Shoulder impingement- mobility and exercise is important
There are different types of shoulder impingement but I am going to talk about secondary external impingement due to instability of the scapular stabilisers which causes rotator cuff dysfunction.
This impingement occurs in the sub acromial space and is normally presented in people under the age of 35 years of age. This instability can occur in sports people especially teenagers and young adults when they are doing the same sports repetitively all year round. This can occur as a result of excessive direction of the acromion due to the scapular muscle instability. These muscles responsible for stabilising and moving the scapula switch off either because of a strength imbalance or a force activation alteration. This means that the muscles could be tight and weak or they could be weak and lengthened due to the shortening of their opposing muscle groups. This dysfunction of the shoulder blade (scapula) will result in an inadequate scapulohumeral rhythm, which means there will be abnormal movement of the shoulder.
The rotator cuff tendons (which are at the back of the scapula, with exception of the one at the front of the scapula) can also become weak due to this abnormal position of the shoulder, especially if you continue to do a repetitive sport such as swimming or throwing in cricket. If an imbalance occurs between the deltoids (elevators of the humeral head) and the rotator cuff muscles (stabilise the humeral head), when using the deltoid muscles in a sport, the space narrows and the tendons can become trapped and encroached.
Symptoms of impingement can be either at the front/top of outer side of the shoulder and can sometimes refer a little way down the upper arm if the deltoid is responsible. Due to this pain, sometimes there can be pain at the back of the shoulder because of muscular imbalance. The pain gradually comes on with overhead activities such as overhead sports (tennis, volleyball, cricket, and swimming). Other aggravating factors can be driving, reaching behind for the seatbelt, putting a coat on and reaching up high. Pain can be sharp on movement but then a dull constant ache can be noticeable throughout the day.
To treat this impingement effectively and to find out what exactly is causing the symptoms, a thorough examination from a Sports Therapist must be completed. This comprises of a subjective assessment where the client is asked questions related to the pain they are experiencing. The an active assessment involving range of motion tests, special tests and muscle resistance tests are carried out along with palpation to determine a diagnosis. Once this is completed, whether you have shoulder pain because of weak rotator cuff muscles, or weak scapular muscles or a mixture, the sports therapist will then work on a rehabilitation programme for you to regain strength and control in your shoulder muscles. The aims of treatment and rehabilitation are to reduce pain and inflammation, correct any postural issues, mobilise and stretch the shoulder, then strengthen it.
So if I were you, I would work on pectoralis minor mobility and start activating your rotator cuff muscles. I always make sure my clients are stretching the muscle that is causing other muscles to switch off. So I would get them to stretch their chest muscles, then give them activation exercises for the opposing muscles immediately after stretching. Here are a few stretches and activation exercises to get you started.
If you need some guidance with your shoulders and not sure what to do, please do get in contact as we see so many painful shoulders and we would like to make them all pain free!
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