Shoulder impingement is a general term often used to label shoulder pain people experience when reaching overhead. The source of pain is generally said to be the rotator cuff or bursa. However, the specific cause is not mentioned (more on this in a minute).

In a nutshell, this “shoulder impingement” happens as a person reaches overhead. Typically, a person will report a painful range that begins at about shoulder height and extends to a nearly full overhead reach.  Generally, once the arm is lowered below shoulder height the pain will subside. During this reaching motion, the bony parts of the shoulder come closer together and “squish” the muscles, tendons, and bursa that move the arm resulting in the pain experienced.

Why does this happen?

Well…as the shoulder is the most mobile joint in the body with 4 separate joints and 10-15 muscles acting on it, there can be multiple reasons for this impingement to occur. So lets break down the three most common ones.

1. Posture – it is not that sitting with a rounded, flexed posture is bad, only that we tend not to move out of that position enough. This causes tightness in the front shoulder muscles and relative weakness in the back muscles. The resulting impact is it relatively narrows the open space in the shoulder allowing for the pinching to happen more easily. – The solution is to work on improving the muscle activation of the back muscles (i.e. squeeze shoulder blades together)
2. Stiffness in upper back – if the upper back is tight this impacts how the shoulder blade moves. If the shoulder blade cannot move as freely then that changes the dynamics of the rest of the shoulder…and can lead to the “impingement”. Solution- work on improving upper back (thoracic) mobility
3. Weakness of the rotator cuff muscles – this group of 4 muscles is important to keep the head of the shoulder “centered” as the shoulder moves. If even slight excess movement happens because certain muscles are not “pulling their weight” so to speak, it can alter the normal motion patterns enough to result in pain. Solution- learn exercises to strengthen these muscles

What to do next?

The best thing to do if a person believes they are dealing with shoulder impingement is to seek conservative care from a health professional. Sure you can try avoiding activity or taking pills, but the cause of the problem is not addressed that way. It will likely return again if not corrected when activity is resumed. Also, injections while they may take the pain away again does not address the cause so should be done sparingly.

Learning the appropriate strengthening and mobility exercises is the best way to overcome and prevent the shoulder impingement from returning. If you would like more information on how to best treat shoulder impingement, please fill out this quick survey asking for more information on how to best solve the issue.