supraspinatus tendon – ROCKSHOULDERS

Which exercises you can and can’t do with shoulder impingement depends on the severity of your symptoms. The more your shoulder pain restricts movement the more conservative your choice of exercise should be. In this blog, I discuss 4 levels of symptom intensity. They are based on when you feel pain in your shoulder while moving your arm. Do you experience pain below or above shoulder height, all the way overhead, or not at all? With this information, you can quickly find the safe exercises and the ones that aren’t. Before I discuss these exercises any further, I shortly discuss what shoulder impingement is. And how you rehab it most efficiently Let’s dive right in! 1. What is Shoulder Impingement? Shoulder impingement is a self-limiting condition with or without injury in the structures of your shoulder. Does that sound confusing? I understand, so I’ll explain. Originally shoulder impingement was understood as a literal impingement of the structures underneath the acromion. A bone that comes from your shoulder blade and forms a roof on top of your shoulder joint. The supraspinatus tendon was often thought to be the victim of the lack of space under the roof, resulting in a tendinitis type of injury. Classical Idea of Shoulder Impingement with compression of the Supraspinatus Tendon/Subacromial Bursa [Image taken from THIEME Atlas of Anatomy – M. Schuenke, et. al., (Thieme, 2010)] HOWEVER!: The special orthopedic tests that your orthopedic surgeon or physiotherapist uses to diagnose shoulder impingement aren’t reliable. Meaning, you can’t trust these tests to give you the information you’re looking for. And what about Magnetic Resonance Imaging (MRI) then? Well, an MRI is great to see if there is tissue damage. But tissue damage doesn’t equal pain. This is the main reason why I call shoulder impingement “sensitive shoulder” or “painful shoulder”. I explain the above issues with shoulder impingement in more detail in my blog about the differences between shoulder impingement and shoulder instability. So, if there isn’t necessarily something impinged in your shoulder, how then do you heal a painful shoulder? 2. How to Heal Shoulder Impingement Fast? From my experience, the fastest way to heal a painful shoulder is by following the steps below: Improve thoracic mobilityImprove scapular mobilityIncrease mobility of the shoulder joint itselfImprove kinesthetic awareness (the ability to control and position your joints) of the scapula and glenohumeral jointStrengthen the rotator cuff muscles and scapular stabilizersDo progressive strength training to increase the strength of the entire shoulder regionTransfer to sports-specific exercises. In the case of climbing, this would include pull-ups, inverted rows, hang boarding, system board training, and climbing easy routes where you practice optimal shoulder positioning The thing is, how do you know when to progress from one step to the next in the above healing scheme? Typically, a painful shoulder comes with a limited range of motion. Lifting your arms overhead is hard and putting your hand on your back as well. Also, either because of the pain or because of weak muscles, you’re not as strong in your injured shoulder as in the healthy one. This brings us to the three main issues with shoulder impingement: PainLimited range of motionReduction of strength Which Exercises are Beneficial and Which are Not with Shoulder Impingement? 3. Which Exercises are Beneficial and Which are Not With Shoulder Impingement? Since pain is restricting your shoulder movements, that’s what you’re going to use as a benchmark for your exercises. We can divide the movement restrictions into 4 levels: Severe limitations: pain moving your arm below shoulder heightMedium limitations: pain moving the arm above shoulder heightLittle limitations: pain starts when you move your arm overheadNo limitations: pain-free during all shoulder movements Based on these 4 levels of movement restrictions I will explain which exercises you shouldn’t do. Always start these exercises right at the start of your treatment, even though I only mention stabilizing exercises at step 4 in the 7-step program above. 3.1 Pain Moving Your Arm Below Shoulder Height Don’t do exercises that involve: Pushing horizontally or vertically (bench press, push-up, handstand, military press)Anything which forces you to lift your arm away from your bodyFast movementsAny form of climbing Generally, safe exercises are: Innies/OutiesDumbbell Row, Inverted Row (keep your elbows close to your body)Mobility exercises for the scapula and thoracic spine Otherwise, this is generally the phase of your healing where you rather do too little than too much. Your shoulder is sensitive, so give it some time to calm down. Do your exercises only once a day and keep it light while you do 3x15-20 repetitions. As soon as you notice that your shoulder pain starts only when you raise your arm over shoulder height you can diversify your exercises and increase intensity. 3.2 Pain Moving Your Arm Above Shoulder Height Don’t do exercises that involve: Pushing horizontally or verticallyAny overhead movementsFast movementsAny form of climbing Generally, safe exercises are: The exercises from the previous phaseSide Raises, Front Raises, Rear Delt RaisesAll rowing (horizontal pulling) exercisesScapula push-upsPull down exercises (from 90 degrees shoulder elevation/abduction downwards) 3.3 Pain Starts When You Move Your Arm Entirely Over Head Don’t do exercises that involve: Pushing vertically (or only with very little weight)Overhead rotation under forceClimbing that involves side pulls (outwards and inwards)Climbing overhang Generally, safe exercises are: The exercises from the previous phasesHorizontal Pulling (pull-ups, lat pulldown)Horizontal Pushing (push-ups, bench press)Climbing vertically with big positive holdsClimbing slabs 3.4 Pain-free With All Shoulder Movements All exercises are allowed but make sure to increase your training load slowly. The fact that you don’t feel pain anymore doesn’t mean your shoulder is at full strength. Slowly increase the weight of your exercises and reduce the number of repetitions. While climbing increase as follows on a 2-weekly basis: Slabs and straight walls with big positive holdsStraight and slightly overhanging with smaller but positive holdsOverhang and all holds including crimps and 1-2-3-finger pocketsRedpoint attempts in bouldering/sports climbing 4. Important Take-aways As you’ve read there is no bad exercise while rehabbing shoulder impingement. Which exercises you can or cannot do depend on what healing phase your shoulder is at. The easiest way to identify the right exercises is by observing at what point you start to feel pain in your shoulder when you elevate your arm. This doesn’t mean though, that you can’t feel pain or discomfort while exercising. In the case of a painful shoulder, I find a pain intensity of up to 4/10 acceptable. But it shouldn’t be a sharp knife-like pain or radiate to other body parts. Besides, the pain should go away as soon as you stop doing the exercise, and finally, never start a new training before the pain from last training has subsided.