Shoulder Impingement. Painful mornings.

Hello, I have been suffering with slight shoulder impingement for around 6 months now. I have been seeing a Physio who gave me some band RC exercises to do. I have been doing these for around 6 weeks & I had not seen much improvement until I researched the problem on the net & started doing wall slides, broomstick stretches & Thoracic foam rolling. I believe I have tight pecs plus my posture isn’t very good, I tend to round my shoulders forward.

The symptoms have eased off considerably but when I wake on a morning the pain comes back & it’s pretty intense for about an hour then it starts to subside. It’s especially painful when I put my hand behind my back to pull my trousers up around my waist. Could this be something else or is this normal when trying to sort out shoulder impingent? Thanks.

Hi Tony , what exercises with bands are you currently doing?

it is necessary to understand where the problem is located, generally, the most common problem of impingement regards the bursa under the acromion, the reduction of the space is due to bad posture like the typically rounded shoulder which is accompanied by an anterior scapulae tilt. If you do not work properly on the muscles that pull back the scapulae in the correct position you have no chances to reduce the rounded shoulder and restore the sub acromial space.

Just now, Alessandro Mainente said:

Hi Tony , what exercises with bands are you currently doing?

Hi Alessandro, I am currently doing bilateral external rotation shown here

and some sort of wood chop exercise. Plus I was also told to do the bilateral external rotation exercise but standing & where I raise my arms upwards while stepping forward onto my right leg.

personally no one of these exercises works properly on the correct muscles, ask your physio to give you exercise for the middle and lower traps.

2 minutes ago, Alessandro Mainente said:

personally no one of these exercises works properly on the correct muscles, ask your physio to give you exercise for the middle and lower traps.

To be honest I did get the feeling that she was not fully understanding of my problem. Having researched this myself I have started doing some strengthening back work at the gym to try and pull everything back because I am very pec dominant. I did see a couple of YouTube videos that did say that you must work on the lower traps. My understanding is that the exercises that the Physio gave me are to strengthen the RC muscles but this will not achieve much if the problem which is causing the impingement is not solved. Could you suggest any exercises for the middle & lower traps? Thanks for your help on this its greatly appreciated.  

hi Tony

First of all you need to correct the scapular posture and kinematics, otherwhise these rotation exercises might even worsen your problem.

If this does not help, get a proper diagnostics/imaging to exclude damages which can not heal in conservative treatment.

Basically also the exercises for middle and lower traps can be painful simply because you need to work overhead. IN case of pain at the shoulder should be planned a physical manipulation of the tight tissue until the pain is gone. then work.

56 minutes ago, Petra Dvorak said:

hi Tony

First of all you need to correct the scapular posture and kinematics, otherwhise these rotation exercises might even worsen your problem.

If this does not help, get a proper diagnostics/imaging to exclude damages which can not heal in conservative treatment.

Thanks for your reply. How do I correct the scapular posture? I am trying to be more conscious of my scapular posture when sitting & standing plus I am doing plenty of rowing exercises at the gym.  

50 minutes ago, Alessandro Mainente said:

Basically also the exercises for middle and lower traps can be painful simply because you need to work overhead. IN case of pain at the shoulder should be planned a physical manipulation of the tight tissue until the pain is gone. then work.

 I only have slight discomfort when exercising overhead. The lingering pain that I have now is mainly at rest or first thing in the morning. Can you point me in the right direction for the recommended trap exercises? Thanks for your advice.

5 hours ago, Tony Burrows said:

How do I correct the scapular posture?

This question is impossible to explain in two sentences. If you are following foundations show the exercises to your physio/coach and ask for corrections, then check yourself with mirrors or filming, until you develop the body avareness. Once you know the correct movement patterns, you can train with growing resistance (very nice example is progressions of sPL)

8 hours ago, Tony Burrows said:

 I only have slight discomfort when exercising overhead. The lingering pain that I have now is mainly at rest or first thing in the morning. Can you point me in the right direction for the recommended trap exercises? Thanks for your advice.

when the pain in the resting position happens means that ligaments and tendon have already begin to present laxity and is not a good sign.

