Video Transcript: Shoulder Impingement Treatment with Posture Strengthening Exercises

Hi, everyone! Dr. Orit Hickman here, owner of Pain Science Physical Therapy. 

And, I'm here today to talk to you about a really common diagnosis that we see in the clinic, and it is shoulder impingement. Oftentimes, we’re the ones making the diagnosis. Although, we’ve had plenty of patients who’ve come in and said, “I think I have an impingement in my shoulder.” 

Shoulder impingement by itself — the diagnosis is — it’s a global diagnosis. There's a lot of different things that can be hurting or causing pain for us to give the diagnosis of shoulder impingement. But, the general idea is that you have some structures that are irritated and most often felt when you bring your arm up overhead. Structures don't have to be actually getting pinched or compressed. They just can be irritated, and they're irritated by this overhead movement. So, if you've been doing a lot of overhead, if you're painting, if you're changing out lots of light bulbs, if you are spending lots of time with your arms up and doing something overhead like organizing shelves in the top shelf of your closets — whatever it may be — if you do a lot of overhead activity over a short period of time, that could cause some shoulder impingement. Other times that we see patients with shoulder impingement — the most common besides that is swimming. So, if somebody has taken up a swimming program and they haven't swam for a really long period of time, that can cause shoulder irritation. Shoulder impingement by itself is — like I said — it's a very umbrella type term. 

The things that we see most commonly with this are certain muscle imbalances. So, there are certain muscles around the shoulder that are stronger than other muscles. And, a lot of times, this is connected with posture. So, if posture is upright, if the head is retracted or brought back just ever-so-slightly and the shoulders sit in a nice, comfortable back position, then range of motion in the shoulder is very normal. If, for some reason, you are spending lots of time in this forward posture — and I'll show you this from the side. So, this is me upright. And, you can see shoulder motion is pretty full, should be able to get that arm pretty high up. Right? If my head falls forward, my arms fall forward. Maybe I'm spending lots and lots and lots of time on a computer. Then, when I go to lift up my arm, I can’t get my arm as high. Right? So, it’s going to get stopped by a change in the position of my shoulder blade. Right? So, if my shoulders are down and back and my head is upright, then my shoulder blades are gently down and back on my spine and it's easier for me to lift my arm up overhead. But, if I am in a forward position and my head is forward and my shoulder blades have tilted forward on my rib cage, then when I go to lift my arm, I'm not going to be able to go very far before I'm stopped by my shoulder blade. So, oftentimes, a lot of what we're doing when we're trying to treat a patient with shoulder impingement is we’re addressing the muscles that stabilize the shoulder blades and we’re talking a lot about posture. So, it can be very, very exhausting for you as a patient because you’re like, “Ah! More postural things!” But, I promise you that if your posture is in a more upright position, it will really calm the shoulders down. 

So, without getting too far into it, we're going to talk about just one — do I have one or two exercises?  I have two exercises that I've listed that are really good exercises for helping to correct posture so that you can start to decrease irritation in the shoulder with shoulder impingement. 

And, the first one — I'm going to the band aside. The first one is called scapular retraction or a shoulder blade squeeze. And so, what you're doing is you're going to try and get as upright as you possibly can. You're going to squeeze your shoulder blades together, and then you're going to relax. Now, when you do this, it's not this movement. A lot of people say, “Well, an upright row is a great exercise for this. Let's do that.” The problem with an upright row is this motion. With this motion, the for-the-the top of the shoulder, the humeral head, will start to slide forward in the joint. And, irritation with shoulder impingement includes, oftentimes, irritation of the long head of the biceps, which comes up the front of the shoulder and dives deep into the shoulder joint. And, when we move our elbows back, it stretches that tendon and irritates it further. So, we are not looking to row. What we’re looking — what I'm looking for you to do is just squeeze your shoulder blades together. Now, squeezing together does not mean squeezing up and back. Squeezing together means squeezing back, and maybe even squeezing down a little bit depending on where your shoulders sit. So, there's a little bit of variation there that we might give to patients in the clinic. But, for your purposes at home, just work on squeezing back. Try not to drive those elbows back. Just squeeze the shoulder blades back and together. Almost imagine bringing your shoulder blades together against like a pencil and that you're trying to hold it there and not let it go. You would hold that for a couple of seconds and repeat anywhere from ten to twenty repetitions, two to three times a day. So, that's the first one. 

The second one is what we call shoulder external rotation. So, when you're in a position where your shoulders are dropping forward, the muscles around the shoulder joint, your rotator cuff muscles, which are pretty deep and they're great stabilizing muscles, they get stretched out because the head of the humerus starts to drop forward in the joint. And so, working on, first, bringing shoulder blades gently down and back, elbows at your side. And then, I like to do this one hand at a time. So, you're going to just take one arm, and you're going to rotate out as far as you can go comfortably using a band. Now, I've grabbed a red band. Red band is medium resistance. Most of the time, tan and/or yellow bands are lighter resistance, and that's a good place to start. So, elbows are down and back. Shoulders are slightly retracted, so slightly brought back. And, you're going to rotate one arm at a time, and you're going to keep your elbow tucked in nice and gently against your rib cage. You're going to do about ten of these on one side, and then you're going to do ten on the other side. And, if you can get to a set of — two sets of ten, that's great. But, starting with a set of ten on each side is perfect. And again, doing that about two to three times during the day. 

Exercises — these exercises should not increase your shoulder pain. If they do, then definitely don't continue with them and seek out the care of a physical therapist so that they can evaluate and see if that's the correct diagnosis. You know one of the dangers of going online is that you diagnose yourself based on — you know — checking out what other people say. And, the reality is that that can be wrong. So, you want to — you know — you can test things out. You want to make sure that — you know — things are helping. And, if the exercises aren't helping, then definitely get in to see a physical therapist so that they can truly evaluate you and make sure that you're doing the correct exercises and that you're doing them correctly. 

I hope this helps. Definitely, I would love a thumbs up if you think this was a good video. And, feel free to share it with your friends and family. Any comments below would be great. So, I hope you guys have a wonderful rest of your day. Thanks! Bye.