward pulling sensation in your shoulder.
  • It is important that you keep your shoulder as relaxed as possible.
  • Apply more tension to the band if you would like to increase the stretch.
  • Hold for 30 seconds.
  • Repeat 3-5 times.

Step 4: Release tight muscles:

If your posture is not ideal, then your shoulder will be in an sub-optimal position. This leads to a higher risk of Shoulder Impingement!

Tight muscles are pulling you shoulder girdle out of the ideal alignment. We need to release those muscles first!


Instructions:

  • Place target area on to a massage ball (or foam roller).
  • Apply a firm pressure in a small circular motion.
  • Aim to do 1 minute on each area.
    • (… or as long as you require)

Images from TriggerPoint.

a) Pec minor

pec-minor-trp

 

b) Upper trapezius

upper-trap-trp

 

c) Latissimus Dorsi

lats-trp

 

d) Serratus anterior

serratus-trp

f) Posterior capsule

A tight posterior capsule can push the humeral head forward in the shoulder socket. This may increase the chance of shoulder impingement.

posterior-capsule-trp

 

Note: Following these releases, I strongly recommend that you also stretch the muscles for best results.

 

Step 5: Initial exercises

The goal here is to keep the shoulder as mobile as possible.

Do what you can. Don’t do more than you can do…

Depending on the severity of your pain, these exercise may be quite challenging (… or not difficult at all). If there is nil issue, move on to Step 6.

a) Pendulum

pendulum

Instructions:

  • Lean over to allow your arm to dangle underneath you.
  • Using the momentum of your arm, gently sway your arm side ways/forwards/backwards/circles.
  • Allow the shoulder to move as much as you can without reproducing any pain.
  • Repeat each movement for 10 repetitions each.

 

b) Forward leans

shoulder-flexion

Instructions:

  • Place your hand on the back of a chair.
  • Lean forward as to bring your arm in an upwards direction.
    • Do this as much as you can without reproducing any pain.
  • Repeat 20 times.

c) Rotations

extrotn-movement

Instructions:

  • Bend your elbows to 90 degrees.
  • Keep your elbows in contact with the side of your body.
  • Proceed to rotated your arm outwards/inwards.
  • Allow the shoulder to move as much as you can without reproducing any pain.
  • Repeat 20 times.

Step 6: Scapula position

Many dysfunctional positions of the scapula will increase the chance of Shoulder Impingement from occurring.

By optimising posture (… and with it the scapula position), the subacromial area where it is subject to narrowing will be adequately maintained.

Note: There is no one perfect position of the scapula. The scapula is designed to move and be adaptive to whatever function it needs to perform.


Video from Daily Bandha.

Main points:

  • The scapula should glide smoothly and be well controlled on the rib cage.
  • As the arm is raised, the scapula should laterally rotate so that the inferior angle reaches the side of your ribs.
  • Over head arm movement is highly reliant on optimal scapula positioning.
  • It can help if you visualise how the scapula should be moving as you use your arm.
  • The scapula should sit flat on the rib cage throughout movement.

Step 7: Strengthening

You must ensure optimal scapula positioning throughout all of these exercises. This is CRUCIAL!

1. Isometric training:

This involves strengthening your shoulder muscles without moving.

This is to make sure that you do not aggravate the inflammation in  your shoulder.

External rotation

isometric-external-rotation

Instructions:

  • Keep you elbows tucked to the side of your body.
  • Pull the resistance band away from each other.
  • Bring your arms forward by 10cm.
  • Hold this position for 30 seconds.
  • Repeat 3 times.

 

 

2. Anti-impingement training:

rotatorcuffstability

If the shoulder bone (… also known as the humeral head) is not centrated in the shoulder joint, it can often move in an upwards position. This can lead to the impingement of the structures in the subacromial space.

Humeral head depression:

You need to get familiar with the sensation of depressing your humeral head in your shoulder socket.

