Exercises and Stretches to Heal Shoulder Impingement Pain
"Shoulder impingement is commonly caused by an imbalance between the strength and flexibility of the muscles that stabilize the shoulder joint."
— American Academy of Orthopaedic Surgeons (AAOS)
Shoulder impingement is one of the most common conditions I see as an occupational therapist. It can affect everything from basic daily tasks to more complex movements, causing pain and limiting function. In my experience, the right combination of targeted exercises and stretches (while limiting pushing and overhead movements) can make a significant difference in restoring mobility and strength.
Shoulder impingement often stems from muscle imbalances, poor posture, or repetitive overhead movements, but it is highly treatable with consistent rehabilitation. I wrote a detailed article on the ins and outs of shoulder impingement including how to know if you have it. Today, I’ll walk you through some of the most effective exercises and stretches to help alleviate discomfort and prevent future injury.
Best Exercises for Shoulder Impingement
1. Scapular Retraction
The scapular retractors, including the rhomboids and middle trapezius, play an essential role in stabilizing the shoulder blade and maintaining the integrity of the subacromial space during shoulder movement.
How to Do It: Sit or stand with a neutral spine. Retract your shoulder blades by pulling them medially toward the spine, while avoiding elevation and keeping the shoulder down. Hiking the shoulder is the most common error I see for first-timers performing this motion. Elevating will only make it worse. Hold for 5-10 seconds, then release. Perform 2-3 sets of 10-15 repetitions.
Upgrade: If you can do 3 sets of 15 reps with 10 second holds per rep (it can get boring) then work up to using resistance (cable, machine, or resistance band) to do the same movement. Then progress to one-sided sets to further challenge your stability and core strength.
Biomechanical Benefit: Strengthening the scapular retractors enhances the scapulohumeral rhythm, promoting proper movement of the scapula and preventing excessive upward migration of the humeral head during shoulder abduction and flexion.
2. Rows
Rows are a fantastic exercise for targeting the muscles of the posterior chain, particularly the rhomboids, trapezius, and lats. They also help enhance scapular retraction and shoulder stability, which is vital for preventing shoulder impingement.
How to Do It: Using a resistance band, dumbbells, or a cable machine, keep your torso neutral and knees slightly bent. Pull the weights or band towards your torso while retracting your shoulder blades together. Focus on keeping your elbows close to your sides and avoid using momentum from your lower back. Perform 3 sets of 10-12 repetitions.
Upgrade: Remove the chest support you may be doing. Also work up to doing one side at a time to engage the core and increase stability and the rotation.
Biomechanical Benefit: Rows strengthen the muscles responsible for scapular retraction and shoulder stabilization, helping to maintain proper shoulder positioning during movements and reducing the risk of shoulder impingement.
3. Horizontal Abduction
Horizontal abduction works the posterior deltoid, infraspinatus, and teres minor, strengthening the muscles responsible for external rotation and abduction of the arm.
How to Do It: Lie on your stomach on a bench or stand while bent forward. Hold a light dumbbell in each hand. With elbows straight, lift your arms out to the sides and back, creating a horizontal "T" shape. Focus on pulling your shoulder blades together during the lift. Perform 2-3 sets of 10-12 repetitions.
Upgrade: Increase the resistance of the band or use dumbbells while leaning forward from a standing position.
Biomechanical Benefit: This exercise helps improve scapular stabilization and external rotation, preventing forward rounding of the shoulders and encouraging better posture. This also minimizes impingement risk during overhead movements.
4. Open Book Half Kneel
This exercise works on thoracic spine mobility while also improving scapular retraction and shoulder stability. It's excellent for those who experience shoulder tightness and impingement.
How to Do It: Start in a half-kneeling position, one knee on the ground and the other foot flat. Place your hands together in front of you with arms extended, then slowly rotate your upper body to one side, opening your arms like a book. Follow the moving hand with your eyes. Hold for a brief pause, then return to the start. Perform 2-3 sets of 10 repetitions on each side.
Upgrade: Use a resistance band held by each hand. You can also do a version of this from an all-fours or quadruped position with one hand planted on the ground and the other “threading the needle” through the body and then rotating all the way around the other direction.
