Can you wave your hands in air like you just don't care? Raise the roof? Or are you really "unsure" because you are you limited by SHOULDER Im"PINCH"ment ? Lol. 90's babies will understand that last one :)
If you can't raise your arm pain free and without tightness at your end ranges you might be suffering from a general term we call shoulder impingement. Shoulder impingement occurs when structures in the shoulder get compressed with overhead movement. This feels like a "tight, painful, or pinchy" feeling when we reach overhead.
Shoulder impingement is one of the most common injuries we see at Physical Therapy San Pedro. It comes on slowly overtime and often rears it's ugly head in the overhead athlete, the weekend warrior and in the weightlifting community. It puts a real damper on our ability to enjoy our sports or just complete daily life tasks.
You might be asking....well how exactly is Shoulder Impingement caused? Most of the time, shoulder impingement is caused by an irritated, inflamed or over-worked shoulder that has resulted in a muscle imbalance. The space in the shoulder gets restricted and the structures get compressed. Things in the shoulder stop working well together at the end of the range of the overhead motion it will feel "pinchy."
Let's take a look at the anatomy to get a better understanding.
The shoulder complex is made up of 3 joints:
1. The Glenohumeral Joint
2. The Scapulo Thoracic Joint
3. The AC Joint (Acromio-Clavicular)
The space in the shoulder is very limited. The rotator cuff tendons and the pectoralis muscles attach in this space. There are ligaments, arteries/veins, nerves and a bursa. When anything is irritated or impaired in this region swelling can occur making the space smaller. These structured can get squeezed pretty quickly.
Posture and Strength play huge roles in shoulder health.
Posture: The way we carry our bodies sets a shoulder posture that can either promote stability and balance for optimal function OR it can set the stage for overuse and impingement. The most common postural deviation we see is an excessively rounded upper back leading to forward shoulder and forward head. This type of posture deactivates many important muscles that stabilize the shoulder from the back, promotes overuse in the front, and closes down that AC Joint that creates shoulder tendon pain & pinching.
Strength: 2 sets of muscles play a role in proper function of the shoulder.
1. THE ROTATOR CUFF: 4 muscles that function as:
Stabilizers by hugging the ball of the shoulder tightly onto its tiny socket & keeping the shoulder centered on its axis.
Mobilizers by assisting with elevation and rotation of the shoulder.
2. SCAPULAR MUSCLES: all the muscles that attach to the scapula from the spine or ribcage that provide a the stable base for the shoulder to move off of and also assist with rotation of the scapula for assistance in end range shoulder motion.
When we have good posture and good strength of in these muscle groups, the shoulder moves smoothly and powerfully for throwing, pressing, tumbling, shooting, spiking, etc. When our posture and strength is inadequate, the result overtime can be shoulder impingement. Shoulder Impingement if not treated appropriately can result in tears of the Supraspinatus Tendon or the Biceps Longhead Tendon. The goal is to get help and address the problems in the shoulder before things get worse!
What are some things you can do?!
Fix your posture! Promote a healing environment for your shoulder tendons giving them space. Sitting erect with a proud chest, engaged upper back, and relaxed neck gives the necessary space to our AC joint. Get off your phone! Takes breaks at your computer. Prolonged positions create fatigue in the body and promote poor posture.
Deload or Rest Aggravated Structures: If you keep performing the irritating movement, it can make it very difficult to heal. Try using a lighter weight or a shorter range to see if it is pain-free. We are big fans of continuing to move but not at the cost of delayed healing. Lighter pain-free movement can keep up flexibility and bring blood flow to the affected tissues. This also gives a chance to work on the ideas in the next section...
Rebuild & Reload: When your shoulder is not longer painful and irritated begin controlled loading in the biceps and supraspinatus muscles with progression back to overhead work. Progress your overhead movements slowly while keeping rotator cuff and upper back strengthening part of your training.
Balance the Body. Don't work your shoulders and chest and neglect your upper back. Make sure you check in with your mobility & flexibility and prep the shoulder to do the movements you are asking it to do. The shoulder relies on a good balance. This means that work needs to be put in to improve the flexibility and strength so that the shoulder can work optimally.
Get Help: As always if you are making the changes highlighted above and not seeing the desired results, do not wait, go get help! Find a good physical therapist that can screen you and figure out your individual needs. No two bodies have been on the same journey. The tips above are general and can help get you on the right path but the quickest recovery always comes with an individualized approach for your body, your level of activity, & your goals.
Questions? Comments ? Concerns? Reach out to us! Need some help? We got you.
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Love...The PTSP Team
Dr. Brown, Dr. Bay, Dr. Daisuke, & Kristin
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