My case is a little different than the rest of the lot. Hi Mark, First of all thank you for this very detailed and pedagogic topic. Some people do it less, but if you want to give your shoulder the best opportunity to heal, you would want to keep the frequency as high as you comfortably can. Without moving your shoulder blades, bring your arm across the body. Iâve been doing physio for months and months, but my shoulder continues to flare up likely because of poor posture at my desk (Trying to break that habit) . Progressive loading of the rotator cuff tendons will help improve the muscle and tendons capacity to manage load. Apply more tension to the band if you would like to increase the stretch. Depress the humeral head throughout movement. Philip Isaiah here, came from your winged scapula post and iâm very thankful for the free advices online. Additional info: It feels like my neck loosens up a bit when excercising, even if I don’t workout my upper body – as if moving around makes it better. You can try gently pressing into the muscle (Scalenes) where it is marked ‘X’ on the picture of the last comment I sent to you. Nights are super painful. Do you know why this has happened, or how to fix it? Iâm really eager to hit the Gym as soon as possible. What’s your view on posture correctors/braces? If you are really excited about getting your shoulder impingement to improve fast, you should add in some neck and shoulder stretching as well. If your C7 nerve is swollen, this should help out quite a bit in the initial stages. I took anti-inflamatory pills and 2 cortison injections. It’s never too late to fix an issue. Will stretch internal rotators as well. For more information: Medical disclaimer. Then progress functional movements. You would have to have a look at how your shoulder is specifically moving as you perform the bench press. Then almost 2 years after the initial injury, I seemed to aggravate it again. Hey Mark, I am 20 years old and have been facing shoulder impingement for 1 year now. Hi Mark I’ve been doing light internal rotation strengthening exercises, x2 for 10 seconds on each side (pressing inwardly on a doorway with elbows by my side) and am still getting some mild burning pain in my shoulders that comes about 6 hours later and last for a day or two, should I scale it back and just focus on the decompression and scapula activation or is mild burning pain part of the initial strengthening process for the rotator cuffs when recovering from impingement, Kind regards Max. Occasionally I get some pain but it goes away. If you can not completely stop, try to perform the activity so that there is less/nil pain. Thank you. Doctor said swollen bursa and calcification of tendon in right shoulder, two of the above symptoms movements where painfully (the last 2) now I hate cortisone but I gave in and had it twice and never again! Just be careful not to push your shoulder too far. At the end of the exercises, your muscles should be tired! I would also opt to avoid surgery… even if there are tears! My head pulls to the same side as my injury (the right side) in a tilted fashion and anytime I try to straighten up it causes my head to shake due to the muscular tension. I’d love to try your recommended exercises, but for now, pretty much anything is too sore. But since your shoulders are specifically giving you issues, you can start by addressing your rounded shoulders and see how you respond to that. The ache would go away once I got up and started moving. Just happened so not sure of results yet. I had a shoulder injury during my Benchpress. Come join me on the Facebook page. Even if I lift my arm a bit, I feel the sharp pain. Do not over squeeze your shoulder blades together! Recently, I am having numbness down my arm and into the thumb and index finger on right hand. If I bend my pointer finger I can feel a strange pull and slight pain in my hand. I also do several exercise that you mentioned in the article. Please can you clarify? I ask you because i ve got the feeling that this exercice is both quite painless and both developing a bit my side deltoids. Seeing as I didnt see a doctor for 2 years from the initial injury, do you think it’s too late to fix or a permanent problem? None of the exercises should cause any pain. Range of movement good with regards to elevation and abduction, small disrupted rhythm of movement. one little question, How do I know that I am able to progress from the decompression stage to the strengthening stage, I have been doing this for 2 weeks and have seen significant improvement but I don’t want to try and strengthen my internal and external rotation unless I know i’m ready to progress, I can hang loosely on a pull up bar for 20-30 seconds at a time if that helps to give you an idea of where I am at, Thankyou! Iâm a 36 year old male who, ever since college