Are you or someone you know struggling with a nagging shoulder impingement that just won’t go away? Have you tried the exercises but found that your condition hasn’t improved or has even worsened? If so, it’s time to dig into the root causes.

Let’s start by talking about the known causes of impingement. If you read the literature, you find that many cases of shoulder impingement are caused by overuse. This is true. Repeated use of the shoulder, along with tired S.I.T.S. muscles, can make your shoulder’s tendons swell, leading them to “catch” on your upper shoulder bone. However, the literature will also say there’s no known cause in many cases, which is only technically accurate. They may not “know” the reason, but we must remember that things generally don’t just happen. It’s cause and effect. So, we must explore potential causes.

So first, we must determine whether your shoulder pain is due to overuse or something else. Let’s start with the classic cases. Are you an athlete in a sport that requires constant over-the-head arm movements? Do you swim, play baseball or tennis? Do you work in an occupation that requires repetitive heavy lifting or where you’ll repeatedly raise your hands above your head, such as construction, painting, or something of that nature? If any of these sound like you, you could be dealing with a classical case of shoulder impingement. Standard therapies could be highly beneficial.

However, if that doesn’t sound like you, we should explore a different path. In this exploration, there’s good news and bad news. The bad news is that while you could see your physician about this, the truth is that medical scans typically can’t spot the “unknown causes.” Instead, healthcare professionals rely on your symptoms and physical exams to identify and treat the problem. And that’s the good news because this understanding allows you to find and potentially fix the problem yourself! However, we need to understand what is going on and why.

Examine the following list. Do you have:

• A sedentary lifestyle,
• Muscle injuries,
• Poor posture,
• Dehydration,
• Unhealthy eating habits,
• A lot of stress,
• A combination of any of these factors?

If you checked any of these boxes, continue reading. We may be on to something in your case.

Let’s talk about the mechanics of the problem for a second. Shoulder impingement syndrome is when the tendons of your rotator cuff muscles become irritated and inflamed as they pass through a space beneath the acromion. However, this doesn’t “just happen.” Something is clearly out of order when this occurs. Clearly, a muscle somewhere in the S.I.T.S. group is not pulling its weight, right?

So, what could potentially fatigue or strain your S.I.T.S. muscles without being a pro athlete or laborer? There are several potentials, but one notoriously overlooked issue is muscle knots. These tight, sensitive areas within your muscle tissue tend to contract your muscles involuntarily, even when your muscles are at rest. Without getting overly technical, I’ll say that if you had a knot in the wrong place, a muscle tightening or an involuntary contraction might pull areas of your body at the wrong time, leading to muscle fatigue and impingement.

It may seem odd, but these knots can create a chain reaction of muscle tension and mobility problems, worsening or even creating shoulder impingement. This is to say that sometimes, muscle knots, especially in your trapezius, rhomboid major, or rhomboid minor muscles, can cause or contribute to impingement. Unfortunately, in such cases, doing certain shoulder impingement exercises might make things worse by further fatiguing muscles, irritating already inflamed tendons, and exacerbating muscle tension. So, we have to fix the underlying cause before attempting any exercise or therapy.

To fix the underlying cause, we have to be students of cause and effect. Understand that the trapezius and rotator cuff muscles are part of the larger network of muscles that control the movement and stability of the shoulder. These muscles work in coordination to perform various shoulder movements, such as raising and rotating the arm. Proper functioning and balance among these muscles are essential for shoulder joint health and preventing injuries.

Of course, in many ways, the trapezius and rotator cuff muscles are interconnected and can influence each other, particularly in the context of shoulder function and health. For clarity, the trapezius is the large muscle that spans the upper back and neck. It plays a significant role in controlling the movement and stability of the shoulder girdle. When the trapezius is balanced and functioning correctly, it can help maintain the correct position and alignment of the shoulder joint. This, in turn, supports the healthy functioning of the rotator cuff muscles. However, when the trapezius is unbalanced, dysfunction can occur.

For example, as previously stated, the trapezius muscle is essential for maintaining good posture. Poor posture can contribute to shoulder and neck problems. If the trapezius is weak, imbalanced, or overcompensating, it can lead to rounded shoulders and a forward head posture, which can stress the rotator cuff muscles. Over time, this stress can lead to overuse and strain of the rotator cuff tendons. Shortly after that, you get an impingement. Of course, that is just one example of how this can manifest.

