Impingement occurs when soft tissues are painfully trapped and compressed under the boney parts of the shoulder (specifically the acromion and the coracoacromial ligament), often occurring during overhead shoulder movements. The most common structures to be compressed or pinched are the supraspinatus and infraspinatus tendons. Both of which are tendons of the famous rotator cuff group of muscles. However, other structures including the subacromial bursa and tendon of the long head of the biceps, can also be trapped in this small space eliciting similar symptoms. Impingement within the shoulder can occur in two circumstances. One, in which there is mechanical compression of the affected tissues and the other, in which there is excess movement in the shoulder girdle, causing unbalanced forces going through the shoulder to irritate the affected tissues.
What Causes Impingement Syndrome?
Factors that contribute to the development of a painful impingement syndrome include:
- Shoulder and postural muscle imbalances
- Tightness in the shoulder joint
- Excessive mobility with lack of control of the shoulder joint
- Disruption in the normal movement and mechanics of the shoulder girdle
- Ongoing wear and tear of the soft tissues and tendon in this region
- Boney changes or deformities in the boney space where the impingement occurs (acromion)
- Previous injuries to the shoulder or surgery
Postures that are associated with an increased risk of developing impingement include:
- Forward head posture
- Increased rounding of the upper back also known as thoracic kyphosis
- Shoulder blades that are tipped forward or spread too far apart on the rib cage (anteriorly tipped and protracted scapula)
- Arm bones that are rotated inwards (internally rotated humerus)
These postures are typical in many of us – especially if we spend much of our days sitting in front of computers or devices. We need to work to restore and maintain good posture to help keep our shoulders healthy and moving with control and optimal mechanics.
How Can Physiotherapy and Chiropractic Help with Impingement Syndrome?
A trusted physiotherapist or chiropractor can help with your symptoms related to impingement syndrome. First, they will conduct a detailed assessment to determine the specific factors contributing to your pain. Each case of impingement syndrome is unique and can have varying factors that contribute to the problem. Once the root cause of your problem is identified, your physiotherapist or chiropractor will work with you to improve your shoulder mechanics; so that the irritated tissues can settle down. Your treatment will include any combination of the following:
Early stages of treatment
- Soft tissue release
- Taping to decrease pressure on the affected tendons
- Laser or ultrasound to settle down the inflammation
- Manual therapies to improve biomechanics of the joints in and around the shoulder girdle
- Postural strengthening and awareness
- Acupuncture & Dry needling
Later stages of treatment- once the pain is less intense
- Individualized, progressive strengthening of postural muscles, rotator cuff muscles & shoulder blade muscles
- Continued manual therapy
- Soft tissue release techniques – and teaching you how to perform these on yourself
- Continued Acupuncture & Dry needling
- Gradual return to aggravating activities
What Should Be Avoided With Impingement Syndrome?
Pain resulting from impingement syndrome is often caused by irritated and inflamed tissues, so, it is generally recommended to avoid or modify painful movements and activities. Once the intense pain settles, movement can be gradually re-introduced, hopefully with better movement patterns and less irritation! Your trusted physiotherapist or chiropractor will guide you more specifically and provide individualized guidance based on your lifestyle and goals.
How Long Does It Take To Recover From Impingement Syndrome?
As with many other conditions, recovery time can vary from individual to individual based on your age, lifestyle, work demands, stage of injury & whether you are remaining compliant to your physiotherapy/chiropractic treatment plan. A simple first time injury that is addressed quickly can resolve within 8-12 weeks. But more complex, long standing (>3 months) and recurrent forms of impingement syndrome can take 3-6 months to reach an acceptable level of recovery. More complex forms of the disease can be left with irreversible damage that can leave you with long term pain. However, with consistent care and a good strengthening program, you can easily manage your symptoms and keep them at bay.
What Are Some Safe Home Exercises I Can Do For Impingement Syndrome?
Since there are many factors that can contribute to your development of impingement syndrome (see the long list above), it can be very difficult to suggest safe home exercises for this condition without a comprehensive assessment being done by a physiotherapist or chiropractor. Successful treatment and exercise programming is very individualized. So we recommend being assessed by a qualified professional. We’ve listed a few common general exercises that we love to give, but they are not for everyone and may not work for your specific needs. Give them a try at your own discretion.
Shoulder blade mobility
- Pinching and pulling apart your shoulder blade, 10 repetitions, 3 times a day
- Shoulder blade circles both directions, 10 repetitions, 3 times a day
Shoulder joint mobility
- Lying on your back with your knees bent – reach your arms straight overhead to line your straight arms with your ears. Reach your arms long without lifting your shoulder blades up. Hold 30 secs and repeat 3 times.
- Lying on your back with your knees bent – reach your arms straight up to the ceiling, then let your arms fall out to the side. Reach your arms long without lifting your scrunching your shoulder blades up. Hold 30 secs and repeat 3 times.
Thoracic spine mobility
- Cat camel stretches in 4 point position, 10 repetitions, 3 times a day
Spine twists, 10 repetitions, 3 times a day
- Bring your ear to your opposite shoulder, return to midline and repeat on the opposite side, hold each side for 30 secs and repeat 5 times
- Turn your head to one side and drop your chin down towards your underarm, return to midline and repeat on the opposite side, hold each side for 30 secs and repeat 5 times
Rotator cuff strengthening with a band
- With your arm by your side and elbow bent to 90 degrees. Hold a resistance band in your stable wrist and using your shoulder cuff, pull the band out to the side keeping your upper arm close to your body. Hold 30 seconds or up to your tolerance and release slowly with control, repeat 5 times.
Wall push ups
- Slow and controlled, pick an angle that is challenging but comfortable. Move towards the wall slowly, with control and push back slowly to your starting position feeling the muscles around your shoulder blade and under your arm activate. Repeat 20 times or as tolerated.
If you are in Toronto, we would be happy to help you recover from impingement syndrome. Contact us today to book your initial visit!