The Ultimate Guide to Shoulder Impingement

Shoulder impingement is one of the most commonly diagnosed shoulder conditions. So, I thought it would be helpful to shed some light on what it actually is and how to fix it.

In this Ultimate Guide to Shoulder Impingement I'll cover:

1. Who gets shoulder impingement?
2. What is shoulder impingement?
3. Where do people feel shoulder impingement pain?
4. When do people feel shoulder impingement pain?
5. Why do people get shoulder impingement in the first place?
6. How do I fix my shoulder impingement?

Who Gets Shoulder Impingement?

Shoulder impingement does not discriminate — it affects both men and women of all ages. However, some groups seem to be more at risk than others. Athletes that spend a lot of time with their arms overhead (think baseball players and tennis players) have an increased likelihood. But these are not the only ones at risk. Your average desk worker is also at risk. The dreaded desk position puts a lot of stress on shoulders and can lead to exactly this type of shoulder imbalance.

What is Shoulder Impingement?

The shoulder joint is made up of the upper arm bone (the humerus) and the shoulder blade (scapula). This complex is attached to the upper body by the collar bone (the clavicle). As the arm moves up overhead, all three of these bones need to work together. For every two degrees of motion of the upper arm over shoulder height, the shoulder blade needs to move one degree to match. There is a complex balancing act between the muscles that control the shoulder and the shoulder blade.

If the balance is off for any reason, your shoulder can exhibit problems.

There is a small space between these three bones where some important structures pass through to attach and support the shoulder. Five particular structures are considered to be involved:

1. Long head of biceps
2. Supraspinatus Tendon
3. Subacromial/subdeltoid Bursa
4. Coracoacromial ligament
5. The Joint Capsule

With so many different structures in such a small area the margin for error is quite small. Over time, increasing pressure, friction, and pinching of the muscles in the subacromial space can build up and lead to shoulder impingement. This means that if you've been told you have "Biceps Tendonitis," "Supraspinatus Tendonitis," or "Shoulder Bursitis," then shoulder impingement is a likely contributor.

Where Do People Feel Shoulder Impingement Pain?

With this type of condition, patients will often report pain in the front side of the shoulder. The pain often travels down the upper arm, but rarely past the elbow. At times people can also suffer from some discomfort on the backside of the shoulder joint. The pain is most often provoked by movement.

When Do People Feel Shoulder Impingement Pain?

Movement is the short answer. Most often, the pain is felt when performing overhead movements with your shoulder. This doesn't have to be throwing a ball — it can be as simple as shampooing your hair. Women often have discomfort when trying to take their bra on and off behind their back.

Two movements you can try to check if you may be suffering from shoulder impingement:

1. Reach your arm across your body and see if this reproduces any symptoms.
2. Reach your hand up overhead like you have a very important question to ask and see if this affects your symptoms.

Why Do People Get Shoulder Impingement?

As we discussed, the balance between your shoulder blade and upper arm is crucial. The improper balance of these muscles can increase the amount of "impingement" occurring in this area.

The biggest culprit has to be the pec minor. This is one of your chest muscles that's attached directly from your rib cage to your shoulder blade. This little guy can get very tight with long-standing sitting and slouched postures. It does a great job of pulling the shoulder blade forwards and down — the exact opposite of what we want as we lift our arms overhead.

In addition, folks with this type of injury also present with weakness in their shoulder external rotator muscles (some of the rotator cuff muscles) and lower traps. These are important muscles for assisting and controlling our arms as they move up overhead.

How Do I Fix My Shoulder Impingement?

The goal is to improve the control and strength of your shoulder and shoulder blade so they work together in perfect balance.

The two biggest culprits are the Pec Minor and external rotation weakness. Here are the exercises to get started:

#1 The Pec Grinder — to improve the mobility of that pec minor muscle.

#2 W's — standing shoulder external rotation to increase the strength of your rotator cuff.

#3 Upper Back Foam Roll — to improve the mobility of your upper back and rib cage, which allows the shoulder blades to float more freely as you move.

These three exercises are often a great place to start but won't take you all the way. What I'd recommend is seeing a health care provider you trust to get a proper diagnosis and begin your rehab process.