Core Principles
Shoulder impingement involves compression of the structures in the subacromial space, usually aggravated by loaded overhead movement, internal rotation under load, or poor scapular control. Three principles guide every exercise choice:
- Protect the Subacromial Space: Avoid loaded overhead pressing and internal-rotation pulls in the impingement zone (typically 60–120 degrees of elevation).
- Control the Scapula First: Teach the client to depress and retract the scapula before loading the arm; the scapula must move with the humerus.
- Choose Pulling Over Pressing: Rowing and pulling patterns strengthen the posterior cuff and scapular stabilizers that unload the joint.
Apparatus-Specific Precautions
Reformer Push-Up
Press-ups put the shoulder in loaded flexion. Use the Knees Down regression and keep the hands below shoulder level; stop at the first sign of pinching.
Chest Expansion
A safe pulling pattern — keep the palms facing forward or neutral and open the chest without shrugging. Neutral Grip variations reduce internal rotation load.
Pulling Straps
Keep the palms facing each other (Neutral Grip Pulling Straps) and the scapulae drawing down as the arms work; avoid end-range overhead positions.
Swan and Spinal Extension Work
Arms reaching forward or overhead can provoke impingement. Shorten the arm range (Reduced Range Swan) and keep the shoulders drawn away from the ears.
Safe Alternatives
Seated rows, midback press-downs, and arm circles with small ranges build the posterior chain and scapular stability without entering the impingement zone. Progress to longer levers only when movement is pain-free and controlled.
Teaching Cues for This Population
- Cue the scapula before the arm: draw the shoulder blades down and together first.
- Keep the tempo controlled; avoid ballistic or end-range holds.
- Watch for the classic substitution — shrugging, winging, or early overhead reaching.
- Stop and reassess on any sharp, catching, or radiating pain.
Programming Notes
Start with pulling patterns and scapular control, add press-downs and circles, and introduce push-up and overhead work only with reduced range and regression support. Document tolerance each session and progress by range, not by load.