Shoulder Impingement Syndrome

Physical Therapy for Shoulder Impingement Syndrome

Shoulder impingement is a common condition that we see here at SSOR.  It can be a painful condition that limits occupational or recreational activities, but as it progresses, can cause pain during rudimentary exercises like dressing and washing your hair.   The staff at SSOR are experts in the treatment of shoulder impingement syndrome.  The purpose of this post is to discuss the how’s and why’s of this painful condition.

What is it?

First, let’s talk about the rotator cuff.  The rotator cuff is composed of four muscles.  Those four muscles compress and depress your humeral head to keep the shoulder stable – think a golf ball spinning on a tee.  That is a healthy shoulder.  If you look at the figure below, you’ll see an inflamed rotator cuff.  To use an analogy, the shoulder bones act as a “roof” over the rotator cuff.  With overuse conditions like swimming or reaching overhead to paint, the rotator cuff “impinges” on the roof of the shoulder, almost like jumping up and hitting your head on the ceiling.  With rotator cuff fatigue and/or weakness, the rotator cuff insufficiency causes the humeral head to “ride high” and as a result, causes pain and gives you the irritation with activities typical of shoulder impingement.

What causes it?

There are a few causes.  One is rotator cuff weakness as mentioned above.  Another is fatigue – with more fatigue, the rotator cuff doesn’t do its job of “keeping the ball spinning on the tee.”  Poor posture is another big one – with the slouched posture, the shoulder rounds forward and effectively creates a bigger roof over the shoulder.  Try this – really slouch then try and raise your arm.  See how you can’t raise it very high?  Now sit up really tall and see how high you can raise it.  Big difference right?  So, good posture is critical.  Lastly, impingement can be caused by a loose shoulder.  The looser the shoulder is, the more the humeral head moves around in the joint and the rotator cuff gets aggravated from all the extraneous movement.  We typically see this in people that have a history of dislocations/instability or in young folks that play sports with lots of overhead activity, like swimming, baseball/softball, and volleyball just to name a few.

How do you fix it?

There are a few things that need to be done to treat this.  First, we have to remove or modify the aggravating stimulus.  If you paint houses for a living and are always working overhead, you may need to get a spray device or get an extension for the rollers to minimize overhead movement.  Secondly, we will do things to address your posture.  Poor posture effectively creates a “roof” over the rotator cuff and can cause pain with elevation.  Finally, we’ll do a fair amount of rotator cuff strengthening and scapular stabilization.  Other things like ultrasound, electrical stimulation, and ice/heat are used rarely because there is no evidence that these things work to treat impingement syndrome.  Ultimately, your treatment plan will be based on your needs, goals, and desires.
Shoulder pain can be a very painful and debilitating condition.  If you have it, you already know it can severely limit your function and make for miserable days.   You don’t have to accept that.  The experts at SSOR get you results quickly and back to doing the things you need and want to do.  We encourage you to not let this condition persist – the longer it hangs around, the longer it takes to go away.   Remember, you don’t need to see a physician first in the state of Kansas to get physical therapy now – give us a call!  It would be a privilege to serve you.

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