Active Care Rehab, Manual Therapy

Shoulder Impingement and Rolled Shoulders

shoulder_impingement_intro01The shoulder joint consist of the shoulder blade, the humerus, and many muscles and ligaments. The key muscles are the rotator cuff (supraspinatous, infraspinatus, subscapularis, and teres minor), scapula stabilizers (serratus anterior and low-mid traps), and the pec muscles. When these muscles become imbalanced limitations and injury can persist.

Shoulder pain occurs in nearly ¼ of the general population and shoulder impingement is the most prevalent diagnosis in these cases. Shoulder impingement is also called supraspinatus syndrome, swimmer’s shoulder, and thrower’s shoulder and occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the joint. The rotator cuff muscles become compressed during movement and the body has to adjust to perform movements.

Symptoms of shoulder impingement are pain with raising arm from the side, weakness in lifting the arm, and loss of range of motion in the shoulder joint. This occurs due to incorrect repetitive motion and faulty posture. These faulty movements and postures tend to cause overuse of the pec muscles, levator scapulae, upper trap, and some of the supraspinatus.  At the same time, weakness of the mid and lower trap occurs. These imbalance leads to increased faulty movement patterns of the shoulder and injury occurs.

 (Photo: erikdalton.com)
(Photo: erikdalton.com)

In today’s society, rolled shoulders or forward shoulders are occurring more and more. This occurs due to computer/desk jobs and the fact that we sit for most of our day.

Commonly when the shoulder rolls forward the pec, upper trap and levator scap muscles become overactive. As a result the shoulder blade elevates and the arm rotates inward. This position places the shoulder stabilizers in a long, weak position. When imbalances occur in these muscles stability is lost and the chance of injury greatly increases.

As the imbalances and faulty posture continues, increased stress is placed on the shoulder, especially the supraspinatus. Due to the rolling and shoulder blade position the space the supraspinatus tendon runs through is lost and the tendon becomes impinged. Over time this compression leads to irritation and inflammation and pain follows.

Treatment for shoulder impingement consist of stretching, Active Release and/or Graston, and functional rehabilitation of the shoulder blade stabilizers, thoracic spine, and rotator cuff muscles. So if you are dealing with shoulder pain see this weeks exercises by clicking here.

Yours in Health,

Dr. Justin Hildebrand

Active Care Rehab

Desk Job Hurting Your back?

Our bodies are bipedal, meaning that we were meant to stand on two feet. Sitting for long periods of time is biomechanically insufficient and places large amounts of stress on the spine. Sustained sitting can cause specific muscles to become shorter and joints to become hypomobile.

Classic seated posture:

Classic Seated Posture
Classic Seated Posture
  • Places one’s head forward and rolls the shoulders, shortening muscles that commonly cause headaches.
  • The shoulder blades more upward and outward increasing tension in the neck and shoulder muscles and inhibiting the stabilizing muscles of the shoulder blades.
  • The mid back and low back round out forming a kyphosis, placing the disc of the spine under uneven pressure.
  • The hip flexor muscles are shortened and the gluts are inhibited which can lead to Lower Cross Syndrome.

Commonly, sitting at a desk for a sustained period of time causes headaches, shoulder and/or neck pain, mid back pain, or low back pain. All of these can be prevented or decreased by taking microbreaks and performing a simple exercise.

A Microbreak consists of standing up, stretching and walking about for 30 secs. This should be performed every 30 minutes to an hour that one is sitting. Performing microbreaks will decrease the risk of muscles becoming shorter and joints becoming stiff.

Bruegger’s exercise will help relax short muscles and help strengthen inhibited muscles due to sitting.

Procedure:

  1. Sit down and spreading your feet shoulder width apart and your toes out.
  2. Pretend there is a string pulling your chest up and out, extending your upper back.
  3. Your arms should be at your side with your head looking straight in front of you.
  4. Gently tuck your chin and rotate your palms forward.
  5. Hold position for 30 secs every 30 minutes seated.
Corrective Exercise for Seated Posture
Corrective Exercise for Seated Posture

Notes:

– You might feel a slight muscle squeeze between your shoulder blades, but not a strong contraction.

– You should still be able to talk when your chin is tucked, if you are unable to talk, relax a little bit!

Next time you are at your desk and you start to feel tension or pain, try taking a microbreak and performing Bruegger’s exercise. You will notice that you can sit for longer periods without pain.

Yours in health,

Dr. Justin Hildebrand