Physical Thearpy Department






Shoulder Exercises
for the
Impingement Syndrome







KAISER PERMANENTE




Impingement Syndrome of the Shoulder


What is the shoulder impingment syndrome?

Shoulder impingement occurs when certain muscles or tendons (the rotator cuff), or other soft tissue, are compressed or "innched" between the bony structures of the shoulder joint. Inflammation and pain occurs and this is usually aggravated by shoulder and arm movements.


What are Common Causes of Impingement Syndrome

  1. Acute trauma: a fall or sever blow to the shoulder or a single heavy lift that strains the soft tissues of the joint.

  2. Chronic strains:

    1. Repeated overhead work

    2. Repeated sports movemetns (weight lifting or throwing)

    3. Prolonged static arm positions (computer work)

    4. Sleeping habits: lying on the same arm each night.

    Most of the chronic causes are related to postural habits creating muscle imbalance of the shoulder joint. Some of the muscles get tight and shortened while others ge weak and overstretched. This may produce pain and stiffness in the shoulder.


Shoulder Impingement Care


There are three (3) stages involved in helping the healing process:

  1. Decrease Inflamation

    1. Take medication if prescribed by the doctor.

    2. Place the arm in the most comfortable positon of rest. Pillows may be used to support the arm. Slings are generally not useful.

    3. Use ice packs on the shoulder frequently during the day, for approximately 15 mintues each time.

  2. Restore postural alignment and pain-free range of motion

    1. Standing and sitting posture needs to be monitored.

    2. Correct sitting posture includes sitting in a chair low enough to allow your feed to rest flat on the floor or other surfaces (e.g., stool). Your knees need to be level with yoru hips as you sit against the back rest of the chair.

    3. Begin the postural exercise (exercise #1)



    Exercise #1

    1. Stand or sit in upright erect position

    2. Pull both shoulder blades together and down toward buttock and hold steady.

    3. Release to resting, repeat. Try to repeat 5 of these movements every ... hour

    To maintain range of motion, begin pendulum exercise.


    Exercise #2

    1. Permit arm to "dangle" freely.

    2. Circular motion in the clockwise and counter-clockwise direction in progressively larger circles.

    3. Slightly swing your arm forward and backward.

    4. Gently swing your arm side to side.


  3. Restore functional strength with specific resistive exercises

    These exercises should not be performed if they aggravate your symptoms in any way. Begin these exercises very gradually and slowly increase repetition, resistance and arc of movement. Over-doing the exercises will delay recovery.

    Exercise #3

    1. Stand or sit in upright erect posture.

    2. Hold the affected arm at the side of the body with the elbow bent at 90 degrees (a right angle).

    3. Positon the forearm across the front of the body with palm against your abdomen and thumbside upright.

    4. Rotate hand and forearm away from the body maintaining the elbow in the same position. Rotate back to resting position.

    5. Once you have repeated this exercise without any difficulties, you may increase the resistance by placing rubber tubing in your hand with the other end secured. As you rotate your forearm, the rubber tubing is stretched.

    Exercise #4

    1. Stand in upright erect posture.

    2. Position the affected arm with a straight elbow at the side of the body. Turn the arm inward so the thusbside is pointing to the body.

    3. Lift arm out to the side angled slightly forward from the side of the body.

    4. Lift only to height of comfort, be sure not to shrug the shoulder.

    5. Lower arm to start postition. Repeat.

    6. Once this exercise can be repeated without difficulty, you may add resistance by holding rubber tubing in your hand and securing the other end under your foot. As you lift your arm, the tubing is stretched.