Shoulder Impingement

shoulder impingement

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Impingement is the fact of having mechanical compression and/or tendon wear of the rotator cuff. Rotator cuff is composed of a serie of 4 muscles connected to the shoulder blade at the humeral head (upper part of the shoulder joint). The function of the rotator cuff is to maintain the humeral head within the glenoid (socket) during normal shoulder function and to participate in shoulder strength during activity. Normally, the rotator cuff glides gently between the inferior surface of the acromion, the bone at the point of the shoulder and the humeral head.

Causes

Any process that can interfere with rotator cuff being able to glide normally can cause impingement. The causes are :

  • Weakening

  • Degeneration of the tendon due to aging

  • Formation of the bone spurs

  • Inflammation of tissues on the space above the rotator cuff

  • Injury due to overuse

Overuse activities that can lead to impingement are most commonly seen in tennis players, pitchers and swimmers.

Diagnosis

shoulder impingement

Diagnosis can be made with the patient’s history and physical examination. Patients suffering impingement often complain of pain in the shoulder. This pain worsens with overhead activity and can be so strong that it causes an awakening during the night. Manipulation of the shoulder in a specific way by a doctor will usually reproduce the symptoms and confirm the diagnosis. X-rays are also useful for the evaluation of the presence of bone spurs and/or the narrowing of the subacromial space.

Treatment

The first thing to do is to eliminate identifiable causes or factor that contribute to the pain. This means temporarily avoiding activities like tennis, pitching or swimming. A non steroidal anti-inflammatory medication may also be recommended by your doctor. The treatment is based on exercises aimed at restoring flexibility and normal strength to the shoulder girdle, especially by strengthening the muscles of the rotator cuff and the muscles responsible for the normal movements of the scapula (shoulder blade). This program may be performed by a doctor, a certified athletic trainer or a qualified physiotherapist. Sometimes a cortisone injection may be helpful in the treatment.

Surgery

Surgery isn’t necessary in most case of shoulder impingement. But if the symptoms persist despite non-surgical treatment, surgical intervention may be beneficial. Surgery involves deriding or surgically removing, tissue that is irritating the rotator cuff. This can be done with open or arthroscopic technique. The result is favorable in about 90% of cases.

Subscribe to my newsletter and share this article if you think it can help someone you know. Thank you.

-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Shoulder Injury (Part 2)

shoulder

I read a Frederic Delavier’s book « Strength Training Anatomy » and there is good stuff.

Dumbbell bench press with elbows along the body to continue training with a shouler injury

Dumbbell bench press with elbows along the body

It’s one of rare exercice to do when you have a shoulders injury, subacromial bursitis

Do dumbbell bench press with elbows along the body work, the anterior bundles of the deltoid and, a little bit, its middle portion to avoid an excessive friction at the front of the shoulders.

Do it regularly, it allows you to keep shoulders voluminious and tonic in spite of a local pathology. And it can use as a rehabilitation movement after a tear of pectoralis major muscle. Keep elbows along the body reduces stretching of pectoral major muscle limiting the risk of tearing of the injured area.

Exercice execution  :

Lying on a bench, your chest out and your back slightly arched. Your elbows flexed and along your body with a dumbbell in each hand :

  • Inhale and push your arms vertically

  • Exhale at the end of the movement

  • Return to the initial position by controlling the movement

Influence of bone morphology on back press

It’s important to take into account the individual differences in morphology when you’re training shoulders with back press.

Arm size

Arms lenght and especially forearms, plays a fundamental role in the execution of the exercice.

People with proportionately long forearms will descend their elbows much lower than those with proportionately short forearms.

This excessive elbow descent has the effect of streching the deltoid strongly, placing it in an unfavorable position that doesn’t allow the muscle to recruit the maximum amount of fiber to start the push powerfully.

Clavicles width

Clavicles width has a influence on the possibility of correctly lowering the barbell behind the neck.

Short clavicles invariably bring the two shoulder blades towards the vertebral axis. It follows that during the back press, when the two shoulder blades tilt towards the inside of the back, their displacement is substantially reduced by the compression of the trapezius and rhomboid muscle which fill the middle of the back, which limits at the same time the possibility of descendent correctly elbows to well feel deltoids work.

In addition, it’s important to note that more you have big muscles in the center of the back, the less the shoulder blades will be able to get closer and the lower the barbell behind the neck will be limited.

