One of the most common issues that people face, irrespective of whether they follow a fitness routine or not, is shoulder stiffness. This might be caused by weakness in the rotator cuff, bad posture or incorrect form (in the case of those who exercise), a shoulder issue is something all of us have faced, or will face at some point in life.
A lot of this is down to the fact that shoulders are the most mobile joint in the human body; and the range of motion of the shoulder joint is triggered by a series of closely knit tendons and rotators and bones and soft tissue. All of them work together so you can be mobile enough to scratch that itch on your back, or remove a t-shirt with a complex cross-arm movement, and even reach up to get something off the shelf. So, when you face a sharp pain while doing these activities, you might have what is known as a shoulder impingement. It could be the first stage of a frozen shoulder but with regular exercise, this can be avoided.
“In my experience, around 70 percent of people I speak with about injuries have suffered from impingements,” says Ahmedabad-based physiotherapist Falgun Bhatt, who is also associated with the city’s ARA Football Club. His expertise is in sports and musculoskeletal rehab, and he recently became the first Indian to do a football performance therapy course from Dubai.
Bhatt says that before one comes to the conclusion that they have an impingement, it is important to be sure. Otherwise, people may fall into what he calls a “false exercise” pattern. “It is important for the physio to realise what is happening. Shoulder impingements are a tough thing to diagnose. It is also about how well the patient can communicate but that entirely depends on the correct questions asked by the physiotherapist,” adds the 29-year-old.
He says that the main cause of an impingement are tight pectoral muscles and weak rotators. “We need to understand why the locking is happening. Weak rotators or tight pecs and weak lower traps will pull the humeral head into a certain position. The condition (impingement) itself is a locking mechanism. The muscles are getting impinged between two bones. You need more space to avoid this,” says Bhatt.
And it is this space creation that fitness content creators call “unlocking” the shoulders. Bhatt says that while these unlocking exercises are necessary for space creation in the shoulder to operate freely, it is also important to focus on mobility and stability because this is not “an impact or accidental injury”.
In his Built With Science blog, Jeremy Ethier mentions a quick self-diagnosis which can help you explain the pain to your physiotherapist as well. “(Raise) your arms up with your thumbs up. Repeat this but with your thumbs down. If you experience pain or the pain worsens in the thumbs down position, this is an indication that you may have this specific type of impingement. Another indication is if your shoulders feel better when you press with a neutral or underhand grip instead of overhand,” he writes in an articlecalledHow To Fix Shoulder Impingement For Good.
Both Ethier and Bhatt prescribe the usual variations of external rotation exercises: Side lying external rotations with light weights or water bottles, prone or medicine ball Y-raises and T-raises. A quick search on the internet will provide a range of such raises which, according to Bhatt, will work for injury prevention.
But Athlean-X guru Jeff Cavaliere says rotator cuff strengthening might not be enough. “The joint itself becomes even more crowded and unable to safely house the tendon as additional inflammation and swelling mount up. Just doing things to strengthen the rotator cuff in this case to try and open up more room in the joint by positioning the humerus in a more biomechanically safe position isn’t enough,” he says in his YouTube video titledHow to Fix Shoulder Pain & Impingement.
Bhatt believes that there are fixes to impingements but the aim should always be to prevent getting to that point, focussing rather on prehabilitating the shoulder and making it injury proof. “These are exercises that people should do irrespective of pain or no pain. There are usually three stages: prehab, rehab, and then performance and strength. But nip it in the bud and you will never have to go through rehab,” he says.
Pulasta Dhar is a football commentator and writer.