Imagine your shoulder bone is constantly being sucked in a downwards/inwards direction into the socket whilst you move your arm. (see picture above)

(This may take some time to understand and perform correctly… and that’s fine. Keep at it!)

a) Extension:

extension

Instructions:

  • Anchor resistance band on top of the door.
  • Face the door.
  • Starting at shoulder height, pull the resistance band down towards your body.
  • Keep constant tension through resistance band throughout movement.
  • Hold for 3-5 seconds.
  • Slowly return the hand back to shoulder height
    • If this hurts, you may want to start at a lower height
  • Repeat 10-30 times. 3 sets.
  • Progression:
    • Start from a higher position.
    • Apply more tension to the band

b) Adduction:

adduction

Instructions

  • Anchor resistance band on top of the door.
  • Stand side on to the door. The affected shoulder should be closer to the door.
  • Starting at shoulder height, pull the resistance band down towards your body.
  • Make sure your palms are facing forward.
  • Keep constant tension through resistance band throughout movement.
  • Hold for 3-5 seconds.
  • Slowly return the hand back to shoulder height
    • If this hurts, you may want to start at a lower height
  • Repeat 10-30 times.
  • Perform 3 sets.
  • Progression:
    • Start from a higher position.
    • Apply more tension to the band

c) Internal rotation:

ir

Instructions:

  • Anchor the resistance band at elbow height.
  • Stand sideways with the affected arm closer to the door.
  • Pull the band towards your body.
  • Aim to keep your elbow in contact with the side of your body.
    • Think about squeezing a piece of paper between your elbow and the side of your body
  • Repeat 10-30 times
  • Perform 3 sets
  • Progression:
    • Apply more tension to the band

3. Against gravity

Progress to these exercises only if you are able to conduct the previous Shoulder Extension, Adduction and Internal rotation exercises easily.

Ensure that you are depressing your humeral head throughout movement. (see above exercises)

a) Flexion:

flexion

Instructions

  • Stand on the end of a resistance band.
  • Aim to pull the resistance band upwards to shoulder height.
    • Consider lifting as high as possible with NO pain.
  • Keep constant tension on the resistance band throughout movement.
  • Hold for 3-5 seconds.
  • Slowly return the hand back to the body.
  • Repeat 10-30 times.
  • Perform 3 sets.

b) Abduction:

abduction

Instructions:

  • Stand on the end of a resistance band.
  • Pull the resistance band side ways to shoulder height.
    • Consider lifting as high as possible with NO pain.
  • Keep constant tension on the resistance band throughout movement.
  • Hold for 3-5 seconds at end range.
  • Slowly return the hand back to the body.
  • Repeat 10-30 times.
  • Perform 3 sets.

c) External rotation:

ext-rotn

Instructions:

  • Anchor the resistance band at elbow height.
  • Stand sideways with the affected arm further from the door
  • Pull the band away from your body.
  • Aim to keep your elbow in contact with the side of your body at all times.
    • Think about squeezing a piece of paper between your elbow and the side of your body
  • Repeat 10-30 times
  • Perform 3 sets

 

4. Get strong at your meaningful task

Ask yourself:

What exact activity can’t you do because of your painful shoulder?

You need to find an exercise that will mimic the motion of doing this SPECIFIC movement/activity.

For example: If you have difficulty hanging out the clothes on the clothes line… you can do the following exercise:

meaningful-task

Instructions

  • Stand on the end of a resistance band.
  • Aim to pull the resistance band upwards to above shoulder height.
    • Make sure there is NO pain.
  • Keep constant tension on the resistance band throughout movement.
  • Hold for 3-5 seconds.
  • Slowly return the hand back to the body.
  • Repeat 10-30 times.
  • Perform 3 sets.

(… Have no idea what to do? Send me an email and I will help you out!)

 

Step 8: Fix your posture!

Remember… if your bad posture is placing your shoulder is an ineffective position, it is going to be susceptible to injury. (… and that includes getting shoulder impingement!)

Oh no… 🙁

… But you’re in luck! I’ve dedicated this WHOLE website to offering the exact strategies to fix your posture.

Bad posture is the root cause of your pain!

Have a look at these posts to get your started:

 

// What about the Cortisone injection?

cortisone-needle

If you have already been to your doctor, then the chances are that they have already suggested that you get the cortisone injection.

“Huh? What’s that?…”

This particular injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to:

  • a) reduce the inflammation and
  • b) reduce the pain by numbing the area.

Sounds great in theory… right?

Yes.

BUT – The problem is that it does absolutely nothing to address the underlying cause of the shoulder impingement.

