New School Ideas on Shoulder Impingement

Shoulder pain is pretty common.  And often people immediately assume that the pain is stemming from an issue in the rotator cuff.

If you feel pain when raising your arm above your shoulder, it could be a lot of other muscles that are causing shoulder impingement.  Not just the rotator cuff.  So let’s dive in and determine which muscles are at play!

The Rotator Cuff

The rotator cuff has four small muscles that are responsible for stabilizing and moving the shoulder joint.  Check out that supraspinatus muscle running between the tiny space between bones.  When you raise your arm out to the side and it gets above shoulder height that space between the bones greatly decreases.  And the poor supraspinatus can get caught or “impinged.”

 

So yes, a rotator cuff muscle could be the culprit of your shoulder impingement.  But the shoulder joint has A LOT of muscles running through it.  Think of it as an apartment building.  Lots of muscles all housed in one small area.  Space is limited and muscles can get angry living in tight quarters.  Shoulder pain can be caused by dysfunction in any of those muscles.  Let’s examine some of my clients who I’ve helped relieve shoulder pain.

 

The Tale of 4 Shoulders

Michelle started having shoulder pain after lifting a heavy suitcase.  She couldn’t raise her arm sideways above shoulder height.  Her range of motion in her rotator cuff was normal and not painful.  So I decided to look at other muscles to discover the problem.  Her deltoid, which is the muscle that caps the shoulder, was weak and painful.  Her chest muscles were weak upon testing too.

Similarly to Michelle, Shannon inured her shoulder trying to lift/move a generator.  Shannon’s range of motion in her rotator cuff was extremely limited.  Her supraspinatus was weak and painful.  (That muscle pictured above.)  Her deltoid and chest muscle were also weak like Michelle’s.  Shannon also had a weak and painful bicep.

These two clients were both reporting shoulder pain, but ended up having different treatments.  Michelle needed to release her overactive deltoid via self massage and strengthen her underactive deltoid, chest, and a couple back muscles.  Shannon needed to release her overactive supraspinatus via foam rolling it against a wall with a tennis ball and strengthen her underactive deltoid, chest, bicep, and back muscles.

 

Keeping score of shoulder pain culprits so far:  Rotator Cuff = 1  Other Muscles = 1

 

Leslie had lingering shoulder pain from an old throwing injury.  She had done physical therapy, but upper body strength training exercises were starting to aggravate it.  Her shoulder range of motion was good.  Her deltoid tested weak and testing her chest muscles produced pain.  So, not a rotator cuff issue.  She needed to massage her deltoid and strengthen her chest.

Rob had been going to physical therapy for both shoulder impingement.  To help it feel looser and get the range of motion for raising his arm sideways above shoulder height, he was rolling his bicep, tricep, and deltoid.  While this freed up his shoulder some, it didn’t completely erase the discomfort.  I tested his supraspinatus and it caused discomfort.  When I had him roll his coracoid process with a tennis ball, he was able to raise his arms completely above his head without issue.

The coracoid process is a bony point on your shoulder blade where one of the chest muscles attaches as well as the bicep.  It’s often overactive and feels like a shoulder issue due to it’s location.  So Rob is working on rolling that area now as opposed to all the other ones in addition to strengthening his back.

Final Score:  Rotator Cuff = 1  Other Muscles = 3

 

Summary

The rotator cuff can be an issue when dealing with shoulder impingement.  But not in all cases.  If I had treated my four clients with all the same approach, they would not have gotten pain-free.

There is a common thread, at least in my client’s cases, and that’s weak deltoid and pecs (chest.)  The deltoid and pectoral muscles are larger than the four rotator cuff muscles.  When the large muscles aren’t doing their job well, the little guys try to pick up the slack.  And it’s usually too much work for the little guys.  Eventually, they can’t keep up and injury occurs or pain sets in.

It’s also important to note that massage or foam rolling won’t be effective without pairing the release with a strengthening exercise.  You need both release of the overactive muscle and activation of the weak muscle in order to properly restore balance to the muscles and the movement they’re responsible for.

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