The use of posture management and scapula stabilization exercises to improve rotator cuff impingement outcomes.
What is Rotator Cuff Impingement?
Impingement occurs when the rotator cuff tendons get pinched in the space between the arm bone (humerus) and the arch of the shoulder blade (acromion) in a region within the joint which is called the sub acromial space. Pain is felt at the front of the shoulder due to irritation and inflammation of the tendon at the point where it becomes trapped. This pain is usually aggravated by overhead or twisting movements of the shoulder.
Causes of rotator cuff impingement
There are a number of reasons to which this problem can be attributed, these might include:
- Wear and tear of the joint between the collar bone (clavicle) and the shoulder blade,
- Structural abnormalities of the acromion
- Weakness of the rotator cuff muscles
- Trauma or direct injury
However one very common reason relates to poor posture which affects the position of the shoulder and the body’s ability to maintain control through movement. The shoulder joint is a ball and socket joint and is the most mobile of any joint in the body. To achieve such large ranges of motion, the socket is quite shallow which means the joint itself is inherently unstable. Complex ligament, muscle and tendon structures (soft tissues) work together to provide the stability that would otherwise be lacking. The rotator cuff is extremely important in providing this balance between mobility and stability.
Postural abnormalities including forward head position, rounded shoulders, internal rotation of the shoulders and an increased curve in the middle back (kyphosis) are commonly seen in patients with rotator cuff impingement (1). The soft tissues at the front of the joint tighten and the soft tissues at the back of the joint lengthen. This adaptation may simply be as a result of prolonged poor posture or could have been caused by poor training methods which have created what is known as a muscle imbalance.
Treatment of rotator cuff impingement
Pain is one of the major symptoms of rotator cuff impingement. It can be treated with a variety of modalities and by a range of clinicians and thus the irritation associated with impingement can be fixed with relative ease. However failure to address the cause of the problem i.e. the imbalance which has caused the impingement in the first place will only lead to a recurrence of the injury and persisting pain.
To achieve long term relief of rotator cuff impingement syndrome, posture management and scapular stabilization exercises must be implemented.
Posture Management and Scapular Stability Exercises
The shoulder has a ‘neutral zone’ much like that commonly described in the lumbar spine. This is the point at which the shoulder joint complex is aligned in such a position that all the supporting structures (muscles, ligaments and tendons) are able to work together to maintain control of the joint throughout the required ranges of motion. The ability to maintain this ‘neutral zone’ is lacking in impingement cases. It can only be restored through correcting postural defects (stretching tight structures, strengthening weak muscles) and stabilizing the scapula to provide a strong base of support around which movement can occur. An exercise program can be implemented very early on the recovery phase. There is no need to wait for pain to settle, in actual fact working within a pain-free range at a load that does not provoke symptoms, will only serve to relieve pain (2).
Unfortunately, there is no universal blueprint of exercises that can be given to correct this problem. The imbalances that lead to the development of impingement are often complex and interlinked. The skill in prescribing the correct exercise program lies in the exercise professional’s ability to fully understand the issues which have led to the onset of the problem. Only through delivery of such an exercise program will long term relief from rotator cuff impingement be achieved.
- resting positin variables at the shoulder: evidence to support a posture-impairment association. Bostard, J D. 2006, Physical Therapy, Vol. 86, pp. 549-557.
- Dynamic evaluation and early management of altered motor control around the shoulder complex. Magarey, ME and Jones, MA. 4, 2003, Manual Therapy, Vol. 8, pp. 195-206.