An impinged shoulder is painful, but there are many treatment options, including shoulder impingement exercises.
What is Shoulder Impingement Syndrome?
Shoulder impingement syndrome symptoms include having trouble “reaching up behind the back, pain with overhead use of the arm, and weakness of shoulder muscles”. Over time, with enough damage, the tendon can tear. This is called a rotator cuff tear, and it leads to weakness and difficulties with elevating the arm. With continued impingement, people can rupture their biceps muscle, as well. Doctors may take X-rays to rule out arthritis. The most common medical treatments for shoulder impingement syndrome are anti-inflammatory medications (naproxen, aspirin, ibuprofen), prescribed for up to 8 weeks. Side effects of these medications include stomach bleeding and irritation. This syndrome is a common shoulder pain cause. The bursa or tendons in the shoulder are impinged due to repeated activity and overhead use of the shoulder. People who engage in activities such as tennis, swimming, lifting, painting, and “overhead sports” are at risk as well as those with joint and bone abnormalities. Patients with this disorder have trouble with everyday activities, such as reaching up to put on a blouse or coat. Besides rotator cuff tearing, this syndrome can lead to tendinitis and bursitis.1
A healthcare professional can perform a shoulder impingement test, such as the Neer test and the Hawkins test. In the Neer test, “the examiner stabilizes the scapula while passively elevating the shoulder” and in the Hawkins test “the examiner elevates the arm to 90 degrees of abduction and forces the shoulder into internal rotation, grinding the cuff”. There is another test in which the patient is asked to “grasp their opposite shoulder and to actively elevate the shoulder”. These tests help to identify the type of impingement. It is important for healthcare professionals to find the location, the impinging structures, and the cause of the impingement. There are 2 types of impingement: primary (impingement is the main problem and is probably anatomy-related) or secondary (impingement is caused by activities, posture, or imbalances in muscles). Depending on the cause and location, treatments will vary.2
Typical medical treatments for shoulder impingement syndrome include the medications noted above and stretching. It is best if stretching can be done in a warm shower. One stretch is to
reach your thumb up and behind your back”. It is important that patients avoid activities that are repetitive, especially ones “where the elbow would move above shoulder level”. Physiotherapy may be recommended to stretch and strengthen the muscles and to provide patients with exercises. If the symptoms continue, a medical doctor may prescribe a cortisone (anti-inflammatory) injection, but “it can result in weakening of muscles and tendons if used repeatedly”. The oral anti-inflammatory medications side effects include headaches, indigestion, and upset stomach, as well as constipation, ulcers, or vomiting.3
Chiropractic for Shoulder Impingement Syndrome
Chiropractic treatment aims to treat the underlying cause of the tendinitis or bursitis condition. In addition, chiropractors can teach patients “self-help exercises” for “long-term relief”. Impingement syndrome is not only caused by repetitive stress, but it can be triggered by the trauma of falling onto an arm or from walking with crutches. The syndrome leads to inflammation. Muscle imbalance is a big problem. This means that a patient has some muscles that are overactive (such as the upper trapezius muscle) and some that are weak (such as the rotator cuff), which leads to abnormal movement. A patient may present with “rounded and forward drawn shoulders” and the “head-forward posture” called “upper-crossed syndrome”. The rotator cuff tendon thickens and the A/C joint shows wear-and-tear. As the bursa and tendons become inflamed, they lead to scar-tissue building up. Because the structures are thickened, they take up additional space, leading to more pinching, and that is why it is called impingement. Patients will complain about lifting the arm up sideways, of pain while sleeping, and of pain on the outside of the upper arm and shoulder.4 The chiropractor may ask the patient to do the Apley’s scratch test (“placing the involved extremity’s hand in front of their upper chest on the opposite anterior shoulder”) or the “Slap Me Five” test. Treatments could include resolving trigger points, using the Activator, and possibly recommending something like the “Theraciser Rehabilitation System by Foot Levelers to the patient to exercise the shoulder joint”. Patients may also have to make lifestyle and dietary changes.5 Another chiropractic test of shoulder impingement syndrome is having patients raise their arms to the side, like when doing jumping jacks. Chiropractors will perform the adjustments of the spine as well as the shoulder area, and they might also use “cross friction massage or…electro-stimulation therapy” to relax and improve mobility in the arms and shoulder joints.6
Like chiropractic care, massage works on the underlying cause of the problems without using medications to mask them. Massage can also be used to treat shoulder impingement syndrome. Shoulder pain is considered “the third most common musculoskeletal disorder” behind cervical and lower back pain. To make an effective plan for treatment, the massage therapist will need to assess which tissues are affected.7 Whenever tendons or muscles are injured, they form an adhesion to protect the area from being damaged more. Unfortunately, these adhesions “stiffen and impede healthy healing”. One type of massage technique, called “friction therapy”, can break the adhesions, reducing stiffness and pain. Friction therapy can also “break apart the scar tissue that forms from repetitive motion injuries”. In order to help patients improve their range of motion, myofascial release and gentle stretches may be employed. Myofascial release is good for not only loosening connective tissue, but it can “help an improperly aligned humorous rotate back into place”. Massage could also be helpful in preventing future injuries. Often, when the muscle is in pain, if there is tension, or if there is a trigger point, it will affect how the patient moves. By moving the wrong way, injury occurs. Massage may be used to help “correct the muscle dysfunctions that lead to the initial injury”.8
Learn more about shoulder impingement syndrome.