Shoulder Impingement Syndrome
By Dr. J. Clayton Hyght
Bench press kills your shoulder. Lateral raises are impossible. Forget about front raises. You couldn’t do an overhead shoulder press with the pink vinyl-coated dumbbells. If any of these have ever applied to you, read on. If you have never suffered from shoulder pain in the gym, you need to read on as well to discover how to continue to avoid impingement syndrome.
Impingement syndrome is one of the most common injuries among serious weightlifters. We tend to make the problem worse by ignoring it and thinking it will go away on its own. Worse yet, some lifters think that shoulder pain is just part of training. It doesn’t have to be. Whatever you do, do not ignore shoulder pain. Doing so can result in bone spurs and a torn rotator cuff. Yes, my friends, that means surgery. Let’s go over the basics of impingement syndrome and how to correct and/or avoid this terrible tragedy that is plaguing America’s gyms.
Impingement syndrome is defined as a compromise of the space between the head of the humerus and the acromial arch. In simple terms: the top of your upper arm bone is too high and close to your acromion (part of the shoulder blade-scapula) and your clavicle (collarbone). This decrease in space can come from either a structural problem (usually bone) or a functional problem (usually muscular). Since a structural problem would likely show up as soon as someone begins lifting weights, we’ll focus on functional causes of impingement which are most likely the culprit in the gym.
When you raise your arm, a complex chain of events takes place. A group of muscles called the scapular stabilizers (serratus, trapezius, levator scapulae, rhomboids, and teres major) function in a very precise manner to ensure that the scapula is in the right place at the right time. At the same time, the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) finely coordinate the movement of the humerus to ensure proper alignment in relation to the scapula.
If these muscles do not coordinate this movement perfectly, the head of the humerus is likely to rise up and forward and bump into the bottom of the acromion. (To feel the top of your acromion, slide your fingers from the middle of your collarbone outward toward your deltoid. Just before getting to your deltoid you will feel the top of your acromion sticking up a bit.) When this impingement occurs, the supraspinatus muscle and tendon, as well as the subacromial bursa, are trapped between the humerus and the acromion. When two soft structures are trapped between two bony structures, you can guess who loses. This results in swelling and tenderness of this bursa (bursitis) and the supraspinatus muscle and tendon (tendonitis).
Rotator Cuff Strength and Flexibility
The way to ensure that the scapular stabilizers and the rotator cuff muscles can do their job is to make sure that these muscles are strong and flexible. Let’s begin with a sample strength and flexibility program that may help to prevent or correct impingement syndrome. A good starting point would be to train your rotator cuff two times per week (for example: Monday and Thursday.) You could work your way up to doing this routine three times per week (for example: Monday, Wednesday, and Friday.) The two basic exercises for rotator cuff are the sword and the seatbelt exercises. They are to the rotator cuff what squats are to the legs.
Exercise #1: The Sword
To perform the sword exercise, begin with a handle attached to a pulley set at the lowest position on the cable crossover machine. To exercise the right rotator cuff, stand with the pulley on your left-hand side. Reach across the front of your body and grasp the handle with your right hand. This will be the starting position. Begin the exercise by raising your arm up and out to the side. You should end up with you arm slightly (about 30 degrees) above horizontal and your palm facing forward. Your arm will basically be at the “Y” position of the YMCA dance maneuver. If you’re not sure what that is, go to your nearest retro dance club and request the song YMCA by the Village People. Then you’ll see what the “Y” position looks like. This exercise is called the sword because its execution resembles taking a sword out of its sheath.
Exercise #2: The Seatbelt
To perform the seatbelt exercise, begin with the handle set just above head level on the cable crossover machine. This time, to exercise the right cuff you’ll begin with the cable on your right side. Reach up and grasp the handle with your right hand with your palm facing forward. Your arm should be about 45 degrees above horizontal (the “Y” position.) Begin the movement by bringing your arm down and across to the left. This will resemble fastening your seat belt in the passenger seat of a car. You’ll end up with your palm facing your body with your hand just in front of your left hip.
Another good cuff exercise is the empty can exercise. If you are currently suffering from shoulder pain you will likely need to wait until some of the pain subsides before attempting this exercise. To reiterate, this exercise should not be painful. To execute the empty can begin with your arm at your side and rotated inward. Begin the movement by raising your arm up at an angle about halfway between the sagital plane and the frontal plane. To find this plane of movement, raise your arm straight out to the side as if you were doing a lateral raise. Now bring that arm forward 30 – 45 degrees. This is called the scapular plane and is the plane in which you want to perform this exercise. As you are raising your arm up (abduction) in the scapular plane, keep your arm internally rotated which means your pinky will be up and your thumb down (as if you were emptying a can.)
All rotator cuff exercises should be performed with a weight that allows you to get 20 reps without much difficulty. Perform all rotator cuff exercises very slowly (about 5 seconds on both the positive and negative portion of the repetition.) Perform three sets of each exercise. Keep in mind that the goal in training the rotator cuff is to train the muscle to fire properly, not to build the muscle. Save your all-out hardcore training for another body part.
Flexibility of the shoulder is just as important as strength. To keep the rotator cuff complex flexible, try the following stretches. With your humerus at an angle of about 30 degrees (this will put your elbow about six inches from your side) and your elbow bent to about 90 degrees, have a partner lightly internally rotate your arm (your hand will end up behind your back in this stretch.) Hold a slight stretch for about 30 seconds. With your humerus still at 30 degrees and elbow at 90 degrees, have your partner rotate you arm externally (hand going out to the side) and hold for about 30 seconds. The other two stretches are the exact same except your humerus will be at 90 degrees of abduction (straight out to the side as if finishing a lateral raise.) Again lightly stretch internally and externally holding each for about 30 seconds. Repeat each 30-second stretch two times. That’s a four stretches held 30 seconds each and repeated. A total of four minutes of stretching that will go a long way toward pain-free shoulders.
To put the finishing touches on achieving a healthy shoulder complex, you should make sure that you stretch your chest often and strengthen the muscles between your shoulder blades – the rhomboids and the middle and lower trapezius. You should already know how to stretch your chest, just do it more often. To strengthen the upper back muscles concentrate on exercises like bent-over flyes and rows with your arms parallel to the ground. In other words, exercises that bring the shoulder blades toward the spine.
Lastly, if you are currently suffering from shoulder pain, icing your shoulder may help reduce pain and inflammation. Place a damp washcloth on the affected shoulder. Place an ice pack or bag of frozen vegetables on top of the damp washcloth. Leave this in place for 20 minutes or until your shoulder goes numb, whichever comes first. Longer is not better! The most important time to ice the shoulder is after any workout involving the shoulder complex. However, you can also ice it throughout the day but not more than once per hour. NSAIDS (non-steroidal anti-inflammatory drugs) can be used for a week or two to help decrease inflammation and pain. After two weeks NSAIDS basically act only as an analgesic (pain reliever) and may actually delay tissue healing. Whatever you do, don’t rely on NSAIDS to get you through your workout.