Ever feel that nasty pinch in your shoulder when you go to lift your arm to the front of your body and up toward the ceiling? This is what we call a shoulder impingement and I’ve been there so I know it’s not a fun feeling. What’s almost worse than that painful shoulder, is it taking you away from living an active lifestyle.
Shoulder impingement is one of the most common causes of shoulder pain, impacting a significant number of people, especially those who engage in activities that require repetitive overhead motions like swimming, tennis, or horizontal pressing movements like bench press or push-ups.
The good news is that there are things you can do to get relief, and one of the best ways to alleviate shoulder impingement is through targeted shoulder exercises that aim to increase the internal rotation of the shoulder. Keep reading for a quick look at what shoulder impingement syndrome is, as well as the simplest most effective way to clean up your shoulder problem in no time.
WHAT IS SHOULDER IMPINGEMENT?
Shoulder impingement syndrome happens when the tendons of your rotator cuff muscles become irritated and inflamed as they pass through the narrow space in your shoulder joint, between your shoulder blade and upper arm bone. This compression of your rotator cuff tendons can lead to pain, limited range of motion, and difficulty performing daily activities.
I like to think of shoulder impingement as a lack of space problem. The humerus, a long bone that runs from your shoulder to your elbow, sits inside of your shoulder capsule. As you go to lift your arm up, this bone not only rotates but also has to move backward. If you don’t have enough space in there, the bone will run out of room and impingement sets in… ouch!
SHOULDER IMPINGEMENT SYMPTOMS
The most common symptom of shoulder impingement is that stabbing pinch you feel in the front of your shoulder as you:
Lift your arm overhead or try to reach behind you
Get in the bottom of the bench press or push-up
Even just lifting your arm out to the side
There are times when this will be a quick sensation going away as you come out of those positions or for some, it’s a nagging nuisance that occurs all day.
You may also experience:
Weakness or loss of strength in the affected arm
Difficulty sleeping on the affected side
Range of motion in all aspects slowly decreases
CAUSES OF SHOULDER IMPINGEMENT
Shoulder impingement is unfortunately, a common condition that is caused by a lack of internal rotation of the shoulder. Your shoulder is a ball and socket joint and must have the ability to rotate inside that socket. Remember earlier when I said it was a “space problem”? When your shoulder lacks room inside the joint capsule for the shoulder to rotate, you’ll inevitably start to feel that pinch as your arm moves.
See also: The Ultimate Guide to Shoulder Pain
WHAT IS MISTAKEN FOR SHOULDER IMPINGEMENT?
Other shoulder problems that are often mistaken for shoulder impingement syndrome include shoulder bursitis, rotator cuff tendonitis, or even a rotator cuff tear. It's crucial to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan.
HOW TO TELL THE DIFFERENCE BETWEEN SHOULDER IMPINGEMENT AND ROTATOR CUFF ISSUES
While shoulder impingement involves compression of the tendons and bursa within the shoulder joint, rotator cuff injuries specifically involve damage to the muscles and tendons of the rotator cuff itself. An orthopedic examination and imaging studies like MRI or ultrasound can help differentiate between the two conditions.
See also: Simple Exercises For Rotator Cuff Issues
HOW TO TEST FOR SHOULDER IMPINGEMENT
I always recommend that clients get any testing done by a licensed practitioner, however, there is a quick way to do an initial test to see if shoulder impingement is present.
For the starting position, place your arm straight out in front of you at shoulder height, with your elbow bent at a 90-degree angle. Your forearm should be perpendicular to the floor.
Keeping the upper arm still, slowly internally rotate the shoulder so your forearm falls inward.
If your arm starts to feel pain or pinching as your arm lowers, then it’s a pretty good indication that shoulder impingement is present.
CAN YOU WORK OUT WITH SHOULDER IMPINGEMENT?
While it's essential to avoid activities that exacerbate shoulder pain, you can still work out your upper body if you have shoulder impingement, but within reason. I would suggest eliminating any pressing movements like bench press, push-ups, and overhead pressing until you have the shoulder impingement under control.
Most back movements like rows, pulldowns, and even shrugs should not cause any problems, however, if you feel any pain or pinching doing any movement, stop what you’re doing and move to another exercise.
WHAT MAKES SHOULDER IMPINGEMENT WORSE?
