If you’ve ever felt a pinching in your shoulder when you moved your arm out to the side or to reach behind you, you’ve probably had what some like to call Impingement Syndrome, or at least the beginning of it. So what actually is impingement syndrome? Let us explain the mechanics behind it…
The acromion process of the scapula is meant to sit slightly behind and above the head of the humerus (upper arm bone). When the front muscles (pecs, etc) are tight and dominant and the back muscles (between the shoulder blades) are weak, the acromion process is pulled forward and sits almost directly on top of the humeral head. When this occurs, the structures that lie between the acromion process and the humerus get pinched. The biggest pinched culprits of pain are the supraspinatus and nerves that run through this tunnel. Once they get pinched, they can cause radiating pain down the arm and weakness of the shoulder.
Often times, once this pinching occurs, shoulder range of motion can become severely limited and the mechanics of the shoulder become skewed and the body starts to subconsciously use compensatory strategies for you to use your arm. Unfortunately, compensatory strategies lead to a bigger shoulder problem than you initially had. The good news is that all of this can be fixed with some release, mobility improvement, and stabilization. By releasing the anterior muscles both manually by a Physical Therapist and through daily stretching, you will allow the shoulder blade to sit back on the ribcage where it is supposed to. Once you have the shoulder blades sitting where they should be and moving freely, the next step is firing up those shoulder blade stabilizers and strengthening the rotator cuff muscles in their appropriate position.
One, often overlooked, contributor to shoulder impingement and the movement of the shoulder blade on the body is the mobility of the thoracic spine. While the thoracic spine is built for stability to protect our lungs, heart, and other mildly important things, it often gets a little too stiff and stuck in a forward flexed position due to us doing everything in front of us. In order for the shoulder blade to move as it is supposed to, we need to have ample mobility of our thoracic spine into extension to give the shoulder blade somewhere to go. The best way to start to gain thoracic mobility is to stretch over a small ball, or spine corrector (if you have access to a Pilates studio). Once you have stretched a bit and have some more mobility moving into thoracic extension, the next step would be to gain strength into thoracic mobility.
While working on all of the above seems like it will be a long a tedious fix to a little shoulder pain, it will actually get to the root of the problem, as opposed to getting a cortisone injection or taking anti-inflammatories, which just address the inflammation and pain, but not the actual mobility or mechanical issues with the shoulder.
-Dr. Alexandra Terpos, DPT-