Shoulder Pain, impingement and how to fix

Shoulder pain is one of the most common topics that the members speak to me about, often on a daily basis. Often I see members just “strap it together” with RockTape. And even though this will help short term don’t you think its time to work out the WHY?

Even though as a physical therapist I have several answers as to why not all athletes are the same and not every cue will work the same to correct the movement, one thing we defintetly need to do is to figure out the mechanics of our shoulders. One of the most common cues you may hear is “Shoulders back and Down” but in some cases this cue might be used at the wrong time. To understand this you need to familiarise yourself with Shoulder Impingement 

• External Impingement which happens when the rotator cuff (RC) becomes impinged. Which basically means the muscles of the RC become trapped under the roof of the shoulder blade as you lift your arm up. There are 2 subcategories of this.

1. Primary: Which is down to the shoulder architecture (ie Shape of the bones or due to arthirits) and this has little to do with movement quality or technique. It’s just your makeup

2. Secondary: Poor shoulder blade control, poor thoracic spine mobility/stability, bad form, weakness, lack of core control, short Lats, bad breathing technique….

This secondary form of impingement is what we mainly see in athletes and will be our main focus.

• Internal Impingement refers to contact between the rotator cuff and the shoulder joint. Usually seen in baseball pitchers.

So, let’s break down External Impingement which is the most common form of shoulder pain. Typically, the pain is felt on the front of the shoulder or side of the shoulder (deltoid). Pain is felt when doing things like taking a sports bra off, pain at night when lying on the arm, pouring the kettle, holding the bar in front rack, cleaning, or doing dips. 

When we look at movements we do a lot at CHALKBOX these are the main movements that impingement pain can be felt:

• Pulling Movements: Rowing, pullups, ring rows

• Dynamic Kipping (Toes to bar or Pull-Ups)

• Catch positions: like dips and muscle ups

• Overhead pressing positions: Snatch/OHS, Clean/Jerk

• Other Overhead positions: HSPU, KB Swing and sometimes even V-ups

If we look at the movements above they tend to be categorized into Pushing or Pulling Movements. But before we workout out what exercises you could do to correct yourself we first need to evaluate whether we think that the pain is Tissue Pain or The Mechanism of the joint is causing the pain, when we consider these two things the cue “shoulders back and down” won’t always help every athlete. In fact, in some, it could make it worse. 

Let’s look at two athletes,

Athlete 1: 

• Pain on rig movements like kipping and T2B, no pain pressing overhead or doing strict Pull-ups

• Fix: Pull Shoulder Down &In, work on core control when kipping.

• Muscles to look at Pecs, Lower Traps, lats

Athlete 2: 

• Pain when Jerking overhead, and clean/Jerking. Pain with Pass-through.

• Fix: Move his shoulder blade up/around ribs into upward rotation. Which will stop rotator cuff getting stuff in Acromion Process. 

• Muscles to look at are Middle and Lower Traps, Serratus Anterior.

Want to know what exercises you could be doing why not book a consultation. Don’t keep moving through the pain and make sure your mechanics are correct.