SHOULDER IMPINGEMENT RESET PROGRAM

 
 

PROGRAM OVERVIEW

PROGRAM OVERVIEW: Welcome to the EverAthlete Shoulder Impingement Program. This comprehensive program will tackle multiple common causes for shoulder impingement to maximize your chance of success. The program is divided into 8 progressive phases and each phase should last at least one week and we provide guidelines as to when to move on to the next one. At the end of phase 6, you will go through a series of tests to ensure you have achieved some important milestones. Phase 7 and 8 are for return to sport and may not be necessary based on your goals.

SESSION STRUCTURE: Each phase comprises a soft tissue, mobility and therapeutic exercise routine. The soft tissue and mobility routines should be done daily and the therapeutic exercises should be performed 3-4x weekly unless stated otherwise. Each full session should last approximately 30min.

EQUIPMENT: Lax ball, foam roller, suspension trainer. elastic band, dumbbells (light/medium), pull up bar.

FOCUS: This program is designed to help you overcome shoulder impingement pain so that you can eventually return to full performance. Initially, you will mostly work on soft tissue and mobility in order to reduce pain and restore full motion. As you progress, the stability and strength component becomes the primary focus and finally you will be taken through some performance training.

This program is for educational purposes only. You should consult your physician prior to engaging in this program.

PHASE 1

EDUCATION

PHASE OVERVIEW

Phase 1 is all about reducing pain. If you find that one or more exercises increases your pain too much, you should skip it for now or reduce the duration of it. 

EDUCATION

While phase 1 is all about reducing pain, try to differentiate between short lasting and long lasting pain. One exercise may temporarily increase your pain a little and that would be okay as long as it is not significant and that it does not linger longer than a couple hours. After performing it a few times, it should no longer be an issue.

When performing soft tissue work, you will likely find some tender spots which you will want to spend more time on. No need to smash as hard as you can. Slowly ease into the pressure, aiming to never let the tenderness reach beyond a 5/10 and focus on slowing down your breathing. Ideally exhale for twice as long as you inhale.

Lastly, some external factors may be influencing your shoulder pain. Things like poor sleep, nutrition and stress can all slowly wear you down to the point that you become injured. Most of us will look into our training and activities for a reason to the pain. The truth is that your training could be flawless, if you chronically sleep 6hrs you are much more likely to sustain an injury. In fact, research has shown that our risk of injury goes up if we sleep less than 8hrs and it only goes up more as we get less sleep.

ACTIVITY MODIFICATIONS

  1. Avoid/limit all painful activities as much as possible.

  2. Improve your sleep to get a sufficient amount.

  3. Give a try to an alternate sleeping position if you wake up from your shoulder pain.

  4. If you deal with stress, give a try to these breathing exercises to help reduce it.

SLEEPING MODIFICATION

BREATH WORK FOR STRESS

 

PROGRESSION CRITERIA

  1. You have achieve a pain reduction of >2/10.

  2. No increased pain from exercises.

  3. Tissue tenderness and range of motion have improved.

  4. You have spent at least one week on this phase.

SOFT TISSUE & MOBILITY

  • 1 ROUND:
    1) Lax ball pec roll (1-2 min)
    2) Upper trapezius Lax release (1-2 min)
    3)Thoracic spine foam roll (1 min)

  • 1 ROUND:
    1) Side lying rib cage opener (2 min each)
    2) Open book stretch (10 reps each side)
    3) Serratus rock backs (15 reps)

EXERCISE ROUTINE

  • 1 ROUND:
    1) Shoulder isometrics at less than 50% of your max (5 sec hold, 8reps each, 5 sec rest in between reps. Keep it pain free!)
    2) Prone scap retractions (5 sec hold, 8 reps)
    3) Supine chin tucks (10 sec hold, 5 reps)
    4) Elbow flex/extension isom. (5s hold, 8 reps each)

PHASE 2

EDUCATION

PHASE OVERVIEW

In phase 2, we are diving in more soft tissue work and adding a bit more exercises. The primary focus remains pain reduction. 

EDUCATION

Just as in phase 1, spend enough time working on the tender spots during the soft tissue work. Go easy as some spots may be very tender.

Continue to be diligent with your sleep, nutrition and stress reduction. It may seem trivial but they are the pillars of your recovery and ultimately your performance.

In the activity modification section, you will notice we are encouraging you to continue some form of aerobic activity. It serves two purposes. Maintaining an elevated heart rate for some time will indirectly improve blood flow to your injured tissue. Secondly, it may help with stress reduction and still give you a sense of accomplishment. The one caveat is that it should not be painful. Running, brisk walking, cycling are all valid forms of aerobic exercises. 

