You were performing your regular overhead shoulder presses. Something didn’t quite feel right. But you pushed through. The pain was there when you finished your workout.
Now, your shoulder feels weak. You have shoulder pain when reaching for items on that hard-to-reach top shelf. It hurts to lie on your shoulder. You might even feel aching or pain in your joint or arm at rest. Overhead shoulder presses are out of the question. What’s going on?
You are likely experiencing shoulder impingement. Shoulder impingements make-up 44-65% of all shoulder injuries. If not treated properly, shoulder impingement issues may result in bursitis, inflammation of the cushioning fluid-filled sacs at the shoulder joint – or in more severe cases, tearing of a tendon.
Shoulder Impingement Explained
Due to its wide range of movement, the shoulder is one of the most vulnerable joints in the human body. The rotator cuff muscles are responsible for most shoulder movements – at least they often play a part. These muscles help flex, extend, and rotate the shoulder joint. Yet, repeated overhead movements can aggravate the rotator cuff tendons.
Your tendons attach your muscle to bone. This is how you are able to move each and every joint. The rotator cuff tendons pass through an area called the subacromial space. With repeated overhead movements, the subacromial space is reduced. In turn, these tendons become irritated and inflamed – causing pain. Other reasons for this injury include general shoulder weakness or structural abnormalities in the joint.
If certain muscles are weak, imbalances may occur. This may shift the position of the humerus in the shoulder joint, eventually creating problems leading to shoulder impingement. Improper posture, due to muscle weakness or other causes, and other abnormalities in the joint may also cause a reduction in the subacromial space – again, leading to shoulder impingement.
How Do You Know You Have a Shoulder Impingement Injury?
Here is a quick self-test you can perform at home. It can help you determine if your injury is, in fact, impingement.
Step 1: Sit on a comfortable chair or stool.
Step 2: Lift your affected arm up. Reach as far as you can. You will feel pain. Take a quick mental note of how far you can reach your arm up, as well as a rating of your pain (0 is no pain at all and 10 is the worst pain you have ever experienced).
Step 3: Make sure you are sitting with good posture. Next, grab the chair or stool with your affected arm’s hand. Slowly tilt or lean your body away from your hand. You should feel a gentle pulling or tugging sensation through the neck and shoulder region. If it causes pain, stop. For solely an impingement injury, it shouldn’t cause pain.
Step 4: Hold the leaning away position for at least 10 seconds. Relax for about 3-5 seconds, and repeat again. Perform this step 5 times.
Step 5: Lift your affected arm over your head again as far as you can.
Step 6: Has your pain decreased? Can you lift your arm farther? If you answer yes, you likely have a shoulder impingement injury.
So, what can you do? What are your treatment options? How can you get rid of shoulder impingement? Let’s dive in!
Treatment for Shoulder Impingement
The average recovery time for an impingement injury is about 6-8 weeks. Treatment may involve anti-inflammatory medications, stretching and strengthening exercises, and ice.
The most obvious treatment strategy involves resting your shoulder. It is important to avoid repetitive overhead movements until your pain levels have improved. However, it is also crucial to still move the shoulder, at least a little bit. If you don’t move the joint, you risk a frozen shoulder – which consists of a much longer recovery time.
In the early stages, it’s all about finding that sweet spot where you aren’t causing more pain or harm, but are maintaining the range of motion. We’ll explore this further in exercises below.
Your doctor may also advise that you take anti-inflammatory medication. These medications may help reduce your pain levels and inflammation at the shoulder joint. However, there are risks associated with taking these drugs long-term, including serious gastrointestinal issues like ulcers and bleeding, liver problems, high blood pressure issues, and more.
Make sure to thoroughly read the label on the bottle before consuming any medication, and make sure you understand the risks involved. It is often not recommended to continue anti-inflammatory medication for longer than a couple of weeks.
Icing may further help alleviate your pain. Ice constricts blood vessels, helping to decrease inflammation. Inflammation of the tendons are the main cause of your pain. By reducing this, you may see significant improvements in your pain levels. Apply ice for 10-15 minutes at a time, with at least 45 minutes in between each application. Place a wet cloth or towel in between you and the ice packet to prevent skin damage.
In the meantime, what exercises can you be doing?
Let’s start with the basics.
Range of Motion Exercises
Before you start with any new exercise program, it’s important to check with your doctor or physical therapist. They know you, your health history, and your situation best.
