How do you know that your car has an alignment issue? Your front end vibrates at higher speeds, the steering wheel pulls to the side, and you are noticing odd tread wear on your front tires. You bring your car into your mechanic and the advice you get is this; “drive faster, take the corners harder and aim for potholes.” I doubt if any of us has gotten this advice for our vehicle and yet this is the approach taken with most rehabilitation practitioners. They start exercising the shoulder!
Restore the alignment
Most shoulder issues at their core are related to poor mechanics. While the reasons why a shoulder is not moving efficiently vary from person to person there are common clinical patterns that we see and certain muscles and joints that fail to work well. First, determine if you have a shoulder dyskinesia or poor movement pattern of the shoulder complex. Second, restore normal movement patterns after determining the 'why' and what muscles and joints are not working well. Lastly, return to strengthening the shoulder if this is needed.
When the underlying problem that has created the shoulder issue, a loss of glenohumeral mobility, a tight muscle, limited rib rotation creating tension, if this has been addressed then exercise or strengthening can occur. The only exercises that should start earlier are movement or control type exercises to reduce pain and tension.
Strengthening should never be first for a shoulder problem or impingement issue.