Activities that involve excessive internal rotation, like any vertical or horizontal pressing movements will make shoulder impingement much worse. It's essential to identify and avoid these movements to help facilitate the healing process. As I mentioned above, you can still train your upper body, just keep everything pain and pinch-free.
COMMON EXERCISES THAT DON’T WORK
When considering shoulder impingement exercises to try and fix the problem, remember, if it’s not increasing the internal rotation of the shoulder, you’re not creating more space, which is what we want. No space = shoulder impingement. I often see people try the following exercises in the gym or at physical therapy that don’t relieve shoulder impingement (in my opinion):
Banded Rotator Cuff Exercises: If you’re reading this blog, you’ve inevitably done a million rotator cuff exercises with a resistance band. I’m also guilty as charged. These exercises are not useless, but the problem is that they don’t increase the internal rotation of the shoulder. Of course, they strengthen all the rotator cuff muscles that “rotate” your shoulder which is awesome. I’d suggest adding these to your routine once you’ve successfully increased your internal rotation.
Scapular Stabilization Exercises: By no means are scapula stabilization exercises bad, but they are used to teach the scapula how to not move and be a support structure for the shoulder. They’re doing nothing in my opinion to create more internal rotation. Once again, adding these in after increasing internal rotation would be a good idea.
Posterior Deltoid Strengthening: This is another great exercise to strengthen the backside of the shoulder, but it does not actually fix shoulder impingement because of the lack of increasing internal rotation.
Stretching Exercises of the Chest and Upper Back: I would never tell anyone not to stretch their chest and upper back, but unless you’re specifically stretching internal rotation, don’t expect any relief in your shoulder impingement.
See the trend here? Effective exercises for shoulder impingement need to increase your internal rotation.
IS IT POSSIBLE TO FIX SHOULDER IMPINGEMENT WITHOUT SURGERY?
Surgery should be the course of last resort for all ailments and injuries, instead leaning on conservative treatments first. By simply increasing the shoulder’s ability to internally rotate, shoulder impingement can be eliminated….no surgeons required!
WHAT ARE RED FLAGS FOR SHOULDER IMPINGEMENT?
Red flags for shoulder impingement include persistent and worsening pain, weakness or loss of function in the shoulder, and symptoms that interfere with daily activities and sleep. If you experience any of these symptoms, seek a licensed practitioner to make sure there is nothing worse going on than just shoulder impingement.
WHAT NOT TO DO FOR SHOULDER IMPINGEMENT
Until you've fixed your shoulder impingement issue, avoid any activities that require excessive amounts of internal rotation, like horizontal or vertical pressing movements. You want to use the exercises below to build up strength of the tissue that creates internal rotation first. Also, you should stay away from any other movements that may cause pain or discomfort as well if possible, avoid sleeping on that shoulder.
WILL SHOULDER IMPINGEMENT GO AWAY?
I’ve worked with many clients who have experienced significant improvement in shoulder impingement symptoms over time. However, the duration of recovery can vary depending on the severity of the condition and individual factors. Consistency with the sequence that I go over below as well as continuing some level of shoulder work after the problem goes away will be the biggest contributor to preventing this from happening again.
THE BEST SHOULDER IMPINGEMENT EXERCISES
My favorite exercise to fix shoulder impingement is Internal Rotation of the Shoulder PAILs and RAILs because I’ve found it to be the best way to increase the shoulder’s ability to internally rotate, which you now know is what you need in order to have more space in the shoulder joint.
PAILs and RAILs are simply acronyms for Progressive and Regressive Angular Isometric Loading, which is a fancy way of saying that we’re going to stretch internal rotation to open up new ranges of motion, and then perform isometrics on both sides of the joint to ensure we get to keep the new range of motion. At the end of this movement, we’ll do some shoulder rotations to hit save on our work, teaching our shoulder how to use this new range of motion.
BENEFITS OF THE SHOULDER PAILS AND RAILS SEQUENCE
After a few weeks of being consistent with this exercise, you should start to notice that you have more range of motion before you feel the impingement in your shoulder. This should continue to improve as time goes on. Unfortunately, changing the function of your shoulder does take time, so be patient and results will come.
Another benefit of this exercise is when internal rotation is improved, many other motions of the shoulder are increased as well, meaning you’re bringing a better shoulder to whatever activity you’re doing like throwing, swinging, pressing, pulling, etc.