Biomechanical Benefit: This exercise helps improve thoracic mobility, which allows for better shoulder movement mechanics. Improved thoracic rotation prevents compensatory movements in the shoulder and enhances overall posture and scapular positioning.
5. External Rotation with Resistance Band
The external rotators of the shoulder, primarily the infraspinatus and teres minor, are often weakened in individuals with shoulder impingement. Strengthening these muscles improves glenohumeral joint stability.
How to Do It: Attach a resistance band to a fixed point at elbow height. Hold the band with your elbow flexed at 90 degrees, forearm perpendicular to the torso. Rotate your arm externally, keeping the elbow close to your side. Return to the starting position. Perform 3 sets of 12-15 repetitions.
Upgrade: Do it in a sidelying position with a dumbbell to limit any compensation. Then work up to doing it from a side plank position.
Biomechanical Benefit: Strengthening the external rotators enhances the ability of the rotator cuff to depress the humeral head, thereby maintaining optimal subacromial space during shoulder movement.
6. Prone Y-T-W-L
This exercise targets multiple regions of the scapular musculature, including the lower trapezius and serratus anterior, which are critical for scapular upward rotation and stability during arm elevation.
How to Do It: Lie prone on an exercise bench. With your arms extended, raise them to form the letters Y, T, W, and L by squeezing the shoulder blades together. Perform 2-3 sets of 8-10 repetitions for each letter.
Upgrade: Add in some lightweight dumbbells (no more than 3-5 pounds) and increase the range of motion by doing it face down on a weight bench.
Biomechanical Benefit: Improves scapular retraction, depression, and upward rotation, which are necessary to avoid shoulder impingement during humeral elevation.
7. Serratus Anterior Punch
The serratus anterior muscle is critical for scapular protraction and upward rotation, which helps maintain the integrity of the subacromial space during shoulder movements.
How to Do It: Lie on your back with a dumbbell in the affected arm. Hold the weight with your elbow fully extended. Without moving your arm, punch the ceiling by protracting your shoulder blade. Slowly return the shoulder blade back to the ground. Perform 2-3 sets of 10-15 repetitions.
Upgrade: Do these from a plank or bear plank position. Once you’ve mastered that, do single-arm versions using a cable positioned out in front of you.
Biomechanical Benefit: Strengthening the serratus anterior reduces the risk of scapular winging, improves scapulohumeral rhythm, and prevents impingement by promoting correct scapular upward rotation during shoulder flexion and abduction.
8. Scaption
The scaption exercise works within the scapular plane, which is approximately 30 degrees forward of true shoulder abduction. This movement pattern avoids excessive stress on the rotator cuff while still engaging the supraspinatus and deltoid muscles.
How to Do It: Stand with dumbbells in each hand, arms by your sides. Elevate your arms in a ‘V’ shape (30 degrees from the body) without shrugging the shoulders or arching the lower back. Lift to less than nipple height, then lower slowly. Do not elevate higher until you are sure your shoulders do not hike or round. Perform 2-3 sets of 12-15 repetitions.
Upgrade: Lean over an incline bench or do them standing with a slight forward lean. Increase the dumbbell resistance. This is an easy one to have a poor form on so use a mirror as visual feedback.
Biomechanical Benefit: Scaption activates the supraspinatus in a safer, less provocative range of motion compared to traditional abduction, minimizing the risk of compressing the soft tissues under the acromion. This is one that I incorporate as a priming exercise between sets in the gym holding a couple of 5 or 10-pound plates.
Best Stretches for Shoulder Impingement
1. Subscapularis Release
The subscapularis is a crucial muscle in the rotator cuff, located on the anterior (front) side of the shoulder blade. Tightness in this muscle can limit shoulder mobility and lead to impingement.
How to Do It: First you need to find the hidden subscapularis muscle. Start by raising your arm to shoulder height, then use the thumb of your opposite hand to reach into the back of your armpit, where your shoulder blade meets your ribcage. The subscapularis can be tricky to find, but once you feel tenderness, you’ve likely found it. This muscle is commonly overworked and may feel quite sore. If using your hand feels awkward or uncomfortable, try placing a broom or mop in a corner, then lean into the top of it so it presses into the area. Move your body slightly to pinpoint the tight spot, and once located, gently massage it for 1-2 minutes. The more tender it is, the more time that needs to be spent on it.
