If you are someone that has experienced persistent pain in either one or both of your shoulders, then you know it can be completely devastating for your training as well as your everyday life! One of the most common cases we see at GO PT is shoulder pain that presents as a sharp pain or a dull ache in the front or back of the shoulder when the patient reaches the arm overhead. Oftentimes, our athletes will say that the pain began as a minor inconvenience that they barely noticed, but progressively worsened over time to the point that any movement overhead brings about a ton of pain making Olympic lifting, shoulder pressing, pull-ups, and everyday household tasks nearly impossible! If this sounds familiar, chances are you are dealing with a common condition known as shoulder impingement. Let’s take a deeper look into why this painful condition develops and how you can fast track your way out of pain and back to training!
Firstly, it’s important to note that while we often refer to the shoulder as a singular joint, it’s actually composed of four joints known as the Sternoclavicular, Acromioclavicular, Glenohumeral, and Scapulothoracic joints. These four joints make up the Shoulder Complex and must work in concert for you to be able to lift the arms overhead without pain. Shoulder impingement or Subacromial Impingement Syndrome are terms used to describe pain that develops when structures between the top of the shoulder blade and upper arm become compressed and inflamed. Looking at the picture below, notice that between the acromion (part of the shoulder blade) and the humerus (upper arm), you have what’s known as the subacromial space. Depending on your anatomy and the position of the arm, this space is only 2-17 millimeters wide! Lack of mobility, stability or faulty movement patterns in any part of the shoulder complex can result in the bones of the upper arm and top of the shoulder blade approximating and causing excessive compression on the rotator cuff tendons, bursa, or other structures within the glenohumeral joint.
To get out of shoulder pain fast, simplify and prioritize your rehab into three main components: mobility, stability, and control. Any joint in the body, whether it’s the shoulder, hip, or ankle, will function optimally provided that it has a full range of motion, strength throughout that entire range, and optimal form or control with functional movements. Beginning with mobility, assess how well your shoulder is moving. Can you get the upper arm in line with the ear when overhead? Are you able to comfortably reach over your head and touch the opposite shoulder blade or reach behind your back? If you feel restricted or painful with these movements, try working on shoulder mobility first. A simple way to start is by taking a lacrosse ball, baseball, or tennis ball, and using it to free up tight muscles that may be restricting your range of motion. Try the following three mobility exercises, then retest how your shoulder moves overhead or when reaching behind the back!
Upper Trap Mobilization
Lat Mobilization
Pec Mobilization
Next, anytime we work on the mobility of a joint, we want to immediately follow up with stability or strengthening exercise that allows our body to hold on to this newly acquired range of motion. Many practitioners make the mistake of attributing poor movement of the shoulder to decreased joint or soft tissue mobility. However, poor mobility or “tightness” can often be a sign of a lack of strength. Try the following three exercises that emphasize strength and stability of the shoulder overhead as well as owning the end ranges of motion:
Wall Slide
Banded Row + ER
End Range ER + Liftoff
The last and possibly most important piece of the puzzle is driving home proper overhead mechanics to not only prevent shoulder impingement but also improve performance in the gym! Anytime we lift or reach overhead, we want to emphasize external rotation torque as this is the strongest and most stable position of the shoulder. If you are someone that does a lot of unilateral, or single-arm work, such as KB presses, dumbbell presses, or banded exercises – I want you to think about turning the thumb back and pointing the armpits forward. These cues put the shoulder into an externally rotated position which creates space for the arm to travel overhead pain-free. Now, if you are using a barbell or hanging from a pull-up bar, you’re probably thinking it’s impossible to point the thumb behind you. For movements where your hands are fixed to a bar or barbell, think about trying to bend the bar while completing the exercise and shoving the armpits forward. This works to create external rotation torque about the shoulder, even when the hands are fixed in one position. Try the following three exercises to work on proper overhead shoulder mechanics:
Banded V-Raise
Kettlebell Windmill
Z- Press
For these exercises, I recommend trying to work them into your training regimen 2-3x/week, however, you can perform the lacrosse ball mobilizations on a daily basis. Try to limit any overhead motions that are bringing on sharp pain as these will keep the shoulder aggravated. We want to load the shoulder, but in a controlled manner that allows for better shoulder mobility, strength, and movement. As your shoulder pain decreases, progress the loading and intensity of the exercises as you would any other movement in the gym! When you return to overhead training, remember to emphasize “bending the bar” or “shove armpits forward” to keep the shoulder strong, stable, and pain-free. I hope this blog post sheds some light on how to get out of shoulder pain fast and keep it from ever coming back in the future. If you guys/gals have any questions or want to learn more, I can be reached at Brett@groundtooverheadphysicaltherapy.com.
Have a great week of training!
Dr. Brett Rolison