What is More Important Range of Motion or Shoulder Tightness in Shoulder Impingement Clients

I am a bit of a journal geek.

I like reading journal articles.

My wife has House & Home and I have journal articles from PubMed Central.

I wanted to share with you an article that I read.

I will try to filter through all of the mumbo jumbo and highlight what you need to know in order to help your clients.

A common injury found in active people is shoulder impingement.

Many times the focus of their exercise program is to increase the range of motion in the affected shoulder.

Is this the right thinking?

Should the focus be on decreasing the tightness of the posterior aspect of the shoulder?

Read on to find out.

Range of Motion versus Decreased Shoulder Tightness

After a course of physical therapy consisting of stretching and mobilization exercises of the posterior shoulder, research shows that complete resolution of internal impingement symptoms is associated with correction of posterior shoulder tightness but not with glenohumeral internal rotation deficit or GIRD improvement.

GIRD and posterior shoulder tightness have been suggested as causative factors in internal impingement of the shoulder, a shoulder injury mainly seen in throwing athletes.  The tightening of posterior shoulder capsule results in abnormal motion of the humeral head with passive shoulder flexion, which in turn, causes the decrease of subacromial space during overhead movements.

GIRD is considered as an adaptive mechanism to repetitive overhead motions, where gradual increase in external rotation and decrease in internal rotation occur. Shoulder pain and decreased full internal rotation of the shoulder develop when the rotator cuff tendons or posterior labrum are pinched between the humeral head and shoulder socket.

3 Key Points about Range of Motion and Shoulder Tightness

1)  Glenohumeral internal rotation deficit (GIRD) and posterior shoulder tightness have been linked to internal shoulder impingement.

2)  Clients with internal rotation impingement who had received stretching and mobilization for 3 to 12 weeks with a physical therapist had a decrease in shoulder impingement symptoms.

3)  In people that had a decrease in shoulder symptoms after the stretching and mobilization, were the clients that had a decrease in posterior shoulder tightness.  Improvement in GIRD did not affect symptoms.

Take Home Message (THE PART YOU MUST READ!)

It is important to have a qualified health care professional perform mobilizations on your client that has internal rotation impingement.  It is also important for you to focus on stretching out the posterior aspect of the shoulder.

Plus, what was not mentioned in the abstract was the subjects also did scapular stabilization exercises and rotator cuff exercises every day.

If your client does all four things, they have a good chance of overcoming shoulder impingement.

If they only focus on one, their chances don’t look good.

Where to get More Details

Tyler TF, Nicholas SJ, Lee SJ, Mullaney M, and McHugh MP. (2010). Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010 January, 38(1):114-119.

Thanks for reading the blog.

If you would like to read another article that I did on pec stretch for shoulder impingement, click here.

I would love to hear what you think of this.

Rick Kaselj, MS