Shoulder pain is an increasingly common complaint for overhead athletes of all levels. Whether you are participating in year round training for school sports, are a weekend warrior playing in bar league softball, swimming laps around the pool, or are simply trying to throw the football around with your kids, you could be at risk for shoulder impingement. Impingement of the shoulder will not only cause pain with your sporting and recreational activity, but can progress to difficulty sleeping, weakness in the arm, and trouble with simple daily tasks, such as dressing.

What causes shoulder internal impingement?

To fully understand shoulder impingement with overhead activity, let’s first review the anatomy of the shoulder. The shoulder complex is made up of the clavicle (collar bone), humerus (upper arm bone), and scapula (shoulder blade). All three of these components need to work together with to allow the shoulder to work optimally. The shoulder blade has no ligament attachments, making it especially susceptible to excessive motion. The rotator cuff is a group of four muscles that connect the humerus to the scapula. The rotator cuff’s job is to allow the shoulder to rotate, prevent excessive motion of the shoulder blade, and stabilize the shoulder joint.

It is very common for overhead athletes (most commonly found in baseball players, tennis players, and swimmers) to have excessive motion into the throwing position (external rotation). However, with excessive motion in one direction, comes too little motion in another. This imbalance is leads to tightness in the back of the shoulder, and decreased shoulder internal rotation, A.K.A GIRD (glenohumeral internal rotation deficit). Posterior capsule tightness and GIRD are contributing factors in developing internal impingement of the shoulder (1). Other possible causes of internal impingement include poor scapular control, scapular muscle imbalances, and poor posture (2).

Internal impingement of the shoulder often presents with pain on the backside of the shoulder, usually more pronounced with throwing. Pain is especially evident during the “cocking” and beginning acceleration phases of a throw. An individual with internal impingement will often present with increased external range of motion during the cocking phase and decreased internal range of motion during follow through. Those who participate in throwing sports may notice a decrease in throwing velocity, decreased accuracy, as well as a “dead arm” feeling of weakness after throwing (3).

How to stretch the back of shoulder

There are a few quick stretches you can perform to prevent posterior shoulder tightness. Try the “cross body” and “sleeper” stretches after your workout or recreational activity for optimal results.

Bring the affected arm across the body, and using your free arm, gently pull the affected arm across your chest until you feel a stretch on the backside of your shoulder. Hold this position for 5-10 seconds, then relax back to start position. Repeat for 5 to 10 repetitions.

Lay down on a flat surface, with the affected shoulder underneath you. Your upper arm should be flat on the ground, with your elbow in line with your shoulder. Using your free arm, gently push your arm down towards the ground until you feel a gentle stretch. Hold this position for 5 to 10 seconds, and then relax back to the starting position. Repeat 5 to 10 repetitions.

Shoulder internal impingement can sometimes show similar symptoms to those individuals who have developed a rotator cuff problem. Determining the cause of shoulder pain is important to achieving full recovery. Add these stretches to your routine to keep you injury free and allow you “play ball!”

If you have suffered an athletic shoulder injury and want to consult a physical therapist, click the link below for your free discovery visit.

References

1. Mihata T, Gates J, McGarry MH, Neo M, Lee TQ. Knee Surg Sports Traumatol Arthrosc. 2013 Jan 16. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/23322267
2. Tate, Angela R., Phillip McClure, Stephen Kareha, and Dominic Irwin. “Effect of the Scapula Reposition Test on Shoulder Impingement Symptoms and Elevation Strength in Overhead Athletes.” Journal Of Orthopaedic Physical Therapy 38.1 (2008): 4-11. Web
3. http://www.orthobullets.com/sports/3054/internal-impingement?expandLeftMenu=true