Shoulder Impingement

[Dale]

Hi everyone,

Over the past month or two I have noticed some occasional minor pain in my right shoulder. It seemed to first appear when I was doing some weight training at a local gym but it never entirely went away. Just recently I began swimming again and that seemed to cause the injury to worsen.

Following the swimming incident I went to a local sport medicine clinic and they digagnosed the injury as an impingement. They gave me some exercises to do for strengthening and stabilizing the rotator cuff muscles.

What I'm interested in finding out is if there are any specific activities/motions that I should try to avoid to promote healing (I'm trying to do a lot of climbing recently but I don't want to prolong the injury) and if there are any exercises/stretches that I can also do to help the shoulder. Also any other general advice about rotator cuff injuries and how to deal with them or avoid them entirely would be greatly appreciated.

Thanks for the help,
Dale

[Bill Hartman]

Your activities are very internal rotation dominant. Every time you push or pull in your weight training workouts or climbing, you are heavily stressing pecs, lats, teres major, and subscapularis. Over time these muscle tend to become increasingly more strong and more easily facilitated than your smaller external rotators, infraspinatus and teres minor. Not too mention that swimming is also very internal rotation dominant. “Swimmers’ shoulder” is a very common form of shoulder impingement.

My guess is that the exercises you got from the sports med specialist were to strengthen the entire rotator cuff. I would probably emphasize the external rotation exercises the most and add some strengthening with isometrics at end range of motion of external rotation in your weakest position. This will help restore any loss of range of motion due to weakness at end range.

The lower trap also tends to be relatively weak in typical weight trainers, so adding some form of scapular stabilization exercises may be in order. If you can do an overhead squat, it will do wonders for your ROM and scapular stability.

The first thing I would do is track down an active release techniques practitioner in your area. You can search for one at www.activereleasetechniques.co m. Most shoulder impingements will clear up in 1-3 treatments. I have had amazing success using these techniques. Then it’s a matter of balancing out your training program to prevent the overloading of internal rotators and progressively strengthen the external rotators.

A little trick you can start using is to alternate all pushing and pulling exercises with sets of external rotation exercises. That will assure that your training volume is equally applied in both rotations.

Obviously, you’ll want to continue to avoid ANY exercise that reproduces pain.

Hope that helps.

Bill Hartman