You can all hear your mother or grade school teachers saying, “Sit up straight,” or “stop slouching in your seat.” Well you can add your physical therapist to that list now. Posture plays a very important part in preventing injuries, especially in your shoulders. Poor posture can lead to such problems as rotator cuff tendonitis, bursitis, and even a rotator cuff tear. Shoulder impingement is a non-specific term used to describe any of these conditions that it may cause. Just like impingement can cause the above types of injuries, poor posture can cause impingement, making it a primary concern for you and your PT.
Shoulder impingement occurs when the tendons of the rotator cuff are pinched, or rub along the acromion (a bone which sits over your shoulder joint, like a roof). This usually happens when your arm is lifted overhead or you are reaching behind your back. Your body is designed so that the space between this bone and your rotator cuff tendons is large enough so that you can move your shoulder in any which way without causing impingement. This space, known as your sub-acromial space, can become compromised due to poor posture and muscle imbalances. Activities such as computer use, studying, reading, throwing, etc. all pull the shoulders forward and can compromise this space. Computer use in the workplace is one of the leading causes of impingement as it pulls your shoulders and head forward. Everything we do in our daily life is in front of us. We don’t sit at work for 4 hours typing facing the computer and then turn around and type the remaining 4 hours of our day with hands behind our back.
With poor posture causing impingement, and impingement causing tendonitis, bursitis, and possible tears you can see how proper posture can be very important. The problem is that most people like to wait until something is really bad before they address it. Often times, a person’s shoulder pain may become so intense that he/she finally sees the doctor and will have a cortisone injection for a tendonitis or bursitis. This often will calm the inflammation and result in a significant loss of pain for months, maybe even a year. This person will continue their normal lifestyle pain free, but may end up needing another injection a few months later, because the pain came back. Months later again, this same person may end up in surgery to fix a rotator cuff tear that has been in the making for a few years now, because the injection did not correct the postural deficit or impingement. The symptom of pain and inflammation was treated and controlled with the injection, but the cause remains unchanged. This is where physical therapy can help!
With proper strengthening and stretching exercises you can improve your posture to prevent cases like those described here. Stretching exercises for the muscles in your chest and strengthening exercises for the muscles between your shoulder blades both help pull your shoulders into better postural alignment. Also, an ergonomic evaluation and proper setup of your workstation can help keep your entire body and shoulders in a good position.
I am currently treating 2 patients whose posture has affected their shoulder function, and will share a brief summary of each:
Patient A: 56 year old male with a recent rotator cuff repair. He had a 5-year history of shoulder pain, seeing his doctor multiple times, and having 3 cortisone injections over that time. He recently was scheduled for a surgery to clean out the joint and ended up having a rotator cuff repair as they unexpectedly found a complete tear during the procedure. Wear and tear from not addressing the cause of the issue (impingement) in the 5 years he was having pain lead to this complete tear and much more involved surgery (and recovery).
Patient B: 41 year old male who recently came to see me for his shoulder pain. He saw his doctor, who offered a cortisone injection and recommended PT. I am now treating him working on posture and proper exercise techniques, and he is doing great. He may end up needing an injection to control some inflammation, but we are treating the cause and if he keeps up with the work he is doing with PT, he should do fine moving forward.
So…your mother is always right, and so is your physical therapist. If you are experiencing shoulder pain, or any type of pain in your body, see your doctor and schedule an evaluation with a physical therapist. If you have any questions about shoulder impingement, please get in touch with me at ScottH@JointVenturesPT.com