by Mitchell Starkman, Registered Physiotherapist
We’re so excited to talk shoulders with you! The idea of shoulder pain as a whole is a huge topic so we’ve decided to focus in on the two most common causes of shoulder pain in runners. These are the most common reasons people have to visit their healthcare provider: Shoulder Impingement and Rotator Strain. The good news is that both of these conditions are greatly related and so, for simplicity’s sake, we will refer to both of them as Shoulder Impingement throughout this guide.
In this Ultimate Guide to Shoulder Pain I will review the following:
- Who gets Shoulder Impingement?
- What is Shoulder Impingement?
- Where do people feel Shoulder Impingement?
- When do people feel Shoulder Impingement pain?
- Why do people get Shoulder Impingement in the first place?
- How do I fix my Shoulder Impingement?
Who Gets Shoulder Impingement?
Shoulder Impingement does not discriminate as it impacts both men and women of all ages. However, some groups seem to be more at risk for these conditions than others. For runners, your average “desk athlete” is at an even more increased risk. The dreaded desk position puts a lot of stress on shoulders and can lead to exactly this type of shoulder imbalance. The repeated motions involved with the shoulder swing can lend itself to this type of condition for runners as well.
What is Shoulder Impingement?
Shoulder impingement is one of the most commonly diagnosed shoulder conditions, but what is it exactly? What is getting impinged? Well, the short answer to that question is a lot.
Let’s start by taking a closer look at the shoulder itself. The shoulder joint is made up of the upper arm bone (the humerus) and the shoulder blade (scapula). This complex is attached to the upper body by the collar bone (the clavicle). As the arm moves up overhead all three of these bones need to work together. For every two degrees of motion of the upper arm over shoulder height, the shoulder blade needs to move one degree to match. There is a complex balancing act between the muscles that control the shoulder and the shoulder blade.
If the balance is off for any reason then your shoulder can exhibit problems.
Now let’s look at how this can lead to Shoulder Impingement. There is a small space between these three bones where some important structures pass through to attach and support the shoulder as a whole.
There are five particular structures that are considered to be involved:
- Long head of biceps
- Supraspinatus Tendon
- Subacromial/Subdeltoid Bursa
- Coracoacromial Ligament
- The Joint Capsule
With so many different structures in such a small area, the margin for error is quite small. This can lead to any one of, or even all, of these structures to be impinged (or more simply put, to be pinched).
Over time increasing pressure, friction and pinching of the muscles in the subacromial space can build up and lead to Shoulder Impingement. This means that if you’ve been told you have “Biceps Tendonitis”, “Supraspinatus Tendonitis”, or “Shoulder Bursitis”, then Shoulder Impingement is a likely contributor.
Where do people with Shoulder Impingement feel their pain?
Patients will often report pain in the front side of their shoulder. The pain often travels down the upper arm but rarely past the elbow. People can often suffer from some discomfort on the backside of their shoulder joint as well. The pain is most often provoked by movement.
When do people tend to feel Shoulder Impingement pain?
Movement is the short answer. The pain is most often felt when performing overhead movements with your shoulder. This doesn’t have to be throwing a ball it can be as simple as shampooing your hair. Women often have discomfort when trying to take their brassiere on and off behind their back.
There are two provoking movements or “tests” you can do to see if you may be suffering from Shoulder Impingement:
- Reach your arm across your body and see if this reproduces any symptoms.
- Reach your hand up overhead, like you have a very important question to ask, and see if this impacts your symptoms.
Why do people get Shoulder Impingement in the first place?
As we discussed earlier the balance between your shoulder blade and upper arm are crucial. The improper balance of these muscles can lead to increasing the amount of “impingement” occurring in this area.
To dive a little deeper into the “why”, let’s chat about some key muscles that can affect the shoulder blade. The biggest culprit has to be the pec minor as this is one of your chest muscles that is attached directly from your rib cage to your shoulder blade. This little guy can get very tight with long-standing sitting and slouched postures. It does a great job of pulling the shoulder blade forwards and down (the exact opposite of what we want our shoulder blade to be doing as we lift our arm overhead).
In addition to this, folks with this type of injury also present with weakness into their shoulder external rotator muscles (some of the rotator cuff muscles) and lower traps. These are important muscles for assisting and controlling our arms to move up overhead.
How do I fix my Shoulder Impingement?
Enough with this talk about what’s wrong with your shoulder. Let’s move onto how to fix it!
The goal is to improve the control and strength of your shoulder and shoulder blade. They need to work together to move your arm any which way you’d like in perfect balance.
We’ve talked about the two biggest culprits when it comes to Shoulder Impingement: The Pec Minor and external rotation (rotator cuff) weakness. We’d like to show you some easy exercises to get started with when trying to tackle these conditions.
We want to help so much so that we’ve created a quick summary below of exercises that should help. These are a great place to start in most cases!
We really hope it helps!
Improves the mobility of the pec minor muscles. These muscles can get very stiff especially when it comes to our modern day desk postures. That stiffness can pull the shoulder blade forward and further irritate that poor shoulder of yours.
Increases the strength of your rotator cuff. The rotator cuff is crucial to your shoulder function and overall shoulder health. This is a super easy exercise to get things started!
Improves the mobility of your upper back and rib cage. This will allow the shoulder blades to float a little more freely as you move them like you mean it!
These three exercises are often a great place to start but may not take you all the way! What I’d recommend is going to see a health care provider you trust to get a proper diagnosis and begin your rehab process. If going to a clinic to see a physiotherapist isn’t a reasonable option for you, and you’d prefer an online program, make sure you check out the OnlinePhysioReady Programs made specifically for Shoulder Impingement or Rotator Cuff Issues.
This program takes you through your rehab process step-by-step and updates your exercises daily. Not to mention that it also allows you to track your progress so you can see just how far you’ve come!
If you’re a runner and you’re suffering from shoulder pain, it’s time to fight back! The most frequent causes of shoulder issues for runners are Shoulder Impingement and Rotator Cuff Issues due to the repetitive nature of the shoulder during running. The first step is to get an accurate diagnosis, once known it’s time to get some treatment! For those that can’t attend regular Physiotherapy appointments due to time or cost, we highly recommended the online PhysioReady Programs.
Mitchell Starkman is a Toronto-based Physiotherapist with a passion for sports, orthopedics, and human movement. Mitchell’s goal is to understand how the site of pain is impacted by the entire body– rather than pinpointing a specific disturbance. He is also the founder of www.TheMovementCentre.ca – a website which provides people the tools they need to self-manage, treat and prevent their injuries.