The Ultimate Guide to Shoulder Impingement

Shoulder Impingement

Written by Mitch Starkman

February 16, 2018

INJURY MANAGEMENT
The Ultimate Guide to Shoulder Impingement

Mitchell Starkman, Physiotherapist

15 Feburary 2018

Shoulder impingement is one of the most commonly diagnosed shoulder conditions. So, I thought it would be helpful to shed some light on this condition.

In this Ultimate Guide to Shoulder Impingement I will review the following:

  1.     Who gets shoulder impingement?
  2.     What is shoulder impingement?
  3.     Where do people feel shoulder impingement?
  4.     When do people feel shoulder impingement pain?
  5.     Why do people get shoulder impingement in the first
    place?
  6.     How do I fix my shoulder impingement?

Who Gets Shoulder Impingement?

Shoulder Impingement does not discriminate as it affects both men and women of all ages. However, some groups seem to be more at risk for these conditions than others. Athletes that play, or spend a lot of time with their arms overhead (think of baseball players and tennis players), have an increased likelihood of exhibiting this type of injury. But these are not the only ones at risk. Your average “desk athlete” is also at risk. The dreaded desk position puts a lot of stress on shoulders and can lead to exactly this type of shoulder imbalance.

What is Shoulder Impingement?

Shoulder impingement is one of the most commonly diagnosed shoulder conditions. But what is it exactly? What is getting impinged? Well, the short answer to that question is a lot.

Let’s start by taking a closer look at the shoulder itself. The shoulder joint is made up of the upper arm bone (the humerus) and the shoulder blade (scapula). This complex is attached to the upper body by the collar bone (the clavicle). As the arm moves up overhead all three of these bones need to work together. For every two degrees of motion of the upper arm over shoulder height, the shoulder blade needs to move one degree to match. There is a complex balancing act between the muscles that control the shoulder and the shoulder blade.

If the balance is off for any reason, then your shoulder can exhibit problems.

Now let’s look at how this can lead to Shoulder Impingement. There is a small space between these three bones where some important structures pass through to attach and support the shoulder as a whole.

There are five particular structures that are considered to be involved:

  1.     Long head of biceps
  2.     Supraspinatus Tendon
  3.     Subacromial/subdeltoid Bursa
  4.     Coricoacromial ligament
  5.     The Joint Capsule

With so many different structures in such a small area the margin for error is quite small. This can lead to any one of or even all of these structures can be impinged, or more simply put, pinched.

Over time increasing pressure, friction, and pinching of the muscles in the subacromial space can build up and lead to shoulder impingement. This means that if you’ve been told you have “Biceps Tendonitis”, “Supraspinatatus Tendonitis”, or “Shoulder Bursitis”, then shoulder impingement is a likely contributor.

Where people with shoulder impingement feel their pain?

With this type of condition, patients will often report pain in the front side of the shoulder. The pain often travels down the upper arm, but rarely past the elbow. At times people can often suffer from some discomfort on the backside of the shoulder joint as well. The pain is most often provoked by movement.

When do people tend to feel shoulder impingement pain?

Movement is the short answer for this one folks. Most often, the pain is felt when performing overhead movements with your shoulder. This doesn’t have to be throwing a ball, it can be as simple as shampooing your hair. Women often have discomfort when trying to take their bra on and off behind their back.

There are two provoking movements or “tests” you can do to see if you may be suffering from shoulder impingement:

  1. Reach your arm across your body and see if this reproduces any symptoms.
  2.  Reach your hand up overhead like you have a very important question to ask and see if this affects your symptoms.

Why do people get shoulder impingement in the first place?

Why, why and why! As we discussed earlier the balance between your shoulder blade and upper arm are crucial. The improper balance of these muscles can lead to increasing the amount of “impingement” occurring in this area.

To dive a little deeper into the “why” let’s chat about some key muscles that can affect the shoulder blade. The biggest culprit has to be the pec minor. This is one of your chest muscles that’s attached directly from your rib cage to your shoulder blade. This little guy can get very tight with long-standing sitting and slouched postures. It does a great job of pulling the shoulder blade forwards and down (the exact opposite of what we want our shoulder blade to be doing as we lift our arms overhead).

In addition to this, folks with this type of injury also present with weakness in their shoulder external rotator muscles (some of the rotator cuff muscles) and lower traps. These are important muscles for assisting and controlling of our arms to move up overhead.

How do I fix my shoulder impingement?

“Okay so enough with all this talk about what’s wrong with your shoulder. Let’s move onto how to fix it!”

The goal is to improve the control and strength of your shoulder and shoulder blade. They need to work together to move your arm any which way you’d like in perfect balance.

We’ve talked about the two biggest culprits when it comes to shoulder impingement: The Pec Minor and external rotation weakness.  I’d like to show you some easy exercises to get started with when trying to tackle this conditions.

#1 The Pec Grinder to improve the mobility of that pec minor muscles:

#2 Ws – Standing shoulder external rotation to increase the strength of your rotator cuff:

#3 Upper Back Foam Roll to improve the mobility of your upper back and rib cage. This will allow the shoulder blades to float a little more freely as you move them like you mean it!:

 

These three exercises are often a great place to start but won’t take you all the way! What I’d recommend is going to see a health care provider you trust to get a proper diagnosis and begin your rehab process.

If going to a clinic to see a physiotherapist isn’t a reasonable option for you and you’d prefer an online program, make sure you check out the PhysioReady Shoulder Impingement Program. This program takes you through your rehab process step-by-step and updates your exercises daily. Not to mention that it allows you to track your progress so you can see just how far you’ve come!  

Authored by:

Mitch Starkman

Mitch Starkman

Physiotherapist and Founder

A Toronto-based Physiotherapist with a passion for sports, orthopedics, and human movement. Mitchell’s goal is to understand how the site of pain is impacted by the entire body – rather than pinpointing a specific disturbance. He is also the founder of DeskJockeyPhysio.com - a website geared toward giving people the tools they need to self-manage, treat and prevent their injuries.

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