One of the most common sources of pain for athletes or gym rats is the shoulder. This often leads to altering or avoiding certain exercises or movements in the gym. As a result, you may not be making any progress towards your fitness goals and find even basic overhead movements are suddenly causing you pain. This may all be due to a common orthopedic condition known as shoulder impingement which is very treatable with conservative management and can even be avoided altogether.
What causes it?
Shoulder impingement is a common overuse injury and often develops as a result of one of your rotator cuff tendons being pinched between the shoulder blade and arm bone known as the subacromial space. The supraspinatus muscle which is one of the four rotator cuff tendons in the shoulder is located underneath where your collar bone meets your shoulder blade. Where these two bones meet is essentially the “roof” that sits above this tendon. If there is not enough space between the tendon and “roof” when you move your arm overhead, the tendon is pressed up against the joint causing the tendon to be pinched. Over time, the tendon starts to fray and become weak and painful.
There are several risk factors for developing shoulder impingement that can be altered by balancing your exercise routine. First, weakness in your posterior cuff muscles that include your infraspinatus and teres minor can lead to poor mechanics in your shoulder when your lift overhead. Secondly, tightness in your anterior chain (muscles in the front) and internal rotators leads to poor resting position of the shoulder and even worse positioning for the joint when lifting overhead. Lastly, weakness in shoulder retractors or postural muscles causes reduced subacromial joint space predisposing you to impingement.
What are the symptoms?
Individuals experiencing shoulder impingement, commonly have localized tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm overhead. This frequently occurs between approximately 60-120 degrees of shoulder abduction known as a painful arc. Moving the arm higher or lower than these points may not be painful. As the condition progresses, you may have pain at night or start losing some of your strength or range of motion.
Conservative treatment consists of addressing your particular risk factors mentioned above. Developing a proper stretching/releasing regimen before exercising is essential. For more specific details on treatment options or developing preventive exercise routines, check out Kevin Martin, PT, DPT’s webinar recordings here.