Primary Causes of Shoulder Impingement
When you raise your arms higher than the level of your shoulder, the subacromial space becomes smaller. The most common cause of shoulder impingement is the overuse of shoulder muscles.
Repeated overhead arm movements create microtears which can result in the inflammation of the SITS tendons (Supraspinatus, Infraspinatus,Teres minor, and Subscapularis, respectively), a condition known as tendinitis.
This inflammation further narrows the subacromial space so that when you raise your arm, the inflamed tendons become impinged and rub against the arch, leading to irritation and more inflammation.
This condition is common among swimmers, baseball players, and tennis players.
Any condition that makes the subacromial space smaller can result in shoulder impingement. Some of these conditions include weak shoulder muscles leading to malalignment of the shoulder joint, a curved acromion process, or the presence of bone spurs in the shoulder joint.
Symptoms of Shoulder Impingement
The most common symptom of shoulder impingement is mild pain in the shoulder, especially when reaching upwards. The pain may be present even at rest, and the shoulder can be tender when touched. The pain may spread to the front and side of the arm.
In worse cases, weakness of the SITS muscles may accompany the pain. Sleeping at night might become difficult because of the pain. It might be difficult to perform daily activities such as putting on a t-shirt, reaching overhead, and pulling a back zipper.
Activities to Avoid When You Have Shoulder Impingement
- Avoid any activity that worsens the pain in the shoulder. Some of these include throwing, reaching for overhead objects, and lifting heavy objects, as these activities might add stress to the inflamed SITS tendons.
- You should also avoid pull-down exercises and bench or tricep dips, which position the shoulder backward. Avoid behind the neck presses, which require extreme outward rotation of the shoulders.
- Athletes are advised to take a break from their usual training. Still, they may perform aerobic and lower body exercises to help in their recovery process and prevent other complications, such as loss of strength and flexibility. Pushing the shoulder beyond its limits will only result in increased pain, poor healing, more complications, and a longer recovery time.
Although physicians advise individuals with shoulder impingement to rest, it does not mean that they should avoid all shoulder movements at all times.
Exercises that do not produce pain may be continued to prevent stiffness of the shoulder joint and weakening of the muscles. Moreover, the lack of movement in the shoulder joint may result in decreased range of motion and loss of muscle strength.
Stretches to Help You Recover from Shoulder Impingement
Stretching will not only increase flexibility but will also help alleviate the tension in the shoulder muscles. Stretching can potentially even widen the subacromial space and relieve some of the pressure in the joint.
Some of the stretching exercises that you can do are listed below. Keep in mind that anything that produces or worsens the pain in the shoulder should be avoided.
You can do all the following stretching exercises by holding the position for 10 to 15 seconds (or up to 30 seconds if tolerable) and repeating it three times. Do this on both sides.
Stretching Your Arm Across Your Chest
This exercise helps stretch the muscles at the back of your arm and the muscles of your mid-back. Place your right arm across the chest with the elbow straight.
Place the left hand on or above the right elbow, then gently pull it towards your body. Always maintain a straight back and avoid rotating your trunk.
Pain in the shoulder is typically accompanied by tension in the neck muscles; some affected individuals may experience neck pain and tension headaches. Stretching the neck muscles will help alleviate this tension.
To perform this stretch, first, bend your neck to the right side. Next, use your right hand to bring your head closer to your right shoulder gently.
You may place your left hand on top of your left shoulder to increase the stretch. Make sure that your back is straight and refrain from bending your trunk sideways.
Neck Rotation Stretching
This is another stretching exercise to relieve the tension in the neck area. First, turn your head to the right and bend your neck down.
Use your right hand to bring your head further down gently. You may place your left hand on top of your left shoulder to increase the stretch.
This stretching improves the flexibility of your chest muscles. You may perform this exercise while sitting or standing. First, sit or stand with your back straight and shoulders level.
Look forward and bring your arms to the side with elbows straight. Gently bring your shoulder blades together and rotate your arms outwards so that your palms are facing forward.
You may bring your shoulders down and slightly backward to increase the stretch. Avoid arching your back.
This exercise stretches the trunk, the muscles at the back of the shoulder, and the back muscles. Sit straight on a chair with your feet shoulder-width apart. Gently turn your trunk to the right side.
Using your right hand, hold the back of the chair, then bring your left hand to the side of the right thigh. Continue turning until you feel the stretch.
This stretch improves the flexibility of the rotator cuff muscles. Perform this with caution and immediately stop if it causes pain. Bring the affected arm backward with your elbow bent.
Hold the towel with your unaffected arm and raise it above your head with your elbow bent. Hold the bottom end of the towel with the arm suffering from impingement.
Gently pull the towel up with the unaffected arm and hold the position for 10 to 15 seconds (up to 30 seconds if tolerable).
Afterwards, gently pull the towel down with the painful arm and hold the position.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.