More often than not – the injection may provide some short term relief, but only to have the pain come back at a later date (… and usually with a vengeance!).

“Mark! … But what do YOU suggest?”

I say, see how you go with these 7 steps for about 4-6 weeks. If there is absolutely no improvement (… or if it’s getting worse), you then can consider getting one.

It should NEVER be the first thing that you do.


Any questions?…

Leave a comment down below and I will get back to you!

About

I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

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56 thoughts on “Shoulder Impingement: The 7 steps to fix it!

  1. Thank you for your great essay. I have got little pain when i try Hawkins but i can do it. I can push up event pull up too without pain but not as powerful as before . So can you give me some advice ? thank you and sorry for my bad English.

  2. Wow Mark, thank you!
    The second time this year my schoulder hurts so much I can’t even use my arm. The doctor thinks it could be an inflamed bursa. First time she gave me an injection in the shoulder, and it worked, but I would rather know exactly what causes this pain and solve it.

    So I found your post via a pin on Pinterest 🙂
    I somehow found out this movement (hawkins kennedy test) releaved some of the pain (but I do have to lift my arm with my healthy arm.
    So when reading through your blogpost I tried the Neer’s test and heard and felt this giant crack. and instantly the pain reduced.

    So I’ll be going for my echo tomorow and i’ll be here again for the excercises!
    thanks so much!

    Anita

      1. hi Mark,
        so the echo en RX showed calcification of the tendon in my shoulder.
        I think the excercises might help with the bloodflow in the tendon as well?
        thanks

        Anita

  3. I have had shoulder imingement since January in both shoulders, worse on left. This was caused by overuse injury but initially thought to be posture related so every single exercise I’ve done has made things worse. Physiotherapist I saw made things worse too with deep tissue massage and stretching exercises. In January the pain was only when I moved my arm in a certain position occasionally, now I’m often in almost constant pain now, down arms and in front and back of shoulders. I have bursitis in both shoulders and subacromial something and tendonopathy. I can’t seem to do anything without pain. I used to be so fit, now even walking aggravates the pain. Sleeping not easy, no comfortable postion – have been sleeping on back for months, side sleeping definitley bad. Rheumatologist wants to do ultrasound guided steroid injection but now I’m scared to after reading on several websites that they’re not that useful. I tried your very simplest exercises and only just a bit and they made the left upper arm hurt. I’m getting so depressed about this and don’t know what to do. Any advice please.

    1. Hi Anne,

      Looks like you have what we refer to as SENSITISATION.

      This basically means you sense things as more painful as they should when you do normal (non-painful) movements.

      On top of that – excess inflammation may have played a role in this as well.

      The best advice I can give you is to just to find 1 simple exercise that you can do multiple times throughout the day that does not significantly increase your symptoms.

      An easy one is a wall push: (see below)

      Push the side of your arm against a wall as hard as you can with nil pain.

      If you are seeing a specialist, make sure they rule out nerve issues coming from the neck and systemic conditions such as Fibromyalgia.

      Mark

      1. Thanks so much for this Mark. I am seeing the rheumatologist tomorrow, but before we decide on the steroid injection or not I shall go over again with him my MRI results to remind him. MRI shows I do have in my cervical spine “moderately severe spondylotic change at the C5/6 level” and in shoulders “mild to moderate supraspinatus tendinopathy in both shoulders” and “mild distension of the subacromial subdeltoid bursa which is suggestive of associated bursitis”. Looks to me like I have several things going on. I will try the isometric exercises today, thanks.

  4. Hi Mark,

    The article is very detailed and articulated. I really appreciate you explaining everything.

    My case is a little different than the rest of the lot. It started in January’18. I do have a posture problem, shoulders are a little slouched. I had been going to the gym for 4 months and started swimming in January and I think swimming was the tipping point. I have taken PT for 3 weeks which only worsened the situation. I have already had a cortisone injection taken in late March’18. It did exactly what you said. Pain went away for a few days and then came back. I am on NSAIDs right now and the doctor says if this doesn’t work out, which my guess is it won’t, then he’ll go for another cortisone injection. He narrowed down the area of problem to be AC joint. I can’t cook or even do my daily routine like wearing a jacket and stuff. Now, I’ve read a lot and I am sure it’s not a tear. I have too much strength in my arm for it to be a tear. I have a few specific questions and rest I am banking on your advice.

