The shoulder is one of the most mobile joints in the body. The shoulder connects the upper limbs to the trunk.
A lot can cause pain at the shoulder joint and in this post, we will be looking at shoulder impingement and the exercises that can help relieve pain.
What Is Shoulder Impingement?
The shoulder is a joint formed by three bones; The clavicle, The acromion process of the scapula and the head of the humerus. These bones are joined together by ligaments.
The shoulder joint is stabilized by muscles. These muscles are attached to the bones by tendons. The major muscles at the shoulder joint are called the rotator cuff muscles. Four muscles make up the rotator cuff muscles and their functions are to keep the head of the humerus in the socket of the shoulder blade and also enable us to move our shoulders in different directions.
When we talk about shoulder impingement, we talk about the rotator cuff muscles tendons getting inflamed or being pressed on by surrounding structures which affects their function at the shoulder joint.
What Can Cause Shoulder Impingement?
- Most of us tend to sit or stand hunchbacked especially when using our laptop or computer systems. As mentioned earlier, the rotator cuff muscles attach the upper arm to the shoulder blade so sitting or standing poorly overstretches the muscles and tendons which can lead to an inflamed tendon.
- Weak Muscles around the shoulder joint can cause a lot of strain on the rotator cuff muscles. This can lead to shoulder instability and inflammation of the rotator cuff muscle tendons at the joint.
- Overusing our shoulders can cause shoulder impingement. A swimmer may complain about shoulder pain because he constantly uses his shoulder to swim in the competitions he is involved in. Using the rotator cuff muscles for a long period of time can cause inflammation at their tendons and in turn, shoulder impingement.
Symptoms Of Shoulder Impingement?
- There is pain when trying to take your hand to the back like zipping up your dress or when wearing a blouse over your head
- A weakness of the shoulder muscles which may occur due to avoidance of pain when moving the shoulder
- Pain which spreads to the elbow
- Pain at rest
- Pain when lifting
- Tenderness and soreness
What Exercises Can Be Done For Pain Relief?
Before carrying out exercises for your shoulder, kindly see a doctor or a physiotherapist as improperly doing the exercise may cause more harm to the inflamed tendons.
Light exercises are usually done for the shoulder to strengthen the muscles and stretch out muscles of the chest and shoulders as well.
Exercises are like a drug and the dosage must be increased only by your physiotherapist or doctor. Like oral medication, stick to the exercise prescription written for you.
Some of these exercises are:
1. Shoulder Pendulum Exercises
This exercise uses gravity to gently ‘space out’ the shoulder joint. As mentioned earlier, the tendons connect the head of the humerus to the socket of the scapula. This means the tendon can get compressed at this point.
Here’s how to do this exercise:
- Stand with your feet slightly apart
- You can hold a weight in your affected hand if you want to. It should not be too heavy.
- While standing straight, bend your upper body towards the ground with your affected hand by your side
- Keep your affected arm straight and swing the arm to the front then to the back
- This can be done for 30 seconds to 1 minute
2. Shoulder Distraction
This is similar to the pendulum exercise but there is no movement involved.
- Lie on your chest on a bed with your affected arm hanging over the side of the bed. A high bed is usually recommended but if you do not have one, it can be done sitting or standing.
- Your arm should be hanging straight down by your side
- Hold a weight that is not too heavy, such as a 3kg dumbbell or sandbag
- Let your arm hang for 30 secs with your upper body slightly bent forward if you are sitting or standing.
3. Shoulder Blade Squeeze
This exercise strengthens the rotator cuff muscles and also assists in correcting our upper body posture, as poor posture can lead to shoulder impingement.
- This exercise can be done while sitting or standing
- Ensure your back is straight when performing the exercise
- Bend your elbows to 90 degrees and keep your arms close to your side
- Pull your elbows to the back as if you want them to touch each other
- Hold for 5 seconds
- Release and repeat 5 – 10 times
4. Pectoralis Stretch
The pectoralis muscle connects the chest to the arm. This muscle may get tight and may affect our posture. Stretching of the pectoralis muscle helps to improve posture.
