Bursitis is an inflammation of small, lubricating structures called bursae. Bursae are typically located between tendon and bone to protect tissue from friction created during normal body motion. In the shoulder, the subacromial bursae is located underneath the bony structure of the acromion and clavicle. Space between these bony structures and the muscles at the top of the shoulder, namely the rotator cuff, can become compromised, resulting in bursal irritation. Exercises are used to improve this spacing and decrease compression or impingement.
Considerations
Bursitis can be caused by falling onto the shoulder or onto an outstretched arm or hand, repetitive overhead activity or degenerative conditions of the shoulder. Bursitis can occur with other conditions, and proper diagnosis is important. Seek advice from your physician if shoulder pain is accompanied with difficulty raising the arm.
Impingement Syndrome
A common cause of shoulder bursitis is subacromial impingement. Diminished space between the bony structures and the muscles at the top of the shoulder will result in pain with shoulder elevation. Several muscular strength and flexibility problems contribute to impingement. Exercise to correct these imbalances can improve your ability to elevate the shoulder without pain and prevent irritation of the subacromial structures. Exercises should not be painful. Pain with exercise suggests further irritation and injury to the shoulder.
Pectoralis Minor
An often overlooked muscle, the pectoralis minor muscle, can dramatically alter the resting position of your shoulder blade. Tightness here can also prevent the shoulder blade from tipping back normally as you raise your arm. If the shoulder blade does not tip back during elevation, impingement can occur in the joint. The pectoralis minor is difficult to stretch on your own. To stretch it, the shoulder blade must be retracted backward and downward toward your spine. Doorway stretches target the pectoralis minor. Try lying on a long foam roller, with it running along your spine, from your head to your buttock. Rest your bent elbows at your side, off of the roller. Allow your hands to fall outward, as if your arms were an open book. Actively squeeze your shoulder blades back and downward. Hold the stretch for several minutes.
Internal Rotation Deficit
Tightness in the back of the shoulder ligaments causes a loss of inward or internal rotation at the shoulder joint. This tight ligament, called the posterior-inferior-glenohumeral ligament, can push the head of the humerus up into the acromion when you raise your arm, causing impingement. The sleeper stretch is a way to improve flexibility in this ligament. To complete this stretch, lie on your affected shoulder, bringing the joint forward from underneath you. Maintain a 60- to 90-degree angle at your armpit between your body and your arm. Bend your elbow and place the side of your face on top of your shoulder. Using your opposite arm, press your hand toward your belly, while preventing the shoulder from lifting. Longer, lower loaded stretches are most effective to improve joint mobility.
Scapular Stabilization
The lower and middle trapezius muscles oppose tightness in your pectoralis minor and stabilize your shoulder blade in an optimal position. To exercise these muscles, lie on your stomach on an exercise ball or weight bench. Bring your arms to a 90/90 position: elbows bent to 90 degrees and shoulder elevated to 90 degrees at shoulder height. Palms should face down toward the floor. These muscles are minimally active below 90 degrees of shoulder elevation, so keep your elbows and shoulders in line. Raise and lower your hand and forearm from just below your body to even with your midline. Work up to 5 lbs. in each hand for three sets of 10 to 15 repetitions.
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