Pain Free Motion: Shoulder Impingement

The most common cause of shoulder pain is called impingement syndrome. Impingement of the rotator cuff tendons inside the shoulder joint is a problem experienced by people typically when they attempt to reach overhead. Often the symptoms of shoulder pain occur during the night when we lay on one side more than the other. This pain is located in the shoulder but also can radiate down into the shoulder blade, up to the neck and sometimes cause pain that travels down the arm. Shoulder impingement is not a structural problem (meaning surgery is needed) but a functional problem (meaning the body isn’t moving properly due to weakness or stiffness). Now if the shoulder impingement is present for years, it will turn into a structural problem that requires surgery (don’t do that). 

Most of the options out there that treat shoulder impingement are focused on identifying and treating the symptom. This is often done with imaging of the shoulder, pain medications, injections, and rehabilitation of the shoulder itself. In this article we are going to discuss the dysfunctions that commonly create shoulder impingement which should be addresses to make the problem go away permanently. The following are the 6 most common causes of shoulder pain/impingement:

Shoulder Pain when reaching up and to the side (Abduction):

1. The opposite side hip is limited in Side to Side Motion. This is often a surprise to most people when you tell them their hip is actually causing shoulder pain. The reason behind this is that for every motion our body takes moving upward, it first needs to move downward to LOAD the muscles. Think jumping…. when you jump you first move down into a squat before moving up into the jump. Limited opposite side hip motion side to side limits the hips ability to load and help the shoulder elevate upward. This creates a large amount of stress on the rotator cuff and overuse injuries occur.1

2. Limited upper back side bending. In order to load the scapular muscles which, create motion upward and to the side of us (Abduction) the shoulder blade must first rotate downward. In order for the shoulder blade to rotate downward the upper back must side bend, otherwise the shoulder blade would run into the spine itself or simply not move at all which does not allow the muscles to load.

3. Limited shoulder blade upward rotation. When the arm moves up and to the side of our body the shoulder blade must rotate upward. Since the shoulder blade is the socket of the ball and socket joint, if it does not move in sync with the arm bone, towards the end of the motion there will be compression in the joint and impingement and pain.

Shoulder Pain when reaching up and in front of us (flexion):

1. Limited same side hip extension. When we reach overhead in front of us our hips contribute a large amount of motion to the task. If we take away hip extension, the shoulder joint moves beyond its limit and causes compression in the shoulder joint, leading to shoulder pain or impingement.

2. Limited upper back extension. In order for the arm to move up and in front of us, the shoulder blade needs to move downward along the rib cage. In order to this to happen the rib cage and mid spine move back into extension. If this is limited the shoulder joint will again move to its limit and cause compression and pain in the joint.

3. Limited shoulder blade motion downward. In order for the arm to move up and in front of us the shoulder blade must move down or depress. If this does not happen the shoulder joint has an increase in compression which leads to pain.

In order to find a solution to your shoulder pain you need a physical therapist who is able to look at the entire body in order to identify the actual dysfunction. We have three options when treating people who are having pain with movement 1.) Treat the symptom. This is often done with massage, ultrasound, traction, positions of comfort. Often there is relief but only for a few hours or days. 2.) Treat the compensation. This is often done by focusing on the shoulder joint only. It is important to recognize that the shoulder is moving incorrectly due to other factors in the body. It is compensating for a problem. 3.) Treat the dysfunction. Treating the dysfunction not only finds the source of the problem but it also indirectly treats the compensation and symptoms at the same time. This is where we should be focusing our efforts.