Shoulder impingement is a common and painful condition that can affect you whether you lead an active or sedentary lifestyle. So you can avoid it
One of the most common problems that people face, regardless of whether they follow an exercise routine or not, is stiff shoulders. This can be caused by rotator cuff weakness, poor posture, or incorrect form (in the case of those who exercise), a shoulder problem is something we’ve all faced or will face at some point in life.
Much of this is due to the fact that the shoulders are the most mobile joint in the human body; and the range of motion of the shoulder joint is triggered by a series of tightly knit tendons and rotators, bones and soft tissues. They all work together so you can be mobile enough to scratch an itchy back, or remove a T-shirt with a complex cross-arm motion, and even reach over to get something off the shelf. So when you’re facing sharp pain while doing these activities, you may have what’s known as an impinged shoulder. It could be the first stage of a frozen shoulder, but with regular exercise, this can be avoided.
“In my experience, about 70 percent of the people I talk to about injuries have suffered impingement,” says Ahmedabad-based physiotherapist Falgun Bhatt, who is also associated with the city’s ARA Football Club. His background is in sports and musculoskeletal rehabilitation, and he recently became the first Indian to take a football performance therapy course from Dubai.
Bhatt says that before you jump to the conclusion that you have an affectation, it’s important to be sure. Otherwise, people can fall into what he calls a “false exercise” pattern. “It is important that the physio realizes what is happening. Shoulder impingements are somewhat difficult to diagnose. It is also about how well the patient can communicate, but that depends entirely on the right questions that the physiotherapist asks,” adds the 29-year-old.
He says the main cause of an impingement is tight pectoral muscles and weak rotator muscles. “We need to understand why the lockdown is happening. Weak rotators or tight pecs and weak lower traps will push the humeral head into a certain position. The condition (impact) itself is a blocking mechanism. Muscles are trapped between two bones. You need more space to avoid this,” says Bhatt.
And it is this creation of spaces that fitness content creators call “unlocking” the shoulders. Bhatt says that while these breakout exercises are necessary for shoulder space creation to work freely, it’s also important to focus on mobility and stability because this isn’t “an accidental impact or injury.”
On his Built With Science blog, Jeremy Ethier mentions a quick self-test that can also help you explain pain to your physical therapist. “(Raise) your arms up with your thumbs up. Repeat this but with the thumbs down. If you experience pain or the pain worsens in the thumbs-down position, this is an indication that you may have this specific type of impingement. Another indication is whether your shoulders feel better when pressing with a neutral grip or underhand instead of overhead,” he writes in an article calledHow to fix shoulder impingement for good.
Both Ethier and Bhatt prescribe the usual variations of external rotation exercises: side-lying external rotations with light weights or water bottles, prone Y and T raises, or medicine ball raises. A quick internet search will provide a variety of such augmentations that Bhatt says will work for injury prevention.
But Athlean-X guru Jeff Cavaliere says that strengthening the rotator cuff might not be enough. “The joint itself becomes even more crowded and cannot safely house the tendon as inflammation and swelling increases. Just doing things to strengthen the rotator cuff in this case to try to open up more space in the joint by putting the humerus in a more biomechanically secure position is not enough,” he says in his YouTube video titledHow to fix shoulder pain and impingement.
Bhatt believes there are solutions to impingement, but the goal should always be to avoid getting to that point, focusing instead on prehabilitating and injury-proofing the shoulder. “These are exercises that people should do regardless of pain or without pain. There are usually three stages: prehabilitation, rehabilitation, and then performance and strength. But nip it in the bud and you never have to go through rehab,” he says.
Pulasta Dhar is a football commentator and writer.