Best Exercises for Shoulder Impingement & Rotator Cuff Injuries

hey everyone dr jeff peng here the goal of this video is to teach you about shoulder pain and rotator cuff disease and then how to fix it so that you can start feeling better we'll first talk about the most common cause of shoulder pain which is rotator cuff disease and then we'll go over the best treatment options as well as an exercise program designed to help rehabilitate the shoulder and get you back to being pain-free now if this is your first time watching one of my videos my goal is to help each and every one

of you live a healthy and active lifestyle so if that's something you're interested in please consider subscribing to my channel okay so the group of people who are at risk of developing shoulder problems is massive anyone who does any overhead repetitive activity involving the shoulder is at risk and this can be during work during sports or during recreational activity now on top of that anyone who is physically inactive or sits for prolonged periods of time is also at risk because this leads to tight and weak shoulder muscles now the overwhelming majority of people who have

shoulder pain have some type of rotator cuff disorder and rotator cuff disease is actually a progression of problems related to the shoulder muscles and tendons it progresses from subacromial impingement syndrome to partial tears of the rotator cuff to full thickness tears of the rotator cuff and then to massive tears and rotator cuff arthropathy and so the best way to understand rotator cuff disease is to first look at the anatomy so at the most fundamental level the shoulder is a ball and a socket joint and this allows us incredible degree of range of motion so when

we move our shoulders with any reaching or pulling or overhead movement our muscles help stabilize the ball in the socket and this prevents instability in the shoulder now the most important set of muscles that help do this are the rotator cuff muscles and we have four of them one in the front and three in the back and these are the subscapularis the supraspinatus the infraspinatus and the teres minor these four rotator cuff muscles along with all the other scapular stabilizer muscles help produce a nice smooth motion of the shoulder now because the rotator cuff tendons

are so important for the movement of our shoulders our bodies actually provide a lot of protection and cushion for them and these cushions are called bursa more specifically we are referencing the subacromial subdeltoid bursa now the other very important thing to point out here is that our rotator cuff and the subacromial subdeltoid bursa sit in a very small space called the subacromial space this is a very narrow tunnel where everything operates together and so anything that reduces or compresses the area in the suburbial space will irritate both the bursa and the rotator cuff and that's

going to lead to problems so now let's talk about people with rotator cuff disorders what's going on in their shoulders well at the heart of the problem is dysfunctional mechanics and the dysfunctional mechanics can be due to muscle weakness or muscle imbalance or muscle tightness it could arise from tears in the rotator cuff and that can be from trauma or injury it could also be from tendinopathy which is a gradual overuse or overloading disorder of the rotator cuff tendons and that too can eventually lead to weakness so dysfunctional mechanics and so whatever the cause may

be the end result is loss of the smooth motion of the shoulder due to dysfunctional mechanics so what happens with dysfunctional mechanics is that the ball of the shoulder is no longer stabilized in the socket so instead of staying in place as we lift the shoulder up it actually migrates upward and it migrates upward into the subacromial space and so remember when that happens well it's going to compress everything it's going to compress everything in the subacromial space which is the subacromial bursa and the rotator cuff and it's this repeated compression it's this repeated irritation

of the rotator cuff and the bursa that leads to rotator cuff disease the constant irritation of the bursa leads to inflammation of the bursa which we call bursitis and the repetitive trauma of the rotator cuff leads to tears and so what if someone already has a tear in the rotator cuff well that tear can get bigger and bigger and bigger until it ends up with a full thickness rotator cuff tear so this is clearly something we want to catch early and something we want to treat early most people who have rotator cuff disease have very

predictable symptoms and clinical findings they usually have pain with overhead motions involving the shoulder and this can include putting on clothes combing your hair opening cabinet doors or any type of lifting or pulling objects away from the body now pain usually localizes to the outside of the shoulder directly over where the inflamed bursa are located it's typically worse with moving the shoulder but it can also be worse at night sleeping can be especially problematic because pain can be worse when lying flat it can also be worse when lying directly on the shoulder or when sleeping

with the arm above the head you can even do a quick test to see if subacromial impingement syndrome or rotator cuff disease is the cause of your shoulder pain and so keep your arms down and your shoulder relaxed and then slowly bring your shoulder up towards the side of your head and if you have pain between here and here so as you're lifting up between 60 degrees and 120 degrees if you have pain in this area this is called a painful arc and a painful arc can be a sign of subacromial impingement syndrome because this

