A common diagnosis of the rotator cuff is impingement syndrome. This refers to the impingement of the soft tissues between the humeral head and the archway that is formed by the acromion and the coracoacromial ligament. Conditions that narrow this archway, such as soft-tissue swelling, bone spurs, or arthritic changes, can predispose an individual to impingement. For some individuals, the acromion is congenitally hooked or curved in shape—as opposed to flat—which may predispose the client to an impingement syndrome as the acromion rubs on the rotator cuff.
The initial stages of training for rotator cuff injuries focus on reducing inflammation and promoting healing. This is a stage of “active rest” in which the exacerbating activities are eliminated or modified. Common causes of injury are overhead sports, military press, incline bench press, and lateral raises in the frontal plane. Restoring shoulder range of motion via flexibility exercises is also an important goal of this phase. However, ranges that are painful should be avoided.
A key component of restoring shoulder stability is to restore the strength of the muscles associated with the scapula. A normal scapula provides a stable base for shoulder rotation and maintains the proper length-tension relationship of the rotator cuff and deltoid muscles. When initiating scapula musculature strengthening, external rotation and extension should be limited to neutral. Closed-chain exercises performed with the hands fixed provide a compressive load to the shoulder joint and promote stability. Examples include wall push-ups and quadruped or plank stabilization exercises.
Because the biceps originates on the scapula, biceps curls performed in a seated position with the elbow supported may reduce the chances of exacerbation. Also, avoiding end ranges of elbow extension may reduce irritation of the area. In addition, performing curls with a neutral forearm position (i.e., hammer curl) will reduce the load on the biceps.
Modifications should be made to the bench press exercise as well. First, there should be a mandatory “handoff” and spot. Second, range of motion should be limited so that the elbows do not dip below the level of the shoulders. Third, a narrower hand spacing (grip) should be utilized to minimize the peak shoulder torque in the pressing motion and reduce the rotator cuff and biceps tendon requirements for stabilization of the humeral head. Also, the incline bench press should be avoided. Repetitions should also be limited to avoid excessive fatigue, which can result in a loss of dynamic shoulder stability. Finally, weight machines such as a chest press, in which range of motion can be controlled, may be a safer option.
The shoulder press or military press is another popular exercise that can aggravate shoulder impingement. For the shoulder press movement, the behind-the-neck position should be avoided, as it places significant stress on the shoulder capsule and ligaments and places the shoulder in a tenuous position for instability. Bringing the shoulder into a more anterior position in front of the body reduces the stress to the shoulder capsule.