Pain with Overhead Exercise?
Pain with overhead exercise, such as weight lifting, tennis or volleyball is a very common complaint we see at City Physio. Most often it is related to how the muscles are stabilising the head of the humerus (arm bone) in the socket as the arm moves throughout the extremes of the shoulder range. This is a form of shoulder impingement in the more extremes of range.
Shoulder impingement is a condition where your shoulder tendons and other soft tissue structures can become trapped or pinched in the shoulder joint during movement. Impingement as a category can include impingement of bone on bone, bone on rotator cuff tendon (often causing rotator cuff tendonitis) and bone on bursa (often causing bursitis). These conditions often coexist causing inflammation of a variety of structures at the same time.
While this can happen as a result of a traumatic injury such as a fall, it is more common with repeated movement of the shoulder with poor biomechanics. This causes the soft tissue structures to become pinched and then as this occurs repeatedly it becomes more and more swollen and becoming more and more likely to be pinched again!
Injuries vary from very mild tendonitis or bursitis, to partial and full thickness tendon tearing overtime.
Impingement often has 2 causes, primary (structural) and secondary (posture and mechanics). Primary impingement is to do with the shape of the joint surfaces- some people are just born with smaller joint spaces and are more prone for the soft tissues to become pinched. Secondary impingement is the most common and refers to the way the shoulder moves. When your muscles in your shoulder fail to work efficiently and accurately, some structures can become caught or overworked as the shoulder moves into range. When your rotator cuff fails to work as it should, it is unable to prevent the head of the arm bone from riding up and squishing the structures in the joint space.
Shoulder impingement most often has a “painful arch”- a small area of pain where the arm is roughly at shoulder height before the pain settles as you move it further into range. There is often pain in the upper arm or shoulder with repetitive movement, particularly overhead and when sleeping on the arm.
Impingement is more common in people who engage in activities that require repeated overhead movement, such as swimming, tennis or golf.
Your physiotherapist will do a full subjective and objective assessment of your shoulder considering a wide range of factors including referred pain from neck or upper back, the mechanics of the whole limb, strength and balance of the muscles surrounding the shoulder and shoulder blade, overhead exercise technique, motor control and biomechanical analysis. We have some special tests specific for impingement and if we suspect a high grade condition can also refer for an ultrasound.
When your rotator cuff fails to work efficiently, the mechanics of the shoulder continue to drift. Normal shoulder blade movement, also known as scapula-humeral rhythm- is required for a pain free shoulder movement. Your physio is the expert in this assessment and treatment of this rhythm and your physio will work to not just decrease your shoulder pain, but to normalise this movement to prevent recurrence and prevention of future shoulder injury.