HOW TO PERFORM THE SHOULDER PAILS AND RAILS SEQUENCE
For the sake of avoiding confusion on the steps below, let’s pretend that your right arm is the arm you’re experiencing shoulder impingement in. I also recommend following along with the video above so you can take advantage of my coaching and cues.
Part 1: Stretch the Tissue Around Your Shoulder
Sitting in a chair, with your right elbow bent to 90 degrees, place the arm directly in front of your shoulder.
Place your left hand and forearm on top of the right forearm and elbow.
Keeping your elbow perfectly still, slowly pull your arm into internal rotation (the forearm of the right arm should fall inwards), by pulling your left elbow down until you feel a gentle stretch. If you feel any pinching, back out of the range until you feel no pain or pinching.
Maintain this position of stretch for 60-90 seconds.
Part 2: Strengthen the Tissue Around Your Shoulder
Remaining perfectly still, start to rotate your right wrist up into your left forearm via external rotation around a 3 to 4 out of 10 intensity for 20 seconds. You should feel the muscles that were stretching, are now contracting in the stretched position. Once again, if you feel pain or pinching, back out of the range to an area you can do this action with zero pain or pinching.
Relax your muscles and you should be able to sink deeper into the stretch.
Next, grab underneath the right arm’s forearm with your left hand. Imagine you're trying to pull up with these fingers and now start to contract the muscles of your right underarm and lats. You will not move at all, but with that resistance you're creating, you should feel like the muscles are starting to work a little. Continue for 20 seconds at a 3 to 4 out of 10 intensity.
Relax everything and sink back into the original stretch for 30 seconds.
Repeat both sets of isometrics one more time each, and then sit back into the original stretch for 60 additional seconds.
Slowly come out of the stretch.
Part 3: Activate the Tissue of Your Shoulder
From here, your right arm will feel very raw, so let’s bring it back to life.
Place this arm by your side, keeping it straight. Start to rotate the shoulder internally and externally staying pain-free for 10 slow reps.
IMPORTANT COACHING TIPS
Avoid Shrugging: When performing this exercise, the number 1 thing people do to compensate is shrugging their shoulder way too much. Shrugging allows you to trick your body into thinking you have way more internal rotation than you actually do. Resist the urge to shrug your way into this range of motion. Just remember to keep your shoulder away from your ear while doing this exercise.
Keep Your Intensity Low: I’m serious when I say, don’t get carried away with your intensity on these. We have a tendency to always want to crank on our joints or get the biggest, most painful stretch and that’s simply not necessary (or helpful). Keep the volume down and you’ll get where you want to go much faster.
Use a Mirror: I’d highly recommend sitting in front of a mirror if possible so you can check your form.
Progress Slowly: Trust me, as a former meathead, I went way too hard, way too fast in trying to fix my shoulder. Take your time progressing by slowly increasing the intensity of the isometrics.
HOW TO PROGRAM THE SHOULDER PAILS AND RAILS SEQUENCE
When first starting out, I recommend performing this sequence 2-3 times per week with at least one day of rest between. During the first few weeks, keep your intensity quite low and make sure you’re not feeling any pain or discomfort while doing this. If you feel any pain or discomfort, simply back out of the range a little until your shoulder feels safe.
Other shoulder related resources to help you relieve pain and increase flexibility:
YOUR STICKY SHOULDER SOLUTION
If you enjoyed this exercise and want to get the exact exercises I use with clients to relieve shoulder pain and increase flexibility, check out the Healthy Shoulders 10 Day Challenge. You can get back to your normal activities and I'll show you how in less than 10 minutes a day.
ABOUT COACH MATT PIPPIN
Matt is a Strength and Mobility Coach with over 15 years experience in his field and has coached over a thousand professional, collegiate and everyday athletes with the goal to help them move, feel and perform at their highest level. He's incredibly passionate about bringing simple and effective online mobility training programs to everyone who wants to take control of their self care and make lasting change.
Certifications:
NSCA Certified Strength and Conditioning Specialist
Level 3: Fascial Stretch Specialist
Level 1: Institute of Motion Health Coach
Certified FRC Mobility Specialist (FRCms)
Level 1 Kinstretch Instructor
Weck Method Qualified