Shoulder pain or impingement, especially in the front of the shoulder is often seen as a muscle tightness issue.

They will be given some stretches and likely some upper back strengthening exercises to bring the shoulder back and down.

The fact is, muscles aren’t the reason for the discomfort. There is a lot more to it than that.

In this article I am going to discuss:

• Two different kinds of shoulder impingements I commonly see
• Compensations at the shoulder that are related to this pain
• Exercises to help with each case

 If you would rather listen and watch, then click below:

 Shoulder Impingement

Impingement happens when there is a reduction of space in the joint. It is also used as a “stabilization” mechanism when lifting the arm or producing force.

At the joint level, the shoulder joint is comprised of the humerus which has a ball on the end of it (humeral head), and a socket (glenoid), which is an extension of the scapula (shoulder blade)

During movement of the shoulder, the ball will slide, roll, glide and rotate within the joint.

This movement can be impacted by a change in the socket position which can be seen as a shoulder shrugging or a rounding.

This impingement can be felt when someone reaches their end range with an associated compensatory movement pattern or position of the shoulder.

 For example, if you were to roll your shoulder forward and then try to lift your arm overhead, the only way you’ll be able to go further is by flaring your ribs.

 Your end range becomes 90ish degrees of shoulder flexion. This is why position influences function. If you want to learn more about this concept, check out my Podcast episode here: Listen Here

First Type of Impingement

 The first type of impingement I will see if at the front of the shoulder when flexing the arm to about 90 degrees.

Let’s say that you have pain in your right shoulder. If you were to take your right hand and grab your left shoulder, then without lifting your hand, you lift your elbow to the ceiling, this is when you may experience that discomfort.

This is a traditional test used to determine shoulder impingement called the Hawkins-Kennedy Test.

Typically this happens because we are missing shoulder flexion and internal rotation at the shoulder.

This range becomes impacted when the sternum and the humerus rotate towards each other. Essentially the front part of the ribcage becomes compressed.

This area is key for shoulder internal rotation.

To overcome this, we need to think about opening the front of the ribcage and increasing the distance of the sternum and the humerus.

Exercise For The First Type of Impingement

One exercise we can use is Crab Breathing.

This movement allows us to not only open the front of the ribcage, but also coordinate the pelvis as well. Stacking the ribcage and the pelvis repositions the shoulder and hip sockets to help restore mobility at those joints.

For some, performing this movement on the elbows vs straight arms could be a better strategy to ensure we are getting the movement at the ribcage and not compensating by hyperextending our elbows.

Keep in mind that this exercise isn’t specific for you, but for educational purposes to illustrate how these discomforts can happen and the principles behind addressing them.

 Second Type of Impingement

 This type of impingement may still be felt in the same area of the shoulder, but this is experienced at the end range of shoulder flexion. 

As you approach the last degrees of shoulder flexion or pressing overhead, this is when this discomfort may show up. 

Different from the first type, this has more to do with the base of the neck and the back part of the ribcage than the front.

With that said, the front of the ribcage has to be open to even reach this range, but to achieve end range shoulder flexion, the base of the neck needs to be able to flex and rotate.

This means that if you’re not able to turn your neck to the left, chances are, you aren’t going to be able to truly lift your arm to its end ranges.

With this in mind, cervical rotation, cervical side bending and shoulder flexion are great ways to determine this type of shoulder impingement. Check out my EVOLVE Biomechanics Mentorship for a full deep dive on these assessments and how to execute them the right way! EVOLVE Mentorship

Exercise for Second Type of Shoulder Impingement:

To address this type of impingement, we need to focus on a few major points: 

• Improving upper back expansion
• Restoring the ability to turn the neck and ribcage
• Reinforce end range positions

This is exactly why I really like using this Bent-over Alternating Cable Pulldown.

By alternating the arms and looking at the moving arm, we are reinforcing the first two points.

The non-moving arm is going to be held in an end-range position but because of the mechanics of how the cable acts on the body, this will reduce compression of the shoulder in this position.

The cable will be inherently tractioning the shoulder which increases the space in the joint, improves the position of the shoulder and expands the upper back.

Summary

Impingement of the shoulder can happen for many reasons. Understanding why this happens by appreciating the true mechanisms at play can lead us to specifically assess and program exercises to overcome these limitations.

If you want a Program of exercises just like this that I have used with clients to improve issues such as these, then check out my Resilient Posture Program!