Healing shoulder pain

Don’t let a sore shoulder sideline your favorite activities

By Jim McGuire, MTI Physical Therapist

Behold the shoulder, the most preposterously unstable joint in the human body. The large rounded head of the humerus sits in the relatively flat and small glenoid fossa of the scapula. If that sounds to you like Latin, well … it is.

Let me put it like this: Our shoulders are like a golf ball on a tee that moves through large ranges of motion in all directions. All of this motion, accompanied by large forces moving through the joint, need to be stabilized, controlled, and coordinated by our poor little rotator cuffs, four relatively small muscles.

Subtle deficiencies and imbalances in the rotator cuff muscles or in the shoulder joint capsule can result in poor control of the humeral head, leading to a painful shoulder condition called shoulder impingement. This condition is also commonly referred to as “swimmer’s shoulder” because swimmers generally subject their shoulders to a lot of repetitive stress through all of the shoulder’s available range of motion. Shoulder impingement is also fairly common in baseball and softball players, tennis players, volleyball players, and other “overhead” athletes.

There are two types of shoulder impingement:

  1. Primary shoulder impingement: Generally caused by tightness of the posterior capsule of the shoulder joint or by certain variations in the bony structure of the scapula.
  2. Secondary shoulder impingement: Generally caused by excess laxity of the anterior shoulder capsule, which results in excess motion of the shoulder joint that is not properly controlled by the rotator cuff. This is the type of shoulder impingement that most commonly happens with swimmers and overhead athletes.

Treatment of primary shoulder impingement should begin with stretching of the posterior joint capsule. The “sleeper stretch” is a good option. Lying on the affected side you’re your shoulder and elbow bent at 90 degrees, use the unaffected arm to gently push your wrist down until a stretch is felt.

If the sleeper stretch is uncomfortable, the posterior shoulder capsule can also be stretched with another stretch that doesn’t have a catchy name. While standing or sitting, reach the affected arm across your body. Use the unaffected arm to gently pull the elbow further across and toward the opposite shoulder until a stretch is felt.

Either of these stretches should be done five to six times, with each repetition held for about 15 seconds.

Treatment of secondary shoulder impingement should begin with training of the subscapularis muscle. This is the primary internal rotation muscle of the rotator cuff, and it is located across the front of the shoulder, which positions the muscle perfectly for reinforcing and stabilizing a shoulder that has anterior capsule laxity. To up-train the subscapularis muscle, lie on your back with shoulders out to the side at 90 degrees and elbows bent to 90 degrees. Using light weights (about 2–5-pounds), rotate shoulders until forearms are vertical, then rotate back to horizontal. Do not rotate beyond horizontal as this would be stretching the already over-stretched anterior joint capsule.

Many other factors can contribute to shoulder impingement, and many shoulder problems will require a more thorough evaluation to tackle. If you are experiencing shoulder pain and the simple exercises above are not solving your problem, you may want to consult with a physical therapist for evaluation and treatment.

—Jim McGuire is a doctor of physical therapy and a fellow of the American Academy of Orthopedic Manual Physical Therapists. MTI Physical Therapy is located in the WAC Wellness Center on the 4th Floor of the Clubhouse. WAC members may schedule an appointment by calling 206.839.4780 or emailing wac@mtipt.com. MTI is in-network with most major health insurance companies. Special thanks to physical therapy intern Jessica Gunn for modeling exercises and stretches.

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