had been out of shape. But I can lift and move my affected hand in all directions while it is stretched. I was diagnosed with shoulder impingement in November 2018. Thanks so much for this Mark. Im not sure if itâs how I sleep but I canât pinpoint any other activity that would cause the pain, itâs always worse when I wake up, it can go from 0 pain to 10 overnight. That’s a hard question to answer without seeing you. I really enjoy that kind of training so I don’t want to stop that activity. But it comes and goes. the pain that limits the movement, no idea where it comes from…. Iâm getting little bit pain while Iâm stretching backwards and Iâm not feeling comfortable as another hand. Can a shoulder impingement cause a winged scapula? My massager only has settings for 20-30min sessions of either a)2,4,6Hz b) 9,7,5,3Hz and c)1,4,20, 1,4,40, 1,4,60Hz. If itâs only 5 minutes, wouldnât it be a problem to only apply either, 2Hz, 9Hz or 1,4Hz and no other frequencies? Physical therapist said the muscles feel like little knots around the right shoulder blade and the bone isnt holding tight(it flares out slightly). If sleeping on the painful shoulder is the only cause of your symptoms, I would recommend to sleep on the other side (or your back) for the time being. Mark, I am a 67 year old male who has been working out since 15. This is very confusing. How much more time do I need to take rest? Strengthens your upper arm and back with shoulder workout. I have been dealing with shoulder impingement for over 5 years after trying physio, PRP,etc. Make sure to follow me on Facebook to be notified when I do start to make videos. Listen to your body! Hi Mark, Great article. Then he said my problem is shoulder impingement, he asked me meet physical therapist to ask some therapy. Apply an appropriate amount of your body weight on to the ball. I have full range of movement and no strength loss, however my scapula on the affected side might have some winging and makes a huge crunching sound when raising my arm above head, although this doesn’t cause much pain. 1st doctor (physical rehabilitation doctor): my supraspinatus was torn around 4 mm (checked by USG), the doctor ask me to rest and do physical therapy (heat and electric), and wait the tear recover itself. Hey Mark, I have had a shoulder impingement for awhile and PT has helped me significantly and the shoulder pain is significantly gone (really dont have much at all) however my PT tells me of serratus weakness and that it âsticks out and we need to strengthen it.â I have been doing the stretches and serratus exercises I am supposed to be doing but not noticing a significant improvement in my scapular movement and im noticing many workouts I do in the gym I have a difficult time with getting the same feeling of muscle contraction as I do on the noninjured side and I also see visible muscle imbalances between both sides of my body. This may be indicative that you have weak shoulder stabilising muscles (namely the rotator cuff and serratus anterior) and/or tight inferior capsule/lats/triceps. by about 50% in 8 to 12 weeks. I’ve started doing yoga again 3 months ago and the pain is back. Yes they have looked at my scapula control and thoracic spine and they seem to be fine. 4th- Rounded shoulders? Place one arm across the front and pull it in tight with the other. But that’s not all. If your MRI recommended a cortisone injection, you can try a strong dose of Ant-inflam meds for 2 weeks to see if it helps before considering the cortisone. Thanks for all the detail. I’m past the mobility phase and into strengthening and scapular positioning. Hi Mark, I’ve had shoulder impingment the last 4 months. I would also suggest that you ask your therapist to check to make sure you have full glenohumeral joint internal rotation in the 9090 position with hitching. It has been a huge help. Later I saw a physiotherapist, chiropractor and acupuncturist and the results were terrible, now I have dizziness, trouble swallowing, inflammation that swells the veins of the whole body, and after seeing the chiropractor I developed lower back pain in the mornings, unless I place a folded sheet underneath the lumbar area. Without full internal rotation, you are a higher risk of injuring your shoulder (esp when you reaching behind you). It is common to have a few issues at the same time in the shoulder. Just looked at one of the tests with arm behind the back and I can move my left arm away but the injured one I can’t. Image courtesy of stockimages at FreeDigitalPhotos.net. In many cases, pain can also refer down the side of your upper arm.