Shoulder Impingement Syndrome in Rock Climbers (SIS, Pinching in Shoulder)

In this episode we break down Shoulder Impingement Syndrome. We discuss some ways to test it yourself, symptoms you may experience, and some initial treatment to try. Be sure to read the show notes below for more details!
What is shoulder impingement syndrome (SIS)?
SIS is any compression or impingement of structures around the glenohumeral joint that occur with shoulder elevation. This may be your: Subacromial Bursa, Supraspinatus, Subscapularis and/or Long head of biceps.
There are two main types of this, primary and secondary impingement. Primary impingement is more anatomical. As in, the space is closed down due to an anatomical variation. The most common mophology is related to your acromion. We have three types: Type I - Flat, Type II - Curved,
Type III - Hooked. If you have a hooked acromion, you are more prone to SIS.
Secondary impingement on the other hand is due to instability or biomechanics deficits causing the humerus to translate inappropriately into the subacromial space causing compression. Your shoulder is quite unstable. Think of a golf ball sitting on a tee rather than a deep ball and socket. It’s this way to make the shoulder so amazingly mobile. But that means it is susceptible to errors. So what are some common risk factors?
Risk factors may include:
- Repetitive activity at or above the shoulder (Ie, overhead sports)
- Instability of the shoulder which allows increased translation of the humeral head
- Scapular dyskinesia - alteration or deviation in the normal resting or active position of the scapula during shoulder movement
Often, SIS is a biomechanical issue. For complete overhead motion we need rotation of the humerus as well as of the scapula. If we are lacking either, the acromion, or the roof of the shoulder, doesn’t elevate, this causes a compression of the underlying structures.
So, if you are an overhead athlete with an unstable shoulder and scapular dyskinesis, you are at a greater risk.
OK so say you suspect it is this issue, what can you expect for symptoms?
- You may have pain with overhead activity localized to the deltoid area or lateral arm.
- May also have pain reaching behind.
- May have pain when lying on the shoulder
- Overtime pain may develop in the posterior shoulder or anterior shoulder.
But how do you know if you have this or something else?
The most important thing to differentiate this from a rotator cuff (RTC) injury or tear
Patients with a RTC tear may experience
- weakness in addition to pain
-- weakness particularly of external rotation. See the "external rotation lag sign" test in the video.
- A drop arm sign
-- The drop arm sign is a test that tests the RTC. If you have a tear, you will be unable to lower your shoulder and rather it will drop. This may be protective (pain) or it may be solely due to inability (muscle tear).
Mechanism of injury is also important. A rotator cuff (RTC) tear may also be more trauma related whereas impingement can develop over time due to poor biomechanics
So how do we test for impingement?
- Painful arc. This test will typically present with a patient who has pain sometime between 60-12 degrees of abduction but can go through the full range of motion. They will have less pain from 0-60 and less pain from 120-180ish
- Hawkins-Kennedy: this test specifically works to close down the subacrominal space. pain with this is common because you are closing space down so it is important to compare to your unaffected side to see if there is a distinct difference between the two sides.
- Pain with external rotation: unlike with a rotator cuff tear, where you may experience pain and weakness. With SIS, you would likely experience pain but not significant weakness with external rotation.
Fixing the cause
Best advice, see a professional. It is hard to know exactly what your issue is. Is it a mobility issue? Stability issue? What if it is anatomical? A professional can help to identify your weakness (strength vs mobility) and develop a plan to help address it.
Also, check out our other videos on shoulder strengthening!
Top 6 Exercises for Rotator Cuffs - Strong Shoulders Pt. 1 - Hooper's Beta Ep. 11 • Top 6 Exercises for Ro...
For many overhead athletes (and all people, really) external rotator strength is an issue. Addressing this may be an easy solution!
For more info visit RockTherapyPT.com
Instagram: @rocktherapypt
Jason Hooper, PT, DPT, OCS, CAFS
Filming and Editing by Emile Modesitt
www.emilemodesitt.com
Instagram: @emile166
Special thanks as always to The Wall for letting us film! @thewallclimbinggym

[@HoopersBeta]

As always, don't forget to read the show notes!