ACTIVITY MODIFICATION

  1. Avoid/limit painful activities as much as possible.

  2. Improve sleep duration and quality.

  3. Maintain alternate sleep position if it is helpful to you. 

  4. Continue with Box breathing for stress reduction.

  5. Maintain some aerobic activity but it needs to be non painful.

PROGRESSION CRITERIA

  1. You have experienced further pain reduction.

  2. You have no lasting pain from exercises.

  3. You are able to perform all exercises with proper form and  without excessive muscle fatigue.

  4. You have spent at least one week on phase 2.

  5. You have worked to reduce stress and improve sleep.

SOFT TISSUE & MOBILITY

  • 1 ROUND:
    1) Lax ball pec roll + pin stretch (1-2 min)
    2) Upper trapezius Lax ball pin stretch (1-2 min)
    3) Peanut shoulder flexion (1-2 min)
    4) Posterior shoulder foam rolling (1-2 min)

  • 1 ROUND:
    1) Open book stretch (10 reps each side)
    2) Quadruped thoracic rotation with superband (10 reps each)
    3) Half kneel hip flexor stretch (3 rounds, 30 sec hold)

EXERCISE ROUTINE

  • 2-3 ROUNDS:
    1) Shoulder isometrics at 70% or less of your max but it must be pain free (5s hold, 8 reps each)
    2) Prone scap retraction (5s hold, 12 reps)
    3) Supine chin tuck + head lift (10s hold, 5 reps)
    4) Sidelying external rotation (light resistance) (10 reps)
    5) Quadruped shoulder taps (10 reps each)

PHASE 3

EDUCATION

PHASE OVERVIEW

In phase 3, we are ramping up the loading of your rotator cuff. This group of muscles is essential to shoulder function as they stabilize the ball of your shoulder into the socket during activities. 

EDUCATION

In this phase, we are achieving rotator cuff strengthening with a sidelying external rotation with a light dumbbell. This exercise can be intense and you should feel happy to put the weight down at the end of each set. Some mild pain during the exercise is okay (<3/10) and again any lasting increased pain after the exercise would be an indicator to use a lighter load the next time. 

ACTIVITY MODIFICATION

  1. Continue to limit painful activities.

  2. Maintain sleep hygiene and duration.

  3. Maintain stress reduction strategies.

  4. Maintain some pain free aerobic activity.

PROGRESSION CRITERIA

  1. Your pain continues to improve with day to day activities.

  2. You do not experience lasting pain/soreness from the exercises beyond 12 hours.

  3. You are able to perform all exercises with proper form and without excessive muscle fatigue.

  4. You have spent at least one week on phase 3.

SOFT TISSUE & MOBILITY

  • 1 ROUND:
    1) Lax ball pec roll + pin stretch (1 min)
    2) Peanut shoulder flexion (1 min)
    3) Posterior shoulder foam rolling (1 min)

  • 1 ROUND:
    1) Open book stretch + arm circles (5 reps each side)
    2) Child pose lat stretch (10 reps, 5 sec each side)
    3) Half kneeling hip flexor stretch with thoracic rotation (10 reps, 5 sec on each side)

EXERCISE ROUTINE

  • 2-3 ROUNDS:
    1) Internal/external rotation isometrics at 90deg (8 reps, 5 sec)
    2) Prone W holds (10 reps, 5 sec with no weight to light weight)
    3) Shoulder taps on knees (10 reps each)
    4) Bodyweight rows (12 reps)
    5) Sidelying external rotation (eccentric focus 1:1:3, 8 reps)

PHASE 4

EDUCATION

PHASE OVERVIEW

In phase 4, we continue to progressively load your rotator cuff while also working more on stability. The same guiding principles are applicable. We are also challenging your mobility further with more active movements. As always, listen to how your body responds and adjust accordingly.

EDUCATION

The arm bar exercise can be challenging and sometimes a bit scary. Make sure you begin with a light weight or even no weight to become familiar with the movement before you progress to heavier loads.

We always advise you spend at least one week on each session but as you progress through our program, the complexity and difficulty increases so you probably will need longer than a week to master them and give your shoulder enough time to adapt to the new load. Trying to move too fast may cause you to experience pain again and have to backtrack.

