Does your client have impingement ?
Localised intense pain usually means the client already has an inflamed tendon or bursae . The pain is most commonly felt on the edge of the shoulder , sometimes radiating down the outside of it . There is a symptom of a ‘ painful arc ’ where , when the arm is raised outwards and upwards ( abduction ), the inflamed part of the tendon or bursae gets caught in the sub-acromial space , producing pain ; then , further through abduction , the sore part of the tendon moves away from the structures and the pain usually lessens at the top of the movement . With severe impingement , the pain does not lessen at the top and with a tear in the tendon there is significant power loss into abduction and lateral rotation , and the client is unable to fully raise the arm .
THE QUICK READ
Why is it happening ?
There are many factors that lead to the impingement process , and if not addressed early can become a cycle that worsens as time goes on . The most common cause is having an ‘ unbalanced ’ shoulder and performing repetitive heavy pressing exercises such as bench press and overhead shoulder press .
Most people have an imbalance between their left and right arms ( being left or right handed ) as well as an imbalance within the shoulder muscles ( power vs . postural ). So , firstly , when training in the gym doing exercises like shoulder press or bench press , where the hands are fixed to a bar , one arm leads the other and the bar acts as a stabiliser between the two .
The problem with fixed bar exercises in a pressing position , whether it be above the head or outwards , is that there is less requirement for the postural ( stabiliser ) muscles - the rotator cuff - to act in controlling the shoulder .
As one arm is stabilised through the bar by the other , it ’ s easier to push heavy weights , hence the results of these exercises in muscle growth and strength gains in the aesthetic pecs and deltoids ( and why these exercises are so popular !).
Secondly , the force generated by the power muscles ( pecs , deltoids ) during the heavy press or abduction movement of the arm , outweighs the functional ability of the rotator cuff muscles . This creates an increased movement of the humeral head into the sub-acromial space , as due to the force of the power muscles impingement is created . Basically , the pull of the big muscles is too great and the little muscles simply can ’ t keep up .
• Impingement can occur when the rotator cuff tendons or bursae get caught or trapped in the ‘ sub-acromial space ’ during certain arm movements , causing inflammation of the tendon and pain
• If the tendonitis is not addressed , the tendon becomes weaker and the function of the rotator cuff is compromised , leading to the cycle of impingement
• In severe chronic and long term cases , the tendon becomes so weak it tears
• The most common cause of impingement is having an ‘ unbalanced ’ shoulder and performing repetitive heavy pressing exercises that do not adequately recruit the postural ( stabiliser ) muscles
• Previous injuries , weak supporting muscles and ligaments , and other factors can contribute to shoulder imbalance that is commonly at the root of impingement
• The problem usually recurs through a ‘ cycle of impingement ’, making it essential to break this cycle for successful recovery .
38 | NETWORK WINTER 2021