Shoulder impingement - Resting it, is not going to improve it!
Shoulder impingement - Resting it, is not going to improve it!
Tommy Conway - Chartered Physiotherapist and Director - OneHEALTH
Are you struggling to Throw the blankets off in the morning? Struggling to use that arm to wash your hair? Struggling to tuck in your shirt or putting on your bra? Struggling to lift the kettle, put on the seatbelt, lift your arm overhead? It just came out of nowhere, you haven’t fallen or injured it, just started to get sore one day and hasn’t eased. You have probably decided to rest it, hoping it will ease but it won’t, it’s getting worse by the day. The pain and restriction is at the front of your shoulder and sometimes can make it’s way down your arm. It starts off as a dull ache, you notice you no longer have the same flexibility in your arm, then certain movements get restricted and start causing a sharp pain and then you start losing power in the arm, rendering it useless. Have you tried physio? If you have then please remember that someone giving you 10 boring exercises isn’t going to improve it. A good physio will give you 1 or 2 and be very clear about when the shoulder will be better. If you have a physio that messages everything and gives you more than 5 exercises they are throwing everything at it because they don’t know how to help it, in other words throwing the kitchen sink at it and hoping for the best. With a shoulder impingement and if you understand how the shoulder works there should be a clear pathway on how to improve it, which I am briefly going to describe today. These are the symptoms of a shoulder impingement and unless treated quickly can require steroidal injections or even surgery.
What causes a shoulder impingement?
A shoulder impingement occurs when the space between the shoulder blade and the arm bone decreases and causes tendons that are in between the bones to pinch. There are three stages that can occur with an impingement.
Stage 1: Swelling and inflammatory change at the shoulder joint
Stage 2: Pinching - the tendon between the space of the shoulder blade and arm bone
Stage 3: Rupture: over time this constant pinching will cause tendon damage and eventually tearing and possibly a full rupture of the tendon. If a rupture occurs you will lose the power of that muscle and sometimes this can result in surgery.
If you look at the picture attached you can clearly see the space between the shoulder blade and the arm bone. When you start to lift your arm over your head, the head of the arm bone should be held in position, if this arm bone moves upwards towards the shoulder blade too early you will get a coming together of the bones. This coming together decreases the space for the tendons to move freely and causes a pinch, this usually happens at 90 degrees of lifting the arm. What causes this coming together of the two bones is timing of muscle activation, if a muscle becomes too dominant it can lift the bone too early and cause the pinch. This is why at the pinching stage you need to resolve the muscle imbalances to have a chance of helping your shoulder.
What can be done to help?
The shoulder moves in a number of different directions, all of these directions are dictated by how much rotation the shoulder joint has. The two rotational movements are called shoulder internal rotation and external rotation.
1: Internal rotation: Is what you need to tuck your shirt in or untie your bra. If you lose Internal rotation you will have pain doing these tasks.
2: External rotation: Is what you need to grab your seatbelt or wash your hair, if you lose external rotation you will have pain doing these tasks.
So when I examine clients in my clinic, I follow these steps.
Step 1: Examine where you have lost movement.
We do this by a physical examination, There are a number of different muscles at the shoulder and they all have different jobs. If you understand what the muscles are meant to do you can figure out which muscles require attention.
Step 2: Restore the movement that you have lost.
What this means is hands on, hands on, hands on. Physiotherapy should be physical, I don’t like when I just see clients getting ten exercises and being told “go away for 2 weeks and see how they go”. I personally feel that’s not what the job is about, I think with all shoulder impingements you have to use your hands to do massage etc, to improve the clients movement and symptoms.
Step 3: Restore the strength you have lost.
This is the last step and is often skipped, why? Because most people are out of pain at this stage and think it’s all over. I don’t let my clients skip this step. I need to finish this to make sure that the shoulder restores it’s full strength or unfortunately the issue will return in a few months and all the time and money spent with me to get the shoulder better “didn't work”. The truth is, it did, but unfortunately we didn't finish the deal.
In summary, I want you to know that a shoulder impingement can improve when you treat it at the right time. So, if you are struggling to throw the blankets off you in the morning, struggling to use that arm to wash your hair, struggling tucking in your shirt or putting on your bra, struggling to lift the kettle, put on the seatbelt and/or lift your arm overhead? You need to start the process before it becomes too late.
