Have clients with history of shoulder impingement?

Background: Shoulder impingement is a common condition affecting men> women(2:1) where someone complains of anteromedial pain that has gradually developed. Contributing factors: History of individual working out predominantly shoulder press, chest press, anterior raises and front of body. Muscle imbalances, type of work and lifestyle. Two types: Primary(Mechanical) impingement: Is caused by a mechanical dysfunction such as bursa, AC joint, acromion, humerus or rotator cuff/supraspinatus tendon beneath the coracromial arch. This is a mechanical problem that may result from sub acromial crowding. Secondary(Structural) impingement: Is caused by a relative decrease in sub acromial space caused by instability of the glenohumeral joint, tight posterior capsule and weakness of scapulothoracic musculature. Evidenced training recommendations: Emphasis is to create scapular stability/balance the shoulder muscles dynamically. • Posterior capsule stretching • Chest stretching • Scapular protraction(strengthening serratus anterior/upper trapezius/low trapezius biomechanically, together all cause an upward rotation of the scapula to maintain the sub acromial space above 90 degrees of shoulder elevation. • Scapular retraction via mid row with tubing or cable (decreases load to front of the shoulder). • External rotation strengthening: ideal is side lying which is more isolative for teres minor and infraspinatus recruitment(decreases the load to the anterior shoulder). Prevention: Keep stretching pectorals and posterior capsule. Avoidance of shoulder press or military press, avoidance of anterior raises and client engaging in regular “balanced “ workout. Targeting weaker phasic muscles(rhomboids, low trapezius, external rotators, scapular depressors).