SHOULDER IMPINGEMENT 101
REDUCING RISK ASSOCIATED WITH EXERCISE
What is Shoulder Impingement Syndrome?
The shoulder joint is complex with lots of muscles, tendons, and ligaments acting on and supporting it. These structures are woven tightly through small spaces. The shoulder joint also moves more freely than any other joint and therefore can be put into compromising positions quite easily.
The space between where your collar bone (clavicle) and your shoulder blade (scapula) meet is called the sub-acromial space. The joint here is called the Acromial Clavicular joint (AC joint). Through the sub-acromial space passes the tendons of the rotator cuff muscles. These muscles are responsible for rotating your shoulder in and out. There is also a smooth ball of jelly like substance in this space called a bursa sac. This keeps the tendons from rubbing directly on the bone causing pain and inflammation.
The narrowing of the sub-acromial space thus compressing that area and causing the acromion (bony prominence of the shoulder blade) to put pressure on these tendons is what is called Shoulder Impingement Syndrome.
What Causes Shoulder Impingement Syndrome?
There are a few factors that can cause this issue…
Overuse is probably the number one cause of shoulder impingement syndrome.
Individuals who are very active and perform lots of overhead tasks on a daily basis have a higher likelihood of experiencing shoulder impingement syndrome. Raising your arms overhead will compress the sub-acromial space. Perform this motion many times throughout a day over the course of weeks, months, or years and you are bound to have some issues.
Take baseball pitchers for instance! They commonly have some type of tendinitis due to overuse. Even non-athletes like construction workers or people who stock shelves as part of their job can get shoulder impingement syndrome.
Poor posture can also increase your risk of developing shoulder impingement syndrome.
Even if you don’t perform loads of overhead motion, your shoulders are naturally compressed in their relaxed position, meaning even simple motions of the shoulder are compromised when they otherwise wouldn’t be.
With exercise or weight lifting, this condition is brought on by three things:
Overuse, poor posture, and poor form.
And as you may have guessed, they are not mutually exclusive.
If you have poor posture, your form is likely to suffer and could cause injury. Overuse can also lead to fatigue and cause poor form.
What Can Be Done To Prevent This?
Fixing posture
Rounded, slumped forward shoulders are usually a sign of underdeveloped back musculature. Even without exercise, you can practice good posture and those muscles will naturally develop over time to keep your shoulders more neutral.
*Note: Poor posture is not always something that needs to be fixed unless it is causing or correlating to pain or dysfunction.
Strengthening the posterior shoulder and scapular musculature
This is very important in long term prevention of shoulder impingement. These muscles are used to stabilize the shoulder joint during most overhead motions and specifically overhead pressing exercises (i.e. military press). A healthy dose of variations of rows, reverse fly’s and external rotation type movements are going to have long term benefits to your shoulders health!
How much should you do?
A good rule of thumb most strength coaches like to use is having a 2/1 ratio of pull to push exercises in their programs.
However, this does not mean you have to crush heavy rows over and over.
Simple exercises like band pull-a-parts or banded face pulls are a great way to achieve that ratio. The posterior shoulder muscles are smaller and benefit greatly from higher reps with lighter loads.
Treatment Options
Relative rest - Resting from activities that specifically aggravate your shoulder. Examples include overhead pressing, barbell back squats, bench press.
Physical Therapy - See a licensed professional
Ice for pain modulation
NSAID’s as needed
*Consult with physician if relief is not achieved with these options after 2-4 weeks.
Yours Truly - Coach Tom