Friday, August 15, 2014

Shoulder Pain: Don’t Let it Keep You from Conquering the Beast

Shoulder Pain: Don’t Let it Keep You from Conquering the Beast
By Jason Dudzic, PT, MSPT, OCS, Cert. MDT
Jason Dudzic, PT, MSPT, OCS, Cert. MDT, holds board certification in Orthopaedics from the American Board of Physical Therapy Specialties (ABPTS). He is one of only three therapists certified in orthopaedics in the Erie area.

The next-gen obstacle races, such as the Beast on the Bay, require intense training that includes not just in running, but the entire body.  When it comes to training for these events, upper extremity overuse injuries can be as much of a limiting factor as the lower extremity injuries that I’ve discussed in previous blogs. 
One of the most common overuse injuries of the shoulder is impingement syndrome, or the more general term “anterior shoulder pain” (pain in the front of the shoulder). Although much of the current literature is conflicted over the causes of “anterior shoulder pain,” most sources agree that it occurs as a result of altered biomechanics and/or structural abnormalities.  There are several different types of impingement syndrome, including subacromial and internal impingements. But most commonly, in non-throwing sports, subacromial impingement is what limits the athlete.  

Subacromial impingement occurs when the subacromial bursa and/or supraspinatus tendon (one of the rotator cuff tendons) gets “pinched” between the acromion and coracoacromial ligament. This can lead to bursitis/tendonitis and, if left untreated, can progress to a tear in the tendon.


Subacromial impingement can be subdivided into primary impingement and secondary impingement.  Primary impingement usually occurs in individuals over the age of 65, and results when the space between the humerus and acromion is reduced due to degenerative changes, such as a spur (See Figure B).

A. Normal Shoulder X-Ray

Spurring noted on acromion and humerus    

Secondary impingement generally occurs in younger individuals and is the result of faulty mechanics, muscle imbalances, hypermobility, or hypomobility of the shoulder capsule.  The faulty mechanics can occur at the glenohumeral joint (ball and socket joint), or the scapulothoracic joint (the joint between the shoulder blade and rib cage).  When the scapulothoracic joint is the cause of impingement, muscle imbalances around the scapulothoracic joint lead to changes in the angle of the glenoid (socket), causing the impingement to occur.

With the Barber Beast around the corner, it’s likely you’ve been doing your upper body training right along with your running.  If you’ve been noticing anterior shoulder pain during your overhead resistance training, including monkey bar training, overhead lifts, military presses, etc…you may be experiencing impingement syndrome. 

Start by trying to stretch the posterior (back) and inferior (bottom) portions of the shoulder capsule, which allows the head of the humerus to drop down,thus creating space for the supraspinatus tendon. Do NOT stretch the capsule if you have known hypermobility in the shoulder or have a history of a shoulder dislocation.

If you’ve performed these stretches for 10 repetitions, three-to-four times a day for  four-to-five days, and you’ve had no change or an increase in your pain, you may benefit from evalauation by your physician or physical therapist.  The appropriate healthcare professionals will determine if your problem is impingement, and determine if you would benefit from other treatment, such as strengthening, modalities (heat, ice, electrical stimulation, ultrasound), stretching, or dynamic stabilization.



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