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Ask the PT: Exercises for Shoulder Impingement

Shoulder Impingement Physical Therapy in Westchester

WSPT,

I live near your Yonkers location and I have shoulder impingement. I want to devise a physical therapy program that includes exercises that involve external rotation however I am already doing rear delt exercises on a combination peck-deck rear-delt machine. I don’t do these as therapy, but in my regular weight training workouts. My concern is that I don’t want to mimic any external rotation movement that I may be doing already on the rear delt machine. Below are some web links of trainees doing the same rear delt movements I am referring to.
http://www.bodybuilding.com/exercises/detail/view/name/reverse-machine-flyes
https://www.youtube.com/watch?v=9Gx2LF48rRA

So my question is, are these weight trainees accomplishing external rotation with their rear delt machine exercises? Are these rear delt machine exercises good for external rotation?

Thank you,
Clay

Good question Clay,

A shoulder impingement can mean many things. In most cases shoulder impingement syndrome involves the head of the humerus (arm bone) pinching another structure against the acromion (socket of the shoulder blade). Structures that tend to get impinged are:
The tendon of any one of your four rotator cuff muscles
The biceps tendon
The subacromial bursa
Any combination of the aforementioned

If untreated or repeatedly irritated, the impinged structures start to shred and ultimately tear. This is a very common cause of rotator cuff tendonitis and tears. Making matters worse is that once the rotator cuff is impinged, it begins to function less effectively in it’s role of depressing the head of the humerus during shoulder movement, the exact function that prevents shoulder impingement.

In order to relieve the irritation of shoulder impingement syndrome and restore proper shoulder mechanics, it is important to achieve normal shoulder rotation range of motion and strength. In the rehab setting, we usually achieve this by performing isolated rotator cuff exercises to engage the internal and external rotators at low resistance and ensure that neuromuscular pathways are intact. During physical therapy sessions with us in Yonkers and the Bronx, once we are comfortable with the patient being able to utilize these muscles, we gradually progress them to more integrated exercises and functional movements.

Getting to your specific question – Is the reverse fly machine good for isolating external rotation of the shoulder? In the video you provided, I would venture to say that the guy doing the exercise is doing very little shoulder external rotation. In fact, his shoulders are in an internally rotated position (palms facing down), virtually eliminating the external rotators. He likely is firing his rear delts, mid traps and lower traps. This is not a bad exercise. It will help stabilize your shoulder blades, which is an important factor in preventing impingement syndrome, but it is not an external rotation exercise.

There are 2 simple exercise used to isolate the external rotators of the shoulder. The first is the side-lying external rotation with or without weight:
Lie on your side with your affected side up, i.e. lie on your left side to work your right shoulder. Bend and stack your knees for stability.
If working your right shoulder, place your right elbow against your side and gently dig your elbow into your ribs.
Place your hand right on your belly, so your elbow is bent to exactly 90 degrees.
With an open palm, keep your elbow against your ribs and slowly lift the back of your hand towards the ceiling, keeping your elbow against your ribs.
If you can comfortably do 8 reps, you can add a 1lb weight in your hand for the next set. Attempt to do up to 3 sets. Remember that you are working a very small and possibly irritated muscle.

The second exercise is done standing:
Tie a light resistance therapy band to a stable object about the height of your navel.
If working your right shoulder, place your right elbow against your side and gently dig your elbow into your ribs.
Place your hand right on your belly, so your elbow is bent to exactly 90 degrees.
Wrap the band around the outside of your hand and slowly move your hand away from your belly, keeping your elbow against your ribs. (Some people like to tuck a small towel roll under their elbow to ensure that their elbow doesn’t move during the exercise.)
Attempt to do up to 3 sets of 8-10 reps.

With each of these exercises, you are aiming to go through the full range of motion, but keep it pain-free. Scale the range of motion to what is tolerable – stay within a pain-free range.

Most importantly, Clay, from the information you’ve provided, I don’t know that these exercises are appropriate and safe for you. To be safe, you should see our Physical Therapy office in Yonkers so that we may develop a professional program for you. You want to rehabilitate and strengthen your shoulder so you can get back to your normal activities. A Physical Therapist is the best person to help you achieve that.

Thanks for asking,

Daniel Seidler, PT

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