A MRi is necessary in order to avoid major problems.

1 hour ago, Alessandro Mainente said:

when the pain in the resting position happens means that ligaments and tendon have already begin to present laxity and is not a good sign.

A MRi is necessary in order to avoid major problems.

The pain is just when I wake up in the morning & I do not know how to go about any further treatment because the Phsyio checked me over again & basically said she would discharge me.

Personally, you need to change physio. when someone with shoulder impingement gives ALWAYS external rotation for solving the problem then the physio is the problem. Th rotator cuff in the 100% of the people is already strong due to the nature of the life ,all the strange movements we do like wrapping something over the head, pulling something behind the back etc.

Impingement occurs because the articular spaces are changed and not because the external rotation is weak. the external rotation can be limited because the internal rotation is too strong, there is rounded shoulder and the scapulae alignment is altered compared to the normal situation.

When you begin to feel the problem is only the last pieces of the puzzle and not the primary one. the loss of external rotation and impingement are 2 consequences. the suggestion of your physio is telling you to do external rotation BUT external rotation act on the upper arm and not on the scapulae, if the problem is the scapulae position and alignment you MUST act on the scapulae, not on the upper arm.

Trust me, I've forgotten the number of PT that I have coached in my courses, some of them are good, some of them should change work.

CHANGE YOUR PT.

I've just been to see a structural integration specialist for shoulder impingement. The first place she looked was not my shoulder but the position of my scapula. She said the primary cause for me was two stuck ribs. Along with releasing them, she worked on releasing subclavius and subscapularis.

Just an example of how infra/supra spinatus are not always the problem.

Definately going to get my mid/lower traps check out as well now though.

1 hour ago, Christopher Hancox said:

I've just been to see a structural integration specialist for shoulder impingement. The first place she looked was not my shoulder but the position of my scapula. She said the primary cause for me was two stuck ribs. Along with releasing them, she worked on releasing subclavius and subscapularis.

Just an example of how infra/supra spinatus are not always the problem.

Definately going to get my mid/lower traps check out as well now though.

How did you manage to see the specialist? I am going through the NHS and my Physio basically was going to discharge me until I said I would prefer she didn't.

I paid for it privately. Don't know where you are in the UK but I see a Rolfer. NHS I have given up with. I only really go if I need an X-ray or MRI.

2 hours ago, Christopher Hancox said:

I've just been to see a structural integration specialist for shoulder impingement. The first place she looked was not my shoulder but the position of my scapula. She said the primary cause for me was two stuck ribs. Along with releasing them, she worked on releasing subclavius and subscapularis.

Just an example of how infra/supra spinatus are not always the problem.

Definately going to get my mid/lower traps check out as well now though.

I am from West Yorkshire, England & sometimes I do not think the NHS do as much as they can.

4 hours ago, Alessandro Mainente said:

Personally, you need to change physio. when someone with shoulder impingement gives ALWAYS external rotation for solving the problem then the physio is the problem. Th rotator cuff in the 100% of the people is already strong due to the nature of the life ,all the strange movements we do like wrapping something over the head, pulling something behind the back etc.

Impingement occurs because the articular spaces are changed and not because the external rotation is weak. the external rotation can be limited because the internal rotation is too strong, there is rounded shoulder and the scapulae alignment is altered compared to the normal situation.

When you begin to feel the problem is only the last pieces of the puzzle and not the primary one. the loss of external rotation and impingement are 2 consequences. the suggestion of your physio is telling you to do external rotation BUT external rotation act on the upper arm and not on the scapulae, if the problem is the scapulae position and alignment you MUST act on the scapulae, not on the upper arm.

