Shoulder pain

Shoulder Impingement

If you’ve ever suffered from a case of shoulder pain, you’re in good company. Second only to low back pain in prevalence across the population, roughly one in every three people will have to deal with shoulder impingement at some point in their life. What’s worse- half of those people will continue to report having pain three years later. Don’t become one of these statistics! In this month’s article I’ll give a basic rundown of the anatomy and go over a few proven options for taking control of your shoulder.

 

 

What is it?

  • Most common cause of shoulder pain
  • Compression of the structures under the acromion (see image above)
    • rotator cuff muscles
    • subacromial bursa
    • biceps tendon
  • Can contribute to rotator cuff tears (estimated to be the cause of 95% of them)

 

Understanding the shoulder

Let’s face it. The shoulder is a complicated joint. Compare the basic flexion and extension of your knee to the multiple degrees and planes of movement the shoulder is capable of, and it should be clear that there’s more potential for things to go wrong.

  • Basic anatomy:
    • Glenohumeral joint (ball and socket)
    • Scapulothoracic joint (shoulder blade on rib cage)
    • Acromioclavicular joint (collar bone and shoulder blade)

In order for you to lift your hands overhead, your shoulder requires controlled movement from all three of these joints. If the timing or ratios of these movements is off, the sensitive structures passing through the subacromial space can get impinged, or pinched. Repeated pinching can lead to damage to the tissues and pain.

 

How can PT help with shoulder pain?

  • MOBILITY:
    • The soft tissues around the shoulder joint (muscles, tendons, ligaments, joint capsule) must be elastic enough to allow the desired movement. Things like manual therapy and specific stretches can help to regain this crucial aspect of shoulder function. Action plan:
  1. chest and back stretching
  2. manual therapy to loosen the posterior/inferior capsule
  • STABILITY:
    • In order for the ball and socket to smoothly execute the rolling and gliding necessary to lift your arm overhead, you need to be able to keep certain parts stable so other parts can move. This stability mostly comes down to strengthening of the rotator cuff. Action plan:
  1. internal/external rotation exercises with elastic bands
  2. pushups on unstable surfaces
  • CONTROL:
    • The importance of motor control and positioning is paramount with shoulder movements. Try this example:
      • roll your shoulders forward and slouch like you’re sitting at a desk typing away, then try to lift your hands overhead.
      • Now pull your shoulder blades down and back, open your chest as you arch your upper back, then try lifting your arms overhead again. Easier, right? This demonstrates the importance of posture and scapular control when dealing with subacromial impingement. Action plan
  1. upper back, neck, and shoulder strengthening for improved posture
  2. movement analysis with verbal, visual, and tactile feedback for improved biomechanics of desired overhead activities.
  3. specific taping strategies for support and improved awareness/muscle recruitment

 

Don’t settle for living with shoulder pain

            In summary, shoulder pain isn’t uncommon, and there are ways to deal with it. Studies comparing surgery vs. conservative rehab for shoulder impingement show no difference in outcomes of pain and function. That said, sometimes surgery or other medical intervention is necessary. Regardless of how you go about it, Stride Strong Physical Therapy encourages you to take control of your health and life this month!

 

By Dr. Nicholas Chamley DPT

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