ACTIVITY MODIFICATION

  1. Continue to limit painful activities.

  2. If feeling okay, gradually ease into some previously painful activities.

  3. Maintain sleep hygiene and stress reduction strategies.

PROGRESSION CRITERIA

  1. Some previously painful activities are no longer painful.

  2. No lasting pain with all exercises.

  3. You are able to perform all exercises with proper form and without excessive fatigue.

  4. You have spent at least one week on phase 4.

SOFT TISSUE & MOBILITY

  • 1 ROUND:
    1) Lax ball pec roll + pin stretch (1 min)
    2) Peanut shoulder flexion (1 min)
    3) Posterior shoulder foam rolling (1 min)

  • 1 ROUND:
    1) Open book stretch + arm circles (5 reps each)
    2) Foam roll pec stretch with angels (1 min)
    3) Kneeling bridge with overhead reach (6 reps each, 10 sec hold)

EXERCISE ROUTINE

  • 2-3 ROUNDS:
    1) Sidelying external rotation (tempo up/down 3:1:3, 8 reps)
    2) Prone T’s (10 reps, 5 sec hold)
    3) Bear shoulder taps (10 reps each)
    4) Arm bar (6 reps each with light to medium DB)
    5) Single arm TRX rows (8 reps each)

PHASE 5

EDUCATION

PHASE OVERVIEW

In phase 5, stability becomes the main goal and the exercises become more challenging. 

EDUCATION

Because the activities are becoming more challenging, it is crucial to maintain good form at all times. If you find your form breaking down due to fatigue, stop the activity and break it down into shorter sets. As you progress you will eventually be able to perform all sets and reps with good form.

Your shoulder should begin to feel a lot better during your daily activities and it is okay to begin a gradual return to some of them. Gradual is the key word. Both intensity and duration needs to be low and it should never lead to increased pain. For example, let’s say you have been able to resume 20 min of swimming without pain once. It does not mean, you are cleared to begin swimming longer or faster the next time. We suggest you swim again 2 to 3 more times easy for 20 min pain free before you try to swim more or swim faster. This is how you build resiliency and minimize your risk of re-injury. The same reasoning goes for any other activities that were previously painful.

ACTIVITY MODIFICATION

  1. Maintain sleep hygiene/stress reduction

  2. Gradual return to previously painful activities is key. Just because some activities might be pain free now, does not mean you can jump full throttle into them.

PROGRESSION CRITERIA

  1. Daily activities should be pain free or near pain free.

  2. You do not experience lasting pain or fatigue with the rehab exercises beyond 12 hours.

  3. You are able to maintain good form with all exercises

  4. You have spent at least one week on phase 5.

SOFT TISSUE & MOBILITY

  • 1 ROUND:
    1) Peanut shoulder flexion (1 min)
    2) Lats, teres major foam roll (1 min)
    3) Lax pec roll + pin stretch (1 min)

  • 1 ROUND:
    1) Foam roller pec stretch with angels (1min)
    2) Prone scorpions (6 reps each)
    3) Supine to prone rolls (6 reps each)

EXERCISE ROUTINE

  • 2-3 ROUNDS:
    1) Plank shoulder taps (8 reps each)
    2) Arm bar (heavier weight, 6 reps each)
    3) Prone Y’s (10 reps, 5 sec each)
    4) Single arm/Single leg TRX rows (8x each)
    5) Half kneeling punch with trunk rotation (8x each)
    6) Theraband tempo external rotation (8 reps, tempo 3:1:3)

PHASE 6

EDUCATION

PHASE OVERVIEW

In phase 6, we continue our forward progression and this may be your final phase if your goal is not to return to sports. This phase also contains a checkpoint made of a series of tests to ensure you have reached certain milestones.

EDUCATION

We have designed a checkpoint with several tests to ensure that you have hit some benchmarks and minimize the risk of re-injury in the future. We feel strongly about those and we take all of our one-on- one clients through these tests before we begin any training with them. If they don’t score well, we focus on that prior to beginning any serious training and so should you!

Do not panic if you do not score well on some of those tests. It simply means you need to continue working on phase 6 a little longer and maybe increase loading a little more.

