Thursday, 10 November 2016

Shoulder Impingement Syndrome

As a physiotherapist, I see many clients who come into The Sports Clinic with shoulder pain and discomfort. Most people don’t realize that shoulder pain is a very common complaint and occurs with those who have everyday jobs or who are involved with sports and exercise. As a previous competitive swimmer, I fully understand the impact that shoulder pain can have on one’s ability to complete the activities they enjoy most. Among the most common causes of shoulder pain, especially with overhead activities, is shoulder impingement syndrome.

Shoulder impingement can affect approximately one in three people at some point throughout their lives. This condition occurs when some of the soft tissue structures surrounding the shoulder get compressed on top of the shoulder. Most commonly, the supraspinatus (part of the rotator cuff), the long head of the biceps, and the subacromial bursa (a fluid-filled sac meant to reduce friction between two surfaces) are the structures that can be pinched through certain movements. To fully understand the mechanism behind impingement syndrome, let’s look at the anatomy of the shoulder. The shoulder girdle consists of:
  • The glenohumeral joint: the connection between the upper arm bone and the shoulder blade
  • The acromioclavicuar joint: the connection between the shoulder blade and the collarbone
  • The sternoclavicular joint: the connection between the collarbone and the breast bone
  • The scapulothoracic “joint”: the connection between the shoulder blade, rib cage and upper back; this joint is connected mainly through muscular attachment
In order for the shoulder to have full, pain-free range of motion, there must be full movement in each of these joints in the shoulder girdle. Any restrictions within these joints can lead to the soft tissue structures becoming compressed between the shoulder blade and upper arm, causing local irritation and inflammation, and ultimately leading to pain and decreased mobility in the shoulder.

Common causes for shoulder impingement:
  • Poor posture 
  • Muscle imbalances in the rotator cuff or muscles controlling the shoulder blade 
  • Poor neuromuscular activation leading to irregular motor control of the muscles
  • Joint restrictions in the cervical and thoracic spine or the rib cage 
  • Myofascial restrictions/muscle tension of the muscles
  • Visceral (organ) mobility restrictions 
  • Acute trauma 
  • Previous injury 
Symptoms of shoulder impingement:
  • Pain occurring in front or side of the shoulder while lifting arm overhead 
  • Pain worse during overhead movements or activities
  • Reaching across or behind the body
  • Pain that radiates into the elbow
  • Trouble or pain while sleeping on affected shoulder 
  • Gradual weakness 
  • Loss of range of motion 
So what can we do about it? A thorough orthopaedic assessment that involves looking at the whole body in order to find out where the problem may be coming from. Finding the correct mechanical and movement restrictions is the key to allowing the shoulder to move freely and without pain. After a thorough assessment, treatment may include: manual therapy techniques from a physiotherapist, chiropractor, massage therapist or athletic therapist to clear restrictions; a comprehensive, individualized home exercise program that focuses on correcting muscular imbalances, tightness within the muscles and joints, or motor control issues; and postural education.

Conservative, non-operative treatment through physical therapy has shown to be highly beneficial in decreasing pain and increasing function in the shoulder. Consider seeing a physical therapist, chiropractor, massage therapist or athletic therapist at The Sports Clinic to begin your journey to recovery!

Megan Provost, Registered Physiotherapist
The Sports Clinic

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