Understanding Shoulder Pain and Impingement Syndrome
Shoulder pain and impingement syndrome is typically a degenerative shoulder injury caused from repetitive compression of the rotator cuff tendons. A traumatic injury can also lead to impingement syndrome as well as poor postural tendencies.
The rotator cuff tendons are situated just below your acromion, the bone on top of the shoulder. This space is very small and when there is an injury or inflammation it becomes even smaller. When the rotator cuff tendons are repetitively compressed during overhead movements this painful shoulder syndrome is likely due to occur especially in patients with poor postural awareness, faulty movement mechanics or strength imbalances.
How Does Shoulder Impingement Syndrome feel?
Patients with shoulder impingement may feel a restriction in their movement of the injured arm, pain may be experienced when lifting the arm out to the side, behind the back and/or especially with movements over head. Shoulder impingement can be quite painful if left untreated.
Athletes that participate in sports that require overhead motion such as swimmers, baseball players and tennis players are more prone to developing impingement syndrome and progressive pain in the shoulder.
How is Shoulder Impingement Syndrome Diagnosed?
Upon evaluation, your physical therapist will be able to perform strength testing, range of motion and special testing to determine which tendons or structures are causing the shoulder pain and impingement. The physical therapist will also assess your posture, shoulder blade (scapula) position and discuss your job duties or sports activities to determine a cause of shoulder pain and injury.
Other tools such as X-rays or MRI will determine other shoulder conditions such as bony abnormalities (bone spurs) that may also be contributing to your shoulder pain.
How Can a Physical Therapist Help with Shoulder Impingement Syndrome?
Shoulder impingement syndrome is a common diagnosis that physical therapists have become very good at treating. It is important to seek physical therapy treatment for shoulder pain quickly to prevent other issues from arising. Upon evaluation, the physical therapist will determine what areas would be most beneficial for treatment to reduce shoulder pain such as range of motion, strengthening, or posture to get you back in the game as quickly as possible.
- Pain Management: At the start, when we have shoulder pain, it is challenging to move or use the arm at all. So, the first thing to do is to manage the shoulder pain by decreasing the inflammation in the tendons or bursa. Use of ice, correction of painful postures or mechanics and use of modalities such as ultrasound or electrical stimulation can be helpful. A general rule of thumb is if you continue to aggravate your shoulder with painful movements and lifting - your shoulder pain will not go away.
-Mobility: Once the shoulder pain is decreased it is important to restore full motion of the shoulder. Performing various stretching exercises to improve the wide range of available motion that the shoulder and shoulder blade complex allows us to perform.
-Strength: Next when the shoulder pain is reduced and motion is improved, it is important to re-strengthen the stabilizing structures of the shoulder and shoulder blade as well as to restore proper joint mechanics of the shoulder joint. The rotator cuff helps to keep the ball of the shoulder joint centered in the socket to prevent impingement, therefore re-strengthening your rotator cuff is key. At Athletic Physical Therapy our therapists send our patients home with exercises programs to perform independently.
Along with the above strategies our physical therapists perform a variety of hands on techniques to restore motion, reduce pain perform hands on functional assessments and training throughout each session.
Can Shoulder Impingement Syndrome Be Prevented?
Shoulder impingement syndrome can be prevented in a variety of ways.
-Posture: If you sit at a desk and notice yourself slouching, sticking your head out toward your computer or rounding your shoulder forward then you are putting yourself at risk to develop this condition! Therefore being aware of how you sit or stand is imperative to prevent this syndrome.
-Strength: Maintaining good strength of your shoulder and shoulder blade are essential to a healthy shoulder. The Shoulder joint is highly flexible and the soft tissue such as the muscles play a key role in maintaining a healthy shoulder.
- Flexibility: Keeping your shoulder flexible and mobile is also vitally important. If you don't allow the shoulder blade and spine to create room for the arm to raise overhead, then every time you raise your arm you will be creating an impingement.
-Overhead Athletes - all of the above are vital to avoiding shoulder pain in addition to rest. Repetitive overhead throwing or racquet sports require rest periods to avoid shoulder pain.
-Seniors - The rotator cuff tendons have a decreased blood supply as we age and tend to deteriorate. To avoid a full thickness rotator cuff tear, get your shoulder treated by a physical therapists.
Physical Therapy Treatment for Shoulder Pain and Impingement
Athletic Physical Therapy offers a wide variety of the latest and best physical therapy shoulder treatments. Our individualized programs are based on research that has proven which treatments are the most effective for reducing and eliminating shoulder pain and impingement.
Shoulder Therapeutic Massage
Massage or Soft Tissue Mobilization is a hands-on technique delivered by the physical therapist to the inured area of your body. This physical therapy treatment helps to decrease pain, improve circulation, and decrease muscle tension. There are many massage techniques including myofascial release, active tissue release, and trigger point therapeutic massage.
Specific massage to the rotator cuff tendons will increase blood flow to the tendon and helps it to heal.
Shoulder Joint Manipulation
Joint mobilization is a specific physical therapy treatment technique whereby the physical therapist passively (the patient is relaxed) moves the joints of your body in specific directions. The purpose of this physical therapy treatment is to decrease pain and improve and restore joint mobility.
Specifically doing shoulder joint mobilizations that increase the space for the rotator cuff tendons will relive shoulder pain and increase shoulder range of motion.
