Training Injuries

Ali-Mazaheri

Ali Mazaheri, MScPT

Resident Physiotherapist

Shoulder Impingement

Shoulder impingement is a term that gets thrown around a lot these days. But what exactly does it mean?

Let’s first start with what a normal shoulder should look like. In a healthy shoulder joint, our upper arm bone (humerus) and shoulder blade (scapula) move together in synchrony to create full, fluid and pain-free motion.

For this synchrony to occur, our scapula needs to upwardly rotate as we lift our arm above our heads.

This movement of the scapula is designed to maintain a certain amount of space within your shoulder joint (called your subacromial space), to allow for tendons and other structures to run through. These structures include your supraspinatus tendon, the subacromial bursa that lies on top, and your long head of the biceps tendon.

training-injuries

To add to the shoulder blade piece, the humerus itself (upper arm bone) should be centered within the shoulder socket. This is done by having a balance in tension between the muscles that rotate your humerus outwards vs the muscles that rotate it inwards.

What we commonly see today are tighter internal rotators of the humerus, such as the pecs, lats, and anterior delts. To make matters worse, we see a lengthening / weakening of the external rotators of the humerus, and a stiffening of our upper back into a rounded posture which further perpetuates the issue.

Due to tighter internal rotators vs external rotators, our humerus bones now sit more internally rotated, which leads to a narrowing of that space within the shoulder joint when elevating your arm and a higher likelihood of those structures getting impinged within that space.

training-injuries

So what does this all mean? Well, shoulder impingement from repetitive exercise / lifting is manageable, and requires a few things to be assessed:

  • Posture: Shoulder position, scapula position, as well has head/neck and upper back posture.
  • Range of motion: Assessing the motion at your shoulder joint, thoracic spine (midback) and cervical spine (neck) as they are all inter-related.
  • Strength of muscles: important for appropriate posture during daily movements and training. Some of these muscles include the external rotators of your humerus, upward rotators of your scapula, deep neck flexors, and core.

How do we treat shoulder impingement? Each individual is different, however we can look at:

  1. Soft tissue techniques: Decreasing the tension in the tight muscles affecting your shoulder, which will provide pain relief and improved range of motion.
  2. Strengthening of the weak muscles: This is used to regaining balance and symmetry in the shoulder joint during movement. This will allow for long-lasting results rather than a quick fix.
  3. Manual therapy: Techniques in manual therapy can help reduce tightness of the shoulder joints itself, as well as help facilitate proper movement patterning at the shoulder complex.
  4. Taping: The use of Kinesio (K) Tape can provide immediate relief from pain in the shoulder area by supporting your shoulder joint and offloading the impingement structures.