In my popular post “Climber Posture” I discussed how posture plays a role in shoulder pain. If you haven’t read it yet I would suggest starting there. In this post I will talk in a little bit more detail about the shoulder.

When most climbers experience shoulder pain they typically try to diagnose themselves online and immediately start doing random exercises and stretches without figuring out the actual cause of their symptoms. 

It is important to realize that there are many reasons why someone might have shoulder pain and that’s why it is important to seek professional help to get an accurate diagnosis. Treatment approaches will be different depending on the injury.

One of the most common shoulder problems I see in climbers in my practice is shoulder impingement syndrome. There are two types of impingement syndrome, internal and external.  External impingement is what I am going to discuss today. Internal impingement will be discussed in a later post.   

QUICK ANATOMY LESSON

The rotator cuff is formed by the tendons of four muscles that attach to the scapula. The four muscles are the subscapularis (at the front of the shoulder), the supraspinatus (on the top part of the scapula), the infraspinatus and the teres minor (on the posterior part of the scapula). The combined action of these four muscles keeps the head of the humerus centered in the glenoid (shoulder socket) to allow the different power muscles (such as the deltoid, pectoralis major and latissimus dorsi) to move the arm.

shoulder

WHAT IS EXTERNAL SHOULDER IMPINGEMENT SYNDROME (ESIS)?

External shoulder impingement syndrome is caused by the tendons of the rotator cuff muscles becoming pinched/impinged as they pass through a narrow bony space called the subacromial space which is between the humerus and the acromion. 

AL_Shoulder_impingement

The space between the top and bottom arrows is the subacromial space. You can imagine that if this person raised their arm over head that would reduce the space between these two arrows and would cause pinching of the rotator cuff muscle.

The truth is, you actually cause impingement every time you move your arm.  Impingement itself is normal and happens in all of us. When it becomes excessive is when injury occurs.

impingement

CAUSES OF SIS?

There are two major causes.

1. Primary: This is an anatomical issue with the acromion. There are three types of acromion and if someone has a curved or hooked type they are much more likely to get shoulder impingement.  

The only way to determine acromion type is with imaging. Type 3 are not super common but I have come across a couple over the last few years and these are usually surgical cases.

Side view of a right scapula showing the different types of acromion.
Side view of a right scapula showing the different types of acromion.

 

2. Secondary: This is a mechanical issue related to improper climbing technique, posture (think Climber Posture here), tightness, or muscle imbalances causing the humeral head to shift in it’s center of rotation and cause impingement.

A majority of ESIS cases respond well to conservative treatment. 

ASSESSING SHOULDER IMPINGEMENT

There are some specific test I use for ESIS, the Neer test and the Hawkins test.

To perform the Neer test I will stabilize the scapula while passively elevating the shoulder, in effect jamming the humeral head into the acromion.

To perform the Hawkins test I will elevate the arm to 90 degrees of abduction and forces the shoulder into internal rotation, grinding the cuff under the subacromial arch.

Another shoulder impingement test called the Impingement Clearing test can be performed by asking the patient to grasp their opposite shoulder and to actively elevate the shoulder.

Pain with any of these tests usually indicates external impingement.

TREATMENT

We can treat the symptoms all we want but they will come back if we do not address the real cause of the problem. The shoulder really isn’t the problem. The shoulder pain/impingement is always a symptom of a larger issue. A more global look at the climber, their posture, muscle imbalances, and movement dysfunction are all important for better long-term outcomes.

Picture 6

In the next post (Part 2) I will talk about treatment strategies for external shoulder impingement addressing the following:

1. Alignment and posture

The alignment of the scapula will determine how much subacromial space we have. We also must realize that scapula position depends on rib position, rib position depends on spine position, spine position depends on pelvic position. It’s all connected.

2. Tissue quality/myofascial release

Tight muscles can pull the scapula out of alignment. “An athlete who’s not getting regular release work from a practitioner and/or doing it on their own is hobbling their performance.” –Papciak

3. Rehab exercise

Reinforce correct movement patterns and climbing technique and address muscle imbalances. 

4. Overuse

Sometimes we get these injuries because of overtraining or doing too much of the same thing. Don’t ignore your body until it becomes too late and you’re forced to take unnecessary time off due to injury, burnout, or worse.

As I mentioned above, there are many reasons why someone might have shoulder pain and that’s why it is important to seek professional help to get an accurate diagnosis.

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READ PART 2 HERE for treatment advice.

If you think you have shoulder impingement syndrome and you can’t wait until next week come see me now at Motus Clinic and we can get you diagnosed properly, start the rehab process and get you back to climbing fast!

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