Internal impingement is a relatively common cause of shoulder pain. It is also fairly prevalent in athletes who use a lot of overhead or throwing motions, especially under resistance. For instance, weightlifters who often perform overhead barbell presses, tennis players who spend a lot of time striking overhead, and bowlers and pitchers who throw with an overhead motion, can all fall prey to it.
It is characterised by repeated or excessive contact between the posterior aspect of the greater tuberosity of the humeral head and the posterior-superior aspect of the glenoid border, typically when the arm is place in extreme ranges of external rotation and abduction. This will ultimately lead to an impingement in the tendons of the rotator cuffs and the glenoid labrum, usually posterosuperior.
This is, of course, a mouthful of jargon. Never mind, we will get onto the actionable stuff shortly. For now, all you need to know is that this kind of injury (tight posterior GH capsule) is theorised to be caused as the posterior GH capsule is hypertrophied in the follow through motion of any explosive action, such as throwing, that works through an externally rotated and/or abducted range of motion. This can limit internal joint rotation, with a typical loss of more than twenty degrees compared to the non-throwing arm.
Muscle tightness – especially unbalanced muscle tightness – is often the underlying factor in any pain and/or injury.
Luckily, this can all be undone. As with any hypertrophied muscle group, the GH capsule can be stretched.
This takes us onto the actionable part.
How to stretch the GH capsule
The following five exercises will all help to stretch the posterior capsule, unburdening the shoulder of much of its pain and tightness, and leading to greater fluidity of movement, especially in throwing motions.
1. Warm up
We’re going to use a pendular warm up to bring heat and blood into the shoulder joint prior to stretching. This will help to improve range of motion, too, as the arm explores and pushes through a full range of positions.
To warm up using a pendulum exercise:
- Lean forwards, using a table, wall or work surface for support.
- Let your arm hang down. You want it to be as relaxed as possible.
- From here, swing your arm in a small circle, first one way ten times, then the other ten times.
- Then change motion, swinging your arm backwards and forwards in line with your body. Don’t let it swing across the body. Repeat 10 – 20 times.
2. External rotation stretch
Use a broom handle, walking stick, hockey stick, pipe or anything similar. Lie down flat on the ground, perhaps with some padding beneath your upper arm (like a small cushion or rolled up towel). From here:
- Grasp the broom handle in your affected hand.
- Push the stick outwards, away from the body. This will turn your upper arm. Keep your elbows tucked into your side throughout.
- Stop when you feel pain or resistance – this is the end of your natural, current range of motion.
- Pause for five slow breaths and reverse. Repeat five times.
3. Passive assisted elevation
This is another one to perform lying on your back. From this position:
- Grasp the forearm of your affected arm or wrist with your non-affected hand.
- Raise your arm as far as possible until you feel pain or resistance – this is the end of your natural, current range of motion.
- Hold for five slow breaths and then lower. Repeat 5-10 times.
4. The ‘siesta’ stretches
The basic ‘siesta’ stretch is performed on your back. From here:
- Place your hands behind your head.
- Gently stretch the elbows downwards, aiming for the floor. They shouldn’t move too much – this is just to ‘activate’ the stretch.
- If you need to, feel free to use your non-affected hand to push the affected elbow downwards.
- Hold for five long breaths and then relax. Repeat ten times.
You can also interlock your fingers together on your chest. To make this work:
- Begin as above, but with your fingers interlocked and resting lightly on your chest.
- From here, lift both your hands and place them behind your head. Then drop your elbows outwards, allowing them to pull slightly in the front of your shoulders (across your anterior deltoids).
- Hold here for five long breaths and then relax. Repeat ten times.
5. Strap behind the back
Use a strap or rolled up towel or t-shirt for this one. From a comfortable standing position:
- Drop the strap over your non-affected shoulder. Take a hold of it with your affected hand.
- Gently use your non-affected hand to pull your affected hand upwards, along your back. Bring it up as far as possible until you feel pain or resistance – this is the end of your natural, current range of motion. It should not hurt – there should be no sharp pain. However, it may not be entirely comfortable, which is OK.
- Hold here for five slow breaths, then relax.
- Repeat 10 times.
Consult your physiotherapist or medical provider before performing any of these exercises, especially if you have an outstanding injury. If any of these exercises hurt, stop and consult your medical practitioner. If you are happy and comfortable with them, try running through them in the above sequence, 2-3 times per week. You should start to feel and see results after the first few weeks.