ACTIVITY MODIFICATION

  1. Maintain the sleep/stress improvement strategies you have implemented.

  2. When returning to sports activities, never get to the point of pain.

  3. Always progress duration first over intensity/load.

PROGRESSION CRITERIA

  1. You do not experience pain from the rehab exercises.

  2. You have spent at least one week on phase 6.

  3.  You obtained passing scores on phase 6 checkpoints

For your progression beyond this phase, please click the “Phase 6 Checkpoint” Tab

SOFT TISSUE & MOBILITY

  • 1 ROUND:
    1) Peanut shoulder flexion (1 min)
    2) Lats, teres major foam roll (1 min)
    3) Lax pec roll + pin stretch (1 min)

  • 1 ROUND:
    1) Floor angels (1 min)
    2) Prone scorpions (6 reps each)
    3)Supine to prone roll (6 reps each)
    4) Prone to supine rolls (6 reps each)

EXERCISE ROUTINE

  • 2 -3 ROUNDS:
    1) Plank to toe taps (8 reps each)
    2) Prone scaption (10 reps)
    3) Plank to flags (8 reps each)
    4) ½ Turkish get up (6 reps each - light to medium weight)
    5) Single arm/Single leg TRX rows + rotation (10 reps each)
    6) Overhead farmers carry (30 sec each)

PHASE 6 CHECKPOINT

If you have made it to phase 6, you should be feeling pretty good right now and you may wonder when you can resume your sports activities without risking re-injury. We created this checkpoint to help you make that decision. You will go through a series of tests to assess your mobility and stability of your shoulder. While it cannot 100% guarantee you will not experience pain again in the future, good scores should reduce that risk significantly.

  • Purpose: Evaluate any limitation in thoracic spine (mid back) mobility as it may cause pain and compensations in the shoulder, neck and low back.

    Method:

    Position: Kneeling position against the wall. The wall is parallel to your side.

    Tools: Phone/inclinometer and partner

    Testing procedure: In a kneeling position, sitting on your heels, place your forearms on the floor with your elbows touching the inside of your knees. Place the hand away from the wall behind your neck and rotate upward. Prior to rotating, have your partner locate the lower part of your shoulder blades and place the phone in between them. They then read the angle once you have fully rotated.

    Common mistakes: Not sitting on your heels and not placing the elbows on the insides of your knees.

    Scoring criteria:

    Pass: 45 degrees or more
    Fail: less than 45 degrees
    Note any side to side difference and the presence of pain.

  • Purpose:
    Evaluate the global mobility of your shoulders in different planes. Poor mobility of the upper and mid back may negatively impact this test (assessed with the kneeling thoracic rotation test). Having good shoulder mobility is important for swimming but also any other sports/activities that heavily use the upper extremities.

    Method:

    Position: Standing

    Tools: Partner

    Testing procedure: In standing, in one smooth motion, reach one arm behind your head and one arm behind your back as far as possible. Your hands are making a fist. Do not allow your ribs to flare out, your back to arch or your head to come forward. Your partner uses their hand to evaluate the distance between your fists.

    Common mistakes: Ribs flaring out, not maintaining a neutral spine, head traveling forward, and not doing the movement in one smooth motion (wiggles to get there).

    Scoring criteria:

    3/3: One hand or less fits between your fists

    2/3: Over 1 hand but less than 1.5 hands fit between your fists

    1/3: Over 1.5 hands fit between your fists

    Score of zero if there is any pain

  • Purpose: assess your capacity to maintain a stable shoulder in weight bearing and your capacity to maintain a stable spine and pelvis. It is especially relevant for activities that require maintaining a stable shoulder and spine.

    Method:

    Position: plank position

    Material: timer

    Testing procedure:
    In a plank position, feet/hands shoulder width apart. Pick one hand off the floor, place it on the opposite shoulder and hold for 45 seconds. Maintain your hips/shoulders square with the ground. Do not let your shoulder sag or creep up toward the ear. Perform on both sides.

    Common mistakes: excessive shifting side to side, shoulder blade winging, shoulders creeping up to the ears, not maintaining a neutral spine, bending of the knees.

    Scoring criteria: Pass or fail

    Pass: able to maintain plank for 45 seconds with square hips/shoulders while maintaining a long neck. Use the lowest score to grade the test.

  • Only focus on the side plank test and not the side pank + lift

    Purpose: assess your capacity to maintain a stable shoulder in weight bearing and your capacity to maintain a stable spine and pelvis.

    Method:

    Position: side plank

    Material: timer

    Testing procedure:
    In a side plank with staggered feet. Head/shoulders/hips and feet are in a straight line. Maintain position for 45 seconds without compensation. Perform on both sides.

    Common mistakes: head/shoulders/hips/feet are not in a straight line, rotate, or drop.

    Scoring criteria: Pass or fail

    Pass: able to hold for 45 seconds without compensation

    Use lowest score to grade test.

