A common injury with the shoulder is shoulder impingement. Rotator cuff exercises are important on helping your client recover from shoulder impingement.
What is Shoulder Impingement?
When the non-injured arm is at your side, there is about 6 to 14 mm of space in the subacromial space (the space between acromion and humerus). As one moves their arm out to the side (abduction), the space in the subacromial space decreases. With some people the humerus and acromion end up pinching the structures in the subacromial space. The structures that could be pinching are the bursa, supraspinatus tendon or long head of the biceps tendon. This pinching is called shoulder impingement. Shoulder impingement is a big problem and commonly seen in my clients. If shoulder impingement is not addressed it could lead to a partial or full tear of the rotator cuff.
What could cause your clients shoulder impingement is their rotator cuff. I know this kind of sounds strange but let me explain how your rotator cuff could be the problem.
#1) Weak Rotator Cuff
If your client has weak rotator cuff muscles, they won’t be able to externally rotate the glenohumeral joint. This won’t allow for the greater tuberosity from moving out of the subacromial space which leads to the greater tuberosity compressing against the acromium and the contents in the subacromial space.
It is one of the reasons why it is so important that you focus on rotator cuff exercises that help improve your client’s rotator cuff strength.
#2) Tight External Rotation
If your client has limited range of motion in external rotation, once again the greater tuberosity does not get out of the way during abduction which will lead to impingement. The big reason why there is a decrease in range of motion tightness is tight internal rotators of the glenohumeral joint.
Combined with a weak rotator cuff, this is a very bad problem. If the rotator cuff does not have the strength to overcome the tight internal rotators, it could be a big reason why your client has shoulder impingement.
You need to focus on all the muscles that are tight in internal rotation of the glenohumeral joint, for example, pectoralis major and latissimus dorsi. I go through this in The Most Effective Rotator Cuff Exercise Program.
#3) Posterior Capsule Tightness
Many times clients with shoulder impingement will have posterior capsule tightness. This will lead to the humerus external rotating and will change the position of the greater tuberosity. With the change in the position of the greater tuberosity, when your client abducts it leads to decrease space in the subacromial space and could lead to shoulder impingement.
It is important you include posterior capsule stretching for your clients with shoulder impingement.
If your client has shoulder impingement, you need to focus on rotator cuff exercises and stretching commonly tight muscles around the rotator cuff.
I go through all of this in the Effective Rotator Cuff Exercise Manual.
Rick Kaselj, MS