Please note: The video on this page was updated on May 1, 2020 to include additional techniques. The new content begins at 5 minutes 47 seconds.
Shoulder Impingement often occurs in the narrow space between the head of the humerus and the acromion process of the scapula. The supraspinatus tendon goes through that space, and there is a bursa above it called the subacromial bursa.
One of the functions of the rotator cuff muscle group is to provide an inferior pull on the humerus to help maintain this space. If the rotator cuff muscles are weak the head of the humerus can move in a superior direction and cause impingement.
One sign of impingement is a “painful arc”. When abducting the arm to the side there may be pain between 60 to 120 degrees of abduction, but then no pain beyond 120 degrees. A simple test for impingement is to place your hand on the opposite shoulder, then lift your elbow toward your forehead. If this causes pain in the shoulder it is likely from impingement.
For treatment have your client in a side-lying position. Stand at your client’s head, then using the fingers and palms of both hands glide down the upper trapezius then down the deltoid while pressing your palms toward each other. The intention is to lengthen the muscles and put a downward pull on the humerus.
I learned this technique originally from James Waslaski. www.orthomassage.net
Inferior Glide – Passive
Another technique is to stand at your client’s side and place one hand on the proximal humerus. Slowly abduct their arm overhead while maintaining a distal pressure with your hand. Stop if there is pain. All treatment must be pain-free.
Inferior Glide – Active
If that is tolerated well, hold your hand on the proximal humerus and have your client actively abduct their arm overhead, stopping if there is pain. clients with impingement syndrome often can abduct further provided there is a downward pressure on the humerus.
If your client has rounded shoulders and the head of the humerus is anterior in the socket, you can help to create a posterior glide of the humerus in the socket. With your client supine stand at the side of the table and place your hands on the anterior arm just above the level of the deltoid insertion. Have your client flex their elbow then slowly reach up toward the ceiling while you provide moderate resistance while still allowing them to move. The intention is to provide leverage to move the head of the humerus posterior in the socket.
No matter how effective our treatment is, clients may go back to their same habit patterns and have a recurrence of pain. Self-care techniques are important for clients to maintain and improve on the gains they get with your treatments. Here is a self-care technique for impingement problems: