Treating Shoulder Pain in Throwing Athletes
Posterior Internal Impingement Syndrome affects many of our throwing athletes.
If you are looking for a way to evaluate and manage these patients with posterior shoulder pain, be sure to watch the video and read below.
11 Facts About Posterior Impingement Syndrome
1. Posterior Internal Impingement (PII) is a common cause of shoulder pain, primarily affecting the overhead athlete. Internal impingement results in posterior shoulder pain when the athlete places the humerus in extreme external rotation and abduction. (1)
2. Long-term internal impingement may result in an articular-side rotator cuff tear and a superior labral injury. (2)
3. Most research and authors identify internal impingement as a leading cause of partial articular-sided rotator cuff tears in throwing athletes. (3)
4. Glenohumeral internal rotation deficit (GIRD) and PII are like peanut butter and jelly. Tightening of the posterior capsule increases anterior-superior glenohumeral movement during overhead activities exposing these patients to a higher risk of developing internal impingement. (4)
5. Treatment of internal impingement begins with improving glenohumeral internal rotation. Consider using the Posterior Capsule Stretch either in the office or at home.
6. PII is characterized by pain in the posterior shoulder during the late cocking phase of the throwing motion. Specifically when the glenohumeral joint is in full external rotation and abduction of at least 90 degrees. (1)
7. The infraspinatus must stabilize the glenohumeral joint during the follow-through phase of throwing. During throwing, the humerus travels from 140-180 degrees of external rotation to 100 degrees of internal rotation in 42-58 milliseconds. (5)
8. Joint mobilization into posterior translation and inferior glide improve the effect of exercise therapy. Consider using the inferior glide and internal rotation mobilization seen in the video above for your next patient with PII.
9. Overhead throwing athletes with PII benefit from scapular stabilization exercises. These patients frequently have weakness of scapular retractors compared to the scapular protractors, which predisposes them to injury. (1)
10. The Jobe relocation test uses a posteriorly directed force to decompresses a so‐called “kissing lesion” that occurs between the rotator cuff and glenoid rim in patients with PII. (6)
11. The rehabilitation process for overhead athletes with acquired shoulder instability requires restoring muscular balance and muscular endurance. Closed kinetic exercises, including isometric activation exercises, improve the co-contraction of the rotator cuff muscles. Once patients can restore normal shoulder range of motion, they should gradually restore proprioception, dynamic stability, and neuromuscular control. (7)
Isometric Shoulder Abduction
Isometric Shoulder External Rotation
Isometric Shoulder Adduction
Isometric Shoulder Internal Rotation
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Manske RC, Grant‐Nierman M, Lucas B. Shoulder posterior internal impingement in the overhead athlete. International journal of sports physical therapy. 2013 Apr;8(2):194.
Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19 (4):404-420. doi:10.1053/jars.2003.50128
Rosinski A, Chen J, McGahan P. A partial articular-sided supraspinatus tear caused by the biceps tendon: a novel etiology of internal impingement. Authorea Preprints. 2021 Feb 3
Clabbers KM, Kelly JD, Bader D, et al. Effect of posterior capsule tightness on glenohumeral translation in the late-cocking phase of pitching. J Sport Rehabil. 2007;16(1):41-49
