Shoulder Impingement (P)Rehab Program
Shoulder impingement is a result of a lack of joint workspace. The most common type of impingement occurs with shoulder flexion, or lifting your arm straight up over head, causing a pinch, pain, or limitation felt on the top side of the shoulder joint. Clinically, there’s a hefty differential diagnosis list, including subacrominal impingment, subacromial bursitis, supraspinatus tendinopathy, glenohumeral impingment and more. From a (p)rehab perspective, the training for all of them has many similarities.
The more important constant in all shoulder impingement (p)rehab is training rotation of the glenohumeral joint. The rotator cuff is a group of four deep muscles that attach to this joint capsule, contributing to shoulder stability through motion and providing important information to the central nervous system about the health and function of the shoulder joint. However, if theres limited space inside the glenohumeral joint capsule, then there won’t be enough room for the humerus to move relative to the scapula (the glenoid cavity). As you move your arm overhead, you essentially “run out of room’ in you shoulder joint, causing an impingement on the closing side of the joint.
Internal rotation and external rotation of the shoulder stresses the deep glenohumeral joint capsule the most specifically. Someone who is limited in internal and external shoulder rotation will have a very tight, restrictive shoulder joint capsule. When the shoulder joint capsule is not functioning properly, then the rotator cuff muscles will not be able to function optimally and the larger muscle will follow suite. This micro-to-macro domino effect will impact the biomechanics, and inevitably negatively impact the muscles and tissues of the shoulder shoulder.
Training to expand and control glenohumeral joint rotation will optimize the joint capsule tissue and increase the amount of space to work with inside of the joint. After 2 weeks of building more joint workspace, we progress to linear-based training, stimulating the muscles and tissues involved in shoulder flexion. As you gain access to new limits of motion, your body will be unfamiliar and weaker in these ranges, so it important to back it up with specific end-range strength training. In this case, we train shoulder flexion to gain strength and control over head.