Certain postures can produce shoulder pain and cause compression of structures in the shoulder however “poor posture,” is not as tightly linked to shoulder pain as you might think.
I’ve worked with dozens of patients with shoulder pain and so-called, “impingement,” who had what society would consider “perfect posture.”
If this is the case, that someone with perfect posture can also have shoulder pain and impingement, then what does this say about so-called poor posture?
In this article we are going to get to the bottom of it and figure out what the deal is with posture, is it bad, is it good, or is there another answer?
- Poor posture and good posture are not accurate depictions of what is actually happening
- Posture can produce pain however it’s likely due to being in a prolonged posture for longer than your body is used to.
- No posture is inherently good or bad
- Shoulder impingement and compression is common in normal shoulders without any pain
- Sometimes compression can cause symptoms other times it doesn’t. It depends on the person and their particular situation.
Can Poor Posture Cause Shoulder Impingement
Yes, poor posture can cause impingement. But, the better question to ask is, is impingement bad, and is it predictive of shoulder pain? Also, what is poor posture and is that even a thing?
The answer to that question is no.
But to understand why that is the case, we need to understand what impingement actually is.
What is shoulder impingement?
Shoulder impingement is generally described as a compression of the structures in the subacromial space, most often the supraspinatus as it travels under the acromion and attaches to the top of the head of the humerus (glenoid).
Just for context, here is a picture of the subacromial space:
It’s long been hypothesized that shoulder pain, particularly when raising the arm and closing down the space in and around the shoulder joint is largely due to some form of impingement. The reason why this has been accepted is that it makes sense to our prior understanding of how pain is caused.
Most of us think (and I at one point did too), that compression of structures in our body was bad and that we should avoid it, lest we succumb to a world of hurt.
Thankfully, we have done additional studies to determine what the base rate of many anatomical presentations, is.
What do I mean by that?
For example, we know that a large % of the population, particularly age 65 and older, if given an MRI, will have a rotator cuff tear. It’s something along the lines of 75% or more, pretty crazy.
And the crazier thing is that these folks oftentimes have no pain.
Now, while it absolutely is true that some people who have shoulder pain will have a rotator cuff tear or some sort of narrowing or impingement we have to be very careful that we do not imply that this means it is causative.
These findings can be correlated but not causative, and truthfully, it’s a weak correlation.
Does this mean that compression and impingement can never cause symptoms?
No, I’m not saying that compression/impingement can never cause symptoms however what I am saying is that if this is occurring, it’s also possible it’s happening in people with no symptoms.
And, more importantly, regardless of whether impingement or compression is happening, the most important thing to keep in mind is that a majority of people will be able to improve their symptoms without injections, surgery, and other more invasive procedures.
Are Shoulder Decompression Surgeries Effective?
Shoulder decompression surgery is no more effective than conservative treatment but comes with much more risk. –source
Here’s a quote from a systematic review and meta-analysis on the topic:
“We aimed to summarise the current evidence of the effects of surgery plus physiotherapy vs placebo (surgery) plus physiotherapy or physiotherapy alone, on clinical outcomes in patients with shoulder impingement syndrome. We found no clinically meaningful differences in pain or function at any 3-, 6-months, 1-, 2-, 5- or ≥ 10-years follow up.”
The same thing is true for meniscectomy surgeries (except for the case of an inability to straighten the knee), and for spinal fusions.
Is Poor Posture Real?
I’ve discussed this at length in another posture-related article and I will echo the same thing here.
Poor posture is a societal construct.
We’ve accepted as a society that we should present ourselves in a certain manner and if we are outside of that range that it is somehow, “bad.”
The reality is that posture is a range and I think what matters most is HOW LONG you are in one posture for and whether your body has adapted to it.
Posture has two aspects. Its function and its appearance.
People conflate the two.
Posture as a function
We can accomplish most daily tasks with a variety of different postures. Sitting in different ways, standing in different ways, and just moving in different ways throughout the day is normal.
It’s true that if you are in certain extreme postures that your mobility will be impaired and you won’t be as efficient. It’s less clear if you will develop pain from a particular posture.
Literally, if you stay in one posture too long it will hurt. If I lay in bed flat on my back for 9 hours, my back will hurt.
If I stand still in one spot for 9 hours, my knees will hurt.
If I stay slouched on the couch for 9 hours my shoulders and neck will probably hurt.
It’s more of a duration thing than a “this posture is bad.”
None of those postures shared above are bad. They just become a problem (for some people) when they stay in them too long.
My best advice for posture is:
Your next posture is your best posture. Change it up often and keep it moving.
Posture as an appearance
This one is all about looks and status. If you stand tall, with your chest out, head pulled back, you look people in the eye, shoulders pulled back, people will assume you are more confident and successful than you actually are.
We make assumptions about people based on their appearance every day. It’s not necessarily a bad thing, it just is what it is.
It becomes a bad thing when we take appearance for truth, or, what other people have an opinion on as truth.
I agree that standing up taller with your shoulders back looks “better,” but this is only because I grew up in a society and in a species that values this for some weird evolutionary reason.
We could have just as easily lived in a world where slouching was “the norm,” and if you had “perfect posture,” in that world it would be considered poor.
Just a helpful thought experiment for you.
What Should You Do If You Have Shoulder Impingement and Pain?
First of all, do not panic.
Second, know that in most cases the pain is easily treatable by working with a physical therapist.
If it is posture related as you sitting in one position for too long or you are doing a very repetitive task and potentially overloading tissues, your therapist will likely help you modify activities and then add in exercises to improve your overall load tolerance (of your muscles, tendons, etc.)
I hope this was helpful and cleared up some questions for you. If you’d like an alternate perspective to this, please read this article about shoulder impingement from my colleague Anthony Maritato, PT.
Please leave a comment below if you have any other questions related to insights you had from this article!
Thanks for reading!