Shoulder conflicts/impingement syndrome

Hi Gianluca A very good summary of the cause and some of the remedies for, as I se it, the most common sports related injury (through not as common in climbers) Typically I see guys who have been focusing on developing their chest muscles (and forgot their back) and as you say thus have caused the pectoralis (chest muscles) to overpower their Traps, Romboids and rear Deltoids (back muscles). The tendon of the Supraspinatusmuscle will be swollen where the tendon have a very narrow passage on the front part of the shoulder. Some get this so called inpignement more easily due to the top of their Scapula (the bone structure prominent on the rear of the ribbcage) beeing shaped like a spoon and thus narrowing the above mentioned space for the tendon of the Supraspinatusmuscle as it makes it way down and forward to connect to the upper part of the Humerus (upper arm bone). People with this unfortunate anatomical makeup tend to have constantly recurring problems till undertaking surgery. The rest of us will get away by first of all stretching the tendon religiously: The injured arms hand on the oposite hip -  grabb the elbow of this arm with your good arm and pull down and in - resist this motion by pulling back and up with your back muscles - done correctly this will give a feeling of discomfort on the front of your injured shoulder - keep the stretch for minimum 15 sec and repeat a minimum of 4 times per day. This considerably helps in the healing process - it helps to restore cirkulation by pressing out fluid from the tendon. If you are in a really bad way a mixture of Cortisone and a local anastaetic injected around the most svollen part of the tendon will speed up recovery ( normaly you can continue climbing but no pressing of weights for 3 weeks) - please have this done only by  a sport medical specialist. If it is not so bad I still recommend you to take a antiinflammatory drug regularly for 2-3 weeks to help in reducing the inflammatory process. As you get better you should as mentioned work on stabilizing back muscle strength in general and specifically train your Supraspinatus. Supraspinatus training  is best done standing leaning slightly forward and keeping the arm straight out from chest to the side -  then bend the arm 90 at the elbow - grabb a small weight - let the hand rotate forwards and down and then rotate it back up. This should be done slowly. Do 12-25 repetitions, 3-5 sets. As you get better :increase the weight and take down on repetions and set ( max 12 reps for max 3 sets ). When you can do this effort and painlessly with more than 5 kg (11pounds) your are most likely fully rehabiltiated. A good idea is to keep the arm in the correct position with the aid of a bracket (Shoulderhorn , made in USA) - this device helps focus the strain correctly. The best idea of all is to start doing stretching and strenght training exercises before having any problems because then you will most likely never have any! Carped diem /Björn

Hi everybody, supposing that extraroting muscles are very important for a correct movement of the shoulder, especially in quick movement like dynoes, and that it's very important to have a correct muscles balance between extraroting and intraroting shoulder muscles, in a very few words we can summarize the impingement syndrome related to rock climbing in this main points: 1. acute phase: rest, medical examination (to confirm the syndrome) and therapy. 2. post-acute phase: re-start climbing from easy to hard moves paying attention to pain (anyway don't climb hard too soon). 3. post-acute phase: at the same time start a parallel training for extraroting cuff muscles (low load extraroting movement of the shoulder, better with an elastic for rehab. plus the specific exercise for sovraspinatus) and start stretching regularly pectorals and latissimus dorsi (the stronger they are the more your shoulder get intraroted, and that stretch the weak extraroting muscles too). 4. prevention: you have to put attention to avoid those moves (especially on your training wall) that emphatizes the shoulder conflict: for examples all the moves where the hold you are holding has the main axis vertical (imaging to hold with your right hand this kind of hold, your arm is flexed and your elbow is at the right from your hand) from this position you try to pull up in order to reach a hold with your left hand crossing over the right hand. This move produce the mechanical conflict (you are doing a big effort at the phisiological limit of the range of motion of the shoulder joint, that is very intraroted) think that this position it's so similar to the medical test for exacerbate the pain due to the inflammation of the extraroting cuff tendons! Avoid all the hard moves where your shoulder joint is forced in this position (intraroted at its limit). the imbalance between the little extraroting and the bigger intraroting muscles is due to practice sport climbing that strengthen pects and dorsi (all intrarotators of shoulder joint); their major muscle tone can also be one of the reason of postural imbalance too. is it true Doc? roberto

Hi Roberto I agree You can simply take a look around the crag and see several good climbers with well developed muscularity that display a forward inward roation of their shoulders - as you say this is problem in progress Carpe diem Björn

This moment i have the same problem. The pain started after a climbing trip in Ceuse. Three months later the pain is still there. I stopped climbing for two weeks and started again with easy routes. The pain is now better except after hard climbing indoors. Outdoors i can still climb 7a's but after a session in the gym the pain is there again. RX scan says that i have tendonisis and beginning calcification of the  suptrasinatus tendon. Next week i see a specialist who will explain me the possibilities. On this site you find some exercises to stretch the supraspinatus: http://www.sportsinjuryclinic.net/cybertherapist/stretching/supraspinatus_stretch.php

threathement started today. Shockwave therapy will remove the calcification of my tendons.

After 3 sessions (1 session each week) shockwave the pain was gone. I went on a climbing trip tot Chateauvert. To prevent the pain came back i took a rest day after 2 climbing days and didn't climb hard every day. During this week i didn't feel pain. After the climbing trip i rested 2 days and went to the climbing gym again. 2 indoor sessions later the pain came back. Again RX and the calcification was still there. I didn't climb for 4 weeks and started again with shockwave. I climb now only one time each week (instead of 3 or 4) and climb at a very low level (max 6A). This time the rest, less climbing and shockwave has not the effect as before. 

I had big problems with my shoulder during late spring/summer, and it is not until now that I feel that it is finally going away completely. For me it has been very important to do the correct strength exercises, at least two times a week. The physiotherapist has helped me with a program to strengthen everything in the shoulder area, though primarily the backside. In the beginning the exercises should be of very low intensity but done almost every day. As you get stronger and add weights, do them fewer times a week. If not doing these exercises, I quickly start feeling pain again. Doing them I can easily climb two or three times a week with pretty hard bouldering. The exercises both strengthen the weak muscles AND help recovery after climbing. I have poor shoulders to start with I think, with weak muscles and unfortunate anatomy (as Dr 8a describes above). For me the exercises are necessary to keep climbing.