  • Purpose: assess the capacity of your shoulder blade muscles and rotator cuff to support your shoulders in a variety of positions and movements. It is especially relevant for swimmers. Weakness is also commonly found in people with a history of neck pain.

    Method:

    Position: flat on your stomach

    Material: timer, dumbbells (3# for females - 5# for males)

    Testing procedure: on your stomach with a dumbbell in each hand, lift your arms off the floor into a W position (it may be helpful to have someone check you are in a proper W form). Your head is also off the floor in line with the rest of the spine. Hold that position as long as you can, elbows remain at 90 degrees and your wrists are level with or above your elbows.

    Common mistakes: shoulders have crept up towards your ears, your wrist have fallen below your elbows, your elbows are not at 90 degrees. (Note: it may be helpful to have a partner assess the test for you as it is easier for them to spot compensations and manage the timer).

    Scoring criteria: Pass or fail.

    Pass: you must be able to maintain the position without compensation or pain for 45 seconds.

The first 2 tests are for mobility and if you did not score optimally, we suggest you continue the soft tissue and mobility sections of this rehab of phase 6. Another option is to check out the mobility interventions we provide in our mobility section.

The last 3 tests are testing stability and if you did not perform optimally, we suggest you continue working on phase 6 therapeutic exercises a while longer or check out the interventions for those deficits in our stability section. 

Lastly, pain is complex and sometimes there is more to it than mobility, stability and strength. Sleep quality, adequate nutrition, stress from work, life and training can also contribute to pain. Those are important factors to consider as well to optimize your recovery and future performances. 

PHASE 7

EDUCATION

PHASE OVERVIEW

In phase 7, we begin training for more challenging activities for sports performance. Aim to maintain good form with all exercises and at this point they should absolutely be pain free.

EDUCATION

During this phase, pay special attention to the shoulder depression exercise as it is a prerequisite to be able to perform pull safely and efficiently. Make use of the cues and scaling options we provide in the videos.

The Turkish get up is a difficult exercise involving multiple movement fundamentals. It takes time to master and may take several weeks of training and coaching to get it perfectly. In the framework of shoulder rehab, you are mostly focused on maintaining shoulder stability in each of the different positions you move through. Pause for a second in each one of them to ensure your shoulder and neck is properly positioned. 

ACTIVITY MODIFICATION

  1. Maintain sleep and stress improvement strategies you have implemented.

  2. Continue with a gradual return to sports.

PROGRESSION CRITERIA

  1. You do not have pain during your return to sports.

  2. You do not have pain with all exercises.

  3. You are able to maintain good form during all the exercises.

  4. You have spent at least one week on phase 7.

EXERCISE ROUTINE

  • As needed (refer to previous phases for instructions)

  • 1 ROUND:
    1) Supine to prone roll (5x each)
    2) Prone to supine rolls (5x each)

  • 3 ROUNDS
    1) Prone swimmers (10x reps)
    2) Turkish get up (light to medium - 6 reps each)
    3) Hanging shoulder depression (6 reps)
    4) Half kneeling shoulder press (light to medium - 8 reps each)
    5) Wall plyo push ups (6x each)

PHASE 8

EDUCATION

PHASE OVERVIEW

Phase 8 is the last one of our progression and it is designed to fully prepare you for full steam training both in and out of the gym.

EDUCATION

This rehab program may have been your first exposure to strength and stability training. Hopefully you realized the value of a well designed strength training plan to help you stay injury free and perform at your best. We encourage you to check our online strength training plans and fill out our training questionnaire for guidance on where to start. Feel free to reach out with any questions. 

ACTIVITY MODIFICATION

  1. Aim to maintain the sleep and stress improvement strategies that you have implemented.

PROGRESSION CRITERIA

  1. You performed phase 8 for at least one week for the prescribed amount of times.

  2. You are able to match the speeds of your sport without pain or form degradation.

  3. You are able to perform all exercises without pain and good form.

  4. You have no signs of irritation after the sessions.

SOFT TISSUE & MOBILITY

  • As needed (refer to previous phases for instructions)

  • 1 ROUND:
    1) Supine to prone roll (5x each)
    2) Prone to supine rolls (5x each)

  • 3 ROUNDS:
    1) Pull up (assisted or unassisted - 3 to 5 reps)
    2) Weighted prone swimmers (10 reps each)
    3) Plyo push ups (on your knees) (6 reps)
    4) TRX fallout (8 reps)
    5) Standing overhead press (light to medium weight - 8x each)