Shoulder Bursitis, Subacromial pain syndrome and Shoulder Impingement are all terms that refer to the same issue, which for the sake of this article we will call Impingement. Essentially all of these terms refer to the narrowing of the space between the head of the humerus and the shoulder blade (cushion known as a bursa). This narrowing can cause a number of things to happen:
- Pinching of the bursa in the area can become irritated or inflamed resulting in pain when moving the shoulder.
- Narrowing of the space can result in pinching of the Rotator Cuff Tendons, which run through that space again causing pain in this space.
- The pinching of the tendons can over time cause different levels of tendinopathy (see Shoulder Injuries in Climbing) and more long term shoulder pain.
The most important question to ask though isn’t which structure is being pinched, it’s what is happening with the way you move or how the muscles are moving in order for these structures to get pinched. Finding the root cause of the impingement is much more important than chasing the symptoms.
Shoulder Impingement tends to occur when the muscles that move and support the shoulder are no longer working well together. This can happen due to repetitive movements, which result in one muscle group getting really strong, while the opposing muscles can’t keep up. The shoulder then moves in a way which reduces the amount of space between the arm and the shoulder blade and therefore pain. The same process can occur if one muscle group gets tight over time. This can then restrict the ability of the arm or shoulder blade to move in an optimal way, reducing the space available and creating the impingement.
What to look For?
Impingement tends to rear its ugly head in a number of quite simple and easily identifiable ways:
- A Painful Arc – Standing up tall with your arms by your side. Bring your arm from here to above your head moving it in an arc out to the side. Look to see if you get pain through the middle third of the movement which then goes away through the top third of the movement.
- Experience an Ache, Catch or Pinch – in the top of the shoulder when doing seemingly normal shoulder movements throughout the day, such as: brushing your hair or getting something out of a high cupboard. This type of pain tends to be described as “catchy” and less consistent than other types of shoulder pain.
- The shoulder will generally feel completely normal with movements below shoulder height apart from positions that put a lot of load on the front of the shoulder eg. The bottom of a dip, bottom of a push up.
- Pain will decrease significantly when shoulder blade movement is assisted by an external force (this could be a physios hand or a band). When the movement is unassisted the pain returns.
What Can I do?
When trying to correct Shoulder Impingement it is important to address all the different factors that can cause the shoulder to get impinged or pinched. If you concentrate on one aspect of Shoulder Impingement, it is common to get some significant changes in the shoulder but not get complete resolution. We find the best results with Shoulder Impingement come from a combination of passive and active stretching, and shoulder strengthening exercises: