What exercises are recommended for impingement syndrome?

Exercise Recommendations for Shoulder Impingement Syndrome

Supervised progressive strengthening and stretching exercises are the most effective treatment for shoulder impingement syndrome, with supervised programs combined with home exercises producing superior outcomes compared to exercise alone or no treatment. 1

Core Exercise Strategy

Primary Exercise Components

Implement a combined program of rotator cuff strengthening and scapular stabilization exercises, as all three major exercise types (open chain resistance bands, closed chain, and range of motion exercises) produce significant improvements in pain and disability. 2

• Supervised strengthening leads to greater short-term improvement in pain and disability compared to wait-listing or no treatment for variable duration impingement syndrome. 1
• Manual physical therapy combined with supervised exercise produces significantly better outcomes than exercise alone, with pain scores improving from 575.8 to 174.4 (versus 557.1 to 360.6 with exercise alone). 3
• Motor control and strengthening exercises result in significant improvements in shoulder function, with all subjects showing meaningful reductions in the Shoulder Pain and Disability Index (SPADI). 4

Specific Exercise Focus

Target neck, rotator cuff, and posterior shoulder girdle strengthening with emphasis on scapular stabilization and ergonomic positioning. 5

• Include stretching and range of motion programs to address kinematic deficits. 5
• Monitor specifically for impingement syndromes during breast cancer rehabilitation, as these principles apply broadly to shoulder impingement management. 5
• Progressive shoulder strengthening addressing core muscle groups (back, thighs, abdomen) should be emphasized. 5

Exercise Prescription Parameters

Frequency and Duration

• Perform exercises 2-3 days per week on non-consecutive days to allow 48-hour recovery between sessions. 6
• Each supervised session should last approximately 50 minutes when combined with circuit training. 5
• Twelve or more directly supervised sessions produce superior outcomes for pain and function compared to unsupervised home programs. 6

Intensity and Progression

• Begin with low resistance (40-60% of one repetition maximum) and progress gradually. 5
• Start with 2-3 repetitions if pain is significant, working up to 10-12 repetitions per set. 5
• Use the Borg Rate of Perceived Exertion scale at 12-15 for resistance training. 5
• Perform exercises through full range of motion at moderate to slow controlled speed. 6
• Rest 2-3 minutes between sets for optimal strength development. 6

Breathing and Technique

Maintain normal breathing patterns throughout exercises—never hold your breath or strain to avoid Valsalva maneuver. 7

• Execute movements in a rhythmical manner with proper form. 6
• Single-set programs are highly effective for beginners and promote adherence. 6

Specific Exercise Types

Strengthening Exercises

Open chain resisted band exercises, closed chain exercises, and minimally loaded range of motion exercises all produce significant decreases in pain, with no clear superiority of one type over another. 2

• There is insufficient evidence that specific scapular or proprioceptive exercise strategies are superior to general resistance exercise programs. 8
• Heavy load eccentric training does not add benefits beyond standard rotator cuff strengthening and physiotherapy for persistent impingement. 1

Flexibility Training

• Stretch all major muscle groups 3 times per week with 3-4 repetitions per stretch. 5
• Hold static stretches 10-30 seconds with 30-60 second rest between stretches. 5
• Exercise affected joints using a pain-free range of motion. 5

Treatment Duration and Outcomes

For persistent subacromial impingement syndrome, supervised and home-based strengthening leads to similar outcomes as surgery. 1

• Supervised strengthening and stretching produce similar short-term outcomes to corticosteroid injections for low-grade nonspecific shoulder pain. 1
• Continue exercises for a minimum of 3 months to obtain optimal benefits. 7
• Long-term adherence maintains benefits. 7

Critical Warnings and Contraindications

When to Stop Exercise

Discontinue exercise immediately if you experience:

• Unusual or persistent fatigue, increased weakness, or decreased range of motion. 5
• Joint swelling or pain lasting more than one hour after exercise. 5
• Discomfort in the upper body (chest, arm, neck, jaw) during exercise. 5
• Faintness or shortness of breath that doesn't resolve within 5 minutes of stopping. 5

Exercise Modifications

• Avoid vigorous, repetitive exercises during acute flare-ups. 5
• With shoulder metastasis in cancer patients, avoid extremes of range of motion. 5
• Gradually progress by adjusting duration, frequency, and intensity to reduce injury risk. 6

Common Pitfalls

• Dropout rates are higher with closed chain exercises, though patients who complete this program may achieve better outcomes. 2
• More patients deteriorate with minimally loaded range of motion exercises alone compared to resistance-based programs. 2
• Unsupervised home programs are less effective than supervised sessions for pain and functional outcomes. 6