INJURY & REHAB
CEC ARTICLE
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ROTATOR CUFF IMPINGEMENT
A WEIGHT TRAINING DILEMMA
Common weight training exercises can lead to shoulder impingement , and if not addressed early the condition can result in a cycle of pain and restricted movement . Physiotherapist Tim Keeley looks at how to identify , treat and prevent reoccurrence of this shoulder injury .
D uring the past few months at our clinic we have had a
greater than usual number of patients presenting with shoulder impingement-type pain and injuries . The ‘ impingement ’ scenario can be a major dilemma for people who are trying to recover and return to weights and exercise without causing further problems .
Breaking the cycle of pain and injury is the key . Successful recovery involves good advice and treatment , exact instruction on the right rehab exercises and order of progression , coupled with a long term plan of prevention that is simple enough to be adhered to .
Sub-acromial shoulder impingement
The shoulder joint moves with two muscle systems : a postural system and a power system . The postural muscles control the shoulder blade movement and stability ( i . e . serratus anterior , trapezius ) and the shoulder joint rotation movement and stability ( the rotator cuff ). The power muscles ( deltoid , lats , pecs ), meanwhile , move the arm bone around .
Impingement can occur when the rotator cuff tendons or bursae get trapped in the ‘ sub-acromial space ’ which is the gap between the roof of the shoulder ( acromion ) and the ball of the humerus ( glenoid head ) during the arm movement , mostly abduction above 90 degrees ( see Figure 1 ). As the tendons get caught , a number of things can occur ; most commonly , the rotator cuff insertion where the supraspinatus attaches is squashed and rubbed on other structures , causing inflammation of the tendon ( tendonitis ) and pain .
If the tendonitis is not addressed , the tendon becomes weaker over time and the person develops a ‘ tendinopathy ’ where the tendon structure slowly degenerates and the function of the rotator cuff is compromised , leading to the cycle of impingement and the training dilemma .
The sub-acromial bursae , which sits on top of the tendon , protecting it from the bony roof of the shoulder , can also become inflamed with more severe impingement . This , in turn , reduces the space for the tendon to slide and adds to the compression problem . In the most severe chronic and long term cases , the tendon becomes so weak it tears , usually near the insertion into the top of the humerus .
Figure 1
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