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Shoulder Impingement and Rotator Cuff Injuries

“He who treats the site of the pain is lost.”- Carel Lewitt, M.D.

This is very true especially of the shoulder. Most people complain of pain in front and tip of the shoulder. However this pain might be arising due to faulty mechanics of the shoulder blade, muscle imbalances, and/or tightness of the shoulder capsule (joint). This is further complicated by the fact that the “ball and socket” joint of the shoulder is more of a “golf ball on a tee”. Maintaining the head of the humerus (ball) in the center of the glenoid (socket) requires flexibility and muscle balance between opposing muscles of the shoulder. In addition to this decreased upper thoracic (back) mobility, weakness of the hips and trunk can add to shoulder problems. Consider the following


  • By age 60, 60% of adults have rotator cuff pathology (Hijioka et al 1993)
  • 36% scapula winging and scapulohumeral (shoulder blade) abnormal mechanics in shoulder instability. Tightness of pectoralis minor (muscle in anterior chest wall) adds to this abnormal mechanics. (Kibler 2000, Borstad 2005, Warner 1992, Sahrmann 2002)
  • 34% more rotational stress to the glenohumeral (shoulder) joint when there is a 20% loss of trunk power (Kibler 2001)
  • 49% scope proven labral injuries with positive Trendlenburg ( a test for hip weakness), and tight hips (Burkhart 2000)
  • 23.6% loss of elevation motion and 16% loss of strength with thoracic spine (upper back) kyphosis (Kebaetse et al 1999)

Traditional physical therapy techniques of ultrasound, electrical stimulation and exercises (general strengthening) might help relieve shoulder pain temporarily but does not help the faulty mechanics that caused you to have the pain in the first place. If you have pain in the shoulder, have your physician or physical therapist perform a comprehensive evaluation of your shoulder to identify the cause of the pain and provide an individualized treatment program.

Summer is a wonderful time for outdoor sports activities. The weekend warrior deep inside us mostly desk bound athletes inspires us to participate in all recreational activities. These might result in pain and discomfort to the shoulder joint. Make sure you review common stretching and strengthening exercises for the shoulder with your physician or physical therapist to prevent shoulder injuries.

Here are some general tips to avoid shoulder injury:

  • Do not work overhead for more than a few minutes at a time
  • Do not lift heavy loads
  • Do not reach with the palm down
  • Do not support yourself on the painful shoulder
  • Do not carry your purse, backpack or other items over one shoulder
  • Do not sit in a poor posture while working on desk/computer.
  • Do not sleep on the painful shoulder
  • Do not reach into the backseat of your car
  • Use foot stool or ladder to reach overhead or perform overhead activities.
  • Perform posture exercises to improve shoulder blade strength

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