Common Crossfit Injuries: Shoulder Impingement Part 2

Shoulder Impingement Exercises Rehab and Prehab

Preventing shoulder impingement is obviously better than curing it. Below is a selection of exercises that will improve shoulder stability and strengthen the shoulder external rotators these can be used to try and prevent shoulder impingements occurring or to rehab shoulder impingement injuries that you are already dealing with.
In Common Crossfit Injuries: Shoulder Impingement Part 1 we looked at what shoulder impingement essentially is and analysed some of the predisposing factors that can make you as an athlete more likely to suffer from this injury. If you read part 1 you’ll know that some of these factors are unchangeable (via conservative treatment) but that the majority factors that cause shoulder impingement you can actually do a lot about. So without further ado lets go through some exercises you can start right now to reduce your risk of shoulder impingement.

Improving Shoulder Stability

1) Serrates anterior

Your serratus anterior is a key muscle in the stabilisation of your scapula-thoracic joint. A weak serratus can reveal itself by allowing the medial border of your shoulder blade to lift off your rib cage. This is known as ‘winging’ (see pic). Here’s why it’s important for you to have a properly functioning serratus anterior:
A. If a teacher doesn’t turn up for class there’s always a supply teacher – If your serratus anterior is too weak to be able to stabilise your scapula other muscles will compensate in an attempt to stabilise the area. The problem is that these other muscles (e.g. rhomboids) when overactive create adverse alterations in the position of your shoulder blade leading to shoulder pain.
B. Missing member of the trio – We mentioned force couples in the last article and that the serratus anterior is a key upward rotator of the scapula during glenohumeral movements. If your scapula is unable to rotate fully upwards to orientate the socket for functional glenohumeral joint movement you will impinge and you won’t be able to achieve full range of motion at the shoulder joint without contorting the rest of your body into a weird horrible ugly mess (and even then it won’t be real full shoulder flexion, you’ll just think it is).
Common Crossfit Injuries: Scapula Protraction Level 1

Scapula Protraction Exercise level 1 is done whilst standing and with a light resistance band. Start by standing in a neutral position, place the band around your arms, straighten your arms out in front of you – parallel to the floor with your palms facing the ceiling whilst pushing out to the sides and creating some tension in the band.
To start pull your scapula back, squeezing your shoulder blades together. Then whilst keeping your arms straight and your elbows locked press your arms out straight in front of you as shown in the video.
Common Crossfit Injuries: Scapula Protraction Level 2

Scapula Protraction Exercise level 2 builds on the previous video as a way to strengthen your serrates anterior and avoid shoulder impingement injuries. This exercise is done whilst laying on the floor and with a light resistance band, and a light set of dumbbells . Place the band around your arms, grab your dumbbells and lay with your arms locked out and the dumbbells pushed towards the ceiling whilst creating some tension in the band.
Start by sinking your your shoulder blades back down into the floor. Then whilst keeping your arms straight and your elbows locked press your arms out straight uo to the ceiling as shown in the video, to start building your shoulder stability.

Shoulder External Rotator Exercises

2) Improving External rotation of the shoulder
There seems to be an unfair predisposition to having internally rotated shoulders. Kelly Starrett explains this really well in one of his journal videos by simply going through the shoulder internal and external rotators and highlighting the obvious mismatch. Let me illustrate the internal vs external rotators of the shoulder below:

I know 5 to 3 might not seem like a massive difference but when you look at the size of the internal rotators the external rotators are tiny in comparison. The point of me blathering on about this is the glenohumeral joint must externally rotate as you lift the arms up overhead to avoid the greater tubercle (an attachment site for the majority of the rotator cuff muscles) bashing against the acromion. If your shoulders are excessively internally rotated it’s more difficult for the external rotators to achieve this due to an altered length-tension relationship (the opposing muscles are stretched into a long and weak position). Here are a few ways to balance the equation:
Common Crossfit Injuries: External rotation Level 1

Closed chain internal rotation & Closed Change external rotation exercises.
Common Crossfit Injuries: External rotation Level 2

Building External Rotation and stability to avoid shoulder impingement.

Rotator Cuff Exercises

3) Supraspinatus and motor control
Without going into too much depth as this is just a recap from the Common Crossfit Injuries: Shoulder Impingement Part 1, the rotator cuff is the dynamic stabiliser of the shoulder (a very mobile joint). As soon as you start moving your arm the rotator cuff goes to work to keep the ball in the socket and stop it from bashing into all the neighbouring structures. Supraspinatus is arguably one of the more important of the rotator cuff as it plays a major role in the force couple with the deltoid (that’s maybe a story for another time). Below is an exercise to help you start building strength in the supraspinatus. I’d advise using light dumbbells for this (1-2.5kg) or you’ll start to recruit larger muscle groups.
Common Crossfit Injuries: Shoulder flexion

This exercise is great for rotator cuff rehab, it is meant to be done with an extremely light weight in order to recruit the weakest muscles in your rotator cuff.

I’d suffered ongoing shoulder problems for years, the pain used to keep me up at night. I thought I tried everything, then I was recommended GLC2000. Within weeks symptoms subsided and I was able to sleep through the night! Allison White

The online medical dictionary defines motor control as “the systematic transmission of nerve impulses from the motor cortex to motor units, resulting in coordinated contractions of muscles.” This basically means an effective coordination between your neurological system and the musculoskeletal system (or neuromuscular system) is required to ensure that smooth purposeful movement is able to occur (please note it’s a fair bit more complex than that, but that’s the basic idea.)
When trying to improve motor control of the shoulder I like to start with closed kinetic chain exercises. This is when the distal part of the limb is in contact with a stable surface e.g. a squat would be a closed chain exercise and a knee extension would be an open chain exercise. Closed chain exercises (with regards to the shoulder) help provide more sensory feedback and enhance proprioceptive co-contractions of the rotator cuff. Below is a video to get you started with improving basic motor control of your shoulder in various planes of movement.
Common Crossfit Injuries: Improving motor control

Shoulder Impingement Checklist

The take home message from these shoulder impingement articles is “treat your shoulders with respect and they’ll treat you with respect.” Stretch and mobilise regularly and don’t use and abuse. Ensure you have a sufficient and effective warm up for your shoulders if you’re going to be doing any upper body movements.
Poor positioning or muscular imbalances can lead to strains or inflamed tendons and ligaments. This leaves the soft tissue around your shoulder weaker and more prone to injury. There are also a number of useful ways to deal with niggling injuries such as shoulder impingements, shoulder tendinitis and even frozen shoulder that you can check out on the GLC2000 Joint Care Checklist.
Big thanks to Jean-Francois for demonstrating the exercises in the video
J.Glover BSc (Hons) Physiotherapist MCSP
Jay is an avid Crossfitter, and runs his Physiotherapy practice out of TRAIN Manchester, UK

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