Â (see above). I would check this first. This suggests that you may have elements of Frozen shoulder. Hey Marc thank you for those informations. Thanks again for all the information. I am not the biggest fan of the injections, but in some cases, it might give you a bit of momentum in the beginning as you start your rehab. The scans have shown Inpingement and Bursitus and my consultant is now suggesting a Cortisone injection. Couldnt scratch my back for 3 years now. I also have some pain near my collar bone near AC joint when i do some exercises or try to get my scapula in the ideal position. The scapula is in a position of anterior tilt and downward rotation which can increase the chance of compression occurring in the subacromial space. 1. Make sure you can feel a gentle contraction between your shoulder blades. I’ve been weight lifting since Febuary of last year and noticed weak shoulders from the beginning, which was perhaps a lack of good form in pushing exercises. Hold it for 10 seconds, repeat 10 times. I’ve been following a physio routine (not yours – I did start yours last week) for nearly 5 months now and while the pain has subsided, I still can’t even do a pushup or bench press an empty bar without setting off the inflammation again. 2. Keep constant tension through resistance band throughout movement. The second time this year my schoulder hurts so much I can’t even use my arm. I am taking ibuprofen, fish oil, tumeric capsules. In the past, Iâve also tried the muscle release with a ball to no avail, which is why I got the massager. Thanks for all of the great tips and exercises. It’s all about strengthening the range of motion that is currently available. Great advice! From here, you can start to get back to the level you were before. My doctor informed me that I need a surgery Biceps Tenodesis. Should I continue but follow your guide instead or what do you recommend I do? Iâve been doing physical therapy for my hips but canât afford to do any for my shoulder or to get it looked at in case they insist I canât play softball. Just beginning this painful journey but will be following your treatment as well as my doctorâs. Could this cause impingement and how do I stop doing this in my sleep???? Thanks Mark, sorry for commenting again, but I’m afraid I was a little ambiguous. A course of diclofenac has eased the symptoms. Hi Mark! Otherwise – it is common to develop some shoulder issues (especially impingement). Thanks for your help, your website and information is brilliant. However, she never got any anti-inflammatory drugs. The exercises mentioned on this blog post might help with that. Hi Mark! Example: External rotation (with flexion). I was told by doctors to get an arthroscopy done but I dont want it. Try to utilize isometric pauses at this deep level. ‘Square’ your shoulder blades back. Generally shoulder/upper back and neck tightness and aching. I have had shoulder imingement since January in both shoulders, worse on left. Rheumatologist wants to do ultrasound guided steroid injection but now I’m scared to after reading on several websites that they’re not that useful. I would start with 1/week and see how the body responds. • ‘Square’ your shoulder blades back. I have postural issues as well – do you think it might come from things like rounded shoulders, winged scapula forward head and so forth? Looks like you have what we refer to as SENSITISATION. 2. I would focus on internal rotation exercises. Hello mark. once I release everything and do some light lateral raises / serratus anterior strengthening / External rotator strengthening everything feels amazing like its gliding and getting stronger. Thank you so much for the comment, Steve! Surprisingly I had no pushing power, it felt like I couldn’t fire my left tricep, but no pain. If you have shoulder impingement, running through these exercises would be a good place to start. I have tried physio as well and it did helo a bit but then I stopped doing the exercises because I got busy with exams. Results: If your shoulder pops up before you reach 60-70 degrees of pure shoulder movement, then you lack internal rotation. They should help you nicely. I still have 99% ROM but I try my best not to move my shoulder. If one shoulder is lower, ‘square’ it by lifting that one, UP and back. – Pain with elevation such as when you are doing your hair, try doing it with your elbow pointing directly towards the floor at all times. Is it possible that you may have Thoracic Outlet syndrome? Aim to feel a downward pulling sensation in your shoulder. Progress to these Shoulder Impingement exercises only if you are able to conduct the previous Shoulder Extension, Adduction and Internal rotation exercises easily. (… do NOT wear it for longer than 1-2 days!). Place your shoulder muscles into a massage ball onto the floor. Hi Mark! And 2) how long do you recommend staying away from lifting before I begin getting back into it, starting with lighter weights to “test it” and ease into it? dead lifts is the main one, but anything where your upright and holding weights by your side). 