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IMPINGEMENT SYNDROME: Techniques for injury prevention

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IMPINGEMENT SYNDROME: Techniques for injury prevention

First and foremost, there are many reasons your shoulder can hurt. Shoulder Impingement is only one example of common pathology amongst overhead athletes (i.e., quarterbacks and pitchers), weightlifters, and CrossFitters. The shoulder as a component of the upper extremity is similar to the hip within the lower extremity in terms of degrees of freedom and planes of motion. However, as a joint that does not necessitate weight bearing, the shoulder sacrifices stability for its superior mobility. This exchange puts the shoulder at risk for injury typically at end ranges of motion. The purpose of this article is to provide a brief understanding of how the shoulder complex works and the pathology of shoulder impingement. With that said, we can begin to integrate prevention strategies and techniques for pain-free overhead activity. Due to the complexity of most shoulder injuries, it is in your best interest to seek a healthcare professional for evaluation and treatment with a preexisting condition.

A brief overview of shoulder biomechanics:

  • The shoulder complex or girdle includes the scapula (shoulder blade). This bone has 18 muscular attachments, each of which effect normal (or abnormal) rhythm of the shoulder.
  • Coupled forces occur in the shoulder girdle to potentiate upper arm movements in a stable and controlled manner. This force coupling of prime movers (bigger muscle groups) should occur in a synchronized pattern. Otherwise secondary movers (smaller muscle groups) have to work harder to keep the shoulder stable.
  • Supraspinatus Impingement can occur when irritation of the supraspinatus tendon and subsequent cascade of inflammation narrows the subacromial space. This irritation can be due to (1) weak and fatigued musculature which causes misfiring, (2) poor posture which puts the shoulder at a mechanical disadvantage, (3) inflamed subacromial bursa, or (4) hitting peak overhead positions with too much force and internal rotation (i.e., flopping to the bottom of your pull-up or wall balls). This can happen in any combination!

Fig. 1                                                                             Fig. 2a                                    Fig. 2b

    

Fig. 1: Force coupling between the trapezius and serratus anterior muscles (prime movers) to rotate the scapula with arm elevation. Fig 2a: Appropriate force couple of supraspinatus and deltoid muscle and normal motion of joint surfaces. Fig. 2b: Abnormal force couple and subsequent supraspinatus impingement in the subacromial space.

What can I do prevent supraspinatus impingement?

Step 1: Protect the subacromial space by making sure you have fluid motion of the scapula as you elevate the arm. Perform postural exercises (i.e., wall-angels) throughout the day to keep you up and avoid rolling your shoulders forward.

Step 2: Ensure you have adequate thoracic extension to allow the arm to move overhead. Use the lumbar roller in the thoracic segments placing your arms overhead.

Step 3: Warm-up with a few pass-throughs using a PVC pipe. This will help to loosen soft-tissue adhesions and generate smoother slide-and-glide motions in the joints of shoulder complex.

Step 4: Prepare the nervous system for overhead activity. Perform shoulder internal rotation, external rotation, abduction and flexion against light resistance (i.e., free weights or bands). Other exercises to warm-up the scapular stabilizers include shrugs, reverse fly’s, bent over rows, and lat pull downs with light weight.

Step 5: Back strengthening exercises are a must. Rowing and kipping pull-ups in a WOD does not suffice! Controlled movements with both concentric and eccentric phases are preferred (i.e., barbell rows and shrugs, strict pull-ups, lat pull downs, etc.). Strength endurance of the rotator cuff muscles can be facilitated with a progression through elastic band resistance.

Step 6: Stretch your shoulders after each workout and ice for 20-30 minutes to limit inflammation and narrowing of the subacromial space.

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