What is Shoulder Impingement?
Shoulder impingement could also be called shoulder “impinchment.” Many people living with a shoulder impingement don’t know what it is, they only know they have an issue with their shoulder that often causes pain and restricts mobility or range of motion. In layman’s terms, shoulder impingement is your body’s inability to lift your arm over your head without essentially smashing the arm bone (humerus) on the ceiling (acromion) of the shoulder blade (scapula) and pinching the soft tissue structures in between those bones.
The shoulder area of our body is also referred to as the “Shoulder Complex,” and for good reason. Mechanically, the shoulder is one complex part of your body that relies on multiple factors to function properly. These factors are strength, mobility, and coordination. Like jamming a wrench in a gearbox, a shoulder impingement affects all of these.
How the shoulder works
Did you know the thoracic spine influences how the shoulder moves? If we have an increased or even decreased mid-back curve, it can cause a chain reaction in how the next part of the shoulder complex behaves, the shoulder blade. The shoulder blade, or scapula, is the platform for your rotator cuff and “Shoulder Joint” to operate. The shoulder blade relies on the ribs and thoracic spine to glide smoothly over it. Also noteworthy here, the only structural attachment for the shoulder blade and essentially your shoulder complex is through your sternoclavicular joint in the front of your skeletal system.
From there the glenohumeral joint, the joint that everyone thinks of the shoulder, is where the oh so important rotator cuff operates, not to diminish the importance of the big muscles such as the deltoid and its friends but since the cuff is where a lot of shoulder pain is felt. As a result, to properly move our arm through this space the glenohumeral joint needs to move correctly on the shoulder blade which needs to glide smoothly over the ribs which need to move correctly on the thoracic spine. The point of getting into the weeds here is that the shoulder is complex. Crossover Physical Therapy in St. Michael can help you diagnose and formulate a plan to increase strength, mobility, and decrease pain caused by shoulder impingement.
Increase Strength and Coordination from Shoulder Impingement
This is one of the biggest reasons athletes and patients contact Crossover Physical Therapy in St. Michael. Shoulder pain usually triggers an initial hassle-free consultation, but increasing strength and coordination are also critical. For example, a shoulder impingement often stymies carrying out routine activities, such as placing groceries easily on the top shelf of the pantry to a golf swing. If the shoulder blade and the numerous muscles that stabilize it are not activating and stabilizing correctly, you are going to put undue stress to the rotator cuff and glenohumeral joint. When this happens impingement is only the beginning of what can happen to your shoulder over time.
Crossover Physical Therapy Approach
Due to this domino effect, you CANNOT just focus on mobility and ignore strength or coordination, or vice-versa, because you will always fall back into dysfunction. The fortunate thing about the human body is that not all of us are built exactly alike. There are some that can lift a house but they can not touch their toes and there are those who can fold themselves in half but asking them to pick up a moderate weight from the floor is like watching a train wreck. It is the synergy of these factors that make use of efficient movers in our environment and decrease our chance for injury or improving an active injury.
At Crossover Physical Therapy in St. Michael, we target underlying dysfunction first with targeting soft tissue, joint mobilizations/manipulations, dry needling, electrical stimulation, and neuro-muscular re-education (essentially teaching good movement patterns), and reinforcing with corrective and functional exercises to solidify results. Initial PT sessions focus on re-establishing movement whether it is at the joint level or overall motor control so repetitive stresses are eliminated and pain and strength can be addressed quickly. Later appointments are focused on getting the patient back to their previous levels of work/exercises or possibly into a fitness program to help accelerate strength goals.
3 Exercises to Consider for Shoulder Impingement
1. Lacrosse Ball/Tennis Ball Massage to Pectoral Muscles:
Place foam roll, myofascial release ball, lacrosse ball, etc. on the corner of the wall or door frame as shown and lean your chest and anterior shoulder into the ball. Roll side to side, up and down, diagonally to involved tissues as directed. Then move the same side arm up and down on a tender spot as well. PERFORM BEFORE AND AFTER EXERCISE IF POSSIBLE.
2. Shoulder Blade Retractions:
Tuck chin back as you pinch shoulder blades together. Hold 5 seconds. Relax; repeat.
3. Bilateral Shoulder External Rotation:
While holding an elastic band with your elbows bent, pull your hands away from your stomach area. Keep your elbows near the side of your body.