Shoulder Impingement Part 3: Addressing Shoulder Stability

In the first two parts of this shoulder impingement series, we reviewed shoulder impingement pathology and how to address mobility restrictions commonly seen with this condition. As you may recall from the first post, shoulder strength and stability are also potential contributors to shoulder impingement. It is not uncommon to see someone suffering from shoulder impingement who has full range of motion and great mobility but lack the strength to support the motion, especially when under load (like overhead pressing). This inability to adequately support the shoulder can contribute to mechanical changes within the joint and surrounding tissue which can then lead to injury. In this article we will go over some exercises and drills for common stability issues that may contribute to shoulder impingement.

Posterior Shoulder Strength:
It’s common to see an imbalance between the front (anterior) and back (posterior) shoulder muscles. Strengthening the back deep rotator cuff and scapula muscles can reduce this imbalance and improve general shoulder mechanics. Below are some of our favorites. Other common gym exercises to work on posterior shoulder strength include reverse flies, face pulls, pull-a-parts, and high rows.

Load Bearing Stability/Balance:
Being able to train the shoulder under load is important to return to sports and overhead weighted activities. Oftentimes, strict overhead pressing is painful for those with shoulder impingement. Fortunately, there are different ways to load the shoulder and provide a similar strengthening stimulus. Loading the shoulder and pressing also engage the serratus anterior muscle, an important scapula muscle. The video below shows some examples of loading the shoulder and activating your serratus anterior using your body weight, kettlebell, or barbell.

One important function of the rotator cuff muscles is to help stabilize the ball in the socket. A great way to train these muscles and challenge the shoulder is by increasing instability (“chaos”) through the use of bands and hanging weights. These exercises also often let those with pain under heavier loads to complete an exercise with less weight but still be greatly challenged. Below are some of the ones we like to use in the clinic. Be careful though as they are generally more challenging than they look!

Kettlebell Carries:
What’s more functional than carrying weight around? Not much. And certain kettlebell carries are great for strengthening the posterior shoulder, upper back, and rotator cuff muscles. Below are a couple variations you can try with kettlebells. You can get a similar effect by using dumbbells, barbell, or sandbags.

Not everyone will have similar benefit to each exercise as each person has different strength and stability limitations. For example, one person may have a large imbalance between the anterior and posterior shoulder muscles and may benefit more from focusing on those posterior muscles. Someone else could have great overall strength but have issues with keeping a good overhead press position. This person may benefit more from overhead carries and chaos exercises. Unfortunately, it’s challenging to tease out specifically what you need. If you find yourself unable to do so, I recommend seeing a physical therapist who can further evaluate and identify areas of weakness.

If you feel you have some shoulder weakness and dealing with shoulder pain, I hope this post has been useful. Please reach out if you have any questions!


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