Shoulder Impingement? What is it and how can we help?
If you have or have had shoulder pain, more than likely you are no stranger to the term "shoulder impingement." It is a term that is commonly used but unfortunately is generalized to encompass many different causes.
So what is shoulder impingement?
Shoulder impingement is basically what the term implies. When you raise your arm or move certain ways, something in your shoulder gets "impinged" or pinched. Most of the time the structure involved is one of the rotator cuff muscles or the bursa, both of which can become painful and irritated. Once the structure gets inflamed, instead of having pain only with certain movements, you now have pain that lingers or hurts when you are not moving at all. There are many different causes for shoulder impingement. The following are some of the most common.
Our moms were onto something when they told us to "sit up straight" or "stop slouching." Over time, sitting postures, especially now in the age of technology, can cause tissues to adapt resulting in stiffness in the upper back, tightness in the chest, and poor muscle strength to hold the body in a good alignment. All of those adaptations places the shoulder at a mechanical disadvantage. The shoulder can still work but there is less room in the shoulder joint which causes the "impingement."
Rotator cuff weakness
The shoulder joint is a ball and socket joint. The ball essentially rotates within the socket which allows the shoulder to be one of the most mobile joints in the body. The primary goal of the rotator cuff is to hold the ball securely in the socket. The rotator cuff muscles have to work together to make sure that happens. The rotator cuff is composed of four different muscles, and often times, these muscles get out of sync. The rotator cuff muscles in the front of the shoulder tend to be stronger than the rotator cuff muscles in the back of the shoulder resulting in an imbalance of the rotator cuff. This means that the rotator cuff muscles do not do a good job of holding the ball securely in the socket so when you raise your arm or move certain ways, the joint isn't being controlled as well as it needs to be leading to "impingement."
Poor scapular stability
The scapula, or shoulder blade, plays a huge role in maintaining a healthy shoulder joint. The "socket" of the shoulder joint is connected to the shoulder blade. Therefore, we need the shoulder blade to provide a stable base for the "ball" to move within. Without this stable base, the shoulder blade tends to tip forward resulting in less space within the shoulder joint and of course..."impingement."
Unfortunately, life sometimes just isn't fair. Some people were created with a "hooked" acromion, which is a continuation of the shoulder blade that helps support the shoulder joint. Having this type of acromion does not mean you will get impingement or have to have surgery but it does predispose individuals to the condition. Sometimes, surgery is the best solution to prevent further damage to the rotator cuff but many times the symptoms will lessen or even go away after addressing the problems listed above.
How can physical therapy help?
The best way to treat any condition is to first fully understand the cause. That's where physical therapy comes in. Your physical therapist will be able to tell you which of these problems or possibly a combination of these problems is causing your symptoms. He or she will then work with you in the clinic to improve the areas that are causing your symptoms and then instruct you in a few exercises at home to maintain those improvements to help you get better faster.
If you have shoulder pain, and you and your doctor feel that physical therapy can help, please contact our office to set up an evaluation.