    1. My biggest worry is that it doesn’t become a tear going forward. What can I do to prevent?
    2. There are some bands in the market to keep the shoulders back. Do you think I should wear nay of those?
    3. Rest in general like if PT, cortisone and NSAIDs didn’t work, what else can I do?

    Rest if you can guide what can I do going forward because nothing seems to be working. I have gotten second and third opinions also and the doctors say this doctor is going by the right approach. I don’t know what to do.

    1. Hi AJ,

      1. Optimal shoulder movement patterns will reduce the risk of further damage to your shoulder muscles. What you focus on is really dependent on what you are lacking. It needs to be specific.

      2. Stay away if you can. Your muscles can do a better job if you work at it.

      3. See answer 1. It can be fixed!

      Mark

  5. Hi Mark,
    I had shoulder pain (Nov’16) and had under gone 10-15 physiotherapy session after which the pain was gone and started my workout again after a break of 3 months in FEB’17.
    Its more than a year since i started working out and developed and gained strength gradually by increase my weights lifted.
    Yesterday night i started feeling similar pain in the same shoulder as i lifted a heavier weight in my shoulder workout yesterday.
    I want to know that why did i got the pain again in the same shoulder and if i need to under go physiotherapy session but really dont want to stop lifting wait as will have to start again and get back in shape again.
    Appreciate your help and quick fix.
    Kind Regards
    Farhan

  6. Hi Mark, I have just a week ago had shoulder arthroscopy and decompression. I have been given some basic exercises to do, pendulums, pulling shoulder blades together, walking hand up the wall, dumb waiter etc. I do a lot of yoga and Pilates and already feel like I could do more but don’t want to over do things. I had and still have a pain in my shoulder blade that I massage against the wall with a spikey ball but nothing seems to help long term. Is there anything you can recommend please?
    Thanks
    Carole

  7. Hi Mark,

    I have deeply appreciated reading your site & have implemented many of your strategies. I work as a pediatric caregiver for a child who is visually impaired, which causes me to lean over a lot at work. I now have double shoulder impingement. Do you have any tips on how to prevent further injury and to heal while working a job like this. I have been trying to fix my posture as much as I can while I’m at work. Also do you have any suggestions for sleeping with double shoulder impingement? I am finding that I wake up with my shoulders feeling like they’re on fire. I can’t quite find the right pillow mattress/scenario.

    Thanks Mark!

    1. Hi Liz,

      With any shoulder injury, you need to:

      1. Stop doing things that make it hurt. This is usually quite difficult if the aggravating factor is what you do for work. If you can not completely stop, try to perform the activity so that there is less/nil pain.

      A cue I like to tell my shoulder patients is to “keep your elbows close to the sides of your body”. This is a safer position for the shoulder.

      2. You will need to strengthen your shoulder muscles in ranges of motion with nil pain first. (Same exercises as in the post)

      3. Once you are strong in these ranges, you will need to address the actual impingement (by doing exercises, anti inflams, injection, correcting posture etc etc)

      4. Sleeping on your back with the back of the shoulder supported with pillows/rolled up towels will be the best position. Side sleeping will generally squash the shoulder .

      Mark

  8. Hi Mark:

    I have been in PT since December for my shoulder and pain is gone after my sessions and then come back after my weekends as a bartender. I can not lift or rotate a bottle to pour a drink with my left arm (the affected shoulder) I take advil and tylenol as needed. I see you do not recommend cortisone shots. I am still doing follow up with my physical therapist, but have since made an appointment with orthopedics for a consult. Is it time to accept that surgery might be needed for this impingement?

    1. Hey Paul,

      If the PT helped, I would still persist with the exercises, for sure!

      If bartending is making it worse, you will need to modify the way you do things there otherwise you will keep aggravating your shoulder.

      Surgery is not warranted is most cases if you do the right things.

      Mark

  9. I really think this is what I have. I have a very tight chest and therefore my shoulders stay somewhat rolled in. I have been lifting weights and thats when it started. Pain and kind of a popping/grinding sensation. Does this sound like impingement?