Trust me, I've forgotten the number of PT that I have coached in my courses, some of them are good, some of them should change work.

CHANGE YOUR PT.

I fully understand what you are saying but I am not sure where to go from here? I originally was referred to a Rheumatologist who then referred me to the Physio. I explained the discomfort I was having. What I did point out to her also is that I was unable to position my left arm into the same position as my right when I was in the bicep type of pose. It was as if something was preventing it. I now think it was my scapular. She just said that our bodies are not symmetrical. She then went onto carrying out various tests with my shoulders. Some stood up & some laid down on the bed. To be fair none of the tests really caused any major pain. Just a slight discomfort was felt when my arm was externally rotated. She said she could not detect anything but a slight impingement. This is when she gave me the RC exercises to do.

I researched the problem myself & over the last 2 weeks I have been doing wall slides, thoracic foam rolling & broomstick stretches as well as a lot of rowing exercises at the gym. I can now get my left arm into the exact same position as my right arm. I have no idea how I have achieved this & which exercise may have helped. I am limiting overhead exercises at the gym & also I have changed my bench press form. Some days I feel no discomfort & some days I do but it’s not debiliting.  For instance, yesterday I woke up with slight pain in the morning then once I had done some shoulder discolations it went away until I woke again this morning. So, the morning pain is the worse. I cannot reach behind my back without a sharp pain in the front of my shoulder. It feels as if something has tightened over night & then it releases once I start moving.

I went back to the Physio on Monday & she did the tests again & said everything appeared ok just maybe slight impingement again & I also should try to correct my posture.

All this treatment is through the NHS in the UK so I do not know how I can change the PT?

3 hours ago, Tony Burrows said:

I am from West Yorkshire, England & sometimes I do not think the NHS do as much as they can.

I think the key is finding someone that you trust and gets results. Someone with an in depth understanding and experience. I have also been in your situation, where you don't know where to turn. I've been through three physios, one NHS and two private over the last year. You've just got to keep going.

Try the UK Rolfing website to find a practitioner.

Good luck in finding someone and getting fixed.

@Tony Burrows

Check out the thread 'Shoulder rehab in the Denver area' in the GB forums. Lots of very useful info.

52 minutes ago, Christopher Hancox said:

@Tony Burrows

Check out the thread 'Shoulder rehab in the Denver area' in the GB forums. Lots of very useful info.

Thanks for that! I have just had a quick read & there looks to be some really good information. I will have a good look when I get home from work. Thanks again.

Guys, if any of you live close to Gloucester or even if you don t live close to, but have a serious physical problem that couldn t be solved after visiting literally thousands of physical therapist then I must tell you that WESLEY TAN is your man. I travelled almost a year and a half a go from Spain all the way to Gloucester to be treated for my shoulder pain. I couldnt even do incline push ups. Purchasing Foundation was the first best decision of my life, visiting Wesley was the second. He s a gymnastic coach (Forma) and an osteophat. That s why he really understand. I knew about him reading the forum and decided to write him. He was super helpfull. It s not just about the treatment, but about the specific exercises he gave me. I know not everybody can dot that, but if you are desperate and serious about training then it s absolutely worthy! 

PD. My wife says that the best decision of my life was marrying her, haha  

I had been thinking about this myself. I'm a 2.5hr drive away. Sound like it's worth the trip though.

Thanks Antonio.

You re welcome. You may also attend some classes if you have the oportunity! 

On 2/28/2018 at 6:25 PM, Tony Burrows said:

The pain is just when I wake up in the morning & I do not know how to go about any further treatment because the Phsyio checked me over again & basically said she would discharge me.

You are still experiencing pain but the physio discharged you... big red flag. As long as you need to find a new one, look for one who specializes in athletes. The average Joe is happy lifting the remote without pain so a lot of physio treatments sadly cater to that level of activity, but an athlete needs more from their therapy, and will actually do that "more", so a PT who knows that will work harder for you.