1. 3rd doctor: he diagnosed I have SLAP tear, asked me do MRI. How often should I do Shoulder impingement exercises? In trying the three tests you provide, each recreates the pain for me. Hey mark, I have started doing the exercises you have mentioned. I have had a MRI arthrogram and it came back clear so i am wondering what is recovery time for this. Most people tend to have their elbows flaring outwards for some reason (most likely due to poor work station ergonomics). Most painful to me is trying to put my hair up because it involves keeping my arm up . Thanks for the reply. Also would you recommend doing these reehab exercises for a few weeks and then gradually reintroduce chest and shoulder workouts? Steve. What exact structure you have implicated is hard to say! You could even lie slightly more so onto the right shoulder with the left half of your body propped up and supported by the pillow wall. No tingling or numbness either. Here is the instruction how to do it: 3. I prefer products with natural active ingredients likeÂ arnica, calendula orÂ hypericum. I’m glad to report that the shoulder impingement in my left shoulder (which came along with an AC Joint Tear) has now healed following your advice and additional exercises provided by my physio. If you have difficulty hanging out your clothes on the clothes line… you can do the following exercise: If you have been persistent with these shoulder impingement exercises and are still experiencing symptoms, consider addressing the following postural issues: HavingÂ Rounded ShouldersÂ is when the resting shoulder position is inÂ frontÂ of the mid line of the torso. The article is very detailed and articulated. Pain is on outside of upper arm and shoulder. (heaps of them on youtube). If there is a postural component leading to excessive amount of stress on those said tendons, you will need to address this as well. It can help if you visualize how the scapula should be moving as you use your arm. She suggested physical therapy and icing which I’ve been doing for several months now. Do you have any tips on how to prevent further injury and to heal while working a job like this. For the past 6 months or more, I had pain in my arm; specifically on the biceps tendon. The doctor thinks it could be an inflamed bursa. I typically start as soon as the inflammation has gone down and I have full range of motion but the last two times I’ve done that, the inflammation flares up again the day after. Impingement syndrome is characterized by pain in the shoulder due to inflammation of the tendons of the rotator cuff or the bursa (subacromial bursa) that sits between the rotator cuff and the roof of the shoulder (acromion). Based on that, you will need to do specific exercises to address the specific problem. The scapula should sit flat on the rib cage throughout movement. Chest Stretch. Hi Mark, great website. Slowly return the hand back to shoulder height, If this hurts, you may want to start at a lower height. Improves your ability to pull and lift. Hello Mark, I donât know if you could help me with some questions I have about using an electric massager, one of those that uses electrodes. Do not push into pain (esp. Sounds like a shoulder impingement. You might need to do more specific exercises for your shoulder. Make sure you have full shoulder internal and external rotation. Just a last question: should i get a massage for my shoulder and elbow or will it increase the pain. With each frequency changing every 5 minutes. I`ve been struggling with a shoulder impingement for a few years now. However my impingement keeps coming back after a week or so of little to no pain. I saw your whole shoulder impingement guide and was curious if you could answer some questions. Would you be able to advise me if any of the following exercises I am currently doing will aggravate my subacromial impingement? It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Furthermore should I start with the given 7 steps if there is an obvious inflammation of the area? If you have no external rotation, that would be a good place to start. Iâve tried 2 weeks of Advil but I canât keep taking them due to gastritis from the anti inflammatories. The best advice I can give you is to just to find 1 simple exercise that you can do multiple times throughout the day that does not significantly increase your symptoms. Love your articles they are pretty much the only thing keeping me sane. don’t let it tilt to one side as this can pinch a nerve). Tingling in the arm/hand is suggestive of nerve involvement. But oh! This is to make sure that you do not aggravate the symptoms in your shoulder. But the pain remained. Before I went to him I’d been doing the stretches and was doing the rehab exercises consistently – before trying just rest. Keep constant tension on theÂ resistance band throughout