    1. Hey Jennifer,

      It sounds like impingement may be a factor in your injury.

      But it also sounds like your rotator cuff may not be centrating the humerus head (arm bone) in the shoulder socket leading to popping and grinding.

      If there is locking (which can indicate joint issue), I would get a scan performed asap.

      Mark

    1. Hey Audrey,

      You can… but only one way to find out! And that is is to try them out.

      Since these exercise aren’t strenuous and only use very light resistance, you should be able to do them everyday providing that your body can tolerate it.

      Thanks for the question.

      Mark

  10. Can a shoulder impingement cause a winged scapula? What about the reverse?

    I had labrum repair on my right shoulder. Once it healed, I realized that I had a severe (3 to 4 inches) winged scapula. I can’t support the weight of my arm when it is above my head. It has been months and the doctor/PT has told me that they think it is LTN damage but that it will regenerate and be ok. We have had no MRIs or any other images taken of this area post surgery.

    I have been through two months of physical therapy and I am not seeing any progress. My doctor has suggested a shot but I don’t know if that will really help me.

    I have winged scapula, shoulder pain, my trap is overworked so I have a sharp pain going from my trap into my shoulder on top (hurts to touch), pain while lifting my hand over head (and during other shoulder impingement tests). One thing is that I don’t have too much pain in my right shoulder until I start reaching the top of my range (head is almost directly over head). I am lifting my hand with my trap mostly.

    I have tried different serratus anterior exercises but I can’t tell if I am working that muscle or if my lat and pec minor are doing all of the work. I can see my pec minor contract when doing all of the serratus anterior exercises.

    What should I do? I think I need to get some imaging to help determine what is wrong!

    1. Hi Ryan,

      Yes – a Winged scapula can result from impingement of the shoulder. (And conversely, winging can also predispose you to impingement.)

      Your winging may be due to the body compensating a) for weak muscles +/- nerve damage, b) tight structures and/or c) to avoid pain.

      It sounds like you are shrugging your shoulders to elevate your arm. This may be indicative that you have weak shoulder stabilising muscles (namely the rotator cuff and serratus anterior) and/or tight inferior capsule/lats/triceps.

      Ideally with arm elevation – you would like the serratus anterior and trapezius muscle to laterally rotate your shoulder blade so that you do not have to shrug your upper traps.

      Do you have full shoulder External and Internal rotation? I would check this first. (see link)

      You can get a MRI if you would like to double check everything.

      Mark

  11. I’ve been in physical therapy for 3 months for my impingement. I’ve gained some strength and mobility but I still have pain. I’ve tried 2 weeks of Advil but I can’t keep taking them due to gastritis from the anti inflammatories. Is it time for a cortisone shot? I’m getting frustrated

    1. Hi Ilene,

      I am not really a huge fan of the cortisone shot as I feel that most inflammation can settle once you remove the aggravating factor… but if you have tried everything with physical therapy and still not getting anywhere, it may be worth a shot.

      Mark

      1. I have an inpigement and being having physio which isnt helping im in alot of pain in my collar bone so been trying to do exercises but nothing is helping im 61 and suffer with ra osterporis osteraritis

  12. Thanks Mark best advice I’ve come across for my shoulder. I’ve had impingement and subacromonial bursitis and these exercises made a massive improvement so much so I happily refused the steroid injection. My weakest area is external rotation but it’s much improved. The issue I have still with no resolve is tightness in the infraspinatus. When it’s really tight I can feel the humeral head off centre. If I abduct my arm and push the infraspinatus with a ball against the wall I get clicking and the tightness releases and humerus gets centred. Sometimes doing a chair lean stretch also resolves it. Is there an exercise I should be doing to prevent the tightness or is the tightness caused by weak external rotation? Thanks S

    1. Hey S,

      If the infraspinatus is tight, you can do stretches for it:

      Also make sure you have full INTERNAL ROTATION:

      70 degrees is what you want.

      If it is weak, continue with the strengthening exercises.

      Mark

      1. Brill thanks! I’ve added in the stretch as that one helps a lot. Just checked my internal rotation and very tight there too – probably at 60. It’s much less than it used to be before injury. Will stretch internal rotators as well. Thanks!

