One of the goals for treating shoulder impingement is more normalized movement. A customized exercise plan will help with this, but with all the scapular exercises out there, which are going to be the most effective when it comes to strengthening periscapular muscles?
What Does the Literature Say?
A systematic review conducted in 2004 by Lori Michener, Matthew Walsworth, and Evie Burnet1 looked at the effectiveness of rehabilitation for patients with Subacromial Impingement Syndrome (SAIS) and found that strengthening the scapular stabilizing muscles was preferable to no treatment.
Paula Ludewig and Jonathan Reynolds2 demonstrated that, compared to healthy shoulders, shoulders with impingement present the following differences:
- Less scapular upward rotation
- Less scapular posterior tilting
- Greater scapular internal rotation
- Greater compensation from the upper trapezius
Ludewig and Reynolds go on to suggest the following interventions for SAIS:
- Serratus anterior strengthening or retraining
- Upper trapezius activation reduction
- Posterior shoulder stretching
- Pectoralis minor stretching
- Thoracic extension posture and exercises
Alisha Fey and her research team3 also noted the important roles played by the serratus anterior, the lower trapezius, and the middle trapezius in producing scapular upward rotation, posterior tilting, and external rotation of the scapula.
Choosing Exercises to Target Shoulder Muscles
So what are the best individual exercises to accomplish these strengthening goals? We’ve broken them down by the specific muscles they target:
- Push-up with plus
- Dynamic hug
- Serratus punch at 120 degrees flexion
- Prone full can
- Prone external rotation at 90 degrees abduction
- Prone horizontal abduction with external rotation
- Bilateral external rotation
- Prone row
- Prone horizontal abduction at 90 degrees abduction with external rotation
Alternatives for Those Who Can’t Perform Prone Exercises
You may have noticed that many of the exercises listed are meant to be performed in a prone position. But what if you work with a population who are unable to tolerate prone exercise or don’t have the means to replicate these exercises outside of a therapy session? While exercises performed prone are often highly effective, they can’t be performed by everyone, and this can result in low carryover at home.
Mike Cricchio and Cindy Frazer4 published a narrative review of electromyographic studies for scapulothoracic and scapulohumeral exercises. This study leads to the recommendation of effective alternative exercises that don’t require a prone position:
- Isometric low row
- Inferior glide
- Wall slide
The literature supports therapeutic intervention in those who have been diagnosed with shoulder impingement and notes the importance of addressing the scapula. Learning which exercises are the most effective and recommending them when appropriate will help get your patients back to their meaningful occupations using their upper extremity.
Regardless of which setting you practice in and the population you serve, my course, Treatment of Shoulder Impingement, will provide you with a variety of exercise techniques to fit the unique needs of your patients and your setting.
- Michener, L.A., Walsworth, M.K., & Burnet, E.N. (2004). Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. Journal of Hand Therapy, 17(2), 152 – 164.
- Ludewig, P.M., & Reynolds, J.F. (2009). The association of scapular kinematics and glenohumeral joint pathologies. Journal of Orthopedic Sports Physical Therapy, 39(2), 90 – 104.
- Fey, A.J., Dorn, C.S., Busch, B.P., Laux, L.A., Hasste, D.R., & Ludewig, P.M. (2007). Potential torque capabilities of the trapezius. Journal of Orthopedic and Sports Physical Therapy, 37(1). A44 – A45.
- Cricchio, M. & Frazer, C. (2011). Scapulothoracic and scapulohumeral exercises: a narrative review of EMG studies. Journal of Hand Therapy, 24, 322 – 334.