(This article was originally written on Nov. 10, 2013 but has been revised on Feb. 21, 2016 to reflect a more accurate understanding of the topic.)
As some of you may know, I’ve dealt with quite a few injuries over the past few years.
One injury that remains steadfast in its mission to piss me off is recurring shoulder impingement. I, for the life of me, cannot figure out how to fix my bum left shoulder. I’ve strengthened my rotator cuff, my serratus anterior, and my trapezius… I’ve mobilized and stretched my tight pec minor and thoracic spine… I’ve established proper movement patterns whilst using my shoulder and scapulae, together. All that fun stuff.
While I can do most pressing exercises again, certain exercises such as the bench press still cause impingement in my shoulder. Sure, I can live without the bench press, but wouldn’t it be nice to perform movements that healthy shoulders can handle?
Shoulder Pain and Hooked Acromions
Before I continue, let me just make sure you guys know what shoulder impingement actually is (well, at least one type of shoulder impingement … there are actually different types).
The rotator cuff attaches to various spots on the head of the humerus (or, the “arm bone”). Above the humerus is the acromion – a bony little segment attached to the scapula (or, the “shoulder blade”). Between the acromion and the humerus are the rotator cuff tendons. In certain movements, the rotator cuff tendons can get pinched or snagged between the two bones, causing irritation and eventual wear-and-tear.
So, I’ve yet to figure out how to help my shoulder. What’s caught my eye a few times over the past years was the mentioning of a “hooked acromion” when reading about shoulder impingement on the internet.
Basically, due to genetics or bad living, the acromion bone can hook downwards towards the humerus.
With this hook-shaped acromion, there is even less space between the acromion and the humeral head. That means that impingement is much more likely. In one study comparing 34 shoulders with rotator cuff tears and 47 shoulders with no issues, 62% of the injured shoulders had hooked acromions versus the 13% found in healthy shoulders.
Although it’s never been confirmed by medical imaging, I’m under the impression that I probably have a hooked acromion. Conservative therapies (from PTs and my own self-treatment) have failed me so far, so it’s just my guess.
Dead Hangs, Mashing Bones, and Reshaping the Acromion
Enter Dr. John Kirsch. Dr. Kirsch is an orthopedic surgeon and the author of Shoulder Pain? The solution and Prevention. He claims that that a number of shoulder ailments arise from having an improperly shaped acromion, and that hanging from a bar can remedy that.
The idea is that when the arm is fully overhead (or, “flexed”), the humerus (or, “arm bone”) will press against the acromion and eventually reshape it. That’s because the humerus has no where to go when it’s fully overhead. The acromion is right in the way.
Check out this video from Dr. Kirsch’s YouTube channel. It shows a shoulder under flouroscope, and you’ll see how the bones come in contact during the overhead position.
Supposedly, gravity and injuries will, overtime, encourage the shoulder to deform and cause the acromion to become hooked downward. Since we humans of the first world no longer swing from branches or climb ropes, we experience zero stimulus to counter-act this “deformity.”
Solution? Just hang from a bar each day and give your shoulder a reason to remodel itself.
Hanging with Relaxed Shoulders or Packed Shoulders?
A month after originally writing this article, I made another article on active shoulders vs. packed shoulders during overhead movements. In the post, I argued how squeezing the lats and pulling the shoulders down would decrease the space between the acromion and the humerus.
Since the rotator cuff tendons run between this space, I thought that pulling down with the lats would increase the likelihood of those tendons to get “caught” on the acromion (AKA, shoulder impingement).
My original idea on this was flawed. The shoulder blades can still rotate upwardly somewhat, despite not elevating (versus being pulled down), giving the rotator cuff tendons some room. The referenced article had since been re-written to reflect this.
As long as you have the ability to control your scapulae – especially the ability to upwardly rotate them – pulling down with your lats when your arms are overhead won’t necessarily do anything bad to your shoulders.
What’s more important is that you can upwardly rotate your scapulae when lifting the arms overhead. Allowing the shoulders to shrug simply makes upward rotation more likely to occur.
Additionally, Dr. Kirsch has argued that the rotator cuff tendons will sit in a space behind the contact point of the humerus and acromion during the dead hang. See below at 1:49:
Now, I must admit that I do feel more pressure/strain in my shoulder if my arms are overhead and I actively pull down and back with my lats and traps. I’m not exactly sure if that means my acromion is getting pressed with more force, or if my rotator cuff tendons are being squished.
I was initially apprehensive of dead hangs, but with closer observation, it seems his idea carries some weight.
I’d love to see some studies proving the efficacy of dead hangs reshaping the acromion, but there haven’t been any performed yet. Now that would be some interesting stuff.
I’ll be implementing more hanging in my workouts to see what benefits I can get, although with fully relaxed shoulder, as to prevent any rotator cuff impingement.
Interested in his work? Pick up a copy of Dr. Kirsch’s book, Shoulder Pain? The solution and Prevention!