Shoulder pain – Impingement Syndrome

Shoulder pain – Impingement Syndrome

Have you ever noticed that you get pain with overhead movements like dumbbell shoulder press or even something as simple as putting the clothes on the line? You may have shoulder impingement syndrome.

Shoulder pain is the third most common condition that presents to a chiropractic clinic. Impingement syndrome is one of the most common shoulder issues that we treat (1).

Impingement syndrome can occur secondary to trauma to the shoulder but more commonly it occurs due to chronically held postures, muscular imbalances and repetitive movement.

First some anatomy

The shoulder joint is complex, when referring to shoulder impingement; people are most commonly referring impingement under the acromioclavicular joint or AC joint. The AC joint is made up of the proximal end of the acromion and the distal end of the clavicle (collar bone). Under the acromion there is the sub-acromial space, through this space runs three tendons of the rotator cuff, the long head of the biceps tendon and the subacromial bursa. When we perform overhead movements or have a slouched postured the size of this space decreases and the contents of the space can become compressed and irritated, leading the impingement symptoms (2).

Symptoms of shoulder impingement

The symptoms vary from person to person and with the degree of impingement.

Symptoms include

  • Pain on the anterior (front) or lateral (side) aspect of the shoulder Painfularc
  • Pain with overhead activities
  • Pain with repetitive movements
  • Pain with shoulder abduction painful arch
  • Popping or clicking in the shoulder
  • Weakness
  • Night pain
  • Pain relieved by rest or postural change (2)(3)

Treatment

Fortunately shoulder impingement can be treated successfully by conservative (non surgical) treatment. At Cartwright physical therapy we pride ourselves on our wide variety of treatment options.

  • Soft tissue work – Massage, active release technique
  • Dry needling
  • Joint mobilization
  • Joint manipulation
  • Individualised rehabilitation program for more information on exercises that are prescribed you can read our previous blog post on shoulder exercises

If you have any questions on shoulder pain or are suffering from shoulder pain or any other type of pain come in and see us or book an appointment today on 02 99226116 or visit our clinic on the Ground Floor, Suite 6, 157 Walker Street North Sydney for more information.

By Patrick Lind

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

 

  1. Pribicevic M, Pollard H, Bonello R. An epidemiologic survey of shoulder pain in chiropractic practice in australia. J Manipulative Physiol Ther. 2009;32(2):107-17.

  2. Seitz AL, McClure PW, Finucane S, Boardman ND, 3rd, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clinical biomechanics (Bristol, Avon). 2011;26(1):1-12.

  3. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138-60.
5 Tips to save your shoulders

5 Tips to save your shoulders

Exercises to ensure healthy shoulders

The shoulder joint allows a lot of movement, however, this movement comes at the expense of stability and security, and is often the cause of many dislocation and instability conditions. The shoulder joint is a “ball and socket” joint, and is supported by a network of ligaments and muscles. More specifically, the shoulder joint is supported and controlled by four muscles known as the rotator cuff: supraspinatus, infraspinatus, teres minor and subscapularis. These small, but very important stabilisers are easily overloaded and injured due to poor exercise design and technique.

Many of the following injury reduction techniques focus on reducing the load on these small joint stabilisers.

Tip 1 – Limit overhead exercises: the safest overhead press is the “Arnold Press”. This exercise allows a greater range of motion whilst keeping the hands closer to the centre of the body. It also reduces shearing forces around the shoulder joint.

Tip 2 – Avoid the dislocation position: imagine yourself lying face up on a bench with your arms at 90 to your body, elbows bent 90, and palms facing the ceiling. ALT TEXT Keeping your arms in this position, if you were then to rotate your arms such that your hands would approach the floor and allowed to continue, you would eventually dislocate your shoulder joints. Avoid, shoulder pressing behind the neck, 90/90 pec-deck machines, and wide grip lat pulldowns behind the neck.

Tip 3 – Avoid small muscle overload: your rotator cuff muscles are small muscles. Exercising your chest on day 1, shoulders day 2, then back on day 3, will be exercising your rotator cuff on all three days. In this instance, you’re more likely to fatigued your rotator cuff and predispose yourself to injury. Either group pressing movements into a single workout session or rest your body by training other non-related muscle groups on consecutive days.

Tip 4 – Increase thoracic spine mobility: the thoracic spine (or upper back) plays an integral role in loading and unloading the shoulder joint. Spending long hours at a desk inevitably results in a more “hunched-over” posture. This is accompanied by stiffness and tension felt along the length of your back. You may well be in need of physical therapy to relieve yourself of this increasing tightness, and at the very least, a series of back extension exercises to offset poor posture at work. A physio roller can be used at home to relieve thoracic tension.

Tip 5 – Avoid the impingement position: impingement occurs when you raise your arm above shoulder height whilst keeping your arm internally rotated. ALT TEXT Mimicking this position repetitively, causes a continual “pinching” or “jamming” of structures between your arm bone and shoulder blade occurs, felt as pain at the tip of your shoulder. Avoid exercises such as lateral raises with thumbs down, close grip high upright rows and some versions of bench pressing where the bar is in a high position, almost under the chin.

The shoulder joint is a joint that can be easily overloaded and damaged in poorly constructed health programs. It is essential that a health professional understands intimately, the anatomy, physiology and common risk areas and exercises for treating shoulder injuries.

An effective modality for treating shoulder injuries is active release technique. Combined with chiropractic care, these two applications of physical therapy can improve both range of motion and muscular health at the shoulder joint.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.