As aforementioned, the initial phases of recovery involve maintaining and improving your shoulder range of motion. This is critical to prevent a frozen shoulder – a condition where you literally can’t move your shoulder joint.
For the following exercises, you will require a hockey stick, broomstick, cane, or something similar. These are called passive exercises. This means that your affected arm is not doing any of the work. You will use your non-affected arm to perform each movement.
Passive Shoulder Flexion
- Hold the middle of the stick in your non-affected hand. Place your affected arm’s hand on the end of the stick. Start with your affected arm at your side.
- Using your non-affected arm, push your affected arm up and forward. Go as high as you comfortably can. Your affected arm is just along for the ride. Your other arm is doing all of the work.
- Hold at the end range for about 3-5 seconds, then slowly lower your arm back down to start.
- Repeat this movement for 8-10 repetitions, 2-3 times per day.
Passive Shoulder Abduction
- Hold the middle of the stick in your non-affected hand. Place your affected arm’s hand on the end of the stick. Begin with your affected arm relaxed at your side.
- Using your non-affected arm, push your affected arm up and out to the side. Go as high as you comfortably can. And remember, your non-affected arm is doing all of the work (hence, the word ‘passive’ in the title of the exercise).
- Hold at the end range for about 3-5 seconds, then slowly lower your arm back down to the start position
- Repeat for 8-10 repetitions and do this 2-3 times per day.
Passive Shoulder Extension
- Hold the middle of the stick in your non-affected hand. Place your affected arm’s hand on the end of the stick. Start with your affected arm at your side, and your non-affected arm slightly out in front of you.
- Using your non-affected arm, push your affected arm back and up. Go as high and as far as you comfortably can.
- Hold at the end range for about 3-5 seconds, then slowly lower your arm back down to the start.
- Repeat for 8-10 repetitions, and perform 2-3 times per day.
Passive Shoulder External Rotation
- Hold the middle of the stick in your non-affected hand. Place your affected arm’s hand on the end of the stick. Start with your affected arm’s elbow bent at 90 degrees at your side.
- Using your non-affected arm and keeping your elbow bent at 90 degrees, push your affected arm out – rotating the shoulder but only moving your forearm and hand. Go as far as you comfortable can.
- Hold at the end range for about 3-5 seconds, then slowly bring your arm back to the start position.
- Repeat 8-10 times and 2-3 times per day.
Once these exercises become fairly easy and less painful, you can try actively moving your shoulder joint in each direction. This means performing the same movements, but without the help from the stick or your other arm.
In addition, you can use the following exercise to help create more room in your shoulder joint and alleviate some of the aggravation caused by inflammation.
- Bend your body forward at the waist. Use your non-affected arm to slightly lean on a table, chair, or another sturdy object for support.
- Let your affected arm hang straight down.
- Slowly move your arm in a circular motion.
- Perform 10 circles clockwise, then 10 circles counterclockwise.
- Do this exercise 2-3 times per day.
After a couple of weeks of rest and range of motion exercises, you can introduce specific strengthening exercises. It is important to still perform your range of motion exercises until you make a full recovery.
Further, make sure to still steer clear of weighted overhead movements until you have fully recovered or until your pain levels have subsided. When eventually getting back into your regular routine, go for lighter weights to start. In other words, ease back into it.
Shoulder Blade Pinch
This exercise helps correct any postural issues relating to your shoulder impingement injury. You can further use this exercise to help you correctly position your body before performing shoulder exercises in the gym. (Bonus: It can also help prevent recurrence or other shoulder injuries from happening.)
- Sit or stand tall.
- Gently pinch your shoulder blades down and in. Do not shrug your shoulders.
- Hold for 5-10 seconds.
- Repeat 10-12 times for 2-3 sets per day.
Isometric Shoulder Exercises
Isometric exercises strengthen and contract the muscles, but without actually moving the joint. This means you can still strengthen your shoulder muscles, even though movement may still be painful. It’s best to find a doorway for these exercises.
- Face the wall and clench your hand in a fist. Press your affected arm forward against the wall – as if you were to bring your arm straight up in front of you. Hold for 5-10 seconds and perform 10-12 times.
- Face away from the wall and again, clench your hand in a fist. Press your affected arm back against the wall – as if you were going to raise your arm up and back. Again, hold for 5-10 seconds and do this 10-12 times.
