Causes, And Solutions To, Shoulder Impingement Syndrome

The development of a shoulder impingement can be caused by a host of contributing factors as it relates to strength training, many of them coming as a result of the poor choices people make, whether they realize it or not.

As it relates to strength training, an impingement can result from one, or more, of the following variables: poor form/technique when lifting, selection of exercises that compromise the subacromial space leading to impingement, poor sequencing of movements during a workout, or imbalanced development caused by incomplete training programs that fail to address individual structural imbalances.

The primary culprit is without a doubt poor form/technique, as most people have little clue in terms of how to actually perform movements properly. Learning how to control and coordinate the body to produce fluid movement initiated by the intended muscle groups is no easy task, which is why there is no wonder as to why it’s the primary cause of the development of chronic injuries, especially shoulder impingement, given the versatility of the shoulder joint and its involvement in nearly all upper body movements.

Assuming poor form/technique is ruled out from being a contributing factor in the development of a shoulder impingement, the next possible explanation would be selecting exercises that compromise shoulder health by mechanically positioning the arm and shoulder joint into internal rotation, and/or shoulder flexion, under load. Both internal rotation of the arm, and flexion of the shoulder, reduce the amount of space needed within the joint for movement to be fluent, and pain free. Therefore, movements that mechanically lock the body into internal rotation, and/or shoulder flexion, or both, are of much higher risk than those which allow the arm and shoulder to move freely.

Two of the more common and popular movements that carry a higher risk component than the possible reward that comes from performing them are the upright row, and the bench dip.

Why bench dips are bad

No matter how hard you try to keep your chest up and shoulders back as you descend when performing a bench dip, your shoulders are going to travel forward past your clavicle (collar bone), and an internally rotated weight bearing arm combined with a humerus rotating forward past the clavicle as you lower yourself, is a perfect recipe for shoulder impingement. Even with textbook form, the external rotators of the arm, which provide stability to the shoulder, can’t do much to help you here.

Whether the purpose for performing a bench dip is to place tension on the triceps, or chest, a better option is perform them on a set of parallel bars. People generally shy away from bar dips because they are much harder then bench dips, and the obvious reason is because you actually have to lift all of your weight, not just a fraction of it (with a bunch of plates piled on your lap to pad your ego). Bar dips lock the arms into a neutral (palms facing each other) position, as opposed to an internally rotated position, and that in itself decreases the likelihood of a shoulder impingement.

Why upright rows are bad

Number one, the arm is locked into internal rotation which decreases the subacromial space, and anytime the subacromial is compromised, the chance for impingement is elevated.

Number two, the closer the hands are together, the greater the flexion of the elbow there will be throughout the range of motion, which increases the demand for the biceps to contribute, and this is problematic because the long head of the biceps passes over the humerus, and through the subacromial space. The likeliness of impingement is magnified as the muscles that pass through this small space swell with blood/get pumped up

Anyone who’s ever gone to a chiropractor or physiotherapist to be tested for shoulder impingement knows that the test, called the empty can test, consists of an almost identical pattern to that of the upright row. This alone should suggest that the movement promotes impingement and therefore is naturally of higher risk.

Another factor that isn’t directly linked to shoulder impingement is the order in which you do things. For example, most people are unaware that the lats are very powerful internal rotators of the arm, and by training them the day before a chest or shoulder workout, in which you intend to perform a lot of pressing movements, can increase the chance of an impingement. This is because muscles tighten up in response to a workout as part of the adaptation process, and why stretching is generally advised at the end of a workout (to minimize the shortening effect, and prevent the muscles from becoming habituating to the shortened state). In this case, the lats are pulling the humerus (upper arm bone) into internal rotation, compromising the subacromial space. This is why it’s important to properly sequence your workouts and not just ‘wing it’.

Another example of a poorly designed routine that could increase the development of a shoulder impingement would be training the biceps and shoulders together on the same day, more specifically performing arm curl variations that emphasises the long head of the biceps (ex. incline dumbell curl) prior to overhead presses.

This is not a good idea at all because, as stated earlier in regards to upright rows, if the muscles that directly pass through the subacromion space become pumped and inflamed from training, the space becomes smaller and the likeliness of a tendon, or the bursa, being pinched is elevated.

Finally, shoulder impingement can be exaggerated by failing to create and maintain structural balance throughout the body. The scapula’s ability to move freely is very important when it comes to shoulder health, but very often people’s routines will consist of presses (done with an overhand grip), rows (done with a neutral grip), pulldowns/pull ups (done with an overhand grip), lateral and front raises (done with an overhand grip), arm extensions (done with an overhand grip), and curls (done with an underhand grip).

Nearly every exercise that people do for the upper body, aside from bicep curl variations, is performed with an overhand grip, and so it’s no wonder, when you take all of these factors into consideration, why shoulder impingements are as common as they are. The logical way to combat this is to perform more work with various grips, and trying to emphasize the use of an underhand grip as much as possible to promote balanced development through the primary muscles involved, as well as the stabilizing muscles.

Some other tips to avoid impingement are to avoid movements that require you to raise or lower a weight behind your head, unless you have the available range of motion to do so properly. Having a weight behind your head requires a great deal of flexibility in the shoulder joint in terms of abduction and external rotation, and most people don’t have the posture to allow for this movement to take place fluidly, therefore the risk is far greater than the reward in most cases.

Perform pulldowns with an underhand grip as opposed to an overhand grip, as the overhand grip can cause an anterior rotation of the shoulder the lower you pull the bar, thus compromising long term shoulder health. An underhand grip is a much better choice in terms of shoulder health as it prevents an anterior rotation from occurring and is much easier to perform effectively, thus increasing the reward at the expense of the risk.

Adopt a neutral grip when performing your dumbell presses, irrespective of the angle, to allow for a slightly greater range of motion. Biomechanically you may not be able to press as much with a neutral grip because the prime movers are strongest in internal rotation, but then again, how much would you be able to press when wincing in pain due to a shoulder impingement? Do yourself a favor and prioritize using a neutral grip when performing dumbell presses.

Lastly, prioritize the muscles directly responsible for holding the joint together – the rotator cuff! Most people who actually do attempt to train the rotator cuff do so ineffectively by way of holding a weight at arm’s length out to the side, with a 90 degree bend in the elbow, and rotating the weight up and back, and down and forward, without any tension really being placed on the targeted area at all. If you want to train a muscle you must position yourself mechanically so that the targeted muscle takes on the greatest percentage of weight. On top of that, this is generally performed as part of the warm-up at the beginning of the workout, and should the targeted areas actually be trained, they may unintentionally be fatigued, in which case they can’t perform their job as stabilizers, thus potentially decreasing performance without even minimizing the risk of impingement.

If you have any questions about factors that can lead to shoulder impingement syndrome, feel free to contact me at ben@paramounttraining.ca. I'm available for online consulting and personalized program design, as well as one on one training if you are located in the Greater Toronto Area (GTA).