Workshop Series: Pilates & Yoga for Healthy Shoulders – Impingement Syndrome

Ask where most people feel pain, discomfort or stress in their body and the shoulders are sure to come up. Anatomically remarkable, the shoulder girdle performs an amazing array of movements from rocking a new born baby to swimming to throwing a fast ball over a hundred miles an hour. But this flexibility comes at a cost – overuse injuries are frequent and often interfere with weekend sports programs and the myriad activities of daily living.

A major player in happy healthy shoulders is the shoulder blade or scapula located in the upper back. Because we spend most of our days rounded over something – phone, computer, steering wheel – our upper bodies start to “hold” this position even when it isn’t needed. Over time, the tendons and muscles and bones and soft tissues and finally the nervous system decide this is the new normal and voila – poor postural habits emerge.

When the shoulders are elevated, rounded and protracted forward, the shoulder blade is downwardly rotated – which isn’t good. This puts stress on the movements of the shoulder in a couple of ways and can result in impingement – a condition that frequently causes pain in the shoulder with certain movements and can lead to fraying and even rupture of delicate tendons.

Pain or discomfort from impingement is usually located near the top of the arm where the deltoids insert – that area that dips in slightly about 3 or 4 inches from the top of the shoulder. This can occur when trying to raise the arms above the head or extend the arm backwards to put on a coat or reach behind to grab a package or purse from the back seat. Or you may feel stuck when trying to get the arms to elevate above the head and experience less range of motion.

Healthy shoulders require the scapula and the humerus (arm bone) to move in a synchronous 2:1 ratio. For every two degrees of arm movement away from the body, the scapula rotates one degree. When the shoulder blade is downwardly rotated, this doesn’t happen.

Healthy shoulders also require functioning rotator cuff muscles. Four small muscles connect the head of the humerus to the front, back, top and bottom of the scapula. The muscles surround and blanket the shoulder blade with broad attachments on nearly the whole surface of the scapula but insert with relatively slender tendons into the head of the humerus creating a structural paradigm prone to injury. This propensity is worsened by the passage of the tendons between two opposing boney structures with a tendency to bang up against each other if movement patterns are compromised. When this happens – ouch – you feel the pain of impingement.

Energetically the shoulders are in the domain of the fourth and fifth chakras. Sometimes persistent pain and poor postural habits result from issues in our psychosocial lives that need attention. When the mind is ruminating with worry, neurologic and hormonal signals flood the body and prevent the body from relaxing and healing.

The fourth chakra pertains to matters of the heart – love, grief, and self-compassion. Much rumination in the mind pertains to past or future grievance’s we have against ourselves. Like holding patterns in the body we develop holding patterns in the mind – bits and pieces of dialogue that play over and over getting more and more remodeled as time goes on. Forgive, forget and let go – it’s much easier to accept life’s rhythm when we accept ourselves just as we are – and know that it’s all part of the journey.

The fifth chakra pertains to communication and self-expression. Hand in hand with the fourth chakra, exercising self-compassion and accepting ourselves helps to create the most authentic self-expression to those around us. We get our needs met more easily.  We reduce stress.  The mind signals the body for all the tendons, muscles, soft tissue structures and particularly the central nervous system to relax. I know I left out bones but I don’t think bones can relax.

If your postural habits need a bit of spiffing don’t despair. Most bodies are resilient and with slow, persistent work, bio-mechanical efficiency can be improved if not corrected. As a general rule – and every body is different requiring tweaks to programming – weighted rows and planks work the scapula in an upwardly rotated direction. Internal & external rotation and abduction (particularly the first 30 degrees of arm movement away from the body) work the rotator cuff muscles.

Healing requires you to first stop doing the stuff that caused the problem in the first place – at least temporarily. If you feel impingement pain with a particular shoulder position it’s a reasonable assumption that the tendons don’t like whatever you are doing and damage is worsening. Ice – particularly after exertion – is helpful in knocking down the inflammation. Stretching should be slow, gentle and limited to less than full of range of motion if tendons are inflamed.

Your body cares what your mind thinks. Align anatomically and energetically for healthy happy shoulders.




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