Shoulder bursitis is a very common injury amongst the athletes treated at Elite Health and Performance. Our athletes generally complain of pain assosciated with overhead activities which range from brushing their hair to overhead barbell press. In its mild stage they feel a nagging ache throughout the shoulder however when aggravated often it can become a sharp pain as the shoulder is flexed overhead.
To further understand what shoulder bursitis is and how to resolve it a brief look at the shoulder anatomy is required.
The bursa acts as a cushion under the acromion bone. The acromion is an extension of the shoulder blade which sits at the top and is the pointy bone you can feel on top the shoulder, its role is to protect a part of the rotator cuff the supraspinatus muscle. In an ideal body as the humerus is raised with overhead motion the area between the acromion and humerus is narrowed only marginally and the bursa protects the supraspinatus from being irritated by the acromion bone.
Unfortunately with prolonged poor postures that we see in our society such as sitting in front of computers the shoulders slowly roll forward and can adopt this position from being chronically slumped over. In this slumped position the shoulder blade and acromion is lifted up over the bursa and supraspinatus. The problem with this is now as the humerus is raised there is less space and the bursa is squashed under the bone and cannot protect the rotator cuff. Each time the bursa is squashed it becomes more and more irritated and begins to inflame leading to bursitis. If left untreated the chronic inflammation can have a weakening affect upon the supraspinatus muscle and lead to rotator cuff tears and even frozen shoulder.
Clearly if left unchecked shoulder bursitis can lead to serious injury in the shoulder however self management and treatment of this condition is very easy and requires only a short amount of time each day. There are two parts to rehabilitating the shoulder. Firstly soft tissue changes from postural stresses need to be corrected with appropriate mobilisations and stretches. Secondly any poor movement patterns need to be addressed with exercises. The length of time to follow these exercises greatly depends on how long the injury has been present. It can range anywhere from 3 to 12 weeks.
To establish a baseline and understand how tight your shoulder internal rotators are is very simple by performing a wall angel test. This position puts your upper back, head and bum against the wall and your arms raised to 90 degrees with your elbows bent to 90 degrees and pushing the arms back so the elbows and wrists touch the wall as shown. If the front of your shoulders are to tight you won’t be able to achieve this position and some mobility work will need to be performed. If you can easily achieve this position but still have bursitis symptoms skip forward and go straight into the rehabilitation strength work to restabilise the joint.
If you cannot perform the wall angel correctly it is a good idea to mobilise the shoulder to allow the joint to centrate. This can be done with the following stretch holding for 3 sets of 30 seconds.
Next mobilisation will be to use a hard ball and roll out the upper outside corner of your pec muscle for 3 sets of 20 seconds each side.
With the front of the shoulder mobilised the mid back also needs to be mobilised to minimise the spinal slump forward and allow the shoulder to move backwards as the tissues release. You may here some cracking as you work up and down the spine. This is completely normal and continue rolling up and down the mid back for 20 – 30 passes.
After a week of mobilising it is time to begin rehabilitating the muscles to correct any poor movement patterns and instabilities. The first of these exercises is the push up plus. This exercise is designed to strengthen the serratus anterior whose job is to stop the shoulder blade from sticking out and allow smoother scapulothoracic motion. It is performed in a push up position and instead of bending the elbows they are locked and the idea is to bring the shoulder blades all the way together by lowering your chest down then rounding the shoulder blades apart. This is all done while maintaining core activation so your hips should not be sagging. Perfrom 3 sets of 10 reps.
The next exercise is to activate the lower scapular stabilisers mainly the lower trapezius muscle. This is performed face down on the ground beginning with your arms outstretched so your body forms a ‘Y’ position. From here take your hands behind your low back and then return to the start position. This movement is done by keeping the elbows and wrists from touching the ground. Perform 3 sets of 10 reps.
The final exercise targets the middle trapezius muscle. For this hold a band with your hands palm up and pull directly to the side not allowing your rib cage to flare up. Again 3 sets of 10 reps.
With these exercises over time the muscles which control the movement of the shoulder blade will be fixed and the overcompensating muscle of the trapezius will be relaxed significantly reducing tension on the neck, fixing poor posture and take pressure off the bursitis.