The “impingement” component of this condition refers to the ‘pinching’ or compression and repetitive trauma to the rotator cuff or bicep tendons. The rotator cuff is a group of muscles which hold your arm into the socket and control smaller movements of the shoulder. The tendons of these muscles pass underneath the bony bridge of your shoulder, through the ‘subacromial space’. Injury occurs when this space becomes crowded, either from bone spurs or, more commonly, from altered functional mechanics of the shoulder.
Impingement syndrome is a common condition and often begins after a period of overuse. Initially, you may feel a sharp pain to the front of the shoulder with overhead activity or while reaching behind the back. The pain also refer down the arm and be more diffuse. As your condition worsens, you may feel a constant ache that is present even at rest and interferes with most activities that involve the arm as well as sleep. If left untreated, this can progress to rotator cuff tears.
The primary goal of initial treatment is to retrain the shoulder to move properly again to restore the range of motion and strength. Avoid aggravating movements that create pain, especially overhead reach and pushups. When you feel a sharp pain, it is a signal that the tendons are being injured.
The Science & Anatomy Behind it…
The ‘acromion’ or bony bridge of the shoulder is actually part of the scapula (shoulder blade). Normally, when you raise your arm to reach overhead, the shoulder blade moves back (retraction) and down (depression). If the mechanics of the shoulder blade are altered, the humerus (long upper arm bone) moves into the sub-acromial space, compressing and injuring the tendons of the bicep and rotator cuff.
Postural positioning plays an important role in this condition. The chest muscles (pectoralis minor) attach to the front of the scapula. When you have rounded shoulders, this muscle becomes shortened and pulls the scapula up and forward. The muscles that are responsible for pulling the shoulder blade back and down (serratus anterior, rhomboids and lower trapezius) become overstretched. The rib joints become ‘stuck’ and protrude, resisting shoulder blade movement. The rotator cuff muscles weaken and the head of the humerus moves superiorly (upward).
If the acromion is unable to move upward, out of the way of the humeral head, the tissues in the sub-acromial space become compressed between the two bones. This tissue trauma is what creates pain and weakness.
How Chiropractic Care Can Treat Shoulder Impingement
Therapeutic Exercise
Retraining the shoulder to move properly again is essential. A focus on regaining shoulder blade movement and correcting rounded shoulder posture is a very important part of correcting this condition. Strengthening the rotator cuff and postural support muscles will be part of progressing your home program. Joint manipulation and mobilization also improves proprioception (knowing where you are in space) and resets/reduces muscle tension.
Joint manipulation and mobilization
There are joints in your spine and ribs that are not moving freely. This creates strain, tension and discomfort. By restoring the motion of those ‘restricted’ joints, we can allow the shoulders to move freely and improve the function of the nerves which control the shoulder muscles.
Myofascial Release
When muscle tissue is injured from trauma, prolonged repetitive postures or overuse, adhesions (scar tissue) develop in the fascia which trap nerves and bind muscle movement causing pain and dysfunction. Myofascial release helps restores healthy movement and function of the muscular tissue system.
Acupuncture
Acupuncture is a very effective therapy which stimulates the muscles to function optimally and speeds up the healing of tissue injury.
Home Pain Relief Solutions
Home Exercises and Stretches
Do your prescribed home exercise program. Movement is nature’s greatest pain reliever!
Pay Attention to Your Habits
Nowadays, many conditions arise because of the repetitive postures and positions we put our bodies into for long periods of time. Pay attention to the postures you have when you are at work; how you sit when you are relaxing; your sleeping positions; which side you prefer to lift and carry with; and how long you spend in one position. Aim for a maximum of 20 minutes in one position.
Use Ice
While this may not accelerate healing, it can be very helpful to ease pain symptoms. Apply for 10 minutes at a time, then take a 10-minute break before reapplying as needed.
Use Heat
This can help to ease pain and ease muscle spasm so that you can move more freely. Apply for 10 – 20 minutes at a time. Apply this to the muscles at the base of the neck/top of the shoulders.
Magnesium Glycinate
Magnesium is an essential mineral that we need for most of the processes that happen in our bodies. It is a natural muscle relaxant and also help to support healthy sleep. Most people can supplement with 400 – 600 mg in the evening.
Stretches & Exercises
| Brugger Stretch | Begin sitting or standing up tall. Bend your elbows to 90. Open your hands away from each other, keeping elbows close to the body, squeezing the shoulder blades together, lifting chest towards ceiling, looking gently upwards, take a deep breath in. Breathe out, bring hands in again, and round the upper back (reversing the position). Repeat 3 sets of 10 repetitions daily.
Add a resistance band for more effect. |
| Corner/Doorway Chest Stretch | Begin standing, facing a corner with your elbows on the wall / against the doorframe. Stand up tall. Step toward the corner / through the doorway and “lean in” to stretch your chest muscles. Attempt to push your hands into the wall and toward each other for 7 seconds. Relax and “lean in” to increase the stretch. Lock into this new position and repeat 3 contract/ relax cycles, twice per day or as directed. Make sure to find a position which does not create pain |
| Pendulum | Lean over a table using the ‘good’ arm for support as shown. If directed, you may hold a light weight in your hand to help with traction. Let the arm hang freely. Use your torso to swing your involved arm in a clock-wise circle for 50 repetitions. Repeat in a counter-clockwise direction. Perform twice a day as directed. |
| Low Row | Attach the center of an elastic exercise band to a doorknob. Hold the end of the band in each hand. Keeping the arms straight, pull back in to a low ‘y’. Keep your palms facing backward and arms pointed straight down throughout the exercise. Return to neutral and repeat 3 sets of 10 repetitions daily, or as directed. |
| YTWL Scapular Depression | While in the standing position, move your arms upward towards the ceiling as in making the letter “Y” with your arms and body. While holding this position, squeeze your (scapulae) shoulder blades downward and back towards your spine. Keep your elbows straight.
Then, lower your arms so that they are extended out to the side as in creating the letter “T” as shown. Squeeze your shoulder blades downward and back towards your spine. Keep your elbows straight. Next, bend at the elbows and lower them slightly, making a “W” with your arms so that the palms point upward and elbows are out to the side. Finally, lower your elbows further so that your upper arms touch your ribs and your forearms point forward. Squeeze your shoulder blades downward and back towards your spine making an “L” with your arms. Keep your palms pointed up towards the ceiling the entire time. |