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Shoulder pain and what you need to know!

Problem: Shoulder Impingement


Shoulder impingement (often called rotator cuff impingement) is a broad term that describes a number of possible conditions at the shoulder.


Because of this, shoulder impingement can look different for each person both in terms of symptoms experienced and treatment necessary.


Generally speaking, shoulder impingement refers to pain originating from the shoulder that is worse in a specific range of motion.


What causes Shoulder Impingement?


In healthy individuals, when you move your arm overhead the rotator cuff and larger muscle groups (ie the deltoid) work together to achieve your desired movement. During this overhead movement, the rotator cuff muscles have an important role and are responsible for maintaining the position of the arm bone in the shoulder joint throughout the movement.  This is critical  in order to clear the structures located underneath the acromio-clavicular (AC) joint (which you can see in this picture labeled the subacromial space).


If this does not happen, the structures in the sub-acromion space can become irritated between the AC joint and the head of the humerus (your arm bone) which can in turn lead to significant pain initially only in a certain range of motion but that can later turn in to more generalized shoulder pain.


Structures in this space that can be effected in shoulder impingement include: the joint capsule, ligaments, tendons of the rotator cuff, biceps tendon, or bursa.



What causes it?


Though there can be some anatomical cases of impingement (in other words structural causes), most shoulder impingement is caused by something that effects how the shoulder can move, such as certain activities, posture, poor dynamic stability, muscle imbalances and/or mobility restrictions of the shoulder, scapula and spine.


With these causes what typically happens is that the rotator cuff muscles cannot do their job of stabilizing the humeral head in the shoulder joint either because they are not strong enough, because they can’t turn on quick enough, or because they are in a poor position to be able to work effectively.


This leads to one or more of the structures in the sub-acromial space being irritated which translates to your shoulder pain.


What are the common symptoms?


As mentioned, shoulder impingement can present very differently for different people but usually starts with pain in the shoulder with certain movements that occur in the ‘painful arc’ range of motion, as seen in the below picture.



Pain will often also be present with pressing activities, such as shoulder press or push-ups.



What can you do?


The first thing that is important to do is to stop performing any painful movements or exercises. If you work with a coach, ask them to modify your exercises so they are pain free.


Second, try rolling the back of your shoulder (near your shoulder blade) with a lacrosse ball to work out any soft tissue restrictions that may be present. You can also try heat or ice to manage your pain (use whichever you find works best for you).


When should you see a physiotherapist?


The earlier you see a physiotherapist the quicker they can get you back to feeling and moving better! What can happen if you leave this injury without treatment for too long is your body will compensate in order to avoid the pain associated with your impingement. In the “right now” this can sometimes be advantageous as your body will try to protect you from pain, but if left for too long these compensations can cause a host of problems that could lead to long term shoulder, neck, and back pain.


When you first notice pain in the shoulder, try to follow the advice above for a day or two. If your pain persists past 48 hours, it’s time to book an appointment with your physio!


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