Shoulder bursitis is a very common injury among athletes treated at Elite Health and Performance. Our athletes generally complain of pain associated with overhead activities, ranging from brushing their hair to performing an overhead barbell press. In its mild stage, they feel a nagging ache throughout the shoulder; however, when aggravated, it can often 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 of 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 are lifted up over the bursa and supraspinatus, leading to scapulothoracic bursitis. The problem with this is that 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 subacromial bursitis. If left untreated, the chronic inflammation can weaken the supraspinatus muscle and lead to a rotator cuff tear and even frozen shoulder.

Clearly, if left unchecked, shoulder bursitis can lead to serious injury in the shoulder, including potential rotator cuff injury and shoulder instability. However, self-management and treatment of this condition are very easy and require 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 to improve shoulder mobility. 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, perform a simple wall angel test. This position puts your upper back, head, and bum against the wall with your arms raised to 90 degrees, 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 too tight, you won’t be able to achieve this position, and some mobility work will need to be performed to alleviate shoulder blade pain. 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 shoulder joint.

In more severe cases, where conservative treatment fails, shoulder replacement surgery might be considered to restore function and relieve pain. However, early intervention with appropriate exercises and posture correction often prevents the need for such invasive procedures.

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.

If you suffer from shoulder pain or experience any of the shoulder bursitis symptoms mentioned, contact us today to learn about our effective bursitis in shoulder blade treatment and start your journey to pain relief and improved mobility.