      2. Hello,

        I can’t understand what to do to mimic the above as dropping you arm down to 70 degree’s seems easy – What am I missing- to get better internal rotation is my issue as well.

        Please elaborate when you can

        1. Hi Raymond,

          If you can do 70 degrees easy:
          a) You have very good shoulder mobility
          b) You compensated your way to 70 degrees.

          I am going to assume you are b) as if you are a), then all is good!

          If you compensated your way to 70 degrees, you likely did not keep you shoulder back and down in a neutral position. Many people “cheat” this movement by letting their shoulder girdle rise up and forward.

          Let me know if that made sense.

          Mark

          1. Hi Mark,

            I finally got this I do not have close to 70 internal rotation since I had PT check it-more like 40 degrees- no wonder its hard to raise that shoulder

            Now i need to focus on the External Stretch’s she said the range can be improved by doing these frequently. You have provide some and are much appreciated i hope this can get back to at least 60? What is the best one i can do daily?

          2. Hey Raymond,

            The best stretches for Internal rotation of the shoulder joint
            – Sleeper stretch
            – Arm across body stretch

            Aim to get a specific stretch in the back of your shoulder joint.

            Mark

  13. Hi Mark
    49 yr old male . love cricket still but have knocking sound in between 90 and 180 degree
    and have zero external rotation. upon acceleration and at point of release my arm goes into extreme pain zone recovery is about 2-3 minutes before the pain goes away.
    When i heavily tape shoulder so that i kinda push it inwards the pain is not as bad. My feeling is im pushing over tissue that provides some cushioning to affected area. Mri did show some laberal tears but this seems common pathology with 49 yr old male. Im getting desperate for the inpingement to be fixed. Ive seen 7 different dr or physios and im just paying their holiday house off. Any advice

    1. Hey Chris,

      If you have no external rotation, that would be a good place to start.

      Without External rotation in your shoulder joint, there is no way you can safely raise your hand over 90 degrees (let alone throw a ball).

      You can work on it doing this simple exercise.

      Listen to your body. Do not push into pain (esp. if you have known labral tears).

      Mark

      1. Hi Mark,

        I was diagnosed with rotator cuff tendenitis and worked with PT and she said things were fine and I could resume my fav sport BB

        I find that I still baby that arm do not have pain just stiffness. I would think its important to keep it mobile. I use thera bands daily to do some of your shoulder inpingement stuff , external rotations, releases etc

        Any good warm ups for BB you would advise and if moving this daily going to make it worse.

        1. Hey Raymond,

          I like do start off with controlled shoulder articulations: Here is a video.

          From here you should try to do sport specific warm ups. Try to mimic the same positions you will be in during your sport.

          Sorry – Is BB basketball or baseball?

          Mark

          1. Thanks Mark-Basketball sorry about that

            I have a ? my right shoulder is stiff but have zero pain-

            Is this RC ( cuff)tendinitis?

            Can this be from poor posture as well?

            Doing a lot of band pull backs to help improve my external rotation.

            Don’t want to make it worse but it seems mobiliy is better than not

            You are great much appreciated

  14. Hi Mark, great website. I was diagnosed with a frozen shoulder, is that the same? Only got one exercise to practice, but seem to have all the symptoms described here.

    1. Hi Ishbel,

      Frozen shoulder (also known as adhesive capsulitis) is where the capsule around the shoulder joint becomes very tight +/- painful. It usually can take >12 months to heal !

      Whereas Shoulder impingement is where the structures in the shoulder joint get squashed when your lift your arm up.

      Although different, shoulder impingement may lead to adhesive capsulitis if not addressed properly !

      Mark

  15. Hi Mark, I have been diagnosed with a frozen shoulder, is that what we are talking about here? I will try the exercises, and hopefully improve overall posture as well

  16. Thank you so much for this. Your explanations and the visual aids have helped me get a better “feel” for what’s happening when I move, and how to go about the exercises. I am a violinist, and experience pain in my bowing arm when lifting the bow – it hurts more to hit the lowest string (G), since it is the one farthest away from my hand, than playing the E string which can be reached with my elbow closer to the ribs.

  17. Thank you for your the great pictures and explanations it’s extremely helpful for myself and my clients.
    It is terrific to have such helpful professionals sharing their knowledge with people like myself.

    Thank you
    Peter

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