Shoulder impingement syndrome is a common problem for people walking through my office doors. In this problem soft tissue structures pinch under the acromion, that bony “roof” of your shoulder that you can feel with your fingers if you rub the upper angle of the joint where the rounding of the ball and socket construction flattens into the portion over the end of your collarbone.
There are many factors, including swelling or thickening of the soft tissues under the acromion, our natural anatomical variations, and our assumed postures that contribute to this pinching. No matter what is contributing to your particular case, this type of shoulder problem will stubbornly frustrate attempts to execute a normal workout. This is because normal workout movements like chest pressing and overhead pressing tend to aggravate the pain by placing the shoulderblade in a “likely to pinch” mechanical position.
As humans, responsive to operant conditioning like we are, we easily fall into the trap of breaking our fitness habit while rehabbing from a shoulder impingement injury. This is a mistake! It’s true that we need to modify our activity when recovering from injury to eliminate aggravators, but this does not mean that we must completely cut out exercise altogether!
First of all, a shoulder injury will not stop you from performing lower body resistance training exercise. So squat away, lunge away, run away (but not from the gym!), gluteal bridge away, monster walk away etc. All of that stuff is still totally in at the gym, and therefore so are you. Secondly, in many cases you can still include pushups, a chest press movement, in your workout. In fact, a carefully executed pushup, with an eye to managing good shoulderblade mechanics can be a great rehabilitative exercise. A pushup can help you to retrain motor control (brain control of the muscles in a movement) and strength of the muscles that will stabilise the shoulderblade, including the serratus anterior, lower traps, and rotator cuff musculature. This will minimise the pinching of those aforementioned unhappy soft tissues under the acromion.
Our job when executing our pushup is to maintain the shoulderblade in an out rotated and posterior tilted position. It’s so much easier to describe this visually so please do look at the video above for more details on what it means to position yourself in this way..
To achieve this positioning I’ll encourage you to assume the 3 point upper body posture position.
FIRST: tuck in your shoulderblade. More specifically tuck the bottom tip of your shoudlerblade into your body. This is a subtle movement. It’s a flattening if the shoulderblade against your body, not a pushing or pulling of the shoulderblade through space. Think of it as a tilt of the shoulderblade that stays static in place.
The traditional model of shoulderblade positioning calls for a jamming “down and back” of the shoudlerblades. This is not that! Instead imagine that you are centering your shoudlerblade rather than taking it into any extreme of range of motion.
You should feel like -when centered- that you have some play in all directions, meaning that you can depress the shoulderblade a bit if you want, that you can shrug the shoudlerblades up if wanted, and that you are neutrally placed between full retraction back and full projection forward of the shoulder.
SECOND: Tuck in your ribs! Once you have tucked in your shoulder blades, you will notice that there is an accompanying front-side flaring of the ribs or puffing out of the chest that comes with it. This occurs when we extend (flatten) the thoracic spine to excess. To correct this chest puffing, contract your abs to tuck those ribs back in.
If you are unsure of the abs contracting action, try blowing a short, sharp puff of air out through pursed lips. Just like what you’d do if you needed to blow out an especially tough-to-extinguish set of birthday candles. The burst of action that you get out of your abdominals as you do this is the same action that you want to hold to maintain the tucked ribs.
THIRD: Tuck in your chin. To finish off the posture set and to really shine it up, complete the exercise by tucking in the chin. Imagine that the bony prominence behind your ear is sitting directly over the shoulder. This is not a “chin to chest” or looking down type movement. Instead Imagine that you are looking straight ahead and drawing your head straight back without changing the incline of your gaze.
From this position, you can execute your pushup, BUT WAIT, we’re not quite finished… When performing, ensure that you keep the angle of your arm below 60 degrees, where zero degrees is arms tight by your side, and 90 degrees is elbows out to the side in a “T” position. There is evidence to show that above 60 degrees, your shoulderblade mechanics are more likely to slip into that crummy pinchy positioning.
You may also want to keep the depth of your pushup a little shallower, certainly at least a fist width of space between your chest and the ground at the bottom of the movement, possibly less if your shoulder is particularly irritable. Keep the pain to a minimum, preferably none as you execute the movement and if you are unsure, consult a physiotherapist to help guide you.
Checkout the video above for a full demonstration of this exercise and be sure to keep exercising even while you are recovering from a shoulder impingement injury, you’ll be grateful that you did!
Further reading (When you really want to impress your friends!)
Arens, T. M. (2016). Effects of Hand Position During a Push-Up on Scapular Kinematics. Unpublished Thesis.
Ludewig, P. M., Hoff, M. S., Osowski, E. E., Meschke, S. A., & Rundquist, P. J. (2004). Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. The American journal of sports medicine, 32(2), 484-493.
San Juan, J. G., Suprak, D. N., Roach, S. M., & Lyda, M. (2015). The effects of exercise type and elbow angle on vertical ground reaction force and muscle activity during a push-up plus exercise. BMC musculoskeletal disorders, 16(1), 23.
Suprak, D. N., Bohannon, J., Morales, G., Stroschein, J., & San Juan, J. G. (2013). Scapular kinematics and shoulder elevation in a traditional push-up. Journal of athletic training, 48(6), 826-835.
