Restore: Shoulder Series, Shoulder Impingement
Injuries and specifically pain is up there with 1 of the most annoying parts of life, and because of this we thought here at Resilient Human, we'd firstly build solutions to start correcting these for you with our Pain to Power programmes you'll begin to find on our Restore pages but not only that, we thought you should have the details in front of you to know just what you're dealing with before you come onboard.
Starting here, with our shoulder series on Shoulder Impingement. Look it's going to get detailed and possibly confusing at points, but stick with it, you'll get total explanations inside these articles to give you the knowledge to progress back to a powerful shoulder.
What is Shoulder impingement ?
Here's the detail, shoulder impingement is one of the most common causes of shoulder pain affecting manual and sedentary workers as well as athletes (1,2,3).
Individuals with shoulder impingement normally report pain, weakness and restricted mobility of the shoulder. These symptoms are insidious and manifest themselves on overhead and repetitive movements which can lead to significant limitations on basic daily living activities and/or during sports activities. Sounding like you?
There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth or inflammation, functional impingement is a relative loss of subacromial space secondary to altered scapulohumeral mechanics resulting from shoulder instability and muscle imbalances.
It is possible that some subacromial impingement results from a combination of both structural and functional factors. (SHOULDER MUSCLE IMBALANCE AND SUBACROMIAL IMPINGEMENT SYNDROME IN OVERHEAD ATHLETES Phil Page, PhD, PT, ATC, LAT, CSCS, FACSM).
Are you wondering what subacromial space is?
Subacromial space is a space between the acromion which is a bone that sits just above your shoulder and the head of the humerus. Within the subacromial space run the rotator cuff tendons, the long head of biceps tendon, and the coraco-acromial ligament, all surrounded by the subacromial bursa which helps to reduce friction between these structures.
When the subacromial space is reduced either by a structural change such as tendon degeneration/ scar tissue or bursa inflammation or by a functional change such as the positioning of the head of the shoulder, the above mentioned structures can be ‘pinched’ causing shoulder pain. This happens specially with overhead movements when the subacromial space is already reduced due to the natural biomechanical movements of the shoulder.
Many factors can therefore contribute to shoulder impingement. Pain, mobility restrictions and weakness can be triggered by structural changes of the bursa, rotator cuff tendon (and others) or by functional changes which can include muscle imbalances of rotator cuff and shoulder blade muscles and postural dysfunction of the spine and scapula.1-3
Why can poor posture lead to shoulder impingement?
Postural dysfunction of the upper body has been suggested as being one important factor associated with shoulder pain and impingement.
Some of the consequences of postural dysfunction are a poor alignment of the head and neck, shoulders and thoracic spine (upper back).
Thoracic spine alignment dysfunction (particularly an increased kyphosis which is increased curvature of the spine) plays an important role on the shoulder function and mobility as it can lead to a forward shoulder positioning. This can then cause a narrowing of the subacromial space.
Why does poor posture cause thoracic kyphosis?
An increased curvature of the upper back, or thoracic kyphosis can occur when we spend a long period of time ‘slouching’, for example if we spend long periods of time sitting at a desk. This will then result in an overstretch of the posterior structures of the back such as the extensors muscles of the back, shoulder blade muscles and ligaments as well as a shortening of the anterior structures of the shoulder and chest such as the pectoralis muscles. Over time this will then change the positioning of the spine vertebrae which will sit into a flexed position causing lack of mobility in extension.
It is therefore important to consider paying attention to posture adaptations, in particular thoracic spine dysfunction and lack of mobility when creating a rehabilitation program that aims to improve shoulder impingement and pain.
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Management of shoulder impingement and pain
Understanding the cause of shoulder pain is the key to creating a successful exercise and rehab plan. As mentioned previously, functional impingement may be associated with imbalances; therefore, careful examination of posture, spinal and shoulder mobility, and flexibility and strength of important muscles of the shoulder complex is vital to understanding the root cause of impingement. Successful treatment of functional impingement related to postural imbalances is often accomplished by addressing the cause of the problem rather than symptomatic treatment of the pain. (SHOULDER MUSCLE IMBALANCE AND SUBACROMIAL IMPINGEMENT SYNDROME IN OVERHEAD ATHLETES Phil Page, PhD, PT, ATC, LAT, CSCS, FACSM)
An overall structured program of thoracic mobility and upper back and shoulder complex strength will allow you to improve posture and therefore shoulder pain.
At Resilient Human, you can access our Restore online physio assessment and get detailed feedback of your issue and support from your Resilient Human physio to support you through your return to powerful living or join our Balanced Shoulder program for access to our 12 weeks of Pain to Power programming. We even believe in our product that much, that once you've completed 12 weeks and are pain free, we'll give you 4 weeks of strength programming totally on us to supported these super shoulders you've just built.