Exercise is a controlled physical stress applied to the body to help improve strength and range of motion. Exercise can be performed using machines, free weights and sometimes just good old body weight. Athletic Physical Therapy is highly specialized in administering the proper "dose" of exercise each treatment to prevent you from flare-ups and re-injury. Proper and complete strengthening is a critical aspect of each physical therapy treatment program both in the clinic and at home.
Specifically strengthening the scapula (shoulder blade) and stabilizing the platform from which the are elevates is critical to controlling shoulder pain and eliminating impingement syndrome.
Stretching is an important part of almost every physical therapy treatment program because pain stops motion. In order to recover, we must restore all of your motion in order for you to have 100% recovery. Stretching occurs when either you or the physical therapist applies sustained pressure over a joint to elongate the muscles and tendons around the joint to increase flexibility. Our progressive physical therapy treatments will help you regain flexibility.
Specifically ensuring that when the arm elevates, the shoulder joint has enough range of motion to prevent impingement of the rotator cuff tendons.
This type of physical therapy treatment is used very frequently for many conditions and injuries because almost all injuries involve loss of muscular control which is regulated by the nerves. This is a highly specialized form of therapeutic exercise and movement re-training that involves retraining of movement, balance, coordination, strength and posture.
Specifically, the scapula must be stabilized and motion must be coordinated with the arm to prevent and eliminate impingement syndrome.
Posture is the position of the body in standing, sitting, and walking. As we age, our body's go through many types of postural changes some occur normally while others can lead to significant pain and injury. Our skilled physical therapists will assess your posture and make changes to correct for improper alignment that can place excessive load on muscles and joints to help relive your pain and prevent further or future injuries due to poor posture.
Specifically, the upper mid back (thoracic spine) must not be hunched or excessively curved as this will block the arm from full elevation because the scapula is in a forward and rounded shoulder position.
Body Mechanics Education
Body Mechanics is the way we move from sit to stand to bend to lift or push. It is how we use or generally position our bodies to perform simple or complex physical tasks during our regular life or during work. Our Physical Therapists are trained to assess proper movement techniques and identify incorrect techniques. The goal of this type of physical therapy treatment is correction harmful movements into a safer and more productive movement pattern.
Specifically the shoulder joint consists of the ball and socket (glenohumeral) and shoulder blade (scapulothoracic) joints. The two joints must work in synchrony or the rotator cuff will not remain healthy as it becomes overloaded.
Vaso (blood vessels) pneumatic (air pressure) compression is a physical therapy treatment technique that uses sequential extremity compression to improve the swelling in an arm or leg. A sleeve is placed over the injured extremity and pressure is applied to the body part pushing edema and swelling towards the heart. This type of physical therapy treatment can be used to reduce recent swelling from an injury or surgery or for chronic lymphedema.
In certain situations, this treatment is beneficial to help improve the circulation of the arm due to the inability to use the arm in a normal manner.
Ultrasound is a deep heating treatment used to for many musculoskeletal conditions especially sprains, strains and tendonitis . Ultrasound is administered by your physical therapist to reduce local inflammation by increasing oxygenated blood circulation up to 4-5 centimeters below the skin. This physical therapy modality will reduce pain and relax soft tissue in preparation for manual therapy techniques such as joint mobilization and soft tissue massage.
Specifically, ultrasound on the rotator cuff tendons is helpful to increase the blood flow and oxygenation of a degenerative tendon as well as decreasing the inflammation in the tendons and bursa.
Laser Light Therapy
Light therapy involves using painless light that is passed through the skin at a specific wavelength to help improve the healing process of injured tissues. The energy from the light increases the energy available inside of the cell thus promoting a healthier cell capable of improved healing. It is important to know for laser therapy to work it does not have to be a hot Class IV laser.
Specifically, laser light therapy on the rotator cuff tendons is helpful to increase the blood flow and oxygenation of a degenerative tendon as well as decreasing the inflammation in the tendons and bursa.
Electrical Stimulation or TENS
There are many types of electrical stimulation that cover a wide variety of conditions with very different results. The most common type of electrical stimulation treatment or TENS (transcutaneous electrical neuromuscular stimulation) is used as a physical therapy treatment to help decrease pain and swelling following a recent injury or surgery. Electrical stimulation can also be used to promote tissue healing and nerve/muscle function.
Iontophoresis is a form of electrical stimulation that is used to deliver anit-inflammatory medication through the skin to inflamed or irritated tissue. The most commonly used steroid medication is dexamethasone which is pushed through the skin by the electrical current. This type of physical therapy treatment decreases pain and inflammation over tendons and ligaments.
Moist heat, or hot packs, may be applied to your body if you have an injury. Hot packs as a physical therapy treatment helps to increase circulation to the injured tissues, relax the muscles, and provide pain relief. Caution must be used when using hot packs at home or in the clinic as the skin may suffer burns if insufficient skin protection and air circulation is not provided.
If you have an injury, cold packs or ice may be applied to your body to help decrease pain and control inflammation. Ice is usually used during the acute or initial phase of injury to limit localized swelling around tissues. Cold packs are usually applied at the end of a physical therapy treatment for 10-15 minutes. When icing at home or in the clinic, care must be taken to prevent skin damage from frost bite.
Westlake Village, Los Angeles, Encino and Simi Valley, California patients that have experienced shoulder impingement or shoulder pain are encouraged to contact the Doctors at Athletic Physical Therapy for an orthopedic examination. Our Sports Physical Therapists are shoulder specialist and highly experienced at treating shoulder injuries, including shoulder impingement. Many times surgery is not indicated and with proper treatment and shoulder injuries can fully rehabilitated.Get Shoulder Treatment