Eric Wong's Three Keys and Four Exercises to Rehab Shoulder Impingement, Rotator Cuff Tear and Shoulder Pain

Kinesiologist Eric Wong describes three key factors and four exercises to rehab a rotator cuff tear to avoid surgery if possible (@PrecisionMovementCoach).

Eric Wong's shoulder rehab routine emphasizes three key factors: proper alignment, muscle activation, and restoring active range of motion. Watch the whole video to understand four important exercises designed to help achieve the three key factors.

This article emphasizes the  highlighted details of the second exercise demonstrated in the video by Eric Wong "Coach E" when he trains muscles involved in upper arm raising and scapula rotation mechanics to avoid impingement in the subacromial space of the shoulder. Impingement can harm the supraspinatus tendon and the long head biceps tendon at the shoulder, causing pain.

The second exercise "Wall Neck Side Bend" relaxes the upper trapeizius and levator scapulae muscles, which have been shown in a study as overactive in people with painful shoulders.

The Study

Differences in scapular motion and parascapular muscle activities among patients with symptomatic and asymptomatic rotator cuff tears, and healthy individuals - PubMed

In the study, patients with symptomatic rotator cuff tears showed that less scapular upward rotation and higher activity of the levator scapulae muscle was significantly higher in the symptomatic group compared with the asymptomatic and healthy groups at 90° of arm elevation. Also, the activity of the upper trapezius was significantly higher in the symptomatic group compared with the healthy group at 120° of arm elevation.

Eric Wong also mentions Posterior Tilt of the Scapula (Shoulder Blade) while explaining the "Wall Neck Side Bend" exercise. Posterior Scapula Tilt is a motion that involves the top (superior border) of the shoulder blade tipping backward away from the rib cage while the bottom (inferior angle) moves forward against the chest wall. Notice that scapula tilting for safe mechanics of the arm connection to the shoulder and torso is analagous to pelvic tilting for safe mechanics of the leg connection to the hip joints, which is important for many people to help them keep a neutral lumbar curve, which prevents or reduces wear and tear on the intervertebral discs of the spinal column.

 

The levator scapulae muscle connection to the scapula or shoulder blade is especially interesting because the vector pull of the levator scapulae is involved in Downward (Inferior) Rotation of the Scapula: Overdrive of excessive contraction of the levator scapulae causes the glenoid cavity (entire shoulder joint) to rotate down. Downward rotation of the glenoid cavity is exactly what you don't want to occur to prevent shoulder impingement, rotator cuff (especially supraspinatus) wear and tear.

The Study's Complete Citation

Ishikawa H, Muraki T, Morise S, Yamamoto N, Itoi E, Izumi SI. Differences in scapular motion and parascapular muscle activities among patients with symptomatic and asymptomatic rotator cuff tears, and healthy individuals. JSES Int. 2020 Dec 15;5(2):238-246. doi: 10.1016/j.jseint.2020.10.014. PMID: 33681843; PMCID: PMC7910733.

Also, here is an article by V Phadke, PR Camargo, and PM Ludewig that provides additional details about overdrive of the upper trapezius as a factor in shoulder impingement in a literature review study that found that the upper trapezius (UT) is involved in clavicular elevation, which can contribute to changes in scapular positioning, including reduced posterior scapula tilt. In some people, overdrive by the upper trapezius may increase the chance of painful shoulder motion.  Increased overdrive of the upper trapezius along with action of the middle deltoid may inhibit activation of the middle or lower serratus anterior and rotator cuff, cause delayed activation of middle and lower trapezius muscle fibers, and cause increased activation of the upper trapezius and middle deltoid in impingement subjects. The literature review cites a study by Johnson G, Bogduk N, Nowitzke A, House D. describing that only the lower trapezius can cause significant upward rotation of the scapula. The upper trapezius -- with its connection to the mobile clavicle and neck vertebrae -- is more important for balancing the load on the neck.

Literature Review Study

Phadke V, Camargo P, Ludewig P. Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement. Rev Bras Fisioter. 2009 Feb 1;13(1):1-9. doi: 10.1590/S1413-35552009005000012. PMID: 20411160; PMCID: PMC2857390.

Study with Trapezius Details

Johnson G, Bogduk N, Nowitzke A, House D. Anatomy and actions of the trapezius muscle. Clin Biomech (Bristol). 1994 Jan;9(1):44-50. doi: 10.1016/0268-0033(94)90057-4. PMID: 23916077.

The trapezius researchers studied the directions (vectors) of trapezius fibers, and concluded that the essentially transverse orientation of the upper and middle fibers of trapezius precludes (makes impossible) any action as elevators of the scapula as commonly depicted. Rather the action of these fibers is to draw the scapula and clavicle backwards or to raise the scapula by rotating the clavicle about the sternoclavicular joint. The trapezius contraction vectors cause balancing of the moments of the trapezius, which relieves the cervical spine of compression loads.

Eric Wong is the founder of Precision Movement. He earned his degree in kinesiology from the University of Waterloo where he studied under Dr. Stuart McGill. From 2006-2013 he specialized in training combat athletes, including multiple UFC fighters, national level amateur boxers and other fighters.  

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