Shoulder Impingement

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:

Passive Pectoral Stretches – Star stretch on a foam roller. Lying long ways on a foam roller so that the roller covers the length of the spine, place the arms horizontal allowing gravity to push them to the ground, keeping the elbows bent at 90 degrees. Spend 5-10 minutes in this position.

2. Active Pectoral Stretches – Rollovers with a broomstick. Hold either end of the broomstick and elbows straight. Gently bring the broomstick over your head to the small of your back then return to the front.

3. Straight arm Shoulder Retraction – With an elastic band or cable machine at shoulder height. Keeping your elbows straight move from reaching as far forwards as you can to squeezing the shoulder blades together and bringing the arms back as far as you can.

4. Lateral Pull-downs with Band – with a light band do single arm lat pull downs concentrating on Shoulder Retraction through the entire movement. Your shoulder will want to round towards the bottom of the movement so make sure you concentrate on keeping the shoulder retracted. Then allow the band to pull the shoulder back to the starting position.

5. Shoulder Press – Immediately follow the Lat Pull-downs with weightless shoulder press on the same side, concentrating on shoulder retraction throughout the full movement. This is a great way to solidify the new movement pattern for your shoulder.

Quick Tips:

Release the Pecs
Retrain the Shoulder Position
Don’t push through pain as it can create problems with the tendons.

Final Thoughts – When treating the Shoulder or managing any type of Shoulder pain it is important to take into account any other factors that could be affecting the movement or load on the shoulder. Because the Shoulder is such a mobile joint, very rarely do things happen in isolation and I would always recommend looking at Shoulder Position, upper back posture and Shoulder strength in conjunction with the tips in this article to ensure the best results for your Shoulder.

We hope you found this helpful! If you have any other questions please don’t hesitate to Contact Us.

The Climbit Physio Team