Referencing the list, muscle knots can form in the trapezius due to various factors such as stress, poor posture, or muscle imbalances. If the upper trapezius is tight or overactive, it can cause the shoulders to elevate or round and other muscles to fatigue, reducing the space under the acromion (the bony prominence of the shoulder blade) where the rotator cuff tendons pass. This can lead to impingement of the rotator cuff tendons, causing pain and discomfort.

So, if you’re dealing with shoulder impingement and standard exercises aren’t helping, it might simply be an unnoticed muscle knot in your mid to upper back. Ask a friend to feel around your upper back for a knot – if you find one, it could cause your impingement. Releasing the knot(s) should help alleviate the impingement.

Chiropractic, massage, and physical therapy are tremendously helpful, but home treatments usually suffice in these cases. I have a few suggestions for you to explore. Of course, if you’re still concerned or can’t manage the impingement on your own, it’s essential to seek professional medical advice. A healthcare provider can create a tailored treatment plan that addresses both issues while avoiding exercises or activities that could worsen things.

Preventing Knots:

To reduce the risk of developing muscle knots and related conditions like shoulder impingement, consider the following preventive measures:

• Maintain a Good Posture, especially if you spend long hours at a desk.
• Stay Hydrated by drinking enough water to nourish your muscles and tissues.
• Regular exercise that promotes muscle strength and flexibility is important.
• Stretch your shoulders, arms, and neck throughout the day.
• Manage stress through techniques like deep breathing, meditation, or yoga.

Self-Treatment for Knots:

If you’re dealing with muscle knots, here are some self-treatment techniques to consider:

• Consider Massage Therapy to address the muscle knots.
• Try Gentle Stretching to relieve tension in the affected muscles.
• Try Foam Rolling to apply controlled pressure to the knot, gradually releasing muscle tension.
• Use Heat and Cold Therapy – heat pads to relax muscles and cold packs to reduce inflammation.
• Use a Percussion Gun (Massage Gun) for deep tissue massage on specific knots, following the manufacturer’s guidelines.

Rehabilitation and Recovery:

Once the knots have been addressed, you can rehab the impingement:

• Once the knots are reduced, you can begin standard shoulder impingement rehabilitation exercises.
• Physical therapy with a customized exercise program can help address imbalances and mobility problems in problem cases.
• Professional treatment, including ongoing massage therapy, physical therapy, or chiropractic, can help. In fact, chiropractic is great for modifying neuropeptides and improving posture.
• In severe cases, medication and injections can help manage pain and inflammation.
• I would also suggest that you learn about proper body mechanics and ergonomics to prevent future muscle knots and related conditions.

Once you’re squared away, you probably need to get a little more active. However, if you are currently more sedentary than you might otherwise like to be, don’t just jump into exercise. That could be problematic. I wrote an article called ‘Finding Balance Between Sedentary And Exercise.‘ Be sure to look at that before jumping in.

By the way, the information provided in this article is an excellent example of why physical trainers and therapists should have some massage therapy know-how. If you are a trainer or physical therapist, consider getting certified in massage. With some massage therapy know-how, trainers and therapists can head off a problem before it arrives, or they can help manage a problem when it presents itself.

Something To Think About

Here is one more useful tip to consider. Think outside of the box to discover the true cause. These types of injuries can take weeks, months, or even years to manifest.

For example, some people with shoulder problems sleep on their backs with a pillow that is way too big for them. Take a moment to think about the mechanics of sleeping on your back with an oversized pillow. Doing so typically results in a forward head posture.

I have seen a pretty gnarly case of shoulder impingement due to a simple muscle knot caused by using an oversized pillow. When the pillow was switched out, the knot released, entirely resolving the shoulder impingement. This is to say that, sometimes, the “unknowns” remain unknown because we haven’t thoroughly examined the behaviors that led to the injury.

To determine whether your pillow is too big, lay down on your back with your pillow behind your head. Now, imagine yourself standing up in this exact position. If your head is facing down, your pillow is likely too big. So, address the knots, but try sleeping with a thinner pillow to see if that helps. Remember, we are shooting for great posture.

Here’s to your health!

Dr. Robertson is a health researcher and educator, not a physician. The information provided here is not medical advice, a professional diagnosis, opinion, treatment, or service to you or any other individual. The information provided is for educational and anecdotal purposes only and is not a substitute for medical or professional care. You should not use the information in place of a visit, call consultation, or the advice of your physician or other healthcare providers. Dr. Robertson is not liable or responsible for any advice, course of treatment, diagnosis, or additional information, services, or product you obtain or utilize. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN.