What is it? Why do we get it? And what can we do about it?
The shoulder joint is a ball and a shallow socket joint. It is formed from a ball on the top of your arm bone and a shallow socket which is part of the shoulder blade. Above the ball and socket joint is a ligament which is attached to a bony prominence ‘acromion’ on your shoulder blade forming an arch. The area between the shoulder joint and the arch is known as the sub-acromial space.
To move your shoulder and control the position of the ball on the socket, you have a group of muscles known as the rotator cuff. They attach from the shoulder blade onto the top of the arm bone, passing through the sub-acromial space. A small fluid lining cushions the tendon from the roof of the arch. When you move your arm away from your side, the rotator cuff works to keep the ball centred on the socket. When your arm reaches shoulder height, the sub-acromial space is narrowed.
What is shoulder impingement? Impingement refers to a trapping of the rotator cuff tendons as they pass through the sub-acromial space. Impingements can be classed as:
- Primary: Abnormalities of bony structures i.e the acromion
- Secondary: Changes in the position of the acromion due to poor muscle stabilisation and co-contractions between the scapula (shoulder blade) and head of the humerus (arm bone). This is the most common presentation.
- Occurs mainly in throwing sports from the forces placed on the shoulder.
When impingement occurs for a prolonged period or occurs under a heavy load, the tendon can become inflamed and the rotator cuff can become weak, swollen and painful, particularly in overhead activities. Once the tendon becomes affected, it swells, filling more of the space, which increases the likelihood of things getting pinched! This is known as impingement.
What can we do about it?
If possible, REST the area by not doing activities that aggravate i.e. overhead movement. A common movement that aggravates shoulder impingement is raising your arm with the elbow twisted outwards. Try keeping the elbow in and then raise your arm, palms up to the ceiling (like a waiter carrying a tray), this may help lower your painful symptoms.
Posture Posture Posture… You need to think about your sitting and standing posture. If you have a desk job think about sitting with your feet flat on the ground and hip width apart. Sit tall, with your shoulders back and chin in. When standing make sure your shoulder blades are slightly drawn back and down towards the spine, your standing tall and your chin is in.
Do the exercises regularly 1–2 times a day. Don’t do them if it is painful.
Shoulder blade squeeze
Begin this exercise lying on your stomach with your arms by your side. Squeeze your shoulder blades together and slowly lift your arms and chest off the ground, keeping your neck straight. Hold for 2 seconds at the top of the movement then slowly return to the starting position.
Shoulder External rotation with band
Keep your elbow by your side. Your elbow should be bent to a right angle throughout. This exercise will improve the strength of your shoulder muscles. Hold an exercise band with your elbow at a right angle. Pull the band away from your body. Slowly return to the starting position. Keep your elbow by your side.
Adduction (toward the body’s midline) with band
To help will improving overhead movement patterning, and increasing functional range into abduction (away from the body’s midline) of the shoulder joint. Uses the shoulder adductors and extensors to assist in the movement, thus reducing the work rate of the abductors and flexors (if they are weak / injures ) as well as reducing impingement and pain.
An effective rehabilitation program should focus on regaining full shoulder range of motion, reestablish shoulder stability, and restore strength and local muscular endurance in the rotator cuff and shoulder stabilising muscles. You should always complete your rehabilitation under guidance of a rehab specialist, email firstname.lastname@example.org to book an appointment or visit www.rehab360.co.uk/bookings