One of those signs that we think indicates that we are aging, is when simple tasks cause you pain. Like when you raise your arm above your shoulder to put on your coat, and your shoulder hurts! Huh? You ask yourself: “When did that start?” Or worse, just lifting your arm to put on deodorant in the morning becomes painful for your shoulder.
Yikes! Is this what I have to look forward to as I get old?
Fear not! Your sore shoulder might not just be because you are getting older, you may have a shoulder impingement.
What on earth is ‘impingement’ you ask? Just what it sounds like. It means that something is inhibiting, or limiting your range of motion. In this case, in your shoulder.
To understand why you are limited, lets talk anatomy (bear with me…)
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). Your arm is kept in your shoulder socket by your rotator cuff, which is made up of four muscles: Supraspinatus, Infraspinatus, Subscapularis and Teres minor. These muscles and their tendons form a covering around the head of the humerus and attach it to the scapula. There is also a lubricating sac (called a bursa) between the rotator cuff and the top of the scapula (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.
Simply put, shoulder impingement is when there isn’t enough room for all those muscles and the bursa to move around, and they rub (impinge) on the acromion and cause you pain.
So why does it hurt?
With all of the muscles and tendons in your shoulder, there are several possible causes of shoulder impingement. You could have inflammation of any of the tendons – Supraspinatus tendinitis being the most common cause – or inflammation of the bursa (bursitis) or shoulder instability.
Tendinitis and bursitis as causes of the impingement make plenty of sense: when tissues are inflamed, they are larger than usual, leaving insufficient space for your shoulder to move through it’s normal range of motion.
If instability is the cause, the head of the humerus actually partially dislocates, and this may cause sufficient reduction in the shoulder space to cause impingement.
OK, so how do I make it better?
The first step is to get assessed. See a manual therapist such as a Chiropractor or Physiotherapist, and have them evaluate you. They will do a few tests which involve shoulder range of motion and confirm if impingement is truly what is causing your shoulder pain.
Once you have been diagnosed with impingement, treatment is fairly straightforward, and centers around reducing inflammation, improving range of motion, and strengthening your shoulder muscles.
To reduce inflammation, ice or cold therapy is typically used. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Ibuprofen can be used in the short term, or for very severe cases, however these will only help to reduce pain and won’t help treat the root cause of the problem. In other words, they help to reduce inflammation, but don’t address WHY the tissues became inflamed in the first place.
To improve range of motion, several gentle stretches can be used. I stress ‘gentle’, since part of the pain caused by impingement is part of your ‘normal’ range of motion. If any of the stretches below cause increased pain, they should not be continued, since the stretch causing pain is likely to slow the healing process. Here are some examples of stretches you can use for your shoulder:
- Pec stretch – (tight pectoral muscles can tend to pull the shoulder forward, and cause impingement) – stand near a doorway, with your shoulder at 90 degrees, and your elbow bent so that your fingers point at the ceiling, place your forearm against the door frame and step forward, you should feel the stretch in your chest
- Supraspinatus stretch – with the hand of your injured shoulder behind your back, and your elbow at 90 degrees, use your opposite (good) hand to pull your (bad) elbow towards the front of your body, you should feel the stretch in the back of your shoulder
- Posterior shoulder stretch – reach the arm of the injured shoulder across the front of your chest, and with your (good) hand, pull gently towards yourself, you should feel the stretch in the back of the shoulder and into your upper back
To strengthen your shoulder muscles, exercises targetting your rotator cuff muscles should be performed. Once inflammation is reduced, this should be the focus of your shoulder rehabilitation. Like any other exercise, to see results, they should be done consistently, and the weight or repetitions should gradually increase until you are pain free. Some exercises that you might be prescribed for shoulder strengthening are:
- External rotation – Lay on your good side with your injured upper arm against your body and your elbow bent at 90 degrees so that your forearm lies across your abdomen. With a small weight in your hand, lift the weight by rotating your shoulder until your forearm is parallel with the ground. Lower slowly.
- Internal rotation – This is the opposite of the previous exercise. Lay on your injured side with your upper arm just in front of your torso, your elbow should be bent at 90 degrees and your forearm on the ground pointing away from you. With a small weight in your hand, lift the weight by bringing your forearm up until it is across your stomach. Lower slowly.
- Forward arm raise – Using a resistance band tied to a chair or bar around waist level, raise your injured arm forward, keeping your arm straight, until your arm is about parallel to the ground. When you are performing this, try to imagine that you are scooping with your entire arm, the shoulder should pull down & back while you are lifting your arm.
- Dumbbell punch – Start by laying on your back holding a small weight with your injured arm straight up in the air and your shoulder resting against the ground. Push your shoulder up off the ground, ensuring that your back and head stays on the ground and your arm stays pointed straight up. If you are doing this correctly, only your shoulder should be moving.
Your physical therapist will recommend the right combination of stretching and strengthening for your particular condition, and it will depend on which muscles are relatively tighter, and which muscles are relatively weaker. Your therapist may also employ some soft tissue work or some other modalities such as ultrasound to speed healing.
If you have shoulder impingement, you are fortunate, as it is one of the simpler shoulder conditions to treat, as long as you seek treatment before your condition becomes severe.
Resources:
- https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis
- https://www.webmd.com/rheumatoid-arthritis/impingement-syndrome#1
- http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/chronic-shoulder-injuries/shoulder-impingement-syndrome
- http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/impingement-syndrome-shoulder/impingement-syndrome-exercises
