Understanding Shoulder Impingement
Shoulder impingement (subacromial pain syndrome) occurs when tendons or bursa are compressed between the humeral head and acromion during arm elevation. The root cause is almost always poor scapular control and/or rotator cuff weakness.
Phase 1: Symptom Control
Modify activity to avoid overhead provocation. Ice after activity. Subacromial corticosteroid injection (if severe) provides window for rehabilitation to begin.
Scapular Stabilization Exercises
Wall slides, band pull-aparts, prone Y/T/W, and serratus anterior wall push-ups restore proper scapular upward rotation and posterior tilting — the fundamental mechanical correction for impingement.
Rotator Cuff Strengthening
External rotation and infraspinatus strengthening balance the force couples that center the humeral head, eliminating the mechanical cause of impingement.
Return to Overhead Activities
Progressive overhead loading is introduced only after scapular control and rotator cuff strength are normalized, ensuring the subacromial space is maintained throughout the range.