Don’t let shoulder pain slow you down. Subacromial bursitis can lead to a lot of pain and a lot of time on the sidelines, but it doesn’t have to.
There are effective ways to treat and prevent the condition and a related issue, shoulder impingement, which I’ll teach you about today.
The Shoulder “Catch”
You might’ve wondered if you have a shoulder impingement before.
Maybe you were throwing the ball around with your kids when you noticed some restriction in your arm – almost like your shoulder was getting caught.
You go to throw the ball and everything’s going fine until your arm reaches a certain point the arc and… suddenly everything is NOT fine.
It’s like something invisible is stopping your arm from moving forward to continue the throw.
Your arm feels weak and painful.
You might have even noticed the pain and that “catch” in your shoulder when simply reaching to grab something off to the side.
It might cause you pain when you’re trying to sleep, or maybe your shoulder and upper arm just kind of ache all the time.
So, what’s causing this discomfort and restriction?
Impingement means that some sort of soft tissue (like muscle or ligaments) is caught or constricted – usually between the harder tissue of bones.
But in the shoulder, the most common cause of impingement isn’t related to either these soft tissues or the bones. There’s usually another issue at play – bursitis.
In bursitis, lubricating, fluid filled sacs of tissue in your joints (called bursae) become inflamed and irritated from an overdose of friction.
Surrounding muscles and tissues rub against the inflamed bursae when you move, causing discomfort and pain.
To understand how this can cause shoulder impingement, let’s consider the anatomy of the shoulder.
The scapulae, or your shoulder blades, come together with your clavicles and the humerus of your upper arms to form the shoulder joint.
At the lateral edge of your scapulae is a projection called the acromion.
Under the acromion are ligaments, tendons, and a bursa that help your shoulder move .
If this bursae below the acromion becomes inflamed, you’ve got subacromial bursitis. And when this happens, all the other tissues underneath the acromion can become constricted.
And ta-da – you’ve got a shoulder impingement – or “subacromial impingement” – on your hands.
Rotator cuff tendonitis can also cause symptoms of impingement, but this is less common and the treatment is the same regardless of which issue is causing impingement.
Acromion Types & Shoulder Impingement Risk
As is true throughout the body, shoulder joints and scaps don’t come in one strict shape.
There are three main types of acromion, and these types can affect the risk of subacromial impingement.
In Type I, the acromion is generally flat, in Type II its curved, and in Type III it has a hooked shape .
Because the acromion curves or hooks inwards, reducing the subacromial space, Types II and III are associated with a higher risk of impingement.
But according to some researchers, we have the power to adjust the structure of our shoulder, and the method by which we can do it is simpler than you’d think.
Orthopedic surgeon Dr. John Kirsch says that all you need to do is hang from a bar .
This might seem strange – your shoulder hurts, and wouldn’t hanging put a lot of pressure on the joint?
But, let’s take a second to consider why Dr. Kirsch recommends this activity.
When you hang from a bar, your humerus shoots straight over head and will press on the acromion.
Over time, if hanging regularly, that pressure from your humerus will start to reshape your acromion.
This can open up space in your shoulder joint and reduce subacromial impingement.
While you can’t tell by looking what type of acromion you have, if your bursae are inflamed, or if your rotator cuff tendon is irritated, you can do a simple self-assessment that will clue you into shoulder impingement.
Simply take the arm of the affected side across your body to grab the opposite shoulder, bending at the elbow .
Now try to elevate the shoulder.
If pain occurs or your symptoms to flare up – you’ve probably got subacromial impingement.
You’d need a MRI to determine if the rotator cuff tendon or bursa is the issue, but it really doesn’t matter all that much – the treatment is the same.
Other Subacromial Impingement Causes
We now know that the shape of your acromion can play a role in impingement, but what other factors can cause the pain?
1) Poor lifting technique
Keeping your scapulae depressed and retracted the entire time you engage in overhead movements can narrow the subacromial space and contribute to impingement.
I’ve recently had to deal with shoulder impingement because I got ahead of myself when training handstands.
Even as a kid I’d never been comfortable on my hands doing cartwheels and such, so when I dedicated myself to nailing the freestanding handstand and started to be able to balance, I was hooked.
But this was the beginning of my demise as my eagerness got me to flipping over into a handstand whenever I could – at parks, against random buildings, in the gym when I should’ve been resting, etc.
Because I was training them so much, I was working them even when my shoulder muscles were fatigued, which led to depression of my scapula during the Handstand.
Whenever your shoulders are flexed (arms overhead), your scapulae should be elevated, not depressed, despite what many (uneducated) trainers may say!
When your scapulae are depressed, you’re narrowing the subacromial space, impinging on the bursa and/or rotator cuff tendon.
So learn from my mistakes and don’t do any overhead exercise with depressed scapulae – either consciously or because you’re fatigued to the point where you can no longer elevate your scaps.
You’ve been warned.
2) Stiffness or kyphosis of the thoracic spine
Stiffness or the excessive rounding of kyphosis in your t-spine – the part of your back upon which your scaps sit and move – can also cause problems.
If the platform for scapulae is a stiff or rounded back, the scap position is likely to be affected as well, and impingement and other issues can result .
3) Rotator cuff weakness
One of the MAIN functions of the rotator cuff is centralization of the humeral head in the shoulder when the arm is raised overhead.
