Written by: Lindsay McGuire, MS, CSCS, PT, DPT
Do you have shoulder pain?
In my years in the gym, I have heard many people mention that they have shoulder pain, especially my fellow powerlifters, and then subsequently correlate it with shoulder impingement. But what is shoulder impingement? What are the signs and symptoms? How can I prevent it or treat it?
What is Shoulder Impingement?
Shoulder Impingement is a condition that usually involves a compression of structures of the shoulder that sit above the head of the humerus and below the acromion process of your scapula. In many cases this is due to chronic overuse and improper mechanics over several years.1 The result is a decrease in space between those two areas and damage to the structures that are in that area. These structures are your supraspinatus tendon, biceps tendon, and the subacromial bursa. This can eventually lead to tendonitis of those tendons and/or bursitis with additional complications, potentially even requiring surgery. As powerlifting and weightlifting are inherently repetitive and intensive in nature, this condition may be extremely detrimental to a lifter’s career.
What are the signs and symptoms?
- Pain: A common area to have pain is in this general area of the shoulder.
Symptoms arise or get worse with repetitive movements especially overhead. Other movements that may cause pain are benching, overhead press, front raises of any kind, etc.
- Pain usually comes on during 60-120 degrees of flexion of the arm with pain diminishing towards the top of the movement.
Three simple exercises to help prevent/treat this particular condition and promote proper biomechanics during overhead movements:
- Posture: This may seem extremely simple however this is absolutely key. In today’s world, we are constantly in a position of forward rounded shoulders with protracted shoulder blades due to working at a desk, sitting in a car, etc. Our body adapts to continually being in this position, resulting in chronic poor posture. When performing shoulder flexion, our humerus elevates while our scapula simultaneously protracts and rotates upward thus creating space for the humerus to move freely in that subacromial space without causing damage to the structures inside. When we are in an already protracted position due to improper posture, we have already taken up the space in which the humerus can move, putting pressure on those internal structures. Maintaining proper posture throughout the day can prevent structural changes overtime. Throughout the day do a quick posture check:
Shoulders back and down (keep your traps relaxed)
Weight distributed equally on both hips, if seated
- Stretch your pec minor! Pec minor is a structure that can get super tight especially with chronic poor posture. It also has a tendency to get tight with powerlifters due to the nature of our sport as one of our main lifts is bench press.
Pec minor attaches to the coracoid process of the scapula and to the surfaces of your first few ribs.3 What this means is when pec minor is tight, it can actually tilt your scapula forward, inhibiting its ability to move properly during shoulder flexion and thus again creating improper biomechanics and further impingement.
One simple way to stretch pec minor:
Lay on a foam roller and lay arms in a Y shaped fashion and hold for 2 minutes 1-2 times per day.
Strengthen your low traps! Low traps tend to be one muscle that is neglected during training. Your low trap, in conjunction with other muscles, is responsible for retracting, depressing, and upwardly rotating your scapula.3 To tie this back to posture, when sitting upright both of your scapula should be retracted and depressed. When performing shoulder flexion, bench, or overhead activities, your low trap will assist in upward rotation of your scapula. This upward rotation is extremely important in creating proper biomechanics, where your humerus moves freely within the subacromial space making impingement of the internal structures less likely.
How do I strengthen this? An exercise that has been extremely beneficial is one I gathered from a physical therapist, Mark R Bookhout 6.
Lie on your stomach with one arm supporting your forehead and the other arm straight by your side with your palm facing up as shown below. Gently reach towards your feet with your straight arm and lift that shoulder off the floor. Focus on bringing your scapula down and back as if you are trying to put it in the back pocket of your opposite side without pinching your shoulder blades together. Hold this for at least 5 seconds and then slowly lower back to the table/floor. Work your way up to 10 repetitions for 10 seconds.
If you are having shoulder pain as described as above, try these three simple items for 2-4 weeks performing the pec stretch and low trap exercise 2 times a day while performing self posture checks as often as possible. If your pain does not decrease or worsens you may consider seeing your primary care physician or local physical therapist to further address these concerns. If you do not have shoulder pain, these are a good and safe option for preventing shoulder issues in the future. I personally program these into my daily routine as I have had shoulder pain in the past and these helped to correct and prevent it from returning. If any of these exercises cause pain do not continue to persist as this may indicate that these are not appropriate for you.
Clinical Management of Patients with Musculoskeletal Dysfunctions III [Lecture ]2016.
Gross Anatomy Course Notes. Chicago, IL: Northwestern University Feinberg School of Medicine
Department of Phyiscal Therapy & Human Movement Sciences 2014.
Kirsten Moisio P, PHD. Gross Anatomy Course Notes Chicago, Illinois Northwestern University Feinerg School of Medicine
Department of Physical Therapy & Human Movement Sciences 2014.
Bookhout P, MS , Mark R. . Exercise as an Adjunct to Manual Medicine
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