Biomechanical Benefit: Releasing tension in the subscapularis promotes better internal rotation and improves the ability of the shoulder to move more fluidly.
2. Pectoralis Minor Stretch
Tightness in the pectoralis minor muscle can pull the coracoid process anteriorly, contributing to an anteriorly tilted scapula, which narrows the subacromial space and promotes impingement.
How to Do It: Stand facing a wall with one arm raised at a 90-degree angle. Press your forearm and elbow into the wall while rotating your torso away from the arm to stretch the pectoralis muscle. Hold for 20-30 seconds, repeat 3 times.
Biomechanical Benefit: Lengthening the pectoralis minor helps restore scapular retraction and promotes proper alignment during shoulder movement.
3. Cross-Body Shoulder Stretch
Tightness in the posterior deltoid and posterior rotator cuff muscles can limit range of motion and contribute to the compression of the rotator cuff tendons.
How to Do It: Bring your arm across your body, holding the elbow with the opposite hand. Gently pull your arm across until you feel a stretch in the back of the shoulder. Hold for 20-30 seconds, repeat 2-3 times.
Biomechanical Benefit: Improves flexibility in the posterior deltoid and posterior capsule, reducing abnormal compensatory movements that can lead to impingement.
4. Thoracic Spine Extensions
Poor thoracic extension often leads to compensatory rounding of the shoulders, which can narrow the subacromial space and increase the likelihood of impingement.
How to Do It: Place a foam roller horizontally under your upper back. Interlace your fingers behind your head, and gently extend your thoracic spine over the roller. Hold for 10 seconds, then return to neutral. Perform 2-3 sets of 5-6 repetitions.
Biomechanical Benefit: Increasing thoracic extension helps maintain proper alignment of the scapula and humeral head, improving overhead shoulder mechanics.
Tips and Things to Consider
Seek Professional Guidance: Consult with a physical therapist, occupational therapist, certified trainer, or other reputable healthcare provider before beginning these movements. They can help you assess the issue and address it with good form. Without these, you may make the impingement worse.
Get Mobed, Stretched, and Scraped: Some trained professionals can help restore the alignment of your shoulders through scapular mobilizations, humeral distractions, and with the use of scraping tools like instrument-assisted soft tissue mobilization (IASTM).
Prioritize Proper Technique: Maintain good form during all exercises to avoid aggravating existing issues. Focus on controlled movements and proper alignment, particularly during shoulder exercises. Watching yourself in a mirror can help provide visual feedback and correct any poor mechanics. The biggest issues I see:
Hiking the shoulders during exercises: This activates muscles like the supraspinatus and upper traps which exacerbates the issue. Instead, “push the elbows in your pockets” as you do these exercises to turn on the scapular depressors.
Relying on momentum: Rely on slow and controlled movements without using momentum to achieve the range.
Going too big too early: The muscles you’re addressing are not meant to be bulging. They’re stabilizers meant to provide support. Go slow and low with the weights.
Avoid Overhead and Pushing Movements: Initially, limit overhead exercises or movements that can exacerbate shoulder impingement. Focus instead on strengthening the muscles around the shoulder joint with targeted exercises that do not strain the area. I typically recommend avoiding all pushing, overhead reaching, and internal rotation exercises for at least 2-4 weeks and then, once the other issues are addressed, I recommend a return to these movements with a push-to-pull ratio of 1:3 or 1:4. That is, for every 1 push or closing exercise (e.g. chest press), do 3 pulls or opening exercises (e.g. lat pulldown, row, external rotation)
Monitor Pain Levels: Be mindful of any pain during exercises. If you experience sharp or persistent discomfort, stop the activity immediately and consult with a healthcare professional. Pain is a signal that something may not be right.
Make Lifestyle Changes: In addition to addressing the muscle imbalance with exercise, you need to address the lifestyle factors that created this imbalance. Check out my article on shoulder impingement to find specific ideas.
Practice Patience: Recovery from shoulder impingement takes time. Be patient with yourself and focus on gradual progress rather than pushing through discomfort. Consistency and mindfulness in your practice will yield better long-term results.
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