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Shoulder Impingement – subacromial impingement

Dear Dr.Tucker
I enjoyed your helpful article in Dynamic Chiropractic on shoulder evaluation & scauplar positioning.
I am 60 yrs old and have practised 37 years. I am kyphotic and have worked hard in both diversified adjusting and forcing down the lever for distraction adjusting on Cox tables a long time now. After a couple firm jolts I now find myself with acromial impingement, MRI recently shows a small osteophyte subacromial with supra spinatus impingement. There is no calcification nor cuff tears.
An orthopedic friend suggested a scope cleaning. Im afraid of any sequela which would be low I think.
What muscles would you emphasize to work on to realign the scapula-glenoid complex?Your article specifies some,but am slightly confused.Thanks for any suggestions.
Dr. Tucker’s response: For years we were taught that the supraspinatus muscle strengthening exercise was the “empty can” or “full can”. Controversy exists about that maneuver in the literature.  I think a good rotator cuff exercise should produce the greatest supraspinatus activity while minimizing the deltoid activation. Theoretically, reducing deltoid activation decreases the upward shear of the humerus during arm elevation, which may be desirable when prescribing exercise to strengthen the suprapsinatus in impingement patients.  
In a study published in Medicine and Science and Sports and Exercise, subjects performed 5 isometric exercises in random order while measuring the EMG activity of the deltoid, supraspinatus, and infraspinatus. The exercises were: full can, empty can, prone elevation, elastic external rotation, and prone external rotation. The researchers noted that all exercises produced similar high levels of supraspinatus activity, while the full and empty can exercises also had higher levels of deltoid activity.
The researchers concluded that shoulder external rotation at 0° of abduction with an elastic band and prone external  rotation were preferable exercises for the supraspinatus. While the full- and empty-can exercises are traditionally favored to isolate the supraspinatus, the authors noted that elastic external rotation and prone external rotation did not activate the deltoid at high levels compared to the full- and empty-can exercises. In addition, the exercises also exhibited high levels of infraspinatus activation.
In summary, clinicians should consider using Thera-Band® exercise bands for resisted external rotation and isotonic prone shoulder external rotation exercises because they preferentially activate the supraspinatus and infraspinatus without activating the deltoid, which may be more beneficial for patients with impingement.
Reference: Boettcher CE, Ginn KA, Cathers I. Which is the optimal exercise to strengthen supraspinatus? Med Sci Sports Exerc. 2009;41(11):1979-83.  
If you are not sure how to perform these exercises, google the name of each one and you will get photos; or go to the theraband website for photos. I would be diligent in performing these exercises every other day, beginning with 3 sets of 10, progress to 3 sets of 20. Try it for 5-6 weeks before making any surgical decisions.  Good luck, Jeff  www.DrJeffreyTucker.com 

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