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SHOULDER PAIN WITH OVERHEAD MOTIONS? LEARN WHY!

A very common issue that occurs in active individuals is shoulder impingement. This condition occurs as a result of faulty mechanics of the shoulder joint. But don’t worry! It can absolutely be resolved and prevented with effective physical therapy!

What IS shoulder impingement?

Shoulder impingement is the fancy term for pinching of the tendons that run in front of the main shoulder joint. This condition typically involves one of the rotator cuff muscle’s tendon and/or the biceps tendon. If this condition progresses for long enough it could result in a rotator cuff tear, specifically of the supraspinatus tendon. This, we definitely want to avoid!!

Why does impingement occur?

Before understanding faulty mechanics, we need to understand NORMAL shoulder mechanics.
Normally, when reaching overhead, our shoulder should pivot smoothly in the ball and socket joint. During reaching, when our arm gets high enough the shoulder blade has to start rotating/tipping in a way to keep the humerus ON AXIS in the socket of the joint.

With faulty mechanics, the shoulder blade can get stuck in a way that does not allow it to rotate. The shoulder will then take the path of least resistance and move up and forwards into a position that pinches the tendons.

Repetitive faulty movement over time can lead to a very unhappy supraspinatus and biceps tendon. And then a very unhappy you. :-(

But wait! We can fix it!

Don’t go running to your ortho surgeon yet….

There are 3 main focus points that should be addressed with physical therapy in order to restore normal mechanics:

Ribcage Position
Not commonly addressed, however, in my opinion the most important requirement for normal shoulder mechanics!! People who experience shoulder impingement typically have a ribcage in an “extended” or tipped backwards position causing the lower ribcage to flare. This position places important muscles that regulate our movement (i.e. diaphragm, abdominals, serratus anterior, mid/low trap) in a weak and inefficient position to contract.

Thoracic Spine Mobility
If the ribcage is in an ideal position then the thoracic spine can move appropriately! In order for our shoulder blade to move appropriately we need good rotation of our thoracic spine. If we are too “extended” it can cause our spine to be “locked out.”

Shoulder Blade Motion
And of course as mentioned, we need good shoulder blade motion to keep the humerus on the axis to avoid pinching.

Our anatomy and biomechanics are perfectly created for normal shoulder motion. However, certain cultural behaviors, like sitting at a computer all day and forward head posturing, can throw us off course!

For assistance in treating or better yet, PREVENTING, shoulder impingement contact Dr. Greer Mackie, PT, DPT, OCS at physioDENinfo@gmail.com.


For further nerding out, see these articles:
Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track? Kevin J. McQuade, John Borstad, Anamaria Siriani de Oliveira. Physical Therapy, Volume 96, Issue 8, 1 August 2016, Pages 1162–1169. https://doi.org/10.2522/ptj.20140230

In Vivo Assessment of Scapulohumeral Rhythm During Unconstrained Overhead Reaching in Asymptomatic Subjects Jonathan P. Braman, MD,1 Sean C. Engel, MD,1 Robert F. LaPrade, MD, PhD,1 and Paula M. Ludewig, PT, PhD2. J Shoulder Elbow Surg. 2009 Nov–Dec; 18(6): 960–967. doi: 10.1016/j.jse.2009.02.001
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