is where that bursa is getting impinged and so a painful arc is one of the many tools that i use to help diagnose people with rotator cuff disease or subacromial impingement syndrome okay so let's move on to treatment now the goal of treatment is to restore the smooth motion of the shoulder remember the problem with rotator cuff disease is dysfunctional mechanics and this can be due to muscle imbalance causing shoulder impingement it can be result of trauma or injury or it can result from tears causing weakness in the rotator cuff all of these will eventually

lead to abnormal movements of the shoulder resulting in pain so if we can correct the biomechanics through strengthening and rehabilitation we can recreate and restore the smooth motion of the shoulder and when you restore the smooth motion of the shoulder you no longer get impingement no impingement means no more inflammation no more inflammation means no more pain and this is exactly why just throwing all these anti-inflammatory medications at the problem is not a good long-term solution these medications can help treat the underlying inflammation but if we don't address the cause of the inflammation which is

the dysfunctional mechanics then the inflammation is going to come right back now with that said anti-inflammatory medications such as ibuprofen and naproxen still serve a very important role after all it can be very difficult to perform an effective exercise and rehab program if you are in pain and so what these medications can do is they can reduce pain and reduce inflammation so that you can do a rehab program more effectively they don't treat the underlying problem but if they can reduce your symptoms so you're able to do the exercises and we know that exercises will

treat the underlying problem then the medications serve a very important role and that's also why many doctors also recommend shoulder injections some people want to do their exercises they want to do physical therapy they want to do their rehab program but they can't because they're in so much pain and that's where shoulder injections come in this is a very quick and very safe procedure where we inject medications into the subacromial bursa to try to decrease pain and decrease inflammation now it's important to point out again that we're not fixing the problem with the injection what

we're doing is providing symptom relief now the goal of the injection is to decrease symptoms so that you can perform a home exercise program or that you can participate in physical therapy more effectively after all you can't expect great results if you're not fully participating in your rehab program now a quick note on surgery why not just jump straight to surgery if you have a rotator cuff tear well that's a great question and one that many patients actually ask about arthroscopic surgery to repair torn rotator cuff tendons especially the full thickness or the massive rotator

cuff tears have been shown to be beneficial but there are also many other studies looking at rotator cuff surgery compared to non-surgical management for the treatment of subacromial impingement syndrome rotator cuff tendinopathy and partial tears of the rotator cuff and all of them show that surgery may not be superior to conservative management and in my experience most patients do very well without surgery in the right clinical scenario even people with large full thickness tears of the rotator cuff can also do very well without surgery so the goal is to get people into an effective rehabilitation

program and this can be done either at home or at a physical therapy office now home-based shoulder exercise programs have actually been shown to be equally effective when compared to physical therapy in treating many painful shoulder conditions you just need to know what to do and then be diligent about doing the exercises remember the goal is to fix the dysfunctional mechanics of the shoulder we want to restore the smooth motion of the shoulder and changes like that don't happen if you only do the exercises once a week the rehabilitation exercises need to be done three

to four times a week at least for six weeks and if you ask why does it need to take so long well physiology if i went to the gym and i started doing bicep curls i don't have big biceps in two weeks it takes time usually it takes four to six weeks after starting a new exercise program before you start to see changes okay so we're going to go over one example of a really effective shoulder rehab program to help treat shoulder pain and to treat rotator cuff disorders now it's really important that before we

start any type of exercise it's really important to warm up so we're just going to first do 10 shoulder rolls forward so 1 2 3 4 5 6 7 8 9 10 i'm going to do 10 backwards 1 2 3 4 5 6 7 8 9 10. now we also want to warm up all our scapular stabilizer muscles you can do that just by doing scapular squeezes so you've got two shoulder blades in the back and you want to try to touch them together and hold it for about one second so one and we're just

going to do ten of these two three four five six seven eight nine ten so now we're gonna move on into our weighted exercises and for this you can either use a light dumbbell something like a two pound dumbbell you can also use a water bottle or a can of soup or you can use resistance bands now the goal is to be able to do three sets of ten but if you're having that acute shoulder pain or that subacute shoulder pain it's okay to do less repetitions and less sets and then build yourself up slowly

the goal is to slowly get to that three sets of ten and then slowly adding more weight as your shoulder gets stronger and your range of motion improves so the first exercise we're going to do is a forward shoulder raise so the right shoulder is the one i'm going to rehab today i'm going to have my dumbbell in my hand and then slowly bring it up to 90 degrees and then back down i'm just going to do our first set of 10. so 3 4 5 6 7 8 9 10. the next movement we're going

to do is a side raise and we call this movement abduction now the goal is to get to 90 degrees and stop but if you're getting to that impingement zone that around 60 degrees and you're starting to have pain it's okay to stop here and then slowly progress as your shoulder starts to feel better okay so one two three four five six seven eight nine ten the next movement we're gonna do is shoulder extension so we're just gonna reach our arm backwards now you don't need to go all the way up just stop at around

