A 40-year-old, competitive tennis player reports to you that she has had shoulder pain since the first half of the tennis season. She is now unable to serve without pain. She has pain in the beginning of her warm-ups but before a match begins, the pain goes away. About 2 hours after a match, her pain is significant. She has pain in the deltoid insertion area. The doctor has ruled out primary impingement but feels that a course of rehabilitation is necessary before the patient returns to tennis. On examination this patient has full ROM except that she is lacking about 10º in elevation. Pain occurs in the end ROM and above 90º of elevation. She has a forward-head, round-shouldered posture. Her glenohumeral rotators and abductors are weak and painful. She has weakness in the lower trapezius and rhomboids.

1. What is the cause of her secondary impingement?

2. What goals will you set up to address the cause(s)?

3. What will your first treatment include?

4. List 5 exercises that address your goals.

5. What will be your guidelines for progressing the athlete beyond these exercises?

6. Please establish a new set of goals once she has met the guidelines for progression.

7. Please list 5 more exercises addressing the new goals.