‘Treatment of Shoulder Impingement Syndrome’
Shoulder Internal Impingement pain involves difficulty placing your arm behind your back and also pain behind the shoulder joint when swinging the arm overhead. In order to correct Internal Shoulder Impingement Syndrome, we need treat and rehabilitate three dysfunctions that commonly exist together in the shoulder complex, a) Restriction on placing arm behind lower back, b) Tilting forward of the Shoulder Joint known as Anterior Instability, c) Weak Muscle Retraction between the Shoulder blades.
Difficulty or restriction when placing the hand behind your lower back is commonly caused by a tight posterior shoulder. The posterior capsule is a sleeve-like material surrounds the ball and socket joint of the shoulder reinforcing its stability and allowing movement. If the capsule becomes tight then it lacks flexibility to allow the arm to move comfortably behind the lower back. In addition the posterior rotator cuff tendons that sit behind the shoulder joint become tight thus also restricting arm behind lower-back-movement. Self stretching exercises are important here under the Guidance of your Physio. A simple stretch of placing your arm, with elbow straight, and holding it in this position with your opposite hand, can achieve a stretch to the posterior joint capsule and posterior rotator cuff tendons.
Anterior Shoulder instability is highlighted by a forward tilting position of humeral head (upper arm) in the shoulder socket. An imbalance in the tensile strength of the 4 rotator cuff tendons will be present with this shoulder abnormality. Exercises should target strengthening of the weak rotator cuff tendons in tandem with balance exercises to strengthen dynamic stability and neurological control of the shoulder when playing sports that involve overhead activity.
Weak scapula retractor muscles that are situated between the shoulder blades is the 3rd issue that needs to be addressed. The upper trapezius muscle is a strong muscle that is situated where the shoulder joins the neck region. During activity this muscle is commonly overactive due to weakness and early fatigue of the lower and mid trapezius that sit between the shoulder blades often highlighted by a rounded shoulder posture. These lower scapula retractor muscles need to be strengthen simply by moving both arms backwards in a standing position, with elbows straight and reaching arms downwards, under the guidance of your Physio.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact Number: 0504 26672 Email: tomaspryan@gmail.com
