Shoulder Impingement: What is it and How Do You Get Rid of it?
by Proclinix, January 9, 2017
By: Dr. James H. Cassell IV, PT, DPT
Shoulder impingement is the most common injury I see in my clinic. Shoulder impingement or rotator cuff tendonitis, occurs when one of the four rotator cuff muscles (called the supraspinatus), is pinched underneath the highest bony piece of the shoulder joint (called the acromion process). There is not a lot of room for the rotator cuff muscle to fit between the tip of the shoulder and the upper arm bone (also called the subacromial space), and any disruption of the normal shoulder mechanics can cause friction. This friction can lead to inflammation in the area, limited mobility, fraying or even tearing of the tendon. Typical symptoms of shoulder impingement include pain when reaching to the side (abduction), but classically, the pain occurs with overhead motion, as this range creates the most compression of the muscle between the two bones. Patients may also report pain down the outside of the arm or in the elbow when performing an overhead motion. There are many contributing factors to consider. Overhead activity, poor posture, and repetitive motions can influence the positioning of the shoulder blade on the ribcage.
Overhead athletes and people with labor-intensive careers are frequently diagnosed with shoulder impingement, as they are repetitively minimizing the space where the rotator cuff muscle is located. If the strength of the muscles of the shoulder blade and the rotator cuff are not balanced properly, there may not be enough space created, leading to impingement of the muscle. The athletes most affected by shoulder impingement are swimmers, baseball pitchers and tennis players. The occupations generally affected are painters, electricians and hair stylists/barbers.
While repetitive overhead activity is a precipitating cause of shoulder impingement, most of my patients are not overhead athletes; rather they are your typical population. The primary cause of the shoulder impingement is poor shoulder blade control due to muscle imbalances. Generally speaking, most people are in a slouched posture throughout the day, whether from sitting, driving, reading or texting. Most of the activity humans do is in front of the body and below eye level, which pulls the shoulder blade forward and upwards on the ribcage, which minimizes the space. For short periods of time, this is not an issue, as the shoulder blade is designed to move in such a manner. However, if the shoulder blade is in this position for multiple hours every day, the muscles in the area adapt to the shortened or lengthened positions. A lengthened muscle is a weaker muscle and a shorter muscle is a stronger muscle. The muscles that are generally tight and strong are the chest and neck muscles, whereas the back muscles are typically weaker.
Treatment for shoulder impingement is fairly straight-forward, focusing on strengthening the weakened muscles and stretching/massaging the tight muscles in an effort to restore a normal balance throughout the region. Exercises that are typically performed are row variations, band external rotation, dumbbell external rotation, serratus punches and prone Ts, all of which strengthen the upper back and shoulder musculature. Stretching of the neck muscles requires no equipment and can be performed sitting.Pectoral stretching can be performed against a doorway. The physical therapist will also identify which muscles require extra focus and will perform a combination of deep tissue massage, trigger point release, Graston Technique® and contract-relax stretching.
Shoulder impingement treatment durations vary greatly, depending on how long the patient has been experiencing the symptoms, compliance with stretching and exercise as well as occupational hazards that are unavoidable. Additionally, patients may have bone spurs in the shoulder, causing the impingement. Bone spurs may be removed via surgery, though the research has shown that an effective physical therapy program can increase the subacromial space 2-3 times more than surgery can.
Dr. James H. Cassell IV, PT, DPT is a physical therapist at ProClinix Sports Physical Therapy & Chiropractic, practicing in their Armonk location (within Equinox). He can be reached at 914-202-0700.