Solutions for Shoulder Impingement (bursitis)

Quite often the cause of shoulder pain is shoulder impingement - where either a rotator cuff muscle called the supraspinatus and/or a bursa (small, fluid filled sac) rubs or gets pinched between the bottom of the lateral edge of the shoulder blade (acromial arch) and the head of the humerus (upper arm bone).  Impingement may result from poor scapulo-humeral rhythm that is the scapular (shoulder blade) movement does not keep in rhythm with the humeral movement and the humerus literally “runs into” the acromial arch, pinching the structures underneath.  The muscles attached to the scapula are responsible for maintaining this rhythm and frequently muscle imbalances are seen due either to poor postural habits or repetitive movements that accentuate the front shoulder muscles e.g. baseball pitchers. 

The key to rehabilitating this condition is to stretch the tight muscles and work the weak stabilizing muscles. Quite often the tight muscles are the muscles that elevate the scapula, for instance the levator scapula and upper trapezius.  Here’s a description of stretches for these muscles:

Stretch for the levator scapula muscle (armpit sniff stretch): Sit in a chair and place the right hand under the right buttock.  Now with the left hand palm, reach over to grasp the head just behind the right ear.  Next, turn the head as if sniffing the left armpit and GENTLY pull the head both forward and to the left simultaneously and only until a tension is felt in the back of the neck and hold for 20-30 seconds.  Repeat 2-3 times.  The reverse actions stretch the left levator scapula.

Stretch for the upper trapezius muscle:  Perform the stretch exactly the same as the levator stretch, but try to sniff the opposite armpit while GENTLY pulling with the hand until tension is perceived.

 The two primary stabilizing muscles of the scapula are the middle and lower trapezius and the serratus anterior.  Here’s a description of exercises to strengthen these three muscle areas:

Exercise for the middle trapezius - lie face down on the floor with the palms down, elbows bent to 90 degrees and the shoulders at 90 degrees to the sides of the body.  Holding this exact position, slowly pull the shoulders straight upwards pinching the shoulder blades together and holding for 3 seconds, relax and repeat (perform 2-3 sets of 10 repetitions).  Seated rows and inverted horizontal pull-ups will also exercise the middle trapezius.

Exercise for the lower trapezius- assume the same face down position as above, but now completely straighten the arms and position them at about 150 degrees to the sides of the body with the thumbs pointing upward.  Holding this exact this position, attempt to raise the arms straight upward as high as possible and hold for 3 seconds relax and repeat (perform 2-3 sets of 10 repetitions).  Try to visualize your shoulder blades sliding down your back towards your buttocks.  Pull-ups will also strengthen the lower trapezius.

Exercise for the serratus anterior-assume a typical chest pushup position either on the floor resting on the toes with hands directly under the shoulders and buttocks, middle spine and back of the head all in a straight line.  Holding this exact position, and with elbows straight, allow the chest to drop slightly and then push the chest up, away from the floor but do not arch the upper back and hold for 3 seconds, relax and repeat. If this exercise is too difficult, try performing pushups against a wall, the distance of the toes from the wall will regulate the intensity. (perform 2-3 sets of 10 repetitions). 

With shoulder impingement, it is also beneficial to strengthen the external rotators of the shoulder as they help to increase the space between the acromial arch and the top of the humerus.

Exercise for the shoulder external rotators – take a small towel, fold it so it is about 2 inches thick and pinch it between the inside tip of the elbow and the side of the body.  Hold one end of a rubber band/tubing with the hand with the towel under the arm and hold the other end with the other hand.  Now turn the forearm and wrist away from the midline of the body all the while keeping the towel pinched against the body.  Regulate the intensity of the exercise by adjusting the initial tension in the band/tubing.  (This exercise can also be performed on an adjustable cable column in the same manner). The rotators may also be exercised by laying in a position similar that described for the middle trapezius and by raising the wrist and forearms off the floor while keeping the elbows pinned down.

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