The most common cause is having an ‘ unbalanced ’ shoulder and performing repetitive heavy pressing exercises
This imbalance is increased with weak scapular stabilisers and tight rotator cuff muscles , mostly because muscles like serratus and lower trapezius are underdeveloped due to a lack of functional and stability exercises and an overuse of power and pressing exercises . If you have had a previous injury to the shoulder ( like falling on the shoulder from a bike or when skiing , or a dislocation in sport ) then the ligament stability may be compromised , in addition to the weakened rotator cuff . If the position of the ball in the socket is an anterior ( forward ) position , the movement of the shoulder is not ideal .
Tightness in the back of the shoulder further increases this irregular movement , along with poor technique during exercise . When the weight is too heavy , the lifter generally cannot keep good form and compensates , because they don ’ t have the strength in the postural muscles to hold the body and shoulder in the correct position , nor keep the correct muscle firing pattern during the concentric and eccentric phase .
During a bench press , the scapular movement is restricted , and so the alignment of the shoulder joint socket is compromised . This creates an increased shearing force at the shoulder joint structures and rotator cuff . The tendons are overused and become fatigued and inflamed , fail to stabilise and rotate the shoulder , and create impingement again .
Breaking the cycle
In almost every case we see , the problem recurs through a ‘ cycle of impingement ’. Breaking this cycle is essential for successful recovery . Because the rotator cuff tendons are sore , inflamed and weakened , they don ’ t perform their stabilisation and movement assisting jobs . Once they start becoming weak , the continuation of conventional exercises , like lateral raises , and shoulder and bench presses , will result in the tendons getting increasingly caught . The tendon and rotator cuff complex becomes weaker and more inflamed , it loses its function and the problem gets worse .
Rest alone , which is what most people do , does not fix the issue . They rest until the pain subsides and initially don ’ t seek physio assistance and rehab exercises . What they don ’ t realise , however , is that inside their shoulder the rotator cuff function has significantly reduced . The tendons have become weak , and they stay weak unless rehabilitated .
Waiting for too long before rehabilitation will create too much weakness , and strengthening the shoulder too early will result in reaggravation .
At the same time , returning to normal exercises too early without enough rehabilitation , or progressing the exercises too quickly ( through boredom or poor guidance ), will return the impingement . If a client has not properly rehabilitated the shoulder to its full function again , they will be a candidate for impingement over time . Even if your serratus anterior , trapezius and rotator cuff muscles are developed , if the pecs and rhomboids are more developed , then you have a relative functional weakness in the stabilisers , and an unbalanced shoulder - which is a very common problem .
The solution
At the client ’ s first episode of injury pain , advise them to consult a physio to test if they have impingement and to diagnose whether they have a significant injury . The physio will provide personalised and structured treatment , education , taping and pain relieving exercises , which will help reduce the pain and inflammation . They will then undergo a rehabilitation program of a progressive course of exercises to increase the mobility , control and strength of the scapular and rotator cuff muscles and improve overall function .
Rehab and stability exercises need to begin at a low level , and in the right sequence , with very slow progression and advancement of difficulty and resistance . For this process , the selection of correct closed kinetic chain exercises will work more quickly and more effectively than open chain exercises . These rehabilitation exercises should be continued as part of the ongoing shoulder training regime .
Ongoing prevention
Once the shoulder is strong enough to return to standard weight training exercise , the client ’ s shoulder training program will need to have a greater focus on stability ( as opposed to purely muscle building ), be varied often and incorporate multidirectional movements with less load .
When initially resuming training , the client should avoid heavy or repetitive movements above shoulder height , bench press , lateral raises , front raises , and any exercise that places excessive demand on the rotator cuff . Any advanced , new or sport specific exercise programs should always be checked over by the physio before commencement .
Tim Keeley , B . Phty , Cred . MDT , APA With over 22 years ’ experience in physiotherapy and the fitness industry , Tim is Principal Physiotherapist and Director of Physio Fitness , a clinic based in Sydney ’ s Bondi Junction . He is also the Director of physiorehab . com , an online education and rehab program platform .
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