Shoulder impingement is a condition that occurs when a structure is caught between the ball and the socket of the shoulder joint when the arm is moved up and down. This condition occurs as a result of tight and/or weak muscles as well as poor postural habits. It is possible to make a complete recovery from this condition by improving your posture, as well as utilizing several simple exercises to strengthen your shoulder muscles.
The shoulder is a joint that is composed of the arm bone (humerus) and shoulder blade (scapula), which form a ball-and-socket joint. In a healthy shoulder, the round ball glides smoothly against the concave groove on the socket when the arm is elevated overhead. A patient with shoulder impingement has poor motion between the arm and shoulder blade, causing pain when the arm is elevated overhead. The arm bone rubs up against one of several structures that run through the joint, causing pain and tissue damage.
Patients with shoulder impingement complain of pain when they lift their arm, usually overhead. They often describe a “painful arc” of motion with no pain at the beginning of lifting the arm, followed by pain when the arm reaches a specific height, finally followed by no pain at the end of the motion. The pain is located deep in the shoulder joint, and can be mild to severe. Patients are usually pain-free at rest.
In impingement syndrome, a piece of tissue, whether tendon or ligament, gets stuck in between the ball and socket when the arm elevates. As a result, the pressure from the ball rubbing up against the structure causes irritation and inflammation, and results in painful motion. The structures can be rotator cuff tendons, the biceps tendon, ligaments that span across the shoulder blade, or the “bursa,” a pad that rests on the shoulder blade to absorb force. Any one or multiple types of tissues can get caught between the ball and the socket.
Impingement syndrome occurs due to range of motion restrictions (tightness) in the muscles and ligaments of the shoulder, or because of weakness in the muscles of the rotator cuff and mid back. If the mid back muscles that surround the shoulder blade (specifically the lower and middle trapezius muscle) are weak, then the shoulder blade will not rotate properly along with the arm bone. If the arm rotates and the shoulder blade doesn’t, the tissues between the ball and socket can get pinched. This can also occur due to rotator cuff weakness. The rotator cuff is a series of four muscles that act to push the ball down in the socket. Weakness in these muscles will cause the ball to be too high in the socket, and grind against the tissues that pass between them.
Practicing appropriate posture will significantly help to avoid impingement syndrome. Sitting in a hunched position tilts the scapula and does not allow it to rotate properly. As a result, you willdevelop a decreased range of motion whenever you lift your arm, and increase the risk of impingement injury. Here are some postural tips:
- Practice lifting the top of your shoulder blades up toward your ears, shortening your neck, followed by reaching the tips of your shoulder blades down toward your heels, elongating your neck. Now, hold the tips of your shoulder blades down toward your heels.
- Take a deep inhale to fill your belly and exhale to empty your belly. Keep your belly empty and continue to breath naturally while still reaching the tips of your shoulder blades down toward your heels. A combination of lowered shoulder blades and engaged abdominals is the start to proper posture!
- Set an alarm on your phone to remind yourself to find and maintain this posture three times a day. Over time you will not have to be reminded by an alarm!
To prevent impingement it is necessary to maintain strength in the middle and lower traps and rotator cuff. The middle and lower (as opposed to the upper) traps serve to rotate your shoulder blade when you lift your arm. Weakness here can cause a lack of rotation. Keeping the rotator cuff muscles strong will make sure your humerus bone is properly situated in the socket and doesn’t elevate and compress the tissues in the joint.
The fix for this malady is the same as the prevention: strengthen your weak muscles! Further, stay away from overhead lifting, as this will irritate your shoulder and delay the healing process.
Shoulder exercises should be performed pain-free. Stop if you experience pain, rest and ice for several days, then try again.
Strengthen your rotator cuff and scapular muscles today!
[box]External Rotation Side Lying