But if the rotator cuff muscles are too weak to properly maintain this action, the humeral head will translate superiorly when the arm is raised, causing impingement.
5 Step Plan for Treating Subacromial Bursitis
If you already have subacromial bursitis, here’s what to do:
Step 1: STOP any movements that cause pain
First, you need to back off from any movements that are causing pain and give yourself a chance to heal.
To this end, I suggest avoiding painkillers if possible.
Painkillers will mask the symptoms – which, while it means you’ll avoid feeling some pain, you’ll also be totally in the dark as to what movements cause pain.
If you can hold off, you’ll quickly learn what movements to avoid, and as such, can actually give your body a break for healing.
Now you need to treat and reduce the inflammation in your bursae that’s behind the problem.
Supplementing with turmeric can help – studies have shown to it be as effective as ibuprofen for combating inflammation and easing pain .
I like PuraThrive – it’s a good brand with quality ingredients.
Fish oil isn’t quite as effective in fighting inflammation as turmeric, but it’s a good option and can help ease pain. I suggest taking about 3 grams per day of a combined EPA + DHA fish oil.
Step 3: Decompress the shoulder joint
Next, you’ll want to go through some drills to release the pressure on your shoulder.
This will help the shoulder joint open up and allow for increased blood flow. As circulation increases so does nutrient delivery and healing.
For these exercises, you’ll first need to:
- Set up a band between head and chest height
- Stick your hand inside the band, then grab it – creating a cross of the band on your wrist
- Step back until you feel just a bit of resistance
I call this drill the 3 Way Shoulder Mobilization and in addition to decompressing the joint, you’re improving scapular mobility and rotator cuff strength – all critical elements to treating and preventing subacromial bursitis.
3 Way Shoulder Mobilization Part 1: 90° Shoulder Flexion
- Protract your scapula (move your scapula forward) without rotating the body or shrugging the shoulders
- Internally rotate the shoulder by focusing on rotating your elbow
- Hold at your end range for 2 seconds, then externally rotate the shoulder and hold
- Repeat 3 times
- Retract the scapula and do the same thing – internally rotate 3 times, externally rotate 3 times
3 Way Shoulder Mobilization Part 2: 90° Shoulder Abduction
- Face away from the band so that your chest is at a 90° angle from the band
- Protract scapula and rotate internally and externally 3 times
- Make sure to keep your shoulder still and only rotate the arm bone
- Retract the scapula and repeat 3 times
3 Way Shoulder Mobilization Part 3: Horizontal Shoulder Adduction
- Face the opposite direction so that the arm attached to the band is crossing in front of your body
- Keep the elbow straight and shoulder depressed
- Protract your scapula to reach the arm toward the band slightly and complete 3 rotation cycles
- Retract and repeat
BONUS: Passive Hanging From a Bar
As I mentioned before, Dr. Kirsch recommends hanging daily from a bar, palms forward, for 3 to 5 minutes of total hanging time, hanging for 10 to 30 seconds at a time.
Your goal is to be as relaxed as possible, other than gripping with your hands on the bar.
If you can’t hold your entire bodyweight, use a chair and take some of the weight off with your legs.
Maintaining this practice alone may prevent impingement for regular folks, but especially for athletes, it’s not enough. You must continue on to Steps 4 and 5.
Step 4: Address thoracic spine mobility and kyphosis
I’ve addressed this topic in a previous post so check it out to discover techniques that will increase the mobility of your thoracic spine and improve your posture.
They’ll help counteract kyphosis and its side effects, including shoulder impingement.
Step 5: Build optimal shoulder mobility and movement patterns
Building full and proper mobility and movement patterns are necessary.
This means you need to work on full range of CONTROL, not just a range of movement.
You also must work with proper sequencing of muscle activation and relaxation to move within the range.
The amount of mobility you need changes depending on what you do.
Athletes and gym junkies will generally need more mobility. This is especially true for overhead throwing or hitting athletes like baseball and tennis players.
Here are a couple of sample exercises you can use to improve mobility and movement patterns.
Overhead Wall Rollout
- Stand leaning against a wall with an ab-wheel in your hands
- Protract your scapulae
- Slowly roll the ab-wheel up the wall and ensure you’re shrugging your shoulders to elevate your scapulae as your arms rise up while keeping tension in your core to avoid lumbar extension
- Roll back down slowly and with control and return to the initial position.
- Breathe naturally throughout the movement
Horizontal Band Fly
- Stand tall with a nice natural posture
- Hold the ends of a strength band in each hand with the length of it passing behind your back
- Keeping your arms straight, open your chest and reach back as if you’re trying to touch the backs of your hands together behind you in line with your shoulders while retracting your scapulae and hold for 3 seconds
- Now sweep your arms around so they’re pointing straight in front of you while protracting your scapulae and hold for 3 seconds then repeat
While working with these techniques, it’s important that you don’t do anything that provokes pain! If a movement triggers symptoms, back off.
Moving Forward to Complete Shoulder Health
While these techniques will help treat and prevent subacromial bursitis, they’re really just the beginning.
To keep every aspect of your shoulders healthy and protect these crucial joints, check out my Scap Control Program.
It’s an in-depth guide to shoulder health, strength, and mobility.
It’ll help you heal from injury, but most importantly, help you prevent future problems.
Check it out now and you’ll be taking a huge weight off your shoulders. Your future, more mobile self will thank you!