Overcoming Impingement Syndrome of the Shoulder

Shoulder impingement syndrome is a common cause of shoulder pain. It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder.  The tendons that are prone to impingement include the biceps tendon and the rotator cuff tendon.  Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome.  Examples include: painting, lifting, swimming, tennis, weightlifting, Crossfit and other overhead sports.  Other risk factors include bone and joint abnormalities.

Musculoskeletal factors that lead to impingement syndrome include, weakness in the rotator cuff and muscles of the upper back, shoulder joint and/or muscle tightness, poor body mechanics (how a person controls his or her body when moving), an abrupt increase in an exercise routine, and age-related body changes.

Impingement syndrome results when excessive, abnormal forces are applied across the tendon or bursa, including tension (a pulling of the muscle and tendon), compression (pushing or pinching), or shearing (rubbing). When the tendons or bursa are subjected to repetitive stresses, they can become irritated, swollen, and painful.

Some movements that can be painful with impingement syndrome include sharp pain in the front of your shoulder when you reach overhead, tenderness to touch at the front of your shoulder, pain when throwing a ball, and difficulty with daily activities, such as reaching behind your back to tuck in your shirt, pulling off a shirt overhead, or putting dishes away in an overhead cabinet.

Other symptoms include pain that may radiate toward the neck or down the front of the arm, dull, achy pain at the front of the shoulder, especially following activity, weakness felt around the shoulder joint, usually experienced when lifting or carrying objects or reaching overhead and a a sensation of irritation in the front of the shoulder at end ranges of movement.

In our physical therapy office, the first recommendation that we usually make is to take a short break from the aggravating activity. This allows for an environment for the inflammation to settle down and the tendon and/or bursa to heal. While taking a break usually helps with pain, we know for our patients to get back to the activities that they enjoy, we have to address the root of the issue.

In many cases, impingement syndrome is coupled with poor mobility of the lats and the t-spine. This can be combined with weakness of the rotator cuff and the lat muscles.  In addition, if there are imbalances at the core and hip muscles, the way an active person moves can be affected which may lead to faulty shoulder mechanics. However, the only way to know what is contributing to pain and injury is to perform a complete assessment.

When pain and stiffness is found via the assessment, our approach includes manual mobilization to alleviate pain and improve mobility. Improvements can be made very quickly if the right regions are targeted. If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well. Once pain is controlled and muscles engage better, our next step is teaching our patients to develop stability of the shoulder girdle with resistance.  We know for the shoulder musculature to become durable at less prone to future injury, proper movement must be taught and a well designed strength and conditioning program must be initiated.

When addressed with a through physical therapy assessment and plan of care, impingement syndrome is a condition that can resolve relatively quickly. However, any sort of repetitive activity with poor mechanics can develop into more serious conditions such as a full thickness tears of the biceps or rotator cuff tendon or a degenerative shoulder condition.  If you feel like you may be developing impingement syndrome, the physical therapists at Movement Solutions would be glad to provide a through assessment and give you a diagnosis for your condition.  We can begin this process with a free 15-minute phone consultation to talk about how your shoulder is affecting you and discuss your treatment options.  If you prefer an office visit, we offer a free Discovery Visit so we can assess your injury in person, provide you a diagnosis, and give you an expected time frame for recovery.  Whether you decide to have continued care with us or another office, we want to you to get back to you active way of life.Call us at (864)-558-7346 and ask how we can help.

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