- Position yourself so that your affected arm is next to the wall. Clench your hand in a fist and press your arm out to the side, against the wall – as if you were going to bring your arm up and out to the side. Hold for 5-10 seconds and perform 10-12 repetitions.
- Bend your arm to 90 degrees. Stand in the doorway. Gently press your forearm against the doorframe – as if you were going to move your forearm and hand out to the side. Hold for 5-10 seconds and do 10-12 times.
- Bend your arm to 90 degrees. Position yourself so that your inner forearm is close to the wall or door frame. Gently press your forearm or hand against the wall – as if you were going to move your forearm and hand inward toward your body. Hold here for 5-10 seconds and perform 10-12 repetitions.
- Do these exercises 2-3 times per day – especially early on to maintain or regain shoulder strength.
At about Week 3-4, you can start gradually transitioning from isometric exercises to full strengthening exercises. However, be aware that timing for each individual may vary, depending on the severity of your injury. The following are strengthening exercises that can be introduced around this time. For each exercise, you will need a resistance band. Start light, and gradually increase the resistance as tolerated. If any pain occurs, stop the exercise or go only to the point before pain.
External Shoulder Rotation
- Bend your elbows to 90 degrees.
- Hold the end of a resistance band in each hand. There should be slight tension in the band to start.
- Gently pull your hands out to the side. Make sure to keep your elbows at your sides. If this is difficult, consider placing a pillow in between your sides and your elbows.
- At the same time, pinch your shoulder blades down and in.
- In a controlled movement, return your hands back to start.
- Perform 10-12 repetitions and do 2-3 sets per day.
Internal Shoulder Rotation
- Attach the end of a resistance band to a secure object, such as a doorknob of a closed door.
- Hold the other end of the band in your affected arm.
- Bend your elbow to 90 degrees. Make sure that there is slight tension in the band to start.
- Bring your hand and forearm in toward your body. Keep your elbow at your side throughout this movement.
- Slowly return your arm to the start.
- Do 10-12 repetitions, 2-3 times per day.
Resistance Band Rows
- Begin sitting tall in a chair or on a stool.
- Wrap the resistance band around a post and hold each end in your hands. Begin with your elbows bent at 90 degrees.
- Slowly bring your elbows back, past your torso. At the same time, gently pinch your shoulder blades down and in.
- Carefully return to the start, and repeat.
- Perform 10-12 repetitions, 2-3 times per day.
Serratus Anterior Punch
- Fasten a resistance band to a secure object behind you.
- Face away from the object and hold the other end of the band in your affected side’s hand.
- Start with your hand close to your affected shoulder.
- Slowly punch your hand forward, extending your shoulder as far as you comfortable can.
- Repeat this punching movement 10-12 times, 2-3 times per day.
Lateral Shoulder Raise
- Stand tall, with your foot planted on one end of the resistance band. Hold the other end of the band in your affected arm’s hand. There should be slight tension in the band to start.
- Slightly pinch the shoulder blades down and back.
- Slowly lift your arm straight up and out to the side. Go as far as you comfortably can. If pain occurs, go to the point before pain.
- Slowly lower your arm back to the start position.
- Perform 10-12 repetitions, 2-3 times per day.
Forward Shoulder Raise
- Similar to the lateral shoulder raise, start by standing tall with the band planted under your foot. Hold the other end of the band in your hand. Again, there should be some tension in the band to start.
- Slightly pinch your shoulder blades down and back.
- Carefully bring your arm straight up in front of you. Raise it as high as you comfortably can.
- Slowly lower.
- Repeat 10-12 times for 2-3 sets per day.
What Else Should You Be Aware of in Getting Rid of Your Shoulder Impingement?
The most important thing is to listen to your body. If something doesn’t feel right, don’t do it. The above exercises are to be used as a general guideline. The last thing you want to do is irritate your shoulder joint further, so it’s always best to err on the side of caution.
For future prevention, work on maintaining a correct posture throughout every exercise. Become aware of your limits. Avoid overdoing it. Slowly and gradually increase your intensity, duration, repetitions, and sets.
In the meantime, avoid any exercises that cause pain. Find ones that feel good to do, such as the exercises outlined above. And if pain does occur, ease off and use ice when necessary.
Many people are able to bounce back after shoulder impingement injuries. It just might take some time. And don’t rush it – you could potentially risk creating a bigger problem, leading to a longer recovery time. Take the appropriate amount of time to get better and feel better. Doing so will enable you to come back stronger than you ever thought possible.