Shoulder impingement

5 Ways to Fix Shoulder Impingement

So you think your nagging shoulder pain is due to a shoulder impingement? 

This is not an uncommon problem!  

Impingement of the shoulder is seen a lot at physiotherapy clinics.  At Fit for Life Physiotherapy we have had a lot of success over the past 10 plus years in our community in resolving shoulder pain and getting people back to the things they love to do!  

Just the other day I was able to discharge a client because she no longer needed treatment and was back to playing golf without pain and could lift her grandchildren without fear of aggravating her shoulder pain.  When she first started at the clinic she was experiencing shoulder pain with simple activities around the house, sleep was disrupted and often had to cut her golf game short (or not play at all) and would deal with increased pain for the rest of her day!  She worked hard on her treatment.  She followed the directions and our advice and before long didn’t need any help at all.  She was back to everything she wanted to do….painfree!

Are you tired of getting a shot of pain every time you reach up for something, take your wallet out of your back pocket or try to get comfortable at night on that painful shoulder? 

There is a way to fix this.

What causes Shoulder Impingement?

The shoulder is a pretty complex joint.  

The shoulder is made up of 3 bones:  

  • the humerus (arm bone), 
  • the scapula (shoulder blade)
  • the clavicle (collar bone)

The rotator cuff muscles are a group of muscles that attach the arm bone to the shoulder blade.  The rotator cuff is a term you may have heard mentioned many times when talking about shoulders and shoulder injury. 

The rotator cuff is made up of the following muscles:

  • supraspinatus
  • infraspinatus 
  • subscapularis 
  • teres minor

These muscles help to raise your arm up and rotate your arm.  They also help to hold the arm bone in the socket of the shoulder blade throughout movement.

There is a bursa that sits underneath the “acromion” of the shoulder blade - that pointy, bony part at the top of your shoulder.  The bursa is essentially like a sack of water that helps to protect the tendons from friction against the bone.  We have bursa all over the body!  In the shoulder the sub-acromial bursa protects the tendons of the rotator cuff from rubbing against the bony acromion.

Did you notice in these diagrams that there is not a lot of space between that bony acromion at the top of your shoulder and the arm bone (the head of the humerus)? Usually there is enough space for the bursa and the tendons but sometimes with a lot of overhead movement those structures can get a bit irritated.  Or if your posture isn’t great and your shoulders are rounded forward, that space gets smaller and those structures can get pinched.  Or impinged.  Over time the tendons or the bursa can get irritated which can lead to some inflammation.  

The inflamed tendons and/or bursa take up more space in that area under the acromion.  

So now every time you raise your arm or reach behind you or lie on that painful shoulder you feel some pain from those irritated tendons or bursa!  

This is a shoulder impingement!

Your physiotherapist can help you determine what caused the impingement in the first place.  

  • Is it your posture that has become so rounded which puts more stress on some of those tendons at the front of your shoulder?  
  • Have some of the muscles of the shoulder girdle have gotten tight and the arm bone doesn’t move well in the socket.  
  • Have the muscles have gotten weak and they don’t hold the head of the arm bone its socket leading to irritation of the tendons.

How do you know if you have impingement of the shoulder?

There are a few common symptoms that someone with shoulder impingement will experience and can include;

  • Pain when reaching up
  • Pain when reaching behind your back
  • Sleeping on the painful side

Talking to a physiotherapist about your painful shoulder will also help you to confirm whether or not you have shoulder impingement.  

There are very specific tests that they will do to determine the cause of your painful shoulder.  

Your physiotherapist will then be able to help you set up an effective plan of care to fix your impingement of the shoulder!

There are 5 important steps to fixing your shoulder impingement.

  1.  Stop ALL activities that cause or increase your pain!

Seems pretty simple doesn’t it!  If it hurts don’t do it!  And that doesn’t mean that you need to stop these activities forever.  But stopping the painful movements for a short period of time can help to decrease the irritation of the tendons and bursa.  Once you stop or decrease these activities you might start to feel better.  But this isnt the answer on its own!  It’s not realistic to never reach up for things or never reach behind you or never sleep on your favourite side.  

  1. Reduce inflammation.

With shoulder impingement the tendons and bursa have become inflamed.  When they are inflamed they take up more space under that bony acromion.  Using ice can be helpful in decreasing inflammation. If you are seeing a physiotherapist, they may use some modalities, such as ultrasound, laser or even acupuncture, to help decrease that inflammation.  

This is a great second step to helping you feel better.  But don’t stop here.  You want to change why the inflammation happened in the first place.

  1. Improve your posture.

Did your mother or grandmother nag you to sit up straight?  Mine did!  They may not have realized it but they were giving out some really important advice that helps with a lot of painful conditions, including helping to fix shoulder impingement.  When your physiotherapist gives you some exercise for shoulder pain, your program will include some postural exercises.  

Here is a favourite postural exercise!

  1. Release tight muscles.

Your shoulder joint is one of the most mobile joints in your body and needs to move well to create enough space under that bony acromion and avoid irritation of the tendons and bursa that pass under there.  The ability of the arm bone to rotate in its socket is particularly important.  

The muscles that tend to get tight and limit this movement include; 

  • pectorals minor/pectoralis major, 
  • latissimus dorsi, 
  • teres major and 
  • subscapularis.  

This is not an exhaustive list but working on releasing these muscles will make a difference in how you move and how you feel while you move!  

Releasing muscles can be achieved through massage of the shoulder.  This might be done by a massage therapist, a physiotherapist or some self massage techniques using massage balls or rollers.  Some specific stretching of these muscles will also get things moving the way you need to!  

Here are some techniques to try for releasing tight muscles!

5. Strengthen the shoulder complex.

And I don’t mean just strengthen the rotator cuff!  While that is important, it is also crucial to strengthen the muscles that control the movement of the shoulder blade as well.  The most important thing is to make sure that you are performing the exercise well.  Without proper form you run the  risk of stressing those same tendons that are already irritated!  

Start with these exercises and once you feel that these are easy, talk to your physiotherapist about how to progress exercises for shoulder pain.

Some Frequently Asked Questions about shoulder impingement...

Does shoulder impingement require surgery?

Surgery is not the first line of action to treat impingement of the shoulder.  There is much more evidence supporting physiotherapy of the shoulder which will include appropriate exercises for the problem

How long does it take to recover from a shoulder impingement?

Recovery will vary for each person and will depend on a few things including severity, length of time that with the symptoms and how closely the treatment protocol is followed.  Generally recovery may take 3-6 months but you should start feeling better within 2-4 weeks when following a good treatment program.

What happens if shoulder impingement is left untreated?

If a painful shoulder due to shoulder impingement is left untreated, there is risk of progressive degeneration of the tendons due to the ongoing inflammation and irritation.  The persistent pain that develops further limits your activities and ability to enjoy the things you love to do and need to do!  It is best not to let it linger but to seek direction from a health care professional such as a physiotherapist.

What do you do next? 

Talking to a physiotherapist can help you understand and confirm what is really causing your painful shoulder.

Click here to set up a free virtual 15 minute consultation with a physiotherapist to get your specific questions answered.

Move well, Live well, Be well