Note : Indivuduals with long forearms and narrow clavicles should have an interest in avoiding the back press to properly work deltoids.

back press anatomy

Attention

Too much space between the glenohumeral joint and the acromio caraoidal osteo ligamentary vault can lead to excessive friction when the humerus is raised in external rotation. With time, risk to damage, even tear, the supra-spinous tendon. With back press, it’s therefore important with the slightest sensation of discomfort in shoulders, accompanied by pain, to change movement in order to avoid a degenerative rotator cuff’s tendinitis.

A too small space between the gleohumeral joint and the acromio caraoidal osteo ligamentary vault can cause, during the arms elevation – when the humerus is carried this time in internal rotation (as with dumbbell lateral raise), excessive rubbing which may damage the infraspinatus tendon.

-Steph

P.S. Do you want a free training program ? Click here 

Shoulder Injury (Part 1)

shoulder

I read a Frederic Delavier’s book « Strength Training Anatomy » and there is good stuff.

Shoulders injuries are frequent in bodybuilding because we want develop all deltoid muscles. To do this, we must perform a signigicant number of repetition and movements thus multiplying the risk of injury.

It’s worth remembering that, in comparison with the solid hip’s articulation where the femur head is deeply embedded in the pelvic cavity of the pelvis, shoulder’s articulation, which must be very mobile to allow arms to move in all direction, is very little embedded.

Shoulders can thus be defined as a joint to muscular fixation, the maintenance of the humerus head on the scapula’s glenoid cavity is mainly ensured by a complex musculo-tendinous ensemble.

Although in bodybuilding most injuries occur during shoulders training, it’s rare to see this muscle directly injured. The wound are generally much deeper and appear most often during a false movement or after a long wear by friction of tendon structure reinforcing the articular capsule.

While in other sports of violent contact (such American football) or rapid arms movements (such as throwers) can result in serious injuries with dislocations and enven tendon pull. The main lesion observed is what we call subacromial bursitis.

Some people when performing elevated arm movements, such as back press or lateral raise, the supra-spinous tendon is rubbed and compressed between humerus head and osteoligamentous vault formed by the underside of the aromion and the coracoacromial ligament.

Consequence

shoulder anatomy

The result is an inflammation which generally begins with the synovial bursa, which normally protects the supra-spinous tendon from excessive friction. And it continue by the supra-spinous tendon itself and ends, if this inflammation isn’t treaed, by touching the adjacent tendons of the infraspinatus at the back and the long portion of the biceps at the front.

Arms elevation becomes extremely painful and there may be an irreversible deterioration of the supraspinatus tendon with calcification and sometimes even rutpure. The latter being observed in general only with people over 40 year old.

The space between the humerus and osteoligamentous vault can vary from one individual to another. Some athletes will not be able to lifte their arms laterally without generating excessive friction. These individuals must therefore avoid all back press, lateral raise to high and also when they train back, pulldown behind the neck.

All exercices with barbell for shoulders should be done in front of, with elbows slightly forward. With dumbbells lateral raise, the correct working angle should be sought, the right movement being the one that is realized painless.

It’s interesting to note that for the same shoulder injury all individuals don’t respond in the same way. Some people can perform all sort of arms raise, compressing and sometimes even deteriorating their tendons without ever triggering a painful inflammatory process. Thus, in the course of an examination, some people have discovered a rupture of the supra-spinous muscle’s tendon without ever having complained of any pain.

Another cause of shoulder pain may be due to an imbalance in the distribution of muscle tension around the joint capsule. Recall that the humerus head is firmly held against the scapula’s glenoid cavity by a muscular system with tendons adhering or passing through the articular capsule. This set is composed at the front by the subscapular, a little more on the outside by the long portion of the biceps, above by the supra-spinous and finally at the back by the infraspinatus and the teres major muscle. Spasm, hypertonicity or, on the contrary, a lack of tonicity of one or more of these muscles, can lead to a bad position of the shoulder joint. This bad position will be the cause, during the movements of the arm, of friction likely to generate inflammatory pathologies.

Exemple : A contracture or a spasm of the teres major muscle and infraspinatus will cause an external rotation of the humerus head which will generate during the movements of the arm, friction in the front of the shoulder joint. And with the time can injure the tendon of the long portion of the brachial biceps.

It will therefore be necessary to ensure to train in a balanced way all the muscles of the shoulder avoiding all the exercices where one will feel a discomfort, a pain or a friction.

Note : Hand massage or better with a vibrator, as well as electostimulation, give very good results to diminish and eliminate spasms and contractures of teres major muscle and infraspinatus.

-Steph

P.S. Do you want a free workout programs ? Click here 

Free smartphone apps:

To track my calories, I use MyFitnessPal

To track my workout program, I use Jefit