- Stand by an opened door with your hands on the door frame
- Push your body through the space in front of you as if you are doing a push-up
- Hold for 5 seconds before going back to the original position
- Repeat 10 times
5. External Rotation Exercises
External rotation is a movement of the shoulder away from the body. When you place your hand on your chest or stomach, for example, with your elbow bent at 90 degrees, you can turn your arm away from your body with your elbow still bent.
- The rotator cuff muscles control this movement and need to be strengthened.
- Hold a resistance band or a weight (either a dumbbell or a sandbag) with your affected arm. The resistance band should be attached to a firm object on the opposite side of the affected arm. If the right side is affected, the band should be tied to a door or a couch on your left side.
- This can be done sitting or lying on the unaffected side
- Bend your elbows to 90 degrees and ensure your back is straight. your thumb should be facing the ceiling and your arm close to your body.
- Pull the band and move your arm away from your body to the side
- Repeat 10 times and rest
6. Internal Rotation Exercises
This is the opposite of external rotation and the exercises are similar.
- This exercise has the same starting position as the external rotation exercise but the resistance band will be attached to an object on the same side as the affected hand.
- Pull the resistance band towards your chest
- Repeat 10 times and rest
7. Quad Rockers
This exercise increases the mobility of the shoulder joint.
- Go into a crawling position with your wrist and elbow straight and under your shoulders and your knees directly under your hips
- In this position, slowly rock your body forward without moving the arms and legs, then rock backward as if you want to sit on your legs.
- Repeat 10 times and rest
What Other Ways Can It Be Treated?
See A Doctor Or A Physiotherapist
As soon as you start feeling pain in the shoulder, go to the nearest hospital and complain to your doctor. Your doctor will check your shoulder and advise that you run some tests like an Xray, CT scan or MRI to ensure that there are no other conditions like a fracture or dislocation that may have similar symptoms with shoulder impingement.
After the assessment, your doctor will prescribe some medications, advise on how to care for your shoulder and refer to a physiotherapist.
Analgesics are pain relieving agents and they can be taken orally or topically. The major active ingredients of these drugs and ointments are diclofenac, ibuprofen, and ketoprofen. Some of the popular brand names of the ointments are Voltaren and Olfen.
The RICE treatment is done in the first 72 hours from when the injury happens or when it is noticed.
The RICE treatment stands for Rest, Ice, Compression and Elevation.
The movement needs to be reduced at the shoulder joint to prevent further injury. This involves resting the shoulder by using a shoulder brace or taping the shoulder. This helps to speed up healing of the injured structures.
Ice is used to relieve pain. Crushed ice in a damp towel or an ice pack can be placed on the shoulder joint for 15 minutes. This should be done every 4 hours.
Compression and elevation are used to reduce any form of swelling at the shoulder joint. A compression bandage can be wrapped around the shoulder to reduce swelling and the shoulder should be elevated on pillows above heart level.
Physiotherapy plays a major role in the rehabilitation process. The physiotherapist will assess the shoulder joint and check for other signs that may affect the healing process.
Apart from ice, the physiotherapist can use other forms of modalities to relieve pain. this may range from heating modalities to electrical stimulation and therapeutic massage.
The physiotherapist will also teach you how to correct your posture and modify your everyday life to reduce pain. Such modifications can involve not sleeping on the affected shoulder or how pillows can be used to support the shoulder while you sleep.
Exercises are prescribed by physiotherapists. These exercises help to relieve pain, stretch out any tight muscles and strengthen weak muscles around the shoulder joint. As the injury heals and pain reduces, exercises will be added gradually and the reps will be increased as well.
Complain to your physiotherapist about pain or any form or discomfort while carrying out the exercises.
If all the treatments mentioned above do not work, surgery is usually advised as a last resort.
Can It Be Prevented?
- Maintain a good posture at all times
- Take stretch breaks while sitting at work
Shoulder impingement is a compression of the anatomical structures around the shoulder joint, especially the tendons of the rotator cuff muscles. Exercises relieve pain and prevent constant dependence on oral pain medications.