45 degrees okay so here's our first set of 10. one two three four five six seven eight nine ten okay now we're going to work on shoulder rotation so the first one is an outward rotation we call this external rotation all right so one two three four five six seven eight nine ten okay so now after outward rotation it's inward rotation or internal rotation of the shoulder okay ready one two three four five six seven eight nine ten so the next movement we're gonna do are rows so this motion now you can do this without

weights you can do it with dumbbells or you can do it with a resistance band just make sure that resistance band is tied around something super stable okay so we're gonna do our first set of ten ready one two three four five six seven eight nine ten okay so the last exercise we're going to do is a bent overarm raise and this is meant to target the trapezius so what i want you to do is hinge at the hips and bend over now you can hold on to a chair you can hold onto a desk

or you could just hinge over and then bring your arm up to 90 degrees just like that and we're just going to do our first set of 10 3 4 five six seven eight nine ten good the last thing we're going to do as part of our shoulder rehab program is to stretch now it's really important to stretch after working out it can help prevent injury it can help minimize pain and it can help restore range of motion so the first thing we're going to do is to open up the front of our chest so

clasp your hands behind your back push down and then push back so just like this and you're going to feel this stretch all over the front of your chest now it's really important to do this because we spend so much time in front of our computer so much time in front of our phones our ergonomics may not be the best and so we tend to be crowded around just like this and that causes a lot of tightness in the front of our chest and our shoulders so it's really important to try to open that up

through stretching so we're just gonna hold this for a few more seconds okay in three two one good so the next stretch we're going to do is shoulder external rotation which is this motion and we're going to hold this for a total of 30 seconds and so what i want you to do is bring this hand down and around and push down and so where you're going to be feeling this stretch is right all over in this region so as you push down you're going to be feeling this stretch and again it's really important because

we spend so much time in front of our computers that the back of our shoulders get really tight and so it's really important that we try to stretch this out so just a few more seconds here three two one good so the next stretch we're going to do is the posterior shoulder or the back of the shoulder so all you have to do is bring your shoulder around use this hand and push backwards and we're going to hold this for a total of 30 seconds now some people actually have pain in front of their shoulder

or some people have pain right here at the top of their ac joint and doing this stretch can actually load those areas a little bit more and cause some discomfort so if all you can do is get over here and as you're pushing back and you're feeling that stretch in the back that's fine you don't have to push all the way back like this to get this stretch so just you want to make sure that you're comfortable when doing this so three two one good the next stretch we're going to do is our inferior capsule

so bring your shoulder up bend your elbow use your other hand and just push straight down and where you're going to feel it is right at the bottom over here now again if you are having a lot of impingement signs in your shoulder and you're having a lot of pain because of impingement getting your shoulder up to this area can actually cause more pain so only do this stretch if it's comfortable for you and as you're doing the rehab as your shoulder starts to recover your range of motion is going to improve and then you're

going to be able to do this stretch a little bit more comfortably so just a few more seconds here in three two one good so the last stretch we're going to do is shoulder internal rotation and for this you can use that resistance band that you were working with earlier where i have a small towel and so what you want to do is throw the towel behind your back grab onto it with your affected shoulder and then pull up and so we're going to hold this for a total of 30 seconds and so my right

shoulder is not actually doing anything my left shoulder is the one doing all the work i'm pulling up and i'm grabbing on with my right shoulder and the right shoulder is really just going along for the ride so i'm just pulling up gently and then i'm feeling a big stretch in my right shoulder so we're just going to hold this stretch for a few more seconds here so in three in two and one good and that's it for the shoulder rehab program remember you're going to want to do this three to four times a week

for at least four to six weeks before you start to see changes be diligent about doing the exercises and this regimen will help relieve your shoulder pain if you found this information useful please like the video and share with others thanks i'll see you next time