[@middle-agedclimber]

When you're in your 20's you feel invincible. But after reaching 35-40 all the old injuries will come back to haunt you. Great video!

[@tgray2735]

Heh heh heh. Wait until you’re 60.

[@robertwhite5125]

Try 23

[@ShadowofWednesday]

I really respect that part of your advice is to talk to a professional. It makes me feel like the guidance you are giving is trustworthy because you know the limits of the information you are able to provide in a KZbin video. I’ll definitely be checking out your exercises and seeking further help if my pain continues! Thanks & Keep up the honest work!

[@The86kluwer86]

Wow, love the video. Great info and very clear, thanks!

[@rogshotz]

Amazing and to the point, thank you!

[@leoingson]

Very very good, thank you man!

[@wizbiz1589]

This channel is so good! Thanks for all this info

[@HoopersBeta]

Glad you enjoy it!

[@Tac0caT0]

Thank god. I have impingement, and not a rotator cuff issue. Super cool tests! Thank you for simplifying (some of this) for self diagnosing.

[@matt3645]

i am thinking (hoping) the same after watching this.

[@ole7282]

Great video, straight to the point. Are some people more prone to SIS then others? I had my long term SIS fixed with great help from my PT recently, but I feel like I've got to watch out for it to not sneak back at me.

[@tgray2735]

I found passive hanging very helpful with my shoulder impingement

[@jake9517]

Great info as always. This me 100% - went to PT for SIS but quit bc all the info is online and I felt like my care wasn't good enough to justify the cost. I feel it more in the rear delt now, seems to have migrated. I've been working on my scapular dyskinesia (wings) bc I think my SIS is posture-related. I still climb but not as hard as I used to.

[@adriansth]

I get this quite frequently. My doctor has just been giving me pain killers and inflamatory treatment and it does not work. What has fixed iy for me and I do this EVERY time to fix now is to hang from a bar with a very wide grip position and pull all I can on the hurting shoulder. There is a loud pop and quite painful bud the next day it is completely gone. Hope it can help someone but be careful and don't injure your self more. I found this from getting sit of waiting for it to pass and just going climbing anyways. The sholder moves allways seemed to fix it.

[@zombiecatcher]

How’s the shoulder

[@Chiny_w_Pigulce]

2 weeks of kinesiology tapes and the pain was gone in my case

[@michor10]

I re-started bouldering training about 6 weeks ago after a long break during COVID and have developed SIS (did the tests accoridngly). It's not very painful but noticeable on both shoulders to the same degree. The discomfort began about a week ago. My plan is to dial back the training intensity and allow myself enough time to recuperate while doing the SIS recovery (strengthening) excersises recommended in this video. Thank you so much for the info!

[@HoopersBeta]

That sounds like a great plan! Sorry to hear of your discomfort but happy to hear that you developed a great plan :)

[@michor10]

@@HoopersBeta just an update. I’ve discovered that my main issue may be a muscular imbalance between my pectoral muscles and my shoulders. I incorporated focused shoulder exercises into my workout to even things out a bit. I’m also taking vitamin C and D regularly and I am logging my nutritional intake to see if it helps. Most of the information I’ve gathered has come from your channel so many thanks to you and your team!

[@MiuraZx10r]

Wow, thats a nice Channel. I would welcome something about Bizeps Tendonitis, with pain closer to the Elbow, not the shoulder. I can't find anything about that on the Internet and my local Doctor is useless. Anyway: Keep up the good work and i hope this grows!

[@HoopersBeta]

Thanks for the feedback! Share with your friends ;) Good idea! I'll get to work on that, it would make for an awesome video.

[@emilferent23]

My shoulder slight pain thanks you for this info :)

[@HoopersBeta]

Hope it helps! :)

[@genomesurfer4875]

All the tests seem to indicate I have a mild case of SIS, but the pain I'm experiencing feels like it's more in the front towards the inside of the joint/near my chest- is this normal or is it indicative of anything in particular?

