A “wonky” shoulder, AKA a shoulder that doesn’t move right, feel right, or down-right hurts when you move it, can be caused by a myriad of reasons: arthritis, bone spurs (due to arthritis,) rotator cuff injury, an injury to the labrum (or deep cartilage in the shoulder) or an insidious little condition called shoulder impingement. This last one is very common in the modern human because we spend so much of our lives with our arms in front of us (on the computer/ smart phone/ tablet, driving, writing, etc.) and very little time moving our arms in other ways (lifting overhead, pulling, pushing, climbing, etc.) This lack of movement variety, along with “less-than-optimal” posture, is a perfect environment to bring about shoulder impingement. A note of caution before I continue: this article is not meant to be a substitute for medical evaluation or advice. If you have a painful shoulder, please see your doctor to rule out the conditions I listed above, before trying any of the exercises.
What causes the “Wonky” Shoulder in the first place?
Shoulder impingement is a term used to describe shoulder pain that is usually felt when raising the arm overhead, and/ or when reaching across to the opposite shoulder. The pain is caused by the tendons and bursa in the shoulder being pinched under the acromion process (a little bone that sticks out next to the end of your collarbone at your shoulder) as you raise your arm or pull it across your body. Impingement can seem more like a sentence than a diagnosis because of how much we depend on our arms to take care of ourselves: washing our hair, pulling a shirt on or off, and even scratching an itch between the shoulder blades. Since all of these motions hurt, the area seems to always be irritated and is slow to improve.
Recently, I have spoken with several different people who have been struggling with impingement. Two of them had been given some “traditional” band exercises for the rotator cuff, but the exercises were actually creating more irritation, and so they stopped doing them. The third person scheduled a surgery to resolve the pain. This surgery would include shaving off the tip of the acromion process—the bone which is part of the shoulder blade itself—to allow more freedom of movement for the arm.
Problems with fixing the problem
The trouble here is neither of these methods actually resolve the source of the impingement: the shoulder blade is not moving properly. When you lift your arm above shoulder-level (parallel to the floor,) your shoulder blade should rotate upward, moving that acromion up and out of the way. That particular shoulder blade movement prevents the vulnerable tendons and bursa of the shoulder from being pinned or squished under the acromion as the arm moves upward.
Rotator cuff exercises are great to activate/ strengthen the rotator cuff, but if the shoulder blade is not moving, the rotator cuff tendon is still being squished when the arm moves up. Eventually, this can cause a tear in the rotator cuff tendon, requiring surgical repair. But at least at first, strengthening the rotator cuff just won’t help, or worse, can create more pain.
The proposed surgery is a viable option. Especially if bone spurs have been spotted on X-ray or MRI, shoulder surgery could be the best option. But otherwise, surgery for impingement alone could be likened to using a hammer to put a thumb tack into the wall.
The 3 hacks
Granted, working on improving the mobility and subsequently the stability of the shoulder blade is not an easy task—remember, you’re still using that shoulder a lot. But as the shoulder begins to regain muscle balance, it begins to move better when the arm is lifted, and that means it becomes less painful. So what can you do to get your shoulder blade moving again? Try these 3 “hacks” to get started. Again, please consult your physician about your shoulder pain to rule out more serious conditions before attempting these exercises. Remember, Rome wasn’t built in a day, so be patient and persistent. To be sure we get the right shoulder exercises for your situation, give us a call. We’d be happy to schedule an assessment and get you started!
Shoulder Protraction at the counter: Stand facing your counter, with the feet stepped back enough that you have a right angle at the shoulders. Hands rest on the counter top at shoulder-width with arms straight and spine long (abs engaged.) Press the hands into the counter to broaden your shoulder blades (without over-rounding your upper back.) Then ease your plank forward toward the counter allowing the shoulder blades to move toward each other a little (keep the spine relatively neutral and elbows straight.) Press into the counter again to return to start position. Practice 2 sets of 5.
Seated Push-up 2 (shoulder blade depression): Sit tall on the edge of your seat with feet staggered and some weight in your feet. Place your hands next to your hips with your elbows straight. Squeeze the shoulder blades together (retract) as you slide just off your seat, lowering your body between your shoulder blades (elbows straight) to put you into a “shoulder shrug” with retraction. Be sure your head is aligned over your neck. Then keep retracting the shoulder blades as you push the body upward (you can push with your feet a little too), bringing the shoulders to a more “neutral” position on your back. Practice 1-2 sets of 3-5 as tolerated.
Chin Glide on Foam Roller (w/ retraction): Lie along your roller so that your head is on one end (with 1-2 folded towels under it) and your tailbone on the other. Knees should be bent with feet on the floor, spine/ pelvis neutral. Reach your arms out into a “A” position, palms up. Exhale to gently nod the chin and “lengthen” the back of the neck (feeling like the head reaches away from the neck,) as you squeeze your shoulder blades toward each other. Inhale to release. Practice 2 sets of 5, without pain or strain.
Now that you have begun to regain movement at the shoulder blade, keep going! This must be a priority at least twice daily. Especially if you spend a lot of time at your computer or behind the wheel of your car (read: in a static shoulder position,) you must remind that shoulder it can move. Want more? Join me at Partner MD Richmond on Tuesday September 13th at 12 and September 20th at 6 to learn more about how you can resolve your shoulder pain and get back to your life!