Shoulder Impingement Part 2: Addressing Mobility Impairments

In the first part of this shoulder impingement series, we reviewed the anatomy and mechanics behind it and possible contributors to this movement dysfunction, to include mobility restrictions. “Mobility” here is defined as the body’s ability to move through a joint’s intended range of motion. For example, knee mobility includes the ability to completely lock out the knee. An inability to do so would be considered a mobility restriction or impairment. Such restrictions can be due to limited muscular flexibility, joint capsule extensibility, altered joint structure/mechanics, postural limitations, or a combination of all the above. In this article we will go over some exercises and drills for common mobility restrictions that may contribute to shoulder impingement.

Pectoralis Major/Minor Tightness:

The way the pec muscles sit across the chest and attach to the upper humerus (pec major) and scapula (pec minor) can impact overall shoulder position, decreasing the available sub-acromion space. Decreased space here provides less “room to breathe” as we raise our arms past shoulder height. Check these out to help improve pec major and pec minor flexibility.

Latissimus Dorsi Tightness:

Although the lats are a “back” muscle, the muscle actually attaches towards the front part of the upper humerus. Therefore, along with restricted pecs, it can also pull the shoulder forward and decrease the available space. Here are few options to improve lat flexibility.

Thoracic Extension Restriction:

In Part 1 we discussed how the shoulder complex includes how the shoulder blade glides along the rib cage. The shoulder blade’s ability to do so partially depends on the thoracic spine’s ability to extend (bend upright/back). We oftentimes see patients and clients with more of a flexed forward posture and “stiff” going back. Here are a few of my favorites to improve thoracic extension.

Limited Shoulder Internal Rotation:

Internal rotation is the ability to rotate your hand towards your stomach or reaching for your back pocket. It can also indicate limited extensibility of the posterior (back) shoulder capsule. Restrictions can theoretically push the ball of the ball-and-socket joint forward, possibly creating irritation to the front shoulder structures. Here are some of our favorites to address this restriction.

Limited Shoulder External Rotation:

External rotation is the ability to rotate your hand out or cocking back as if throwing a ball. It is also responsible for being able to point your armpits forward and keeping elbows in when pressing overhead. Limited external rotation results in overhead movement dysfunction that can lead to shoulder impingement symptoms. Below are some exercises to work on this.

Everyone is unique, and not everyone will need the same flexibility exercises and mobility drills. If you feel you are “stiff” in an area or two, try out the associated exercises in the videos above and see how it feels. One way to assess if an exercise is beneficial is simply by testing and retesting a potential painful or “stiff” movement: try the movement (ex: overhead pressing), complete mobility work to address the restriction (ex: thoracic extension drills), then retest the movement. If the movement feels better, then it may be worth working on further.

If you feel you are restricted and dealing with some shoulder pain, I hope this post has been useful. The next part of this series will be geared towards shoulder strength and stability. Stay tuned!

Pat