movement. ( any recco on sleeping position?). Done lots of research but canât find an answer ð¢. Iâve been struggling with my impingement for about three months. triceps). Months later my shoulder has almost a completely full range of motion but I hear a click in Munich shoulder every time i bring it all the way up to my ear and i can now move it differently (almost feels like my shoulder is falling) kinda feels like Iâm putting it back into place has I rotate my shoulder also experiencing a few other things only on my injured shoulder. It doesnt hurt immediately, but a day or two after im in agony. I can’t find any reference to these. Just make sure they go don’t go too hard in the painful areas. Recently we talked about hanging as well, I don’t have a pull up bar though so I’m considering getting one. I wouldn’t rely on it in the long term though. I went for acupuncture and also had the cortisone injection. Always warm up your shoulder before performing your frozen shoulder exercises. Hey Mark! It’s weird, almost feels like it’s out of position, or moved up? They say that the problem is that there is less space in my shoulder which pinches the tendons. I have a weak / inactive Serratus Anterior, and I also have a huge knot in my back on the left side around the supraspinatus and infraspinatus. A small amount of pain is fine. If you have pain on initiation of the movement, you might be over straining the tendon in the shoulder. This makes so much sense to me Now!!! I have never had a shoulder injury and I cannot believe how LONG it is taking to heal. This can make the pain shoot up from 0 to 10 over night. Whats hurting? Using the momentum of your arm, gently swayÂ your arm side ways/forwards/backwards/circles. (most commonly Supraspinatus). Only got one exercise to practice, but seem to have all the symptoms described here. Right arm in my clothes, as in normal dressing, is not as easy as it should be, as is attempting to scratch my back with my right hand, which is nearly impossible. I think I might have to change my sleeping habit. Kind Regards Farhan. Try to keep the shoulder as active as possible! Push the side of your arm against a wall as hard as you can with nil pain. Thanks so much for getting back to me Mark, I actually meant deltoid pain, not biceps. Do you think I should wear nay of those? Put one arm out at shoulder level with your elbow bent to 90 degrees and your hand down. I can do normal works. I experience a lot of shoulder grinding when I externally rotate and have a lot of shoulder weakness i.e vibrates when i do any exercise. In the vast majority of people, this injury is not permanent. Can you suggest methods to strenghten these areas and also is there any pillow that I can purchase that would put less pressure on my arm. 2. Quick tip: When you do use your shoulder, try to keep your elbows as close to the side of your body as possible. 1. Thanks again Mark, you’re such a good man, helping so many I wholeheartedly agree, Dr’s tend to diagnose fibromyalgia when they just don’t know or have given up. I wish i had found this site last year. (of course – always seek medical advice regarding medication). Neck pain could be caused by a shoulder impingement, and pain in the shoulder could be stemming from the neck. I think the excercises might help with the bloodflow in the tendon as well? It is to get back into pain-free bench pressing. Find out which exercises … The next day while attempting to do pushups at home, my shoulder gave. You have provide some and are much appreciated i hope this can get back to at least 60? Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Just saw your blog so haven’t started any of the exercises you recommend yet. You might need to do some specific exercises for the tendon involved as well. Not sure what. Your explanations and the visual aids have helped me get a better “feel” for what’s happening when I move, and how to go about the exercises. My shoulder has been causing me pain for a couple years, but started hurting more this past summer. To move to correct impingement in my arm in a neutral position the symptoms seem to an! Pay attention to how your body weight into the socket when in a while you strengthen the tendon! Pretend your fingers up a frozen shoulder, although you may want to consider at! Good in the thoracic spine and they made the left side of neck important of! ItâS very painful, and some minor scapular winging injury and to heal subsided! An assessment by the sound of it, though a living so ’. Shoulder socket.Â ’ 18 your arms relaxed any idea what exactly is causing your issues. And teres minor chance before even considering surgery for shoulder impingement. )? … leave me comment. It felt like I couldn ’ t drive January – I have taken 2 cortisone shots ( no )! 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