9 Best Scapular Exercises to Perform for Shoulder Impingement (and 4 Alternates)

One of the goals for treating shoulder impingement is more normalized movement. A customized exercise plan will help with this, but with all the scapular exercises out there, which are going to be the most effective when it comes to strengthening periscapular muscles?

What Does the Literature Say?

A systematic review conducted in 2004 by Lori Michener, Matthew Walsworth, and Evie Burnet¹ looked at the effectiveness of rehabilitation for patients with Subacromial Impingement Syndrome (SAIS) and found that strengthening the scapular stabilizing muscles was preferable to no treatment.

Paula Ludewig and Jonathan Reynolds² demonstrated that, compared to healthy shoulders, shoulders with impingement present the following differences:

• Less scapular upward rotation

• Less scapular posterior tilting

• Greater scapular internal rotation

• Greater compensation from the upper trapezius

Ludewig and Reynolds go on to suggest the following interventions for SAIS:

• Serratus anterior strengthening or retraining

• Upper trapezius activation reduction

• Posterior shoulder stretching

• Pectoralis minor stretching

• Thoracic extension posture and exercises

Alisha Fey and her research team³ also noted the important roles played by the serratus anterior, the lower trapezius, and the middle trapezius in producing scapular upward rotation, posterior tilting, and external rotation of the scapula.

Choosing Exercises to Target Shoulder Muscles

So what are the best individual exercises to accomplish these strengthening goals? Weve broken them down by the specific muscles they target:

Serratus Anterior

• Push-up with plus

• Dynamic hug

• Serratus punch at 120 degrees flexion

Dynamic Hug

Lower Trapezius

• Prone full can

• Prone external rotation at 90 degrees abduction

• Prone horizontal abduction with external rotation

• Bilateral external rotation

Prone External Rotation at 90 Degrees Abduction

Middle Trapezius

• Prone row

• Prone horizontal abduction at 90 degrees abduction with external rotation

Prone Row

Alternatives for Those Who Cant Perform Prone Exercises

You may have noticed that many of the exercises listed are meant to be performed in a prone position. But what if you work with a population who are unable to tolerate prone exercise or dont have the means to replicate these exercises outside of a therapy session? While exercises performed prone are often highly effective, they cant be performed by everyone, and this can result in low carryover at home.

Mike Cricchio and Cindy Frazer⁴ published a narrative review of electromyographic studies for scapulothoracic and scapulohumeral exercises. This study leads to the recommendation of effective alternative exercises that dont require a prone position:

 

• Isometric low row

• Inferior glide

• Wall slide

• Lawnmower

Lawnmower

The literature supports therapeutic intervention in those who have been diagnosed with shoulder impingement and notes the importance of addressing the scapula. Learning which exercises are the most effective and recommending them when appropriate will help get your patients back to their meaningful occupations using their upper extremity.

Regardless of which setting you practice in and the population you serve, my course, Treatment of Shoulder Impingement, will provide you with a variety of exercise techniques to fit the unique needs of your patients and your setting.