[@adrienl4949]

So I have an SIS ! I think it's due to too much compression style bouldering without warming up properly. It's been 4-5 days, should i start doing rotatif cuff exercises or should I wait a bit more so i'm sure it's not gonna be painfull ? By the way, can I continue to climb and just avoid shouldery moves ? Thanks you for everything Doc !

[@Chennaiclimbers]

Hi, my elbow is hurting when I climb or hangs . Can you please explain why?! Thanks hooper

[@TheXeeman]

ok so i do check the list for the "painful arc test" but i don't feel any pain at all doing the hawkins - kennedy test. why would this be? Also could I have gotten SIS from benchpressing with bad form? like benching with my elbows flared out and bar not far out enough?

[@HoopersBeta]

Try doing the painful arc test again but with your elbow bent to 90 degrees. It can take some of the weight off of the supraspinatus. If it is less painful that way, it may be a supraspinatus muscle issue rather than a SIS issue. And yes, benching (primarily increasing weight too quickly and/or losing good form) is a common irritant. Sorry to hear of it though!

[@Ian-ox1hi]

Quick question! Should I stop climbing and weight training while I rehab?

[@jferriol1998]

Do you tink that SIS can be caused because doing pullups with wrong method? I've started doing pullups because I can't go climbing because of quarantine. Can be this the cause of shoulder pain? Very good video! Thank's and excuse for my bad writting english skills.

[@HoopersBeta]

It's possible, yes, particularly if you went from doing minimal pull-up training to doing 100 a day :) Load management is key here. But there are some other factors as well you can look at with your training that can contribute to shoulder pain! Here they are 1) not controlling the bottom of the motion (example, quickly lowering once you reach the top because you are tired) 2) resting a lot at the bottom and just "hanging" on your shoulders 3) performing far too many narrow grip pull ups without good and equal shoulder activation.

[@jferriol1998]

@@HoopersBeta Wow!!!! I feel identified with most thinks you say that maybe I do.... thanks!!! I will start with the rotator cuff exercices in the other video and try to recover (it's not very painfull but I prefer to avoid serious injury). Thank you very much!!!!!

[@ikebranstad1191]

Not sure if you check your old video comments but curious to know if you have a video covering shoulder clicks when doing pullups?? I dont think its SIS

[@HoopersBeta]

Yes we do see old video comments :) but no nothing regarding that. Shoulder clicks can be somewhat benign if it is not painful. But that may require an individual evaluation and may not be as appropriate for a general video.

[@laurindamasonrealtor1925]

I pass all the rotator cuff tests but I still have a ton of clicking and popping in my shoulders, no pain with the sounds. But I was told I have unstable shoulders. After years of doing my therapy exercises the popping is still there and only occasionally do my shoulders feel a dull ache. Physical therapy three times without a diagnosis except instability and nothing has changed

[@HoopersBeta]

Thanks for sharing! This is one of those situations where the comment just gives me more questions. How unstable? What are the exercises? Was there progressive overload? Were the exercises challenging the correct muscles? And what is the origin of the clicking anyway, because often clicking is quite benign in the shoulders (they are very mobile with many structures surrounding them that can cause clicking). Basically, if your therapist isn't a climber / climbing specialist, perhaps you should see one?

[@laurindamasonrealtor1925]

@@HoopersBeta thanks for the reply! How do I find a physical therapist/climber? Is there a good way to search for that? I think it's shoulder crepitus btw. And inch worms, external rotation, and ITY raises

[@nachCe]

When I do the Hawkins test with my left arm, at 45°, it hurts just by pushing on my hand with one finger.. my whole left side feel so weak I can't even hang from the bar with only my left hand. Crazy..

[@HoopersBeta]

Sounds like you have a few things to work on!

[@brutalctg7654]

@@HoopersBeta 😂

[@ErinM-2024]

What does it mean if I have popping/clicking as I come down. It’s in the range of 60-120

[@HoopersBeta]

Since the shoulder is quite mobile, with many bony prominences, and many muscles that help control it, it's hard to say what it exactly means. Clicking/popping without pain is often quite benign, though. It's typically just a small error somewhere such as 1 muscle being slightly too tight, etc.

[@meekrodriguez6438]

First