Handling an Overhead Athlete with “Shoulder Impingement”

When handling overhead athletes, the saying that an ounce of prevention is worth a pound of cure could not be more accurate. It is much easier to strengthen and attack deficiencies in biomechanics, muscle imbalance, and flexibility while the threshold of injury has not been reached, than it is to try and rehabilitate those areas once injury has occurred. With that being said, sometimes injury does occur, and in something like the shoulder it can be tricky to deal with. In this week’s blog, we will be discussing rehabilitating shoulder injuries, more specifically rehabilitating an athlete that is presenting with impingement issues.

Before deciding how to approach the rehabilitation plan you will use with your athlete, it is important that you determine the type of impingement that your athlete has. The two most common types of impingement that you will see in an athlete are known as subacromial impingement and internal impingement.

Subacromial Impingment
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6258038-common-shoulder-injuries-in-weight-lifting

The more general subacromial impingement occurs when the rotator cuff has difficulty moving in the already small subacromial space. This can be due to things such as mobility restrictions of the shoulder or muscle imbalance, to name a few causes. What happens in subacromial impingement, is once the rotator cuff is not efficiently moving through the subacromial space, it becomes inflamed and painful. Commonly in subacromial impingement, the rotator cuff, which is important in dynamic stabilization of the humerus is weak. This causes the humeral head to excessively translate superiorly, further shrinking the subacromial space in which the rotator cuff tendons need to move.2 Patients with this type of impingement commonly report feeling a pinch in movements such as shoulder flexion or internal rotation.

Internal Impingement
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/shoulder-impingement-3-keys-to/

Internal impingement on the other hand, commonly seen in overhead athletes is typically the result of hyperlaxity in the anterior direction due to constant external rotation. According to Reinold, the humeral head slides anteriorly, causing the underside of the rotator cuff to impinge against the posterior-superior glenoid rim and labrum.2 Internal impingement is a secondary issue that follows rotator cuff weakness, fatigue, or inability to dynamically stabilize the shoulder.2

In treating either type of impingement, the main goal should be correcting whatever is causing the impingement to occur. You can treat and correct the shoulder pain, but without correcting the whole problem, your athlete will soon be back to where they started. More often than not, combined with stretching the surrounding tight musculature, strengthening of dynamic stabilization in the rotator cuff is necessary to find success in returning an overhead athlete to play.1

References:

1Manske, R., Grant-Nierman, M., & Lucas, B. (2013, April). SHOULDER POSTERIOR INTERNAL IMPINGEMENT IN THE OVERHEAD ATHLETE. The International Journal of Sports Physical Therapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625798/pdf/ijspt-08-194.pdf.

2Reinold, M. (n.d.). Shoulder Impingement - 3 Keys to Assessment and Treatment. Retrieved November 17, 2016, from http://www.mikereinold.com/shoulder-impingement-3-keys-to/