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Shoulders are complicated. After all, you need all those bones, tendons, and muscles to maintain 360° of movement. But with the ability to reach up, down, and all around comes an instability that brings a high risk of injury.
That’s why shoulder pain is one of the most common physical complaints, according to the American Academy of Orthopedic Surgeons. “Most upper-body workouts place a tremendous amount of stress on the shoulders,” explains Anthony D’Angelo, M.S.P.T., senior vice president of clinical operations for Professional Physical Therapy. “These external forces can cause fatigue, breakdown, and eventual failure.”
One of the most common injuries for weightlifters is shoulder impingement syndrome, which can stem from the motion of raising your arm to shoulder height. This movement causes the space between the acromion (a bony extension of the shoulder blade) and rotator cuff tendons to narrow. “The acromion can rub against, or ‘impinge’ on the tendons and the bursa [a fluid-filled sac that helps reduce friction in the shoulder area], causing irritation and pain,” says D’Angelo. Left unchecked, this friction can create microtears, causing pain and inflammation or a tear in the rotator cuff.
Any activities that require your arms to be repeatedly raised above the shoulders can put you at risk for an impingement injury. That includes sports like swimming, golf, and softball, as well as overhead exercises like military presses or lat pulldowns. But your genes may also be to blame. “Some people are naturally more loose-jointed than others, which can put them at greater risk of impingement and instability,” notes Armin Tehrany, M.D., an orthopedic surgeon and founder of Manhattan Orthopedic Care in New York. If you have more movement in the shoulders, he says, the joints will have a greater tendency to shift in and out during exercise, which increases the chances of developing an impingement.
Shoulder impingements often begin with a dull ache near the shoulder blade or lateral deltoid. If untreated, additional symptoms may appear, including difficulty raising your arm forward or to the side. You may also feel pain on the affected side when you’re trying to sleep. If you’re in the gym, you may find it painful to do a move like a shoulder press or similar overhead moves, or if you try to reach your arm behind your back. “It can be a sharp, stabbing pain near the surface of your skin, rather than from deep within the joint,” says Tehrany.
Mild cases—those in the beginning stages—are usually treated with a combo of anti-inflammatory medications like ibuprofen or naproxen, along with rest and physical therapy to strengthen the shoulder and rotator cuff.
“The medication will reduce the inflammation in the tendons, which then lowers the pain and the inhibition of the muscle, allowing it to resume normal function,” says D’Angelo. You may not feel a difference for about three days, since it can take time for the anti-inflammatories to do their job. Most patients will experience almost a complete improvement within three to six months.
More severe impingement issues may require a cortisone injection to take down some of the inflammation. Even more advanced cases may require surgery, which may involve removing the inflamed bursa, along with smoothing out the acromion to prevent future impingement issues, notes Tehrany.
Although physical therapy will help strengthen and stabilize the shoulder musculature, if you’re dealing with shoulder impingement syndrome, most treatments (aside from surgery) will help alleviate your symptoms without solving the problem. “Unfortunately, even if you start to feel better, the bone spur that causes the impingement is still there, so you remain at risk for recurrence and a possible rotator cuff tear as you get older,” warns Tehrany.
To curb your risk of future injury, focus on maintaining good posture. “Posture is important since forward or rounded shoulders further narrow the space between the rotator cuff and humerus, increasing chances of impingement,” says D’Angelo. And keep your training to a minimum: D’Angelo recommends limiting overhead activities to two to three times a week, and making sure you take time off if any symptoms start to present themselves.
It can also help to strengthen the rotator cuff as a form of prehab, says D’Angelo. And be sure to see a medical professional if you start to feel discomfort. “If moderate pain is present during your workouts, cease the activity. If it’s still at the same level of discomfort 24 to 48 hours later, consult your physician,” he advises. “The quicker you figure out the problem, the sooner you can start to get healthy.”