If you have been diagnosed with shoulder impingement, it's important to maintain a broad perspective.

Not only is it important to treat your specific shoulder symptoms, but we need to take a step back and consider what has caused this to happen.

Understanding the root cause of shoulder impingement isn't necessarily a tricky or complicated scenario. But it does involve keeping an open mind.

And as we'll get to in this article, trying to solve shoulder impingement means taking a look at more than just your shoulder.

So let's get to it!

What is Shoulder Impingement?

To cut a long story short, shoulder impingement is essentially a jamming of the tissue in the shoulder during normal movements.

Traditional shoulder impingement occurs at a very important anatomical space - the sub-acromial space.

This space is important for a number of reasons. One is that it’s supposed to remain a space.

Now that may sound strange, but the idea of the subacromial space is that, when orientated and positioned correctly all tissue in the area is loaded and used correctly.

As you can see from the image above, the sub-acromial space famously houses the Supraspinatus muscle (one of the all-important four rotator cuff muscles) as well as what's call a bursa.

The bursa itself is a sack of fluid used to decrease the friction between two surfaces. And this does an amazing job when positioned correctly.

When most shoulders impinge, we often see either the Supraspinatus tendon or bursa become inflamed and irritated. This is why we commonly see Bursitis and Rotator Cuff tears or tendinopathy associated closely with shoulder impingement.

And to circle back to a previous point, it’s important to understand that shoulder impingement is usually a consequence of less than perfect shoulder mechanics as a whole. Dysfunction in and around the shoulder forces a change in the way we the shoulder moves and any involved tissue has the potential to become involved if things go on for long enough.

But as we said at the beginning of the article, understanding what's irritated and sore is one thing, but figuring out what has caused this to happen is another.

And you could argue that without working to solve the broader issues at fault its hard to expect a long-term resolution.

What Causes Shoulder Impingement?

A breakdown in shoulder mechanics can occur in a number of ways, so let's pick out the main ones and go from there.

The interesting thing about these factors is they are rarely sore themselves. You may literally have no reason to believe they're involved at all until they are individually assessed and treated and you bear witness to the results.

Clinically you can mount a strong argument there are three main areas that are consistently at the heart of shoulder impingement:

1. Upper back stiffness
2. Posterior shoulder tightness
3. Less than ideal shoulder postural habits

Again, none of these may stand out or seem connected on the surface. But there's every chance one if not all will be in play.

Upper Back Stiffness:

As we've mentioned in previous articles, the upper back has perhaps the biggest influence over general shoulder function. Its relationship to the shoulder blade and shoulder tissue is so strong that any upper back dysfunction - muscle tightness, joint stiffness, or poor positioning, can strongly contribute to shoulder pain.

If we think of shoulder impingement as a sub-acromial space that jams, any restriction in the upper back can contribute to this. This may look like the upper rib joints being stiff or the superficial muscle tissue being tight.

It forces the shoulder blade to move poorly decreasing our ability to maintain a good sub-acromial space while the arm moves. So if you are struggling to overcome an impingement, start by hunting around your upper back for stiff and tight areas like in the video below:

Posterior Shoulder Tightness:

Similar to upper back stiffness, any restriction at the back of the shoulder can rob the sub-acromial space of vital room to move - increasing the risk of impingement.

Interestingly, posterior shoulder tightness is also one of the main issues responsible for a lack of shoulder internal rotation. This range of motion is significant as we generally incorporate this movement into our testing for shoulder impingement. So any loss of this range plays a strong role in asking the structures of the shoulder to jam up.

Whether it be posterior capsule tightness or restrictions through the posterior rotator cuff or rear deltoids, it’s important to mobilize this tissue and optimize your ability to move normally.

Try the exercise technique below for some gentle

Poor Postural Habits:

This probably isn’t the sexiest topic of conversation, but the quality of your daily shoulder positions really do matter when trying to solve shoulder impingement (and understand it’s cause).

Deep down, everyone has at least some basic appreciation of how important good postural habits are. Whether it was your parents growing up, your teachers at school, learning an instrument, or playing a sport we are exposed to the idea of good posture in some way at some stage.

Yet we all know how hard it is to be constantly conscious of our posture let alone be in consistently good positions in this modern sitting-based world of ours.

So when trying to address shoulder impingemen†, it’s imperative that we appreciate the need to put those tissues into better positions.

Your specific postural improvements and postural focus points may differ from the next person, but one thing remains the same. We need to move as close to the ‘anatomical position’ as possible. Again, you may have moved away from this baseline human position in a slightly different way than someone else based on your environmental demands, but the goal remains the same.

Interestingly, we can also look to our postural habits to explain the cause of the upper back and posterior shoulder dysfunction mentioned above.

As we slouch and round forward, we increase the load and resting tension through the upper back and posterior shoulder. So it goes without saying that any attempts to rectify common, hidden underlying features associated with shoulder impingement are heavily supported by encouraging more anatomically correct positions as well.

Conclusion

Treating shoulder impingement requires more than just treating the impinged area itself. If you’re struggling to shake persistent impingement, you could do a lot worse than explore the current state of your upper back and posterior shoulder tissue. Similarly, good posture supports good shoulder function.

Ultimately it’s important to look at your shoulder impingement with an open mind.

If you can you might be pleasantly surprised at what you might find!

If you’d like a little more specialized help with your shoulder impingement consider booking in with one of our Physical Therapists. We can assess your shoulder and design an individualized rehab program to suit your needs.

Alternatively, come in for one of our FREE monthly in-clinic shoulder workshops! Register here!