Strength and conditioning coaches can play a crucial role in driving the exercise approach for treatment of subacromial impingement syndrome (SAIS) and can substantially reduce the economic burden of funding what could be unnecessary or unsubstantiated surgical interventions for this condition. There is strong evidence for managing shoulder subacromial impingement syndrome (SAIS) through exercise rehabilitation. This case study examines the effects of an eight-week exercise rehabilitation programme on a 17-year old elite male gymnast with SAIS. Clinical assessment tests that allow for diagnosis and identification of the cause of SAIS were completed before and after the exercise rehabilitation programme. These tests included: validated outcome measures such as quality of life questionnaire, video analysis, ultrasound, glenohumeral and scapulothoracic assessment measures. The most informative tests post exercise rehabilitation included; the alignment of the scapulothoracic joint with the lateral slide test (1cm decrease in scapula upward rotation), video analysis on dysfunctional movement patterns and stability control under functional loads (cross position on rings apparatus), joint range of motion tests identifying shoulder joint restrictions, internal rotation range (increased by 55 degrees) improving posterior capsule mobility, "dynamic ultrasound" testing confirmed improved glenohumeral head stability (8.0mm in posterior views) and disability of arm, shoulder hand (DASH) questionnaire (50% improvement on symptom score). The main test results showed scapula dyskinesia with medial and inferior scapula border winging and anterior translation of the glenohumeral head contributed to SAIS. The key exercises to correct this targeted the scapulothoracic joint stabilisers (lower and middle fibres trapezius, serratus anterior) and glenohumeral joint stabilisers (infraspinatus, subscapularis). Importantly, the programme combined these groups with full kinetic chain (lumbopelvic) stabiliser activation, proprioceptive retraining and motor control endurance-based exercises. The findings from this comprehensive SAIS exercise rehabilitation programme based on correction of the identified dysfunctional kinetic chain movement patterns, scapulothoracic and glenohumeral joint deficits, indicates surgical intervention was not necessary and symptom free loading was achieved.
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