Shoulder Impingement Exercises for Muscle Balance

by Dr. Phil on January 31, 2011

Shoulder impingement and rotator cuff injuries often respond well to physical therapy exercises. The success of the exercise program will depend on an accurate clinical assessment and an evidence-based approach to prescribing appropriate interventions. Two expert physical therapists and clinical researchers published an excellent review on the rehabilitation of shoulder impingement syndrome and rotator cuff injuries in the British Journal of Sports Medicine.  

Drs. Todd Ellenbecker and Ann Cools offer a well-detailed description of the literature behind range of motion limitations, scapular dyskinesis, and muscle balance. Both authors have published extensively in these areas of clinical research, giving them an excellent perspective at translating evidence into practice by sharing their expertise. Their article featured some unique exercises for restoring shoulder muscle balance.  

I was pleased to see discussion on muscle balance, particularly of the upper and lower trapezius, since this was the topic of my PhD dissertation. I was not surprised to see the discussion, however, since Ann Cools has been one of the top researchers in this area. When making a clinical decision on therapeutic exercise prescription, it’s not enough to just know which muscles are activated at the highest levels…the balance between muscle strength is just as important.  

Relative EMG activation between antagonist muscles must be considered, particularly the upper trapezius to lower trapezius (UT:LT) ratio in patients with shoulder dysfunction. As Dr. Vladimir Janda noted, the upper trapezius tends to be tight and strong, while the lower trapezius tends to be weak. While this imbalance is commonly noted in his Upper Crossed Syndrome, the imbalance is regularly seen in patients with secondary (functional) subacromial impingement.  

Cools et al. published an excellent paper on exercises with optimal UT:LT ratios. These exercises, as well as those suggested in Ellenbecker and Cools’ paper would be great choices for restoring muscle imbalance of the scapula and rotator cuff.  

Best Exercise for Upper Trap & Lower Trap Ratio

Used with permission The Hygenic Corporation